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1.  BioSense 2.0 Governance: Surveying Users and Stakeholders for Continued Development 
PMCID: PMC4050756
BioSense; BioSense 2.0; syndromic surveillance; governance; platform
2.  Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial 
Journal of Clinical Oncology  2011;29(8):1029-1035.
Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians.
Patients and Methods
This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians.
The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful.
The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.
PMCID: PMC3068053  PMID: 21282548
3.  ActiveOptions: Leveraging existing knowledge and usability testing to develop a physical activity program website for older adults 
ActiveOptions ( is a multi-agency effort to help people remain healthy as they age by providing Web access to information about senior-friendly exercise programs. This resource is currently available and in use in many locations across the United States. This paper focuses on the user interface to the site. It synthesizes existing knowledge related to creating an effective interface for this population, and describes the process we used which included a heuristic evaluation and usability testing.
PMCID: PMC2655872  PMID: 18693902
4.  Active Options: A Web Application to Help Seniors Locate Fitness Resources 
We describe a Web-based survey system that collects information about physical activity programs for elderly adults, and permits elderly users to search for programs that meet their needs. The system is a centralized application that supports multiple regions and facilitates data extraction and analysis.
PMCID: PMC1839339  PMID: 17238614
5.  Mobile eHealth Interventions for Obesity: A Timely Opportunity to Leverage Convergence Trends 
Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes.
This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer–assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model.
Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.
PMCID: PMC1550687  PMID: 16403722
eHealth; obesity; intervention; mobile computing; cellular telephone; weight loss; health behavior; health communication; behavior modification; consumer health informatics
6.  Design and Implementation of Cell-PREVEN: A Real-Time Surveillance System for Adverse Events Using Cell Phones in Peru 
With more clinical trials involving evaluations of new drugs or vaccines, monitoring for early detection of adverse events is essential. The overall goal of this study was to develop an interactive-computer system using cell phones for real-time collection and transmission of adverse events related to metronidazole administration among female sex workers (FSW) in Peru. We developed an application for cell phones in Spanish, called Cell-PREVEN, based on a system from Voxiva Inc. We used cell phones to enter data collected by interviewers from FSW in three communities. Information was stored in an online database, where it could be immediately accessed worldwide and exported over a secure Internet connection. E-mail and text messages sent to mobile devices alerted key personnel to selected symptoms. This pilot project has demonstrated that it is feasible to develop a public-health-surveillance system based on cell phones to collect data in real-time in Peru (
PMCID: PMC1560594  PMID: 16779025
7.  Syndromic surveillance using automated collection of computerized discharge diagnoses 
The Syndromic Surveillance Information Collection (SSIC) system aims to facilitate early detection of bioterrorism attacks (with such agents as anthrax, brucellosis, plague, Q fever, tularemia, smallpox, viral encephalitides, hemorrhagic fever, botulism toxins, staphylococcal enterotoxin B, etc.) and early detection of naturally occurring disease outbreaks, including large foodborne disease outbreaks, emerging infections, and pandemic influenza. This is accomplished using automated data collection of visit-level discharge diagnoses from heterogeneous clinical information systems, integrating those data into a common XML (Extensible Markup Language) form, and monitoring the results to detect unusual patterns of illness in the population. The system, operational since January 2001, collects, integrates, and displays data from three emergency department and urgent care (ED/UC) departments and nine primary care clinics by automatically mining data from the information systems of those facilities. With continued development, this system will constitute the foundation of a population-based surveillance system that will facilitate targeted investigation of clinical syndromes under surveillance and allow early detection of unusual clusters of illness compatible with bioterrorism or disease outbreaks.
PMCID: PMC3456541  PMID: 12791784
Biological warfare; Bioterrorism; Data collection; Database; Informatics; Information systems; Sentinel surveillance
8.  Roundtable on Bioterrorism Detection 
During the 2001 AMIA Annual Symposium, the Anesthesia, Critical Care, and Emergency Medicine Working Group hosted the Roundtable on Bioterrorism Detection. Sixty-four people attended the roundtable discussion, during which several researchers discussed public health surveillance systems designed to enhance early detection of bioterrorism events. These systems make secondary use of existing clinical, laboratory, paramedical, and pharmacy data or facilitate electronic case reporting by clinicians. This paper combines case reports of six existing systems with discussion of some common techniques and approaches. The purpose of the roundtable discussion was to foster communication among researchers and promote progress by 1) sharing information about systems, including origins, current capabilities, stages of deployment, and architectures; 2) sharing lessons learned during the development and implementation of systems; and 3) exploring cooperation projects, including the sharing of software and data. A mailing list server for these ongoing efforts may be found at
PMCID: PMC344564  PMID: 11861622
9.  Diagnoses, Syndromes, and Diseases: A Knowledge Representation Problem 
Despite their widespread use, the terms “syndrome”, “disease” and “diagnosis” are sometimes utilized improperly and ambiguously, compounding the complexities of medical knowledge representation. The definitions and illustrative examples provided here will be useful for developers of diagnostic expert systems.
PMCID: PMC1480257  PMID: 14728307
10.  A Proposed Ontology For Online Healthcare Surveys 
This paper results from the research efforts of the Clinical Informatics Research Group in building a generalized system for online survey implementation. Key to the success of any generalized survey system is a standard ontology for the differing components of any survey, particularly those sought to be implemented online, over the World Wide Web. In this paper, we introduce the need for generalized survey authoring tools, discuss our methods for elucidating the different components present in many healthcare instruments and classifying them as per existing standards, and later present our proposed ontology for online surveys in the healthcare domain. Next is a more detailed description of the different question types mentioned in this ontology. Finally, we compare some general purpose authoring systems currently available to determine their flexibility in representing these disparate question types (
PMCID: PMC1480110  PMID: 14728183
11.  Critically Appraised Topics (CAT) Peer-to-Peer Network 
A peer-to-peer network of Critically Appraised Topics or CATs would allow sharing of relevant clinical information regarding specific clinical problems among physicians. This proposed network would enable clinicians to develop and share CATs to other users within the network. This poster describes a proposed implementation of a peer-to-peer internet based sharing of critically appraised topics in the Philippines.
PMCID: PMC1480064  PMID: 14728311
12.  GEM 
Objective: To develop a guideline document model that includes a sufficiently broad set of concepts to be useful throughout the guideline life cycle.
Design: Current guideline document models are limited in that they reflect the specific orientation of the stakeholder who created them; thus, developers and disseminators often provide few constructs for conceptualizing recommendations, while implementers de-emphasize concepts related to establishing guideline validity. The authors developed the Guideline Elements Model (GEM) using XML to better represent the heterogeneous knowledge contained in practice guidelines. Core constructs were derived from the Institute of Medicine's Guideline Appraisal Instrument, the National Guideline Clearinghouse, and the augmented decision table guideline representation. These were supplemented by additional concepts from a literature review.
Results: The GEM hierarchy includes more than 100 elements. Major concepts relate to a guideline's identity, developer, purpose, intended audience, method of development, target population, knowledge components, testing, and review plan. Knowledge components in guideline documents include recommendations (which in turn comprise conditionals and imperatives), definitions, and algorithms.
Conclusion: GEM is more comprehensive than existing models and is expressively adequate to represent the heterogeneous information contained in guidelines. Use of XML contributes to a flexible, comprehensible, shareable, and reusable knowledge representation that is both readable by human beings and processible by computers.
PMCID: PMC79044  PMID: 10984468

Results 1-13 (13)