October 25, 2007
E-health Privacy and Security Standards Published
The Healthcare Information Technology Standards Panel has issued a set of standards for keeping patients’ e-health records private and secure. The Human Services Department has sponsored a panel with the goals of identifyng and harmonizing existing information standards so that e-health records can be exchanged among institutions.
The panel published "constructs" or sets of standards and specifications which will serve as a technical foundation that is applicable to the policy requirements in federal and state laws, or to other business and organizational requirements for protecting and preserving health information.
There is such variability in health information security and privacy laws across the country that trying to establish a common set of constructs was a significant challenge for the panel. With this in mind, the committee used an approach based on the identification of a core set of overarching policy concepts, and the establishment of a minimum common base set of requirements that could be applied to different health information exchange scenarios.
The constructs are as follows.
* Manage document sharing and preserve document integrity
* Collect and communicate security audit trail
* Maintain consistent time, by synchronizing system clocks among the systems on a network
* Secured communication channel
* Entity identity assertion, to validate the identity of people or applications
* Access control
* Nonrepudiation of information origin
* Manage and communicate consent directives from a patient.
It reported that the constructs have some gaps. "For example, there is a lack of standards to communicate the full access control policies and obligations in the fidelity that health care ultimately needs," it said in the document. "In cases like this, HITSP will present the best solutions available, and encourage standards organizations to fill the gaps."
The panel expects to update the constructs from time to time.
Link to HITSP Security and Privacy Documents
October 23, 2007
Playing Social-intelligence Games Can Reduce Cortisol Levels
In the October Journal of Personality and Social Psychology, scientists examined personality processes relating to social perception and its role in stress. In several studies, the authors demonstrate that early stage attentional processes influence the perception of social threat and modify the human stress response as measured by cortisol release.
Using a video game designed by McGill University, researchers help train people to change their perception of social threats and boost their self-confidence. This new study has now demonstrated that it can reduce the production of the stress-related hormone cortisol. The McGill team have been developing a suite of video games that train players in social situations to focus more on positive feedback rather than being distracted and deterred by perceived social slights or criticisms. The games are based on the emerging science of social intelligence, which has found that a significant part of daily stress comes from our social perceptions of the world.
In a 2004 study of 56 students, a standard reaction-time test showed that the game, called the Matrix, helped people shift the way they processed social information. The researchers next conducted several studies to see whether the effects of the game would translate into lower stress levels in a high-pressure context.
In one of their recent studies, they recruited 23 employees of a Montreal-based call center to play one of their games, which involves clicking on the one smiling face among many frowning faces on a screen as quickly as possible. According to the researchers, through repetitive playing, the game trains the mind to orient more toward positive aspects of social life. The call-center employees did this each workday morning for a week. They filled out daily stress and self-esteem questionnaires and had their cortisol levels tested through saliva analysis on the final day of the experiment. These tests showed an average 17-percent reduction in cortisol production compared to a control group that played a similar game but without the smiling faces.
The team’s ongoing research led to the creation of a spin-off company, MindHabits, whose MindHabits Trainer game recently won Telefilm Canada’s Great Canadian Video Game Competition. The distinction has earned the company $800,000 from Telefilm to be matched with private funding for a total of $1.3 million to support the commercialization of the game. The resulting product is scheduled for release this month and is available through the company’s website, www.mindhabits.com.
Journal of Personality and Social Psychology
Mindhabits.com
October 18, 2007
Reliability of Open Source Editing
According to a new report from Dartmouth College, "the beauty of open-source applications is that they are continually improved and updated by those who use them and care about them." But what about the quality and reliability of individuals who occassionally contribute to open source programs like Wikipedia?
Dartmouth researchers looked at the online encyclopedia Wikipedia to determine if the anonymous, infrequent contributors, the "Good Samaritans," are as reliable as the people who update constantly and have a reputation to maintain. Surprisingly, the answer is yes. The researchers discovered that Good Samaritans contribute high-quality content, as do the active, registered users. They examined Wikipedia authors and the quality of Wikipedia content as measured by how long and how much of it persisted before being changed or corrected.
In most studies, it is difficult to study the so called "good samaritans" because carefully designed studies don't allow for participation outside of the study. In this case, a real-life situation such as the online Wikipedia, allowed for such an evaluation since through the very nature of Wiki software, a history of every change is recorded.
Study
The researchers from set out to examine the reputation and reliability of contributors to Wikipedia. Wikipedia has an archive of the history of changes and edits to its entries, which allowed the researchers access to analyze the perceived quality of content.
By subdividing their analysis by registered versus anonymous contributors, the researchers found that among those who contribute often, registered users are more reliable. And they discovered that among those who contribute only a little, the anonymous users are more reliable. The researchers were most surprised to find that the reliability of Good Samaritans' contributions were at least as high as that of the more reputable registered users' contributions.
According to the authors, "wikipedia is a great example of how open-source contributions work for the greater good, and because it welcomes input from anyone, not just programmers and geeks, it is a great research tool. We can mine information from Wikipedia that helps us understand human behavior."
This study has been presented at academic conferences, and it is available online.
October 16, 2007
Technology to Study Psychosocial Stress
Researchers from Carnegie Mellon University and the University of Pittsburgh are studying how effective a wrist-mounted instrument can be for measuring psychosocial stress exposure during the course of daily life. The study is funded by NIH for the first year of a four-year project designed to study environmental factors that people encounter every day that may increase their risk of certain diseases.
Using an instrument called eWatch which is a multisensor package about the size of a large wristwatch that has been developed by Daniel Siewiorek, director of the Human-Computer Interaction Institute in Carnegie Mellon’s School of Computer Science, and Asim Smailagic, research professor in Carnegie Mellon’s College of Engineering. Both are co-investigators in the new study.
Previous studies have determined that people who report highly stressful lifestyles may develop higher rates of a variety of illnesses, ranging from viral infection to heart disease, but measuring exposure to stress is problematic.
In the new study, each participant will wer an eWatch, which can sense sound, motion, ambient light, skin temperature and other factors that provide clues about the wearer’s location, health status and current activity. Every 45 minutes over the course of five days, the eWatch will prompt wearers to take part in a 2-to-3-minute interview. The instrument will record their response to questions about their current activities, such as "Working hard?" and "Working fast?" By the end of the study, several hundred people will have tested the eWatch.
Previous research has shown that responses to such interviews help predict who will show higher rates of plaque development in the arteries, a risk factor for heart attack or stroke. Using interviews in real time allows researchers to quantify how stressors affect one’s daily life, as well as to pinpoint when these effects begin and when they end.
Use of the eWatch technology should assist researchers in finding the optimal method for responding to such interviews during daily activities, whether by pressing a button, moving the wrist or speaking into a wireless ear bug device. Environmental data collected by the eWatch also may assist the researchers in characterizing the types of environments people find most stressful, so that their location, such as home or work, may be recorded automatically.
Source: AAAS
October 15, 2007
Citation Rules for Weblogs from NLM
The National Library of Medicine and the NIH came up with and official guide to citing medical weblogs in the literature. They define a blog and offer numerous examples on individual citations or how to cite an entire blog.
They also include citation rules for email, LISTSERVs, and Wikis with detailed examples of each.
Definition of Blog by NLM
Detailed examples of citations
General information on citing material on the Internet
October 04, 2007
Microsoft Introduces No-Cost, Online Personal Health Record
According to today's New York Times, Microsoft announced a new no-cost, online personal health record program called HealthVault which will also include an Internet search function for health queries.
The PHR is being developed in conjunction with with hospitals, disease-prevention groups, health care companies and other potential partners. Microsoft is developing HealthVault projects with organizations, such as:
* American Health Association;
* Johnson & Johnson LifeScan;
* Mayo Clinic;
* MedStar Health; and
* NewYork-Presbyterian Hospital.
Microsoft hopes that individuals will grant physicians, clinics and hospitals the right to access test results and other medical information directly to their HealthVault account. This includes the right to transmit prescriptions. One of the partners, NewYork-Presbyterian Hospital in New York is planning to conduct a pilot project that will enable certain types of patient data to automatically be transmitted to patients' HealthVault accounts. The American Heart Association is working with Microsoft on an online blood pressure management tool that will allow patients to go to the association's Web site and open a HealthVault account with their blood-pressure readings, weight and medication data.
Also, Johnson & Johnson LifeScan is working with Microsoft to allow the readouts from diabetes patients' glucose monitors to be added to patients' HealthVault account.
Privacy Concerns
Privacy has always been a major concern that has hindered the adoption of PHRs. HealthVault PHRs will be stored in a secure, encrypted database, and patients will be able to set the privacy controls ini which they can specify what information goes into their PHR and who can view their record.
In reference to the online health searches, Microsoft said that HealthVault searches are conducted anonymously and will not be connected to patients' personal information.
October 02, 2007
Virtual Reality for Burn Patients
Distracting burn patients while clinicians attend to a patients’ wounds, can make a significant difference in their ability to manage pain. Rather than traditional distractions, such as books and music, doctors and nurses at Nationwide Children’s Hospital in Columbus, Ohio, are using virtual realilty to allow patients to escape into a computer-generated world complete with its own environment, creatures and sounds.
Patients wear a virtual reality helmet and they interact in the virtual environment with the help of child life specialists, trained to assist kids through stressful medical treatments.
According to psychologst Catherine Butz, at Nationwide Children’s Hospital, "it’s long been known that the actual treatment for a burn is far worse than the actual injury. Initially, the wound has to be cleaned and the dressing applied, and that can be a very painful and lengthy procedure. Research shows a very strong connection between anxiety and pain -- distraction does a great job in decreasing any kind of anxiety that might be associated with the anticipated procedures, so by distracting patients and keeping anxiety at a minimum, procedures tend to go much more smoothly and be much less painful for the child."
In order to better understand the effect on pain, doctors at Nationwide Children's have launched a study to compare the results of virtual reality pain distraction with traditional distraction techniques, such as watching television, listening to music, counting and deep breathing. Patients will be randomly assigned to receive virtual reality or another pain distraction technique. Following the procedure, they will be asked to gauge their level of pain on a scale of zero to 10. The study will also assess the perspectives of parents and nurses in terms of the child's pain and level of distress.
The burn program's goal is to be able to better engage the child in a distraction activity which will hopefully have a beneficial affect on the procedure. An added benefit for patients may be a decrease in the amount of pain and anxiety medications needed. However doctors point out that pain is a very individual experience, and the benefits of virtual reality distraction as well as the level of medication must be determined on a case by case basis.
Nationwide Children's Hospital
Columbus, OH
Related articles:
Computer-Generated Virtual Reality to Control Pain and Anxiety in Pediatric and Adult Burn Patients During Wound Dressing Changes
J Burn Care Res. 2007
Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan
Virtual Reality Pain Distraction
Bulletin of the American Pain Society
Research uncovers virtual pain relief for children
HIT Labs and Snow World - VR for Pain
Scientific American
Virtual-Reality Therapy