Reproducing social inequality and unequal treatment in the national health information infrastructure: A discourse analysis of IOM executive summaries.

This paper reports on preliminary data analysis for a larger research project whose purpose is to study how the discourse constituting the currently proposed NHII may reproduce existing social inequality in healthcare. The purpose of this preliminary study is to test the methods planned for the larger study. Textually oriented critical discourse analysis and corpus linguistics methods have been used to compare three executive summaries, the first report of two recent series and one stand alone report from the Institute of Medicine: the Quality Chasm and the Insuring Health series, and the report Unequal Treatment. These methods proved to be an effective way to study the social action of language in use in the Institute of Medicine executive summaries and will be useful in studying a larger corpus of the discourse constituting the NHII. Further research along these lines will provide information required to prevent or mitigate the reproduction of social inequality in healthcare through the proposed NHII.

Roundtable on bioterrorism detection: information system-based surveillance.

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 http://bt.cirg.washington.edu.

Social construction of the patient through problems of safety, uninsurance, and unequal treatment.

The purpose of this research was to study how the Institute of Medicine discourse promoting health information technology may reproduce existing social inequalities in healthcare. Social constructionist and critical discourse analysis combined with corpus linguistics methods have been used to study the subject positions constructed for receivers of healthcare across the executive summaries of 3 different Institute of Medicine reports. Data analysis revealed differences in the way receivers of healthcare are constructed through variations of social action through language use in the 3 texts selected for this method's testing.

Reproducing social inequality and unequal treatment in the National Health Information Infrastructure: a discourse analysis of Institute of Medicine executive summaries.

This research analyzes how discourse constituting the currently proposed National Health Information Infrastructure (NHII) may reproduce existing social inequality in healthcare. Textually oriented critical discourse analysis and corpus linguistics methods compare 3 executive summaries from the Institute of Medicine reports: the Quality Chasm and Insuring Health series, and the stand-alone report Unequal Treatment. These methods proved effective in studying the social action of language used in those summaries and will be useful in studying a larger corpus of discourse constituting the NHII. Further research will provide information to prevent or mitigate the reproduction of social inequality in healthcare through the proposed NHII.

Sibling violence silenced: rivalry, competition, wrestling, playing, roughhousing, benign.

In this article, sibling violence and the silence surrounding it is explicated through professional literature and research findings, exemplars from clinical practice, and statistics. Theoretical positions and discourse analysis have been used to help explain how regular broken bones, bruises, lacerations, and verbal humiliation can be minimized as normal sibling rivalry or roughhousing, which does not cause serious consequences. Nursing should be on the front lines of ending practices of violence. Recognizing sibling violence as such is part of this work and is a social justice issue.

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.

Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing.

PURPOSE/OBJECTIVES: To develop and test an innovative computerized symptom and quality-of-life (QOL) assessment for patients with cancer who are evaluated for and treated with radiation therapy. DESIGN: Descriptive, longitudinal prototype development and cross-sectional clinical data. SETTING: Department of radiation oncology in an urban, academic medical center. SAMPLE: 101 outpatients who were evaluated for radiation therapy, able to communicate in English (or through one of many interpreters available at the University of Washington), and competent to understand the study information and give informed consent. Six clinicians caring for the patients in the sample were enrolled. METHODS: Iterative prototype development was conducted using a standing focus group of clinicians. The software was developed based on survey markup language and implemented in a wireless, Web-based format. Patient participants completed the computerized assessment prior to consultation with the radiation physician. Graphical output pages with flagged areas of symptom distress or troublesome QOL issues were made available to consulting physicians and nurses. MAIN RESEARCH VARIABLES: Pain intensity, symptoms, QOL, and demographics. INSTRUMENTS: Computerized versions of a 0 to 10 Pain Intensity Numerical Scale (PINS), Symptom Distress Scale, and Short Form-8. FINDINGS: Focus group recommendations included clinician priorities of brevity, flexibility, and simplicity for both input interface and output and that the assessment output contain color graphic display. Patient participants included 45 women and 56 men with a mean age of 52.7 years (SD = 13.8). Fewer than half of the participants (40%) reported using a computer on a regular basis (weekly or daily). Completion time averaged 7.8 minutes (SD = 3.7). Moderate to high levels of distress were reported more often for fatigue, pain, and emotional issues than for other symptoms or concerns. CONCLUSIONS: Computerized assessment of cancer symptoms and QOL is technically possible and feasible in an ambulatory cancer clinic. A wireless, Web-based system facilitates access to results and data entry and retrieval. The symptom and QOL profiles of these patients new to radiation therapy were comparable to other samples of outpatients with cancer. IMPLICATIONS FOR NURSING: The ability to capture an easily interpreted illustration of a patients symptom and QOL experience in less than 10 minutes is a potentially useful adjunct to traditional face-to-face interviewing. Ultimately, electronic patient-generated data could produce automated red flags directed to the most appropriate clinicians (e.g., nurse, pain specialist, social worker, nutritionist) for further evaluation. Such system enhancement could greatly facilitate oncology nurses coordination role in caring for complex patients with cancer.