The Identity Mapping Project: Demographic differences in patterns of distributed identity.

The advent of cloud computing and a multi-platform digital environment is giving rise to a new phase of human identity called "The Distributed Self." In this conception, aspects of the self are distributed into a variety of 2D and 3D digital personas with the capacity to reflect any number of combinations of now malleable personality traits. In this way, the source of human identity remains internal and embodied, but the expression or enactment of the self becomes increasingly external, disembodied, and distributed on demand. The Identity Mapping Project (IMP) is an interdisciplinary collaboration between psychology and computer Science designed to empirically investigate the development of distributed forms of identity. Methodologically, it collects a large database of "identity maps" - computerized graphical representations of how active someone is online and how their identity is expressed and distributed across 7 core digital domains: email, blogs/personal websites, social networks, online forums, online dating sites, character based digital games, and virtual worlds. The current paper reports on gender and age differences in online identity based on an initial database of distributed identity profiles.

StructConsult: structured real-time wet read consultation infrastructure to support patient care.

Our research addresses how to improve physician to physician communication of patient information, and how to prevent lapses of patient care as they are referred to other clinicians within the healthcare system. The wet read consultation is defined as a rapid response to a clinical question posed by a referring physician to a clinical specialist. This research involves the development of an imaging-based wet read consultation system called StructConsult (SC), which facilitates communication between non-imaging specialist (i.e., primary care physician (PCP), emergency room (ER) physician, or referring physician), and an imaging specialist-radiologist. To facilitate data mining and effective recall, SC utilizes a data model based on the Digital Image Communications in Medicine (DICOM) standard for grayscale presentation state and structured reporting. SC requires information from four sources: (a) patient-specific demographics, clinical hypothesis, and reason for exam, (b) sentinel image capture from a DICOM image study, (c) direct capture of radiologist's image operations and annotations, and (d) radiologist's response to the chief compliant, and the reason for examination. SC allows users to add additional functionality to a Picture Archiving System to improve patient care.

OpenSourcePACS: an extensible infrastructure for medical image management.

The development of comprehensive picture archive and communication systems (PACS) has mainly been limited to proprietary developments by vendors, though a number of freely available software projects have addressed specific image management tasks. The openSourcePACS project aims to provide an open source, common foundation upon which not only can a basic PACS be readily implemented, but to also support the evolution of new PACS functionality through the development of novel imaging applications and services. openSourcePACS consists of four main software modules: 1) image order entry, which enables the ordering and tracking of structured image requisitions; 2) an agent-based image server framework that coordinates distributed image services including routing, image processing, and querying beyond the present digital image and communications in medicine (DICOM) capabilities; 3) an image viewer, supporting standard display and image manipulation tools, DICOM presentation states, and structured reporting; and 4) reporting and result dissemination, supplying web-based widgets for creating integrated reports. All components are implemented using Java to encourage cross-platform deployment. To demonstrate the usage of openSourcePACS, a preliminary application supporting primary care/specialist communication was developed and is described herein. Ultimately, the goal of openSourcePACS is to promote the wide-scale development and usage of PACS and imaging applications within academic and research communities.

Effect of an imaging-based streamlined electronic healthcare process on quality and costs.

RATIONALE AND OBJECTIVES: A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. MATERIALS AND METHODS: A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. RESULTS: Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. CONCLUSION: A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.

Evidence-based radiology: requirements for electronic access.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the electronic requirements for supporting evidence-based radiology in today's medical environment. MATERIALS AND METHODS: A software engineering technique, use case modeling, was performed for several clinical settings to determine the use of imaging and its role in evidence-based practice, with particular attention to issues relating to data access and the usage of clinical information. From this basic understanding, the analysis was extended to encompass evidence-based radiologic research and teaching. RESULTS: The analysis showed that a system supporting evidence-based radiology must (a) provide a single point of access to multiple clinical data sources so that patient data can be readily used and incorporated into comprehensive radiologic consults and (b) provide quick access to external evidence in the way of similar patient cases and published medical literature, thus supporting evidence-based practice. CONCLUSION: Information infrastructures that aim to support evidence-based radiology not only must address issues related to the integration of clinical data from heterogeneous databases, but must facilitate access and filtering of patient data in order to improve radiologic consultation.

DataServer: an infrastructure to support evidence-based radiology.

Following a requirements analysis for development of an information infrastructure supporting evidence-based radiology, the objective of this study was the development of a data gateway to support flexible access to the totality of a patient's electronic medical records through a single, uniform representation, regardless of the underlying data sources (eg, hospital information systems [HIS], radiology information systems [RIS], picture archiving and communication systems [PACS]). XML-based (eXtensible Markup Language) technologies were employed to create an application framework permitting querying of different clinical databases. The contents of different data sources were represented by using XML. On the basis of these representations, users can specify queries. The system transforms the XML queries into a query format understood by the specific databases, processes the query, and transforms the results back into an XML format. XML results can then be transformed in accordance to different data-formatting standards. Access to several different data sources, including HIS, RIS, and PACS, has been accomplished with this framework. The extensible nature of the XML data gateway enables data sources to be readily added. The framework also provides a means by which data can be systematically de-identified to protect patient confidentiality, thus supporting research endeavors.

Designing a patient education framework via use case analysis.

One of the challenges of developing patient education content in electronic form is to determine the information and interaction needs that motivate a patient to learn in the first place. We have found that use case analysis of patient education helps in clarifying the types of information and interaction required to educate a patient effectively. This paper presents a use case model for patient education as well as a Java-based framework that facilitates both the extension and updating of individually tailored, electronic patient education content. The framework defines an abstract interface that represents a particular panel of information, and provides a content manager that dynamically discovers and refreshes new panels as they are added or modified.

An XML Gateway to Patient Data for Medical Research Applications.

As the medical environment becomes increasingly electronic, clinical databases are continually growing, accruing masses of patient information. This wealth of data is an invaluable source of information to researchers, serving as a testbed for the development of new information technologies and as a repository of real-world data for data mining and population-based studies. However, the true utility of this information is not fulfilled, in part because of issues pertaining to security and patient confidentiality, but also due to the lack of an effective infrastructure to access the data. This paper describes a system, DataServer, that permits researchers to query and retrieve data from multiple clinical data sources, automatically deidentifying patient data so that it can be used for research purposes. DataServer functions as an application framework, enabling extensible markup language (XML)-based querying of existing medical databases. Key aspects of DataServer include ready inclusion of new information resources, minimal processing impact on existing clinical systems via a distributed cache, and flexible output representation via XSL (eXtensible Style Language) transforms.