Social media platforms continue to play a leading role in the evolution of how people share and consume information. Information is no longer limited to updates from a user’s immediate social network but have expanded to an abstract network of feeds from across the global internet. Within the health domain, users rely on social media as a means for researching symptoms of illnesses and the myriad of therapies posted by others with similar implications. Whereas in the past, a single user may have received information from a limited number of local sources, now a user can subscribe to information feeds from around the globe and receive real-time updates on information important to their health. Yet how do users know that the information they are receiving is relevant or not? In this age of fake news and widespread disinformation the global domain of medical knowledge can be tough to navigate. Both legitimate and illegitimate practitioners leverage social media to spread information outside of their immediate network in order to reach, sway, and enlist a larger audience. In this research, we develop a system for determining the relevancy of linked webpages using a combination of web mining through Twitter hashtags and natural language processing (NLP).

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) Retail Immunization Coordination Project established a partnership between VA and Walgreens to empower Veterans to elect to receive their immunizations at a local Walgreens, which might be located closer to their home than their nearest VA facility. Analysis of Veterans immunized at Walgreens between September 2014 and January 2015 showed that 64% of study Veterans now traveled <5 miles to receive their immunization, 12% of study Veterans traveled between 5 to 10 miles, and 24% of study Veterans traveled more than 10 miles. In addition, we note that 93% of Veterans traveled less than 54 miles, the average distance rural Veterans traveled to the nearest VA facility. We conclude that the VHIE Retail Immunization Coordination Project improved Veteran access to healthcare and discuss future directions of this effort.

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) had been deployed at all VA sites and used to exchange clinical information with private sector healthcare partners nationally. This paper examined VHIE's effect on allergy documentation. Review of all inbound VHIE transactions in FY14 showed that VHIE use was associated with a nearly eight-fold increase in allergy documentation rate. Preliminary manual document review further showed that VA and partners had shared knowledge of only 38% ofpatient allergies, while VA had exclusive knowledge of another 58% ofpatient allergies, and partners had exclusive knowledge of the last 5% of patient allergies. To our knowledge, this is the first study that examined the effect of HIE on allergy documentation.

As part of ongoing data quality efforts authors monitored health information retrieved through the United States Department of Veterans Affairs' (VA) Virtual Lifetime Electronic Record (VLER) Health operation. Health data exchanged through the eHealth Exchange (managed by Healtheway, Inc.) between VA and external care providers was evaluated in order to test methods of data quality surveillance and to identify key quality concerns. Testing evaluated transition of care data from 20 VLER Health partners. Findings indicated operational monitoring discovers issues not addressed during onboarding testing, that many issues result from specification ambiguity, and that many issues require human review. We make recommendations to address these issues, specifically to embed automated testing tools within information exchange transactions and to continuously monitor and improve data quality, which will facilitate adoption and use.

Authors studied the United States (U.S.) Department of Veterans Affairs' (VA) Virtual Lifetime Electronic Record (VLER) Health pilot phase relative to two attributes of data quality - the adoption of eHealth Exchange data standards, and clinical content exchanged. The VLER Health pilot was an early effort in testing implementation of eHealth Exchange standards and technology. Testing included evaluation of exchange data from the VLER Health pilot sites partners: VA, U.S. Department of Defense (DoD), and private sector health care organizations. Domains assessed data quality and interoperability as it relates to: 1) conformance with data standards related to the underlying structure of C32 Summary Documents (C32) produced by eHealth Exchange partners; and 2) the types of C32 clinical content exchanged. This analysis identified several standards non-conformance issues in sample C32 files and informed further discourse on the methods needed to effectively monitor Health Information Exchange (HIE) data content and standards conformance.

PURPOSE:We describe the Department of Veterans Affairs' (VA) Virtual Lifetime Health Electronic Record (VLER) pilot phase in 12 communities to exchange health information with private sector health care organizations and the Department of Defense (DoD), key findings, lessons, and implications for advancing Health Information Exchanges (HIE), nationally. METHODS:A mixed methods approach was used to monitor and evaluate the status of VLER Health Exchange pilot phase implementation from December 2009 through October 2012. Selected accomplishments, contributions, challenges, and early lessons that are relevant to the growth of nationwide HIE are discussed. RESULTS:Veteran patient and provider acceptance, trust, and perceived value of VLER Health Exchange are found to be high, and usage by providers is steadily growing. Challenges and opportunities to improve provider use are identified, such as better data quality and integration with workflow. Key findings and lessons for advancing HIE are identified. CONCLUSIONS:VLER Health Exchange has made great strides in advancing HIE nationally by addressing important technical and policy issues that have impeded scalability, and by increasing trust and confidence in the value and accuracy of HIE among users. VLER Health Exchange has advanced HIE interoperability standards and patient consent policies nationally. Policy, programmatic, technology, and health Information Technology (IT) standards implications to advance HIE for improved delivery and coordination of health care are discussed. The pilot phase success led to VA-wide deployment of this data sharing capability in 2013.

Applications in public health and health services require access to a range of heterogeneous data, from environmental information in a region, to population-level data across regions, to more closely held personal health information, and, from reference scientific datasets to observational data and sensor streams. The cyber infrastructure support for such applications must include the ability to access a variety of contextual and background information, along with the tools for integration, analysis, and mining across such datasets. The expected volume of information and users -- including many with only basic skills in data handling and analysis of such systems -- also demands an elastic solution. This paper introduces the "seeded cloud" concept where the on-demand cloud environment includes defined, prepared, and tool-rich datasets, reducing the barrier to application development in this multidisciplinary domain of public health and health services. The seeded cloud architecture is presented and illustrated through two case applications. The implications for discovery-based research as well as practice are discussed.

BackgroundThere is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs.PurposeThis research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications.MethodsA multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals.ResultsEvaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health.ConclusionsFindings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care. There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care.

Traffic injuries are the number one non-disease related cause of death in the world. It has been estimated that throughout the world close to 1.2 million people die each year due to traffic accidents. Outside of the loss and harm to human life, there are also considerable economic impacts that result from vehicular accidents. This problem calls for concrete efforts for effective and sustainable prevention measures. Opportunities for making travelers more aware of road safety issues are increasingly being provided by websites and social networking resources that allow people to consume, visualize, and analyze data on a more personal level. SafeRoadMaps (www.saferoadmaps.org) is an innovative, GIS-based application that provides traffic fatality information across three main user categories: Travelers, Policy Makers, and Crash Analysts. In conjunction with the release of the new version (SRM3), an effort was made to conduct and communicate research to raise awareness of the safety issues surrounding seasonal (i.e. summer) travel. This paper provides an overview of findings and public communication relating to crash fatality patterns found throughout the United States based on spatial (rural / urban) and temporal (all year / summer) dimensions. This analysis has identified various “hot spots” throughout the country that represent areas of increased crash rates and in doing so, provides travelers with warnings of hot spots where greater precautions should be taken. The article concludes with a review of communication activities using SafeRoadMaps and implications for enhanced safety information provided to travelers and other stakeholders.

This paper examines the impact of cyberinfrastructure architecture on healthcare services. More specifically, this research details the architectural design for a personal health record system called "HealthATM" that utilizes and integrates services from Google's cloud computing environment. These services are integrated into an unobtrusive and easy to use ATM-style interface for health consumers and care providers to manage and track their health. The impact for such an application, particularly for the underserved, is an important step toward better health management across this population with the end-goal of better health outcomes in the future.

The advent of electronic personal health records (PHR) provides a major opportunity to encourage positive health management practices, such as chronic disease management. Yet, to date there has been little attention toward the use of PHRs where advanced health information services are perhaps most needed, namely, in underserved communities. Drawing upon research conducted with safety net providers and patients, the authors propose a multi-level analytical framework for guiding actions aimed at fostering PHR adoption and utilization. The authors first outline distinctive user and technical requirements that need to be considered. Next, they assess organizational requirements necessary to implement PHRs within health systems bound by limited resources. Finally, the authors analyze the overriding health care policy context that can facilitate or thwart such efforts. The conclusion notes that heightened national attention toward health information technology and reform provides a significant opportunity for initiatives whose goal is to increase widepread access to PHRs.

As the US healthcare system becomes further impacted by factors such as the oncoming flood of aging baby boomers, increases in the amount of people uninsured or underinsured, higher occurrences of chronic illnesses (diabetes, hypertension, etc.), and a potentially insufficient pool of incoming healthcare workers, the burden of managing one's own health, therapy, and medical transactions will increasingly fall on the patient, their family and care managers. A multitude of new systems for personal health management are being developed and it will be critical that these systems are responsive to the unique and specific needs of all people and perhaps more importantly those who are the most at-risk. As an initial step toward identifying core system requirements, interviews with care managers and administrators of a personal health information system (PHIS) for use with migrant farm workers was conducted providing preliminary recommendations toward the development of a framework for effective use of PHIS within diverse and underserved populations. Initial findings indicate that PHIS within these types of communities will exist not so much as an isolated tool for health management, but moreover an artifact for bridging health information communication between patients and their healthcare providers.

As the field of e-government expands and grows, the number of academic courses, professional workshops, online courses, and continuing education opportunities in this field also increases. Due to the interdisciplinary nature of the field, learning and teaching content tends to be pulled from numerous paper and electronic sources. This pilot study explored the potential structure and benefits of an online repository of electronic learning objects for the field of e-government. Design research was used as a methodology to design, implement, and evaluate an online learning object repository within the context of a University e-government course. The pilot project is described, qualitative evaluation findings reported, and implications and future research directions are presented.

The efforts of this research are to educate patients within vulnerable populations in the use of electronic personal health records so they may better monitor their health, attain desired health goals and manage their health services. Evaluation measures will include facets of self-management of health, patient-physician communication, and assessment of accessibility and usability factors of the personal health record.