OBJECTIVES:Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy.BACKGROUND:Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians.METHODS:The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs.FINDINGS/DISCUSSION:(1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for medication list changes. (3) Processing patient feedback will requires both software algorithms and human interpretation. For the 107 forms subsample, pharmacists accepted patient input in 51 percent of cases where they could not contact the patient. Where the patient was contacted, they accepted feedback from 68 percent. This suggests there may be opportunities to automate feedback filtering and processing for more efficient (and larger scale) medication-list optimization. (4) A supportive overall e-health environment makes acceptance of an online patient feedback system more likely. Review of Geisinger usage data showed patients who completed the medication feedback form had previously accessed MyGeisinger 2.3 times as often as the average patient and initiated secure messages with a clinician 1.35 times as often as patients not involved in the pilot.CONCLUSIONS:Patient feedback, placed in a useful workflow, can improve medical record accuracy. Electronic health record (EHR) vendors and developers need to build appropriate capabilities into applications. Continued research and development is needed for enabling health care organizations to elicit and process patient information most effectively.

Information is the lifeblood of modern medicine. Health technology (HIT) is destined to be its circulatory system. (1) I INTRODUCTION In January 2007, Dave deBronkart was diagnosed with stage IV kidney cancer, a condition which at the time, had a median survival rate of twenty-four weeks (2) He immediately underwent surgery and became a participant in a clinical drug trial, deBronkart, who was employed in the computer industry, also became a determined e-patient, (3) using any and all online resources that might help his treatment and aid him in coping with his condition. All of this was successful, and deBronkart became a technology-focused cancer survivor, an active blogger on an e-patient website, (4) and a year later, co-chair of the Society for Participatory Medicine. (5) The hospital that provided his medical care, Beth Israel Deaconess Medical Center in Boston, had been a pioneer in providing patients with online access to their medical records, (6) and in early 2009, deBronkart took advantage of a new feature that allowed him to download his medical data into an electronic health-record system called Google Health. (7) The Beth Israel system was not linked electronically to other hospital systems. Therefore, the primary benefit of Google Health was that it would allow deBronkart to keep all his medical data, from any system or physician, in one place, accessible from anywhere. Shortly after Beth Israel copied deBronkart's data into the Google Health system, the Google site reported to him that his cancer had spread to his spine and that he had chronic lung disease and many other illnesses and conditions. (8) He was informed via a Medication Alert that his blood-pressure medication required immediate attention. Given the news he was receiving, deBronkart probably did need a much higher dosage of blood-pressure medication at that point, but he eventually figured out that he did not have any of the problems Google Health told him he had. What he learned was that in downloading his file to Google Health, Beth Israel Deaconess sent billing codes instead of clinical diagnoses. (9) Google, however, accepted the codes as medical diagnoses and then informed deBronkart that he was quite ill. deBronkart's problem was novel and his response unusual. Instead of consulting a lawyer and threatening to litigate, he recounted his experience on his blog. (10) That led, eventually, to a front-page story in the Boston Globe (11) and prompt attention by the hospital to correcting the problem. In the long term, deBronkart used the publicity he received to focus attention on the role of the patient in healthcare, and his credibility in this regard enabled him to turn his avocation into a vocation. (12) This article is about new problems and the need for new solutions. The new problems are a consequence of a new technological environment in healthcare, one that has an array of elements that makes the emergence of disputes likely. This novel environment, for example, will generate large numbers of transactions; innovative entrepreneurial efforts; and the appearance of new roles, responsibilities, and relationships; all generating large amounts of data being used in novel ways and supported by an extraordinarily complex technological infrastructure. If, as noted earlier, information is the lifeblood of modern medicine, it is also true that high-quality is the lifeblood of high-quality medicine and, conversely, that low-quality is the lifeblood of low-quality medicine. The manner in which is currently employed in healthcare is highly inefficient, which slows down communication and can, as a result, reduce the emergence and discovery of problems. Accelerating communication and the use of creates new opportunities to improve healthcare, but also new opportunities for problems to occur. The problems that surface when the digital merges with the physical world (13) need to be addressed with tools made possible by the digital world. …

Fleets of aerospace equipment are managed through carefully controlled supply chain processes. When any of the planning assumptions are no longer valid, an unexpected demand on maintenance and supply can develop, reducing the availability of equipment. Earlier detection of unexpected trends in demand can mitigate their impact. Systematic failures of components in man-made fleets bear an analogy to disease outbreaks in the human community. This paper presents evidence that mathematics originally developed for public health surveillance can be effectively used in support of aerospace fleet management. The central results include the formulation of new data-driven analytics to allow maintenance and supply managers to be notified about emergence of a possible problem substantially earlier than it was possible before, the ability to routinely screen incoming data for indications of problems of a broad variety of types even if their number is very large, and the ability to pragmatically prioritize investigative efforts according to the statistical significance of the detections. 12

The Obama Administration has initiated an open government policy for the United States to increase transparency, citizen participation and collaboration; the Mexican and Canadian governments have been pursuing similar efforts of their own. This panel will review the status of these initiatives with representatives from government agencies in the US and Mexico, as well as academic researchers who have been studying their progress and strategies. The panelists will discuss their experiences and insights into the process of making government more open and participatory, not only through conventional broadcast style website information, but also through increased citizen interaction through social media and Web 2.0 technologies, including twitter, Facebook, YouTube, tagging, and social bookmarking. Research on crowd sourcing, young voters and citizen-generated content will provide scholarly perspective on these initiatives.

The United States has committed to promote Health Information Technology through Electronic Health Records that will be exchanged among participants in the healthcare enterprise. In anticipation of problems, legal remedies have been established to protect the rights of all participants, especially their rights to protect the privacy of their own information. However, there are certain to be situations where disputes arise among participants that can be resolved without recourse to legal action. This paper pursues the possibility of establishing policies to encourage alternative dispute resolution through online methods integrated into the health information technology processes and lays out areas requiring research.

A perfect storm is the convergence of factors that result in an unanticipated and very serious situation. Health data may be heading for one. The migration to electronic health records (especially those that merge data from different sources), the emergence of a patient health data rights movement, and the continued lack of standardization in healthcare data and documentation are converging toward what some believe will be a perfect storm of consumer requests, complaints, and disputes involving the accuracy and quality of their personal health information. It seems clear that electronic record systems will need to provide a means of communication and negotiation between consumers and providers when issues arise regarding the quality of health information. such means will also help improve data quality and assist covered entities in complying with HIpAA regulations that grant consumers the right to amend their health information. [Authors, above: are only providers affected here? can payers and other healthcare entities expect an increase in questions and requests?] A Convergence of Forces previously, the inconvenience associated with accessing paper-based health records from a variety of fragmented sources has left patients typically unaware of what information was contained in their medical records, let alone its accuracy or completeness. even after the implementation of the HIpAA privacy rule—in which individuals were granted the legal right to receive copies and challenge the accuracy of their health records—the frequency with which most HIm professionals received such requests ranged from rare to never. However, as patients begin to gain access to the information in their providers' electronic health records (eHrs) or collect and manage their own personal health records (pHrs) through online sources such as Google Health or microsoft Health Vault, this is likely to change. public and private initiatives are also furthering the change. patient access to personal health information is a recognized part of the effort to improve health outcomes, and it is a criteria for the " meaningful use " of health It as defined in incentive programs in the American reinvestment and recovery Act. patient access is regarded as allowing patients to become more active participants in their own healthcare, which can lead to the desired outcome of higher quality and lower cost. The rise of social networking and environments such as Health 2.0 reflect important trends that are enabling and encouraging patients to take control of their health. Assuming greater control of their health inevitably also …

Equipment service sector supports a nation's infrastructure. Improved diagnostics–prognostics technologies have enabled aggressive equipment producers to offer a new service – a long-term guarantee on the operation of a product for a fee. Without a rigorous framework for managing these guarantees, the producer is exposed to extensive risks, resulting in serious losses. In this article, we formulate a conceptual framework for the design and delivery of a new service paradigm, Functional Guarantees. In Functional Guarantees, producers sell a service of providing well-defined 'functionality' from a physical equipment. As the core of the framework, integrated risk management enables viable delivery of the required quality of functionality from the equipment. The framework utilises operational learning and feedback mechanisms for operational risk management. For long-term sustainability and viability, strategic analysis integrally assesses the impact of a portfolio of service guarantees. The framework allows the producer to meet customers' needs and reduce risk of loss, while constantly looking toward improving profitability.

This panel will survey the virtual world phenomena, introduce the governance issues that arise there and suggests why the digital government community can both contribute to virtual worlds' success and benefit from the online laboratory these environments provide.

Fleet maintenance and supply management systems are challenged to increase the availability and reliability of equipment. Prognostics can help. This paper examines the utility of selected statistical data mining algorithms, originally developed for bio-surveillance applications, in achieving fleet prognostics. Preliminary experimental evaluation suggests that it is possible, useful and practical to apply such algorithms to rapidly detect emerging patterns of systematic failures of equipment or support processes, and to continuously monitor relevant data for indications of specific types of failures. The key remaining technical challenge is to tame down a potentially large number of plausible pattern detections without compromising high detectability rates. The key practical consequences to maintenance and supply managers include the ability to be notified about emergence of a possible problem substantially earlier than before, the ability to routinely screen incoming data for indications of problems of all conceivable types even if their number is very large, and the ability to pragmatically prioritize investigative efforts according to the statistical significance of the detections.

Fleet maintenance and supply management systems are challenged to increase the availability and reliability of equipment. Prognostics can help. This paper examines the utility of selected statistical data mining algorithms, originally developed for bio-surveillance applications, in achieving fleet prognostics. Preliminary experimental evaluation suggests that it is possible, useful and practical to apply such algorithms to rapidly detect emerging patterns of systematic failures of equipment or support processes, and to continuously monitor relevant data for indications of specific types of failures. The key remaining technical challenge is to tame down a potentially large number of plausible pattern detections without compromising high detectability rates. The key practical consequences to maintenance and supply managers include the ability to be notified about emergence of a possible problem substantially earlier than before, the ability to routinely screen incoming data for indications of problems of all conceivable types even if their number is very large, and the ability to pragmatically prioritize investigative efforts according to the statistical significance of the detections.

This poster is showing that process definitions can be effective in specifying and guiding Online Dispute Resolution (ODR) to facilitate effective interactions and mediation among disputants. Simply specifying these interactions is not sufficient to assure that the mediator and the participants are effectively engaged in performing their roles in such processes. Our project is developing a system to translate process definition specifications into actions that are reflected in the screens that participants and mediators view while participating in these processes. Thus we are demonstrating that, with the help of the system we are building, the process definition can control changes to the user interfaces of the participants involved in the process itself. This should enable the process to keep all users continually informed about the state of the process in which they are participating including the actions that the user needs to perform. This should improve the ability of the process to be an effective aid to ODR mediation.

This paper describes early experiences in using process definitions to facilitate requirements specification. The paper emphasizes addressing the constraints posed by the particularly challenging activity of obtaining requirements for digital government systems. The use of precise definitions of processes is suggested as a vehicle for bringing diverse stakeholders together to agree on system requirements in a transparent environment facilitating trust. A user interface prototype is employed to help make the implications of the process definitions concrete. Iterative incremental application of these technologies is leading to new understandings of how to elicit system requirements in the challenging domain of digital government. Experience from the development of an Online Dispute Resolution system for use by the US National Mediation Board illustrates our approach.

We report on the development of formal models of alternative dispute resolution processes, the creation of an online dispute resolution system based on this model and initial experimental analysis of this system. Early results suggest that formalizing the negotiation process definition indeed leads to clearer understandings and a greater chance for effective automation.

This demonstration shows a prototype tool that projects an impression of how execution of a formally defined process will facilitate dispute resolution. Tool flexibility supports projecting the look and feel of a range of different processes, facilitating user evaluation of alternatives.

e-Government offers its constituency the hope of engaging in government interaction at any time from any place. This has been slow to materialize. We believe this is due in large part to the complexity of government processes. This paper reports experimental field study evidence that a rigorously defined process modeling language can accurately map this complexity. It introduces Little-JIL, a rigorously defined process modeling language. It then reports experience using this language to capture government processes for an e-Government system to allow online license renewals for the government of Massachusetts. These processes were previously described using Use Case methodology. The errors and shortcomings identified provide opportunities for a more correct and efficient implementation of these processes. The paper concludes with a proposal for improved e-Government development methods.

Abstract E-government developers need to clearly understand processes they are automating and ensure that automated processes are defect-free. This paper introduces readers to Process Definition Language (PDL) technology that provides rigor and precision over traditional forms of process documentation. We report our experience documenting license renewal processes for application in the Mass.gov portal. The PDL helped analysts identify inconsistencies and errors in natural language-based documents that were guiding system development. This case provides an initial demonstration of the benefits PDLs can bring to e-government application development. We conclude with a discussion of the current limitations of PDLs and a discussion of computer-based analysis approaches that will likely emerge in the future.

In this paper, we report early lessons learned from a new project to understand how Online Dispute Resolution (ODR) can improve efficiency, effectiveness and fairness in Government dispute resolution and how ODR systems can gain acceptance.