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Importance: Assumption of a well-mixed population during modeling is often erroneously made without due analysis of its validity. Ignoring the importance of the geo-spatial granularity at which the data is collected could have significant implications on the quality of forecasts and the actionable clinical recommendations that are based on it., Objective: This paper's primary objective is to test the hypothesis that the characteristic dynamics defining the trajectory of the pandemic in a region is lost when the data is aggregated and modeled at higher geo-spatial levels., Design: We use publicly available confirmed SARS-CoV-2 cases and deaths from January 1st, 2020 to August 3rd, 2020 in the United States at different geo-spatial granularities to conduct our experiments. To understand the impact of this hypothesis, the output of this study was implemented in Tampa General Hospital (TGH) to provide resource demand forecast., Results: The Mean Absolute Percentage Error (MAPE) in the forecast confirmed cases can be 30% higher for modeling at the state-level than aggregating model results at the scale of counties or clusters of counties. Similarly, modeling at a state-level and crafting policy decisions based on them may not be effective - county-level forecasts made by partitioning state-level forecasts are 3x worse for confirmed cases and 20x worse for deaths relative to the same model at the county level. By leveraging these results, TGH was able to accurately allocate clinical resources to tackle COVID-19 cases, continue elective surgical procedures largely uninterrupted and avoid costly construction of overflow capacity in the first two epidemic waves., Conclusions and Relevance: Accurate forecasting at the county level requires hyper-local modeling with county resolution. State-level modeling does not accurately predict community spread in smaller sub-regions because state populations are not well mixed, resulting in large prediction errors. Actionable decisions such as deciding whether to cancel planned surgeries or construct overflow capacity require models with local specificity., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: The practice of "genomic" (or "personalized") medicine requires the availability of appropriate diagnostic testing. Our study objective was to identify the reasons for health systems to bring next-generation sequencing into their clinical laboratories and to understand the process by which such decisions were made. Such information may be of value to other health systems seeking to provide next-generation sequencing testing to their patient populations., Methods: A standardized open-ended interview was conducted with the laboratory medical directors and/or department of pathology chairs of 13 different academic institutions in 10 different states., Results: Genomic testing for cancer dominated the institutional decision making, with three primary reasons: more effective delivery of cancer care, the perceived need for institutional leadership in the field of genomics, and the premise that genomics will eventually be cost-effective. Barriers to implementation included implementation cost; the time and effort needed to maintain this newer testing; challenges in interpreting genetic variants; establishing the bioinformatics infrastructure; and curating data from medical, ethical, and legal standpoints. Ultimate success depended on alignment with institutional strengths and priorities and working closely with institutional clinical programs., Conclusion: These early adopters uniformly viewed genomic analysis as an imperative for developing their expertise in the implementation and practice of genomic medicine.

Background: Air travel plays a key role in the spread of many pathogens. Modeling the long distance spread of infectious disease in these cases requires an air travel model. Highly detailed air transportation models can be over determined and computationally problematic. We compared the predictions of a simplified air transport model with those of a model of all routes and assessed the impact of differences on models of infectious disease., Methodology/principal Findings: Using U.S. ticket data from 2007, we compared a simplified "pipe" model, in which individuals flow in and out of the air transport system based on the number of arrivals and departures from a given airport, to a fully saturated model where all routes are modeled individually. We also compared the pipe model to a "gravity" model where the probability of travel is scaled by physical distance; the gravity model did not differ significantly from the pipe model. The pipe model roughly approximated actual air travel, but tended to overestimate the number of trips between small airports and underestimate travel between major east and west coast airports. For most routes, the maximum number of false (or missed) introductions of disease is small (<1 per day) but for a few routes this rate is greatly underestimated by the pipe model., Conclusions/significance: If our interest is in large scale regional and national effects of disease, the simplified pipe model may be adequate. If we are interested in specific effects of interventions on particular air routes or the time for the disease to reach a particular location, a more complex point-to-point model will be more accurate. For many problems a hybrid model that independently models some frequently traveled routes may be the best choice. Regardless of the model used, the effect of simplifications and sensitivity to errors in parameter estimation should be analyzed.

In this paper, we discuss two important elements to lowering the barrier to creation of a National Health Information Network. The first element is the adoption of standards that will enable interoperability while guarantee open interfaces (and preventing vendor lock-in). The second element is the role of open source. While adoption of open standards by large EMR vendors is critically important to enterprise healthcare providers and payors, the availability of inexpensive (or free) standardized Healthcare Information Technology for small physician practices is critical. By analogy to the emergence of the World Wide Web, a framework for creating inexpensive and open source applications for physicians will be as important to realizing a National Health Information Network as availability of free browser technology was to the growth of the internet.