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Objectives: Smartphone-based digital exposure notification (EN) tools were introduced during the COVID-19 pandemic to supplement strained case investigation and contact tracing efforts. We examined the influence of an EN tool implemented in Washington State, WA Notify, on user engagement in behaviors that protect against COVID-19 transmission. Methods: From January 25 through June 30, 2021, we administered 2 surveys to WA Notify users who received notification of a possible COVID-19 exposure. The initial survey, sent when users received a notification, focused on intent to engage in protective behaviors. The follow-up survey captured data on self-reported actual engagement in protective behaviors and contact by a public health contact tracer. Results: Of 1507 WA Notify users who completed the initial survey, 40.1% (n = 604) reported intending to seek COVID-19 testing and 67.1% (n = 1011) intended to watch for COVID-19 symptoms. Of 407 respondents to the follow-up survey, 57.5% (n = 234) reported getting tested and 84.3% (n = 343) reported watching for COVID-19 symptoms. Approximately 84% (n = 1266) of respondents to the initial survey received a notification from WA Notify before being reached by public health contact tracers; on follow-up, 42.5% (n = 173) of respondents reported never being contacted by public health. Conclusions: Our findings suggest that WA Notify users may initiate protective behaviors earlier than nonusers who will not know of an exposure until notified by public health or by a known contact. Digital EN tools may be a valuable addition to existing public health outbreak investigation and response activities.

BackgroundSecure and anonymous smartphone-based exposure notification tools are recently developed public health interventions that aim to reduce COVID-19 transmission and supplement traditional public health suriveillance. We assessed the impact of Washington State’s exposure notification tool, WA Notify, in mitigating the spread of COVID-19 during its first four months of implementation.MethodsDue to the constraints of privacy-preservation, aggregate metrics and disparate data sources were utilized to estimate the number of COVID-19 cases averted based on a modelling approach adapted from Wymant et al (2021) using the following parameters: number of notifications generated; the probability that a notified individual goes on to become a case; expected fraction of transmissions preventable by strict quarantine after notification; actual adherence to quarantine; and expected size of the full transmission chain if a contact had not been notified.ResultsThe model was run on a range of secondary attack rates (5.1%-13.706%) and quarantine effectiveness (53% and 64%). Assuming a 12.085% secondary attack rate and 53% quarantine effectiveness, the model shows that 5,500 cases (central 95% range of sensitivity analyses 2,800-8,200) were averted statewide during the first four months of its implementation. Based on an estimated COVID-19 case fatality of 1.4%, WA Notify saved 40-115 lives during the study period.ConclusionsThese findings demonstrate the value of exposure notification tools as a novel public health intervention to mitigate the spread of COVID-19 in the U.S. As new variants emerge and non-essential travel bans are lifted, exposure notification tools may continue to play a valuable role in limiting the spread of COVID-19.

Objective: Previous research identified data gaps between traditional paper-based STI notifiable condition reporting and pilot electronic initial case reporting (eICR) relying on Continuity of Care Documents (CCDs) exported from our clinical partner’s electronic health record (EHR) software. 1 Structured data capture is needed for automatic processing of eICR data imported into public health repositories and surveillance systems, similar to electronic laboratory reporting (ELR). Coding data gaps (between paper and electronic case reports) using standardized vocabularies will allow integration of additional questions into EHR or other data collection systems and may allow creation of standard Clinical Data Architecture (CDA) templates, Logical Observation Identifiers Names and Codes (LOINC) panels, or Fast Healthcare Interoperability Resources (FHIR) resources. Furthermore, identifying data gaps can inform improvements to other standards including nationwide standardization efforts for notifiable conditions. Introduction: Under the CDC STD Surveillance Network (SSuN) Part B grant, WA DOH is testing eICR of sexually transmitted infections (STI) with a clinical partner. Existing standard vocabulary codes were identified to represent previously-identified information gaps, or the need for new codes or concepts was identified. Methods: In prior work, CCDs were securely received from our clinical partner and then analyzed for gaps compared to the existing paper-based STI case reporting form. 1 Now, codes associated with gap concepts were identified in standard vocabularies such as LOINC and SNOMED CT. Standards were searched using online browsers offered by the standards development organizations (SDO) to identify potential codes, which were reviewed with public health epidemiologists and clinicians. Gaps were listed, and wording and intent was compared to standard codes including accessory information found in the SDO browsers and a final table of recommended codes was produced. Results: Acceptable congruity between currently used case reporting questions and coded vocabularies was found for the majority of data gaps previously identified. Where data need was incongruous with standard coded vocabularies, new codes or concepts could be proposed to the SDO. Pregnancy status is often missing from CDA documents but is well-conceptualized in both LOINC and SNOMED CT systems under several codes, including any current laboratory tests for pregnancy. HIV status is similarly well-conceptualized in both LOINC and SNOMED CT both as a problem list item well as thru a variety of laboratory tests. However, problem list EHR models lack standard inclusion of date of last HIV test or dates of current pregnancy as an associated coded data element which is desirable for public health. Information about the case patient’s sexual partners, need for partner STI treatment, and partner treatment completed is lacking in standard CCD documents. 1 Number of current sexual partners [requiring treatment] – has a SNOMED-CT code, but lacks a match in LOINC coding system. This gap identified the need for exploration of how information about sexual partners can best be represented in interoperability artifacts, including the most useful division of information content between the information model and the standard terminology. Needed concept could resemble ‘record target’ found in HL7 version 3.0 and would allow data to be provided without specifying additional codes. Exploration of information model options or new codes is recommended. Many codes are possible for site of infection and specific symptoms but the overall concepts of ‘symptomatic infection’ and ‘site of infection’ as coded elements would need to be added. Conclusions: This coded element gap analysis found that most information requested in an STI case report can be found in a CCD. Gaps can be addressed by using existing standard terms except for concepts about sexual partners that might be better addressed by exploring the information model rather than through the addition of standard codes. Standards use will facilitate complete case reporting using CDA or FIHR, for example, within a ‘blue button’ or other system with functionality for exchanging additional information about notifiable condition case patients. Collaboration with clinicians, public health practitioners, informaticians, and EHR vendors in will help determine how these concepts might best be modeled. Understanding data gaps involves working closely with a broad range of stakeholders, to understand why gaps exist and how well proposed solutions will meet stakeholder needs.

Purpose – The purpose of this paper is to review stakeholder perspectives and provide a framework for improving governance in health data stewardship. Patients may wish to view their own lab results or clinical records, but others (notably academics, journalists and lawyers) tend to want scores of patient records in their search for patterns or trends. Public Health informatics capabilities are growing in scope and speed as clinical information systems, health information exchange networks and other potential database linkages enable more access to healthcare data. This change facilitates novel service improvements, but also raises new personal privacy protection issues. Design/methodology/approach – This paper summarizes a panel session discussion from the 2015 Information Technology and Communication in Health biennial international conference. The perspectives of health service research, journalism, Public Health informatics and privacy protection were represented. Findings – In North America, an expectation of personal privacy exists as a quasi-constitutional right. Individuals should be allowed to control the amount of information shared about them, and in particular the public expects that details of their personal healthcare data are protected. This is supported by laws, regulations and administrative structures; however, there are fundamental differences between the approaches taken in Canada and in the USA. In both countries, population and Public Health has wide powers to collect data and share it appropriately in order to accomplish a social good. A recent report issued by the British Columbia Information and Privacy Commissioner, and a recent story issued by the Bloomberg News service, highlight ways in which laws and regulations have not kept pace with advances in technology. Changes are needed to enable population and Public Health agencies to protect confidential personal information while still being able to comply with legitimate requests for data by researchers, policy makers and the public at large. Originality/value – Similarities and differences in approach, gaps, current issues and recommendations of several countries were revealed in a conference session. Those concepts and the likelihood of ensuing legislative changes directly impact healthcare organizations’ patients and leadership.

Objective Demonstrate that use of the Washington State health information exchange (HIE) to facilitate access to prescription monitoring program (PMP) data enhances the effectiveness of a PMP. The increased accessibility will lead to improved patient care by giving providers more complete and recent data on patients’ controlled substance prescriptions. Introduction Washington State experienced a five-fold increase in deaths from unintentional drug overdoses between 1998 and 2014. The PMP collects data on controlled substances prescribed to patients and makes the data available to healthcare providers, giving providers another tool for patient care and safety. Optimal impact for the program depends on providers regularly accessing the information to review patients’ dispensing history. We have found through provider surveys and work with stakeholders that the best way to increase use is to make data seamlessly accessible through electronic health record systems (EHRs). This approach does not require a separate login to the PMP portal. This linkage works through the Health Information Exchange (HIE) to make PMP data available to providers via EHRs. The HIE facilitates electronic communication of patient information among organizations including hospitals and providers. In addition to the PMP, another resource to address the prescription drug abuse problem is the Emergency Department Information Exchange (EDIE), a web-based technology that specifically connects emergency departments statewide to track patients who visit multiple EDs. We also developed a connection between EDIE and PMP data through the HIE. Methods Increased provider utilization of the PMP will be achieved by using the HIE to create more seamless access to PMP data through providers’ EHRs and through the EDIE system. This will be done by completing the build out of a transaction using NCPCP 10.6, piloting the connection with healthcare systems and EHR vendors, and by continuing to promote and encourage the PMP to remain an MU option through recent rule changes being proposed by CMS/ONC. The pilot with Epic was conducted in 2015 from April to October. Epic has released an update, available to Washington customers, that includes the connection between EHR and PMP. PMP data is also connected to EDIE. That connection is now live in 80 of 93 acute care hospital emergency departments. Results To date the transaction is in production with 80 emergency departments and achieving positive results. In 2015 the PMP received more than 2 million queries from the EDIE system via the HIE, compared to 900,000 queries via the online PMP portal in the year before the link through the HIE was available. We have also finished a pilot with a major EHR vendor and are working to on-board their customers. We are also working directly with healthcare systems, and as of September 2016 there are 3 healthcare facilities in testing that are expected to go live by the end of the year. Over 90 registrations for meaningful use of the PMP have been received, representing more than 1000 clinics. Improved access to PMP data benefits providers by allowing them to check the history of transactions linked to their DEA numbers, which can alert them to fraudulent prescriptions. Conclusions Integration of PMP data with other information systems will greatly enhance the accessibility and impact of the data. Making a connection to EDIE alone more than doubled the number of queries we received from providers in 2015. We anticipate even more inquiries once additional care settings are connected. We hope from this to see a continued decline in unintentional poisonings due to prescription drugs.

Healthier Washington's Innovation Plan leverages "big data"  analytics to combine different data sources providing a local picture of health including geo-mapping at census tract level and hot-spotting disease burden estimates. These approaches ensure robust availability of information that enables communities to address health inequities through targeted initiatives to improve the health of those most in need, and effectively measure progress over time. Washington's State Medicaid program, Department of Health, and Public Health Seattle & King County are working with the University of Washington to inform best practices in application of these methodologies. This panel will review some approaches under consideration

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.

This paper describes the process of enhancing Trial/DB, a database system for clinical studies management. The system's enhancements have been driven by the need to maximize the effectiveness of developer personnel in supporting numerous and diverse users, of study designers in setting up new studies, and of administrators in managing ongoing studies. Trial/DB was originally designed to work over a local area network within a single institution, and basic architectural changes were necessary to make it work over the internet efficiently as well as securely. Further, as its use spread to diverse communities of users, changes were made to let the processes of study design and project management adapt to the working styles of the principal investigators and administrators for each study. The lessons learned in the process should prove instructive for system architects as well as managers of electronic patient record systems. Control Clin Trials 2000;21:440–461

Objective: To develop a guideline document model that includes a sufficiently broad set of concepts to be useful throughout the guideline life cycle. Design: Current guideline document models are limited in that they reflect the specific orientation of the stakeholder who created them; thus, developers and disseminators often provide few constructs for conceptualizing recommendations, while implementers de-emphasize concepts related to establishing guideline validity. The authors developed the Guideline Elements Model (GEM) using XML to better represent the heterogeneous knowledge contained in practice guidelines. Core constructs were derived from the Institute of Medicine's Guideline Appraisal Instrument, the National Guideline Clearinghouse, and the augmented decision table guideline representation. These were supplemented by additional concepts from a literature review. Results: The GEM hierarchy includes more than 100 elements. Major concepts relate to a guideline's identity, developer, purpose, intended audience, method of development, target population, knowledge components, testing, and review plan. Knowledge components in guideline documents include recommendations (which in turn comprise conditionals and imperatives), definitions, and algorithms. Conclusion: GEM is more comprehensive than existing models and is expressively adequate to represent the heterogeneous information contained in guidelines. Use of XML contributes to a flexible, comprehensible, shareable, and reusable knowledge representation that is both readable by human beings and processible by computers.

To set appropriate priorities in the development of BioSense 2.0, its governance body understand the needs and requests of users and stakeholders. The Governance Group has surveyed this community several times, refining its methods along they way. There is now a clearer understanding of the appropriate priorities for developing BioSense 2.0.

Purpose Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. Patients and Methods This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. Results The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Conclusion The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

A cadaveric model that incorporated quadriceps and hamstrings muscle loads was developed to simulate the squat exercise. The addition of hamstrings load affected knee kinematics in two ways. First, anterior tibial translation during flexion ("femoral roll-back") was significantly reduced ( P = 0.003) and second, internal tibial rotation during flexion was reduced ( P = 0.008). However, quadriceps force was unaffected by the ad dition of hamstrings load. Thus, it seems likely that hamstrings muscle activity that has been observed in vivo during a squat probably functions synergistically with the anterior cruciate ligament to provide anterior knee stability. After the ACL was sectioned, anterior tibial transla tion was significantly increased during the squat ( P = 0.04). The anterior cruciate ligament was then recon structed using a graft instrumented with a load cell. During passive motion, maximal graft tension was at full extension. During simulated squat exercise, the addition of hamstrings caused a significant decrease in graft load ( P = 0.006). During the squat, maximal graft tension was at full extension, and was equal to the graft tension at full passive extension. Thus, the squat exercise may be useful in the early stages of anterior cruciate ligament rehabilitation.

The use of computers has become well established throughout the business enterprise; but computer usage within the health care sector has lagged, particularly for automation of interactions between individual clinicians and their patients. A number of factors have contributed to this including difficulties in representing medical knowledge in computer-processible formats, the limited application of standards for data recording and transmission, and problems in human-computer interaction.A major obstacle to the use of computers in medicine has been the stationary nature of desktop computers. Most clinicians are mobile knowledge workers who need access to information across a wide variety of settings: in offices, exam rooms, emergency departments, hospitals, nursing homes and at home. Within each setting, there is concern that a large box on the consultation desk may interfere with communication between clinicians and patients. Moreover, many physicians do not have keyboard skills. Even for those who can type, keyboard data entry---concomitant with interviewing and examination-- is difficult. To overcome these obstacles, our group at the Yale Center for Medical Informatics has developed systems that operate on small, mobile platforms and accept pen-based data entry.We recognized early on that systems would have to be integrated tightly with clinical workflow and provide benefits to offset the inconvenience associated with their use. Clinical workflow refers to the complex interacting tasks performed by clinicians as they go about their daily work and to the corresponding information flows that are generated. A particular interest has been in providing clinical decision support at the point-of-care. We have extracted knowledge from evidence-based clinical practice guidelines and embedded it in mobile, pen-based systems that inform decision making by clinicians.

This paper describes the development process of an evaluation framework for describing and comparing web survey tools. We believe that this approach will help shape the design, development, deployment, and evaluation of population-based health interventions. A conceptual framework for describing and evaluating web survey systems will enable the developers of health interventions to identify, select, and use the most appropriate and relevant survey tools. The primary contributors included survey methodologists, computer scientists, informaticians, technical communications specialists, educators, evaluators, clinical practitioners, and health services researchers, who together developed a comprehensive ontology to describe the electronic survey domain. This paper will describe the survey ontology development process and detail lessons learned in the creation of the web survey system evaluation framework.

As part of a preliminary investigation, proof-of-concept software was developed to automatically retrieve, process, and classify online behaviors related to STI/HIV transmission. 300 online sexual solicitations were automatically collected, processed and characterized by the software using a shallow natural language processor. The results of the software analysis were compared with expert manual coding for agreement. The study demonstrated the feasibility of an automated online behavioral surveillance system.

Purpose. The effectiveness of a point of dispensing (POD) used in a mass dispensing exercise was evaluated. Methods. Public Health—Seattle & King County (PHSKC), in conjunction with the University of Washington, conducted a functional exercise of mass dispensing plans to test the effectiveness of a POD. Specifically, the organization and maintenance of patient flow, staffing model, signage, and dissemination of public information were evaluated. A data collection application using cellular telephones was used to record time and patient flow data to evaluate patient flow. Questionnaires distributed to staff and volunteer patients at the end of the exercise obtained feedback regarding the setup, organization, and operations of the POD. Results. The POD was operational for approximately 68 minutes. The majority of POD staff reported feeling comfortable with their specific job tasks and duties within 15 minutes of opening the doors to the POD to the public. Staff questionnaires also revealed a high level of self-reported confidence in their ability and in the ability of their colleagues to perform the job-specific responsibilities required of them or respond to this hypothetical event. The majority of volunteer patients found the signs helpful and easy to follow and the check-in form easy to complete. Despite efforts to provide patients with oral and written information about the medications being dispensed, only 80% indicated that they knew how to take the medication, and only 73% reported understanding the medication instructions for all the individuals for whom they picked up medication. Conclusion. The majority of volunteer patients and staff who participated in a functional exercise of mass dispensing plans found the POD to be effective. Time-flow analysis provided preliminary estimates of the total amount of time needed to complete the dispensing process for each head of household.

The Clinical Informatics Research Group and Biobehavioral Nursing and Health Systems at the University of Washington are working with interdisciplinary teams to improve patient care and tracking of patient-reported symptoms and outcomes by creating an extensible web-based survey and intervention platform. The findings and cumulative experience from these processes have led to incremental improvements and variations in each new implementation of the platform. This paper presents progress in the first year of a three-year NIH study entitled Electronic Self Report Assessment--Cancer (ESRA-C). The project's goals are to enhance and evaluate the web-based computerized patient self-reporting and assessment system at the Seattle Cancer Care Alliance. Preliminary work and lessons learned in the modification of the platform and enhancements to the system will be described.

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.

The syndromic surveillance project at Public Health-SeattleKing County incorporates several data sources, including emergency department and primary care visit data collected and normalized through an automated mechanism. We describe significant changes made in this "second generation" of our system to improve data quality while complying with privacy and state public health reporting regulations.The system uses de-identified visit and patient numbers to assure data accuracy, while shielding patient identity. Presently, we have 124,000 basic visit records (used to generate stratified denominators), and 29,000 surveillance records, from four emergency departments and a primary care clinic network. The system is capable of producing syndrome-clustered data sets for analysis.We have incorporated data collection techniques such as automated querying, report parsing, and HL7 electronic data interchange. We are expanding the system to include greater population coverage, and developing an understanding how to implement data collections more rapidly at individual hospital sites, as well as how best to prepare the data for analysis.

Public Health Informatics (PHI) education began at the University of Washington (UW) with a Summer Institute in 1995. The Biomedical and Health Informatics graduate program, which is housed in the School of Medicine, is an interdisciplinary, multi-school program. It demonstrates the UW's cooperative efforts in advancing informatics, encompassing the schools of public health, medicine, nursing, dentistry, pharmacy, information and graduate schools in computer science. This article provides an overview of the developmental milestones related to activities in PHI and describes the evaluation strategy and assessment plan for PHI training at the UW (http://phig.washington.edu).

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.

9519 Background: Assessment of common cancer symptoms and quality of life (QOL) during therapy, notably psychosocial concerns, is known to be incomplete at times. Electronic self-report methods for patients are now available, yet evidence that such methods improve patient/clinician communication is lacking. A confidential, electronic self-report method for patients to report symptoms and concerns, ESRA-C, has been created and we report on a randomized clinical trial (RCT) of its effectiveness. Methods: A RCT was conducted at two urban cancer care institutions in adult patients with all types and stages of cancer. Participants completed two assessments, about 6 weeks apart, one prior to treatment and one during treatment, containing validated symptom and QOL measures on touch-screen computers. A graphical, color summary of participant responses was given to clinicians who assessed intervention group patients, versus no summary in the control group. Same-day clinic visits were audio-recorded and then coded ...

Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes. This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer–assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model. Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity. [J Med Internet Res 2005;7(5):e58]