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Objectives: Identifying those individuals requiring medical care is a basic tenet of the pandemic response. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online 'symptom checkers' used within the triage pathway., Methods: A simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical) and COVID-19 mimickers (eg, sepsis and bacterial pneumonia). The same simulations were applied to each of the four country's symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared., Results: The symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77%, respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home., Conclusion: Our results suggest that whilst 'symptom checkers' may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well-performing symptom checkers are discussed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The interrogation of established, large-scale datasets presents great opportunities in health data science for the linkage and mining of potentially disparate resources to create new knowledge in a fast and cost-efficient manner. The number of datasets that can be queried in the field of multimorbidity is vast, ranging from national administrative and audit datasets, large clinical, technical and biological cohorts, through to more bespoke data collections made available by individual organisations and laboratories. However, with these opportunities also come technical and regulatory challenges that require an informed approach. In this review, we outline the potential benefits of using previously collected data as a vehicle for research activity. We illustrate the added value of combining potentially disparate datasets to find answers to novel questions in the field. We focus on the legal, governance and logistical considerations required to hold and analyse data acquired from disparate sources and outline some of the solutions to these challenges. We discuss the infrastructure resources required and the essential considerations in data curation and informatics management, and briefly discuss some of the analysis approaches currently used., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Precision medicine seeks to leverage technology to improve the health for all individuals. Successful health information systems rely fundamentally on the integration and sharing of data from a range of disparate sources. In many settings, basic infrastructure inequities exist that limit the usefulness of health information systems. We discuss the work of the Yale Transdisciplinary Collaborative Center for Health Disparities focused on Precision Medicine, which aims to improve the health of people in the Caribbean and Caribbean diaspora by leveraging precision medicine approaches. We describe a participatory informatics approach to sharing data as a potential mechanism to reducing inequities in the existing data infrastructure., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

Aim: Public health systems have embraced health informatics and information technology as a potential transformational tool to improve real-time surveillance systems, communication, and sharing of information among various agencies. Global pandemic outbreaks like Zika and Ebola were quickly controlled due to electronic surveillance systems enabling efficient information access and exchange. However, there is the need for a more robust technology to enhance adequate epidemic forecasting, data sharing, and effective communication. The purpose of this review was to examine the use of informatics and information technology tools and its impact on public health delivery., Method: Investigators searched six electronic databases. These were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Database of Systematic Reviews, COMPENDEX, Scopus, and Academic Search Premier from January 2000 to 31 March 2016., Results: A total of 60 articles met the eligibility criteria for inclusion. These studies were organized into three areas as (1) definition of the term public health informatics; (2) type of public health surveillance systems and implications for public health; and (3) electronic surveillance systems functionality, capability, training, and challenges. Our analysis revealed that due to the growing expectations to provide real-time response and population-centered evidence-based public health in this information-driven age there has been a surge in informatics and information technology adoption. Education and training programs are now available to equip public health students and professionals with skills in public health informatics. However, obstacles including interoperability, data standardization, privacy, and technology transfer persist., Conclusion: Re-engineering the delivery of public health is necessary to meet the demands of the 21 st century and beyond. To meet this expectation, public health must invest in workforce development and capacity through education and training in informatics.

Background: As health care becomes more reliant on technology, a better understanding of the factors that contribute to acceptance and use of technology is now critical. The Unified Theory of Acceptance and Use of Technology (UTAUT) has been applied to study a variety of technologies in different settings, and it is one of the most cited theories in Information Systems (IS) research. However, there has been limited application of UTAUT to health IT and, in particular, to patients' IT use., Objectives: The aim of this study is to adapt UTAUT to the context of patient acceptance and use of an Emergency Department (ED) wait-times website, and to empirically test the modified model and compare the results to those of the original UTAUT model. Specifically, it is proposed that there will be a significant relationship between facilitating conditions and behavioral intention., Methods: A survey of patients in the ED of a Canadian hospital was conducted, yielding 118 completed surveys, and subsequently analyzed using Partial least squares (PLS)., Results: This study found that the modified UTAUT produced a substantial improvement in variance explained in behavioral intention compared to the original UTAUT (66% versus 46%). The modified-UTAUT model showed significant effects in performance expectancy (r = 0.302, p < 0.01) and facilitating conditions (r = 0.539, p < 0.001) on behavioral intention to use the website, while the effort expectancy impact was not significant., Conclusions: This study provides empirical support for the modified-UTAUT in the context of patients' intention to use an ED wait times website. Some results of this study support prior research, while some differ, such as the non-significant relationship between effort expectancy and behavioral intention and the finding that performance expectancy is not the main driver of intention to use. As proposed, facilitating conditions - having the resources necessary to view the website and having the ability to find the website - were the most important factors influencing behavioral intention. UTAUT is a key theoretical advance in IS research and by modifying it to the context of patient use, we contribute to both IS and health research., (Copyright © 2018 Elsevier B.V. All rights reserved.)

In response to data collection challenges during mass immunization events, Denver Public Health developed a mobile application to support efficient public health immunization and prophylaxis activities. The Handheld Automated Notification for Drugs and Immunizations (HANDI) system has been used since 2012 to capture influenza vaccination data during Denver Health's annual employee influenza campaign. HANDI has supported timely and efficient administration and reporting of influenza vaccinations through standardized data capture and database entry. HANDI's mobility allows employee work locations and schedules to be accommodated without the need for a paper-based data collection system and subsequent manual data entry after vaccination. HANDI offers a readily extensible model for mobile data collection to streamline vaccination documentation and reporting, while improving data quality and completeness.

A fast paced workshop designed for senior public health decision makers and clinical leaders implementing information systems to support delivery of public health programs. The tutorial will introduce public health information systems and provide best practices for implementing solutions related to immunization, communicable disease case management and outbreak management. Using a combination of formats, the tutorial will: • Highlight key functionality of public health information systems. • Review global crises currently exposing gaps and deficiencies in public health information. • Examine governance, planning, and implementation priorities. • Highlight considerations supporting implementations nationally and in special populations. • Provide real, actionable lessons learned to take away and apply in the real world.

Today's public health crises, as exemplified by the Ebola outbreak, lead to dramatic calls to action that typically include improved electronic monitoring systems to better prepare for, and respond to, similar occurrences in the future. Even a preliminary public health informatics evaluation of the current Ebola crisis exposes the need for enhanced coordination and sharing of trustworthy public health intelligence. We call for a consumer-centric model of public health intelligence and the formation of a national center to guide public health intelligence gathering and synthesis. Sharing accurate and actionable information with government agencies, health care practitioners, policymakers, and, critically, the general public, will mark a shift from doing public health surveillance on people to doing public health surveillance for people.

The impetus and opportunities for improving birth, death, and cause of death data have never been more propitious. Renewed country commitment to strengthen vital registration systems is clearly evident, supported by nascent regional coalitions of technical and development organisations. The announcement of a major new investment by Bloomberg Philanthropies to strengthen data systems and capacity in selected countries has the potential to catalyse and realise significant improvements in the availability and quality of data for health. This will require technical leadership, strategic intervention choices, strong country partnerships, and efficient delivery and management of multiple technical interventions across participating countries.

In Europe, health and medical administrative data is increasingly accumulating on a national level. Looking further than re-use of this data on a national level, sharing health and medical administrative data would enable large-scale analyses and European-level public health projects. There is currently no research infrastructure for this type of sharing. The PHRIMA consortium proposes to realise the Public Health Research Infrastructure for Sharing of health and Medical Administrative data (PHRIMA) which will enable and facilitate the efficient and secure sharing of healthcare data.

Problem: Public health programs must be based on the real health needs of the population. However, the design of efficient and effective public health programs is subject to availability of information that can allow users to identify, at the right time, the health issues that require special attention., Objective: The objective of this paper is to propose a case-based reasoning model for the support of decision-making in public health., Results: The model integrates a decision-making process and case-based reasoning, reusing past experiences for promptly identifying new population health priorities. A prototype implementation of the model was performed, deploying the case-based reasoning framework jColibri., Conclusions: The proposed model contributes to solve problems found today when designing public health programs in Colombia. Current programs are developed under uncertain environments, as the underlying analyses are carried out on the basis of outdated and unreliable data.

Objectives: The objectives of the study were to use persona-driven and scenario-based design methods to create a conceptual information system design to support public health nursing., Design and Sample: We enrolled 19 participants from two local health departments to conduct an information needs assessment, create a conceptual design, and conduct a preliminary design validation., Measures: Interviews and thematic analysis were used to characterize information needs and solicit design recommendations from participants. Personas were constructed from participant background information, and scenario-based design was used to create a conceptual information system design. Two focus groups were conducted as a first iteration validation of information needs, personas, and scenarios., Results: Eighty-nine information needs were identified. Two personas and 89 scenarios were created. Public health nurses and nurse managers confirmed the accuracy of information needs, personas, scenarios, and the perceived usefulness of proposed features of the conceptual design. Design artifacts were modified based on focus group results., Conclusion: Persona-driven design and scenario-based design are feasible methods to design for common work activities in different local health departments. Public health nurses and nurse managers should be engaged in the design of systems that support their work., (© 2013 Wiley Periodicals, Inc.)

Public health information systems are often implemented considering the functionalities and requirements established by administrative staff or researchers, but sometimes ignoring the particular needs of decision makers. This paper describes a proposal to support the design of a Decision Support System for Public Health Surveillance in Colombia, by conducting a qualitative study to identify the real needs of people involved in decision making processes. Based on the study results, an intelligent computational component that supports Data Analysis Automation, Prediction of future scenarios and the identification of new Behavioral Patterns is proposed. The component will be implemented using the Case Based Reasoning methodology, which will be integrated as a new component of the Open Source DHIS2 Platform, enabling public health decision-making.

The objective of this paper is to explore the process of aligning the College of Public Health and Health Informatics research strengths at KSAU-HS with Saudi National Science Technology and Innovation Plan (NSTIP). Nineteen participants responded to a survey and reported on their research strengths, research goals, and research barriers. All 19 participants had academic faculty appointments at the assistant professor level. Five of the 19 participants, also had administrative level positions. A thematic content analysis was performed on the data. The comments were grouped into themes in a manner that reflected the objective of the exercise. Results show that although there are a variety of research strengths within the college, funding, staffing, bureaucracy, data access, and linkages with other healthcare organizations were barriers hindering research progress. This process has led the college to focus on two NSTIP-KACST national priority areas of 1) Information technology; and 2) Medical and Health related research. Future research will assess the outcome of the plan on the research agenda of the college.

Despite the growing limited English proficiency (LEP) population in the US, and federal regulations requiring multilingual health information be available for LEP individuals, there is a lack of available high quality multilingual health promotion materials. The costs and personnel time associated with creating high quality translations serve as barriers to their creation, especially in resource limited public health settings. To explore the potential adoption of novel machine translation and document dissemination technologies for improving the creation and sharing of translated public health materials, we interviewed key health department personnel in Washington State. We analyzed translation workflow, elucidated key themes regarding public health translation work, and assessed attitudes towards electronic document exchange and machine translation. Public health personnel expressed the need for human quality assurance and oversight, but appreciated the potential of novel information technologies to assist in the production and dissemination of translated materials for public health practice.

The purpose of this research was to obtain information about general and pandemic preparedness efforts of residents within San Patricio County in South Texas, as well as to identify the most effective means of communicating the risks posed by pandemic influenza. The population of San Patricio County is socially vulnerable to a variety of disasters, including influenza pandemics due to the unique demographic profile of the county as well as its location on the Gulf Coast. The goals of this study were to help with pandemic planning efforts and to provide recommendations that could serve as a foundation for building more resilient communities within San Patricio County. Clearly the various governmental levels must work together to assist communities prepare for pandemic preparedness but broad, inclusive community participation is also necessary to strengthen community resilience.

Background: We have developed manual methods to gather data on the point prevalence of observed smoking in road vehicles. To enable the widespread international collection of such data, we aimed to develop a smartphone application (app) for this work., Methods: We developed specifications for an app that described the: (1) variables that could be collected; (2) transfer of data to an online repository; (3) user interface (including visual schematics) and (4) processes to ensure the data authenticity from distant observers. The app functionality was trialled in roadside situations and the app was made publicly available., Results: The smartphone app and its accompanying website were developed, tested and released over a period of 6 months. Users (n=18) who have registered themselves (and who met authentication criteria), have reported no significant problems with this application to date (observing 20 535 vehicles as of 5 July 2012). The framework, methodology and source code for this project are now freely available online and can be easily adapted for other research purposes. The prevalence of smoking in vehicles was observed in: Poland 2.7% (95% CI 2.3% to 3.1%); Australia 1.0% (95% CI 0.7% to 1.3%); New Zealand 2.9% (95% CI 2.6% to 3.2%)-similar to results using preapp methods in 2011 (3.2%, 95% CI 3.1% to 3.3%)., Conclusions: This project indicates that it can be practical and feasible for health researchers to work together with information science researchers and software developers to create smartphone apps for field research in public health. Such apps may be used to collect observational data more widely, effectively and easily than through traditional (non-electronic) methods.

With the growth of telehealth applications and the need for public health managers to have tools that facilitate visualization of indicators produced by telehealth services arose the need to have simple systems to better planning the interventions. Furthermore, Health systems are considers difficult in order to visualize the right information by many health professionals [1] because of the complexity of its Graphical User Interface (GUI) and the high cognitive load needed to handle it. To overcome this problem, we have proposed a 3D environment for the analysis of telehealth indicators in public health by managers of public health sites. Users who will use the environment are part of public health manager of family health sites that participate of Network of Telehealth Centers of Pernambuco (RedeNUTES) [2] that is part of Brazil telehealth program. This paper aims to present a 3D environment for analysis of telehealth indicators by public health manager.

After India and Brazil, Indonesia has the third highest incidence/prevalence of leprosy in the world. Every year thousands of new cases and case with grade-2 disability are reported and, while the recovery rate lingers only 80-90 %. Therefore, more than 10 % of leprosy patients drop out of treatment and can be a source of new infections in the community. Our research was aimed at determining apparent difficulties in the leprosy control program as well as how a health information system (HIS) could assist the Indonesian leprosy control program. We used qualitative method with deep interview and observation of document. One of the difficulties which the Indonesian leprosy control program faces is discontinuity of patient's data due to rotating staff as well as the treatment monitoring and queries patients which should be monitored after treatment has ceased. Technology implementation is feasible through short message service (sms) reminders and web base applications. The leprosy control program urgently needs to implement continuous monitoring and recording of patients because of the particular characteristics of this contagious disease.

E-Record (in Danish: E-Journal) is at National repository of record information from all public hospitals in Denmark. It has been introduced in 2007 and today it is a backbone for interchanging EHR-information across hospitals. It is not a national EHR, but a read-only repository that supplements the local EHR-information with national information. Both GP's and patients/citizens can access the information due to improved patient empowerment. Almost 50.000 different clinicians at hospitals and almost 300.000 patients/citizens have used E-Record in 2012. E-Record contains information about ICD-10 diagnosis, Pro-cedures, Notes and Discharge letters and cave information.

The use of bicycles as a mean of healthy and eco-friendly transportation is currently actively promoted in many industrialized countries. However, the number of severe bicycle accidents rose significantly in Germany and Canada in 2011. In order to identify risk factors for bicycle accidents and possible means of prevention, a study was initiated that analyses bicycle accidents from selected regions in both countries. Due to different healthcare systems and regulations, the data must be selected in different ways in each country before it can be analyzed. Data is collected by means of questionnaires in Germany and using hybrid electronic-paper records in Canada. Using this method, all relevant data can be collected in both countries.

Data warehouse projects are perceived to be risky and prone to failure due to many organizational and technical challenges. However, often iterative and lengthy processes of implementation of data warehouses at an enterprise level provide an opportunity for formative evaluation of these solutions. This paper describes lessons learned from successful development and implementation of the first phase of an enterprise data warehouse to support public health surveillance at British Columbia Centre for Disease Control. Iterative and prototyping approach to development, overcoming technical challenges of extraction and integration of data from large scale clinical and ancillary systems, a novel approach to record linkage, flexible and reusable modeling of clinical data, and securing senior management support at the right time were the main factors that contributed to the success of the data warehousing project.

Kiribati is among one of the least developed countries in the world. Every year international agencies and other health stakeholders request information on Kiribati mortality and morbidity, but unfortunately most health data has never been analysed and therefore, health reports have never been formally provided. Despite this, Kiribati has taken important steps forward in improving its health information system (HIS) by prioritising health information in the Ministry of Health's Strategic Action Plan. The main purpose of this case study is to explore the HIS issues and challenges Kiribati faces, actions taken to address these challenges, its next steps, and key messages for other countries in the Pacific.

The aim of this paper is to summarise common issues and challenges for health information systems (HIS) in Pacific Island Countries and Territories (PICTs) as identified by Pacific participants at two meetings held by the HIS Knowledge Hub in 2009 and provide suggestions for future action. The global agenda and drivers of HIS were discussed at both meetings to provide a clearer understanding of how Pacific Island countries are positioned within the larger international agenda. The two meetings provided the opportunity for participants to highlight suggestions for future action. Many of the solutions proposed highlighted the potential for regional solutions to progress the issue. This suggests an urgent need for national health authorities and regional partners to agree on strategies and programs to derive maximum benefit from regional HIS resources.

Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.

Rapid advances in information and networking technologies have greatly expanded the modes for conducting business and science. For the past two decades, the National Science Foundation (NSF) has been supporting efforts to develop a comprehensive cyberinfrastructure with the goal of transforming the nature of scientific investigations. More recently, the NIH began supporting efforts to develop a cyberinfrastructure of healthcare research and practice. However, the best structure and applications of cyberinfrastructure in health care have yet to be defined. To address these issues, the NIH and the Kay Center for E-Health Research at Claremont Graduate University sponsored a symposium on "Cyberinfrastructure for Public Health and Health Services: Research and Funding Directions." The symposium convened researchers, practitioners, and federal funders to discuss how to further cyberinfrastructure systems and research in the public health and health services sectors. This paper synthesizes findings of the symposium, the goals of which were to determine the dynamics necessary for executing and utilizing cyberinfrastructure in public health and health services; examine the requirements of transdisciplinary collaboration; and identify future research directions. A multi-faceted conception of use-inspired research for cyberinfrastructure is developed. Use-inspired research aims to further basic theory but is grounded, inspired, and informed by practical problems. A cyberinfrastructure framework is presented that incorporates three intersecting dimensions: research-practice, health services-public health, and social-technical dimensions. Within this framework, this paper discusses the ways in which cyberinfrastructure provides opportunities to integrate across these dimensions to develop research and actions that can improve both clinical outcomes and public health., (Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.)

The Johns Hopkins University Applied Physics Laboratory (JHU/APL) implemented state and district surveillance nodes in a central aggregated node in the National Capital Region (NCR). Within this network, de-identified health information is integrated with other indicator data and is made available to local and state health departments for enhanced disease surveillance. Aggregated data made available to the central node enable public health practitioners to observe abnormal behavior of health indicators spanning jurisdictions and view geographical spread of outbreaks across regions.Forming a steering committee, the NCR Enhanced Surveillance Operating Group (ESOG), was key to overcoming several data-sharing issues. The committee was composed of epidemiologists and key public health practitioners from the 3 jurisdictions. The ESOG facilitated early system development and signing of the cross-jurisdictional data-sharing agreement. This agreement was the first of its kind at the time and provided the legal foundation for sharing aggregated health information across state/district boundaries for electronic disease surveillance.Electronic surveillance system for the early notification of community-based epidemics provides NCR users with a comprehensive regional view to ascertain the spread of disease, estimate resource needs, and implement control measures. This article aims to describe the creation of the NCR Disease Surveillance Network as an exceptional example of cooperation and potential that exists for regional surveillance activities.

Public health relies on data reported by health care partners, and information technology makes such reporting easier than ever. However, data are often structured according to a variety of different terminologies and formats, making data interfaces complex and costly. As one strategy to address these challenges, health information organizations (HIOs) have been established to allow secure, integrated sharing of clinical information among numerous stakeholders, including clinical partners and public health, through health information exchange (HIE). We give detailed descriptions of 11 typical cases in which HIOs can be used for public health purposes. We believe that HIOs, and HIE in general, can improve the efficiency and quality of public health reporting, facilitate public health investigation, improve emergency response, and enable public health to communicate information to the clinical community.

The healthcare industry has an increasing need for clinical data content standards to support patient care and data re-use in areas such as research, quality and public health. The Diabetes Data Strategy (Diabe-DS) project was formed in 2009 by the HL7 EHR Working Group to demonstrate a repeatable process that identifies disease-specific Common Data Elements (CDEs) for clinical care and secondary use. The Diabe-DS project previously developed a set of important CDEs and supporting data models for clinical care, quality and research uses of diabetes data. This paper will describe the process for identifying the data elements and activities required for public health use of clinical data, and mapping them to Diabe-DS CDEs, use case and data models. The result is a model for consideration which provides data needed in the immediate clinical environment of care, and supports the use of data for multiple uses.

Disease surveillance for hepatitis C in the United States is limited by the occult nature of many of these infections, the large volume of cases, and limited public health resources. Through a series of discrete processes, the Massachusetts Department of Public Health modified its surveillance system in an attempt to improve timeliness and completeness of reporting and case follow-up of hepatitis C. These processes included clinician-based reporting, electronic laboratory reporting, deployment of a Web-based disease surveillance system, automated triage of pertinent data, and automated character recognition software for case-report processing. These changes have resulted in an increase in the timeliness of reporting.

Purpose: To describe the clinical and public health activities of all entities involved in long-term follow-up of children with conditions identified by newborn dried bloodspot screening, including the requirements for interoperable clinical and public health information systems that will support care from birth through adulthood., Methods: The Southeastern Newborn Screening Genetics Collaborative (Region 3) convened a workgroup of experts in pediatric care, genetics, and public health, facilitated by the Public Health Informatics Institute (the Institute). The Institute's Collaborative Requirements Development Methodology was used., Results: Three overlapping steps in the long-term follow-up process were examined: needs assessment, ongoing treatment/management, and knowledge generation. In addition, greater definition was given to the roles of Clinical Care Coordinator and Public Health Care Coordinator, as defined by a previous workgroup, and a new role was identified-Care Plan Leader (primary care provider or specialist) who would serve as treatment coordinator and centralize long-term follow-up care provision to minimize gaps in clinical care., Conclusion: The outcome of the Region 3 Workgroup's efforts is an expanded notion of long-term follow-up to extend throughout the patient's lifespan, with an emphasis on the coordination of care involving both clinical and public health sectors and on requirements for interoperable clinical and public health information systems.

The outcomes of a meeting that focused on the role of the residual dried blood spots from newborn screening for uses in the improvement of newborn screening are reported. Discussions of policy development, such as this one, begin by identifying the problem to be solved; in this case, it is achieving common ground to develop consistent policies for the use of residual dried blood spots, such that their benefits to the public's health and the health of children are amplified, and harms are minimized. Similarly, the issue must be considered contextually. The example of newborn screening for phenylketonuria was used to highlight the issues in the context of the condition with the longest history in newborn screening. Principles and recommendations for the use of the residual dried blood spot were developed.

Purpose: State newborn screening programs are designed to prevent morbidity and mortality from hereditary disorders through early detection and ongoing disease management. These programs have traditionally focused on short-term follow-up. However, capturing data on the long-term follow-up process is emerging as a new priority. Long-term follow-up data can be used to assess the accessibility, continuity, and quality of care provided to these children. The California Newborn Screening Program uses a Web-based data collection system for short- and long-term follow-up. This article provides a description of the follow-up data collection system in addition to preliminary findings to demonstrate the efficacy of the California data collection approach., Methods: A preliminary analysis of short-term follow-up data collected from July 7, 2005, through April 30, 2009, and a preliminary analysis of long-term follow-up data collected from July 1, 2007, through April 30, 2009., Results: A majority of children are able to access ongoing care through age 5 years. The majority also have positive health outcomes at each year of follow-up., Conclusion: California's short- and long-term data collection system can serve as a model for other states interested in implementing a comprehensive Newborn Screening Program follow-up data system.

New technology in newborn screening permits clinicians to approach strategies for defining optimal treatments for newborn-screened conditions. The Health Resources and Services Administration Maternal and Child Health Bureau, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Centers for Disease Control and Prevention have all established initiatives for long-term follow-up assessment of children identified after newborn screening. In October 2008, an inaugural meeting of the National Institute of Child Health and Human Development-sponsored National Coordinating Center Long-Term Follow-Up Data Collection Work Group brought together partners from Health Resources and Services Administration-sponsored Regional Genetics Collaboratives to review pilot projects undertaken to promote systematic long-term follow-up for children with inborn errors of metabolism identified by newborn bloodspot screening. Beginning with these projects, the goal of this meeting was to provide a foundation for national planning for a common data set to be used for long-term follow-up. This supplement summarizes these initial projects.

Background: Information system integration is an important dimension of a company's information system maturity and plays a relevant role in meeting information needs and accountability targets. However, no generalizable evidence exists about whether and how the main integrating technologies influence information system integration in health care organizations., Purpose: This study examined how integrating technologies are adopted in public health care organizations and chief information officers' (CIOs) perceptions about their influence on information system integration., Methodology: We used primary data on integrating technologies' adoption and CIOs' perception regarding information system integration in public health care organizations. Analysis of variance (ANOVA) and multinomial logistic regression were used to examine the relationship between CIOs' perception about information system integration and the adopted technologies., Results: Data from 90 health care organizations were available for analyses. Integrating technologies are relatively diffused in public health care organizations, and CIOs seem to shape information system toward integrated architectures. There is a significant positive (although modest, .3) correlation between the number of integrating technologies adopted and the CIO's satisfaction with them. However, regression analysis suggests that organizations covering a broader spectrum of these technologies are less likely to have their CIO reporting main problems concerning integration in the administrative area of the information system compared with the clinical area and where the two areas overlap., Practice Implications: Integrating technologies are associated with less perceived problems in the information system administrative area rather than in other areas. Because CIOs play the role of information resource allocators, by influencing information system toward integrated architecture, health care organization leaders should foster cooperation between CIOs and medical staff to enhance information system integration.

Guided by how weather data from the National Oceanic and Atmospheric Administration fuels all kinds of weather reports, maps and forecasts, HHS officials saw parallels on how to distribute health data so software developers could create tools to be used by patients and providers. "We thought that was inspiring," said Todd Park, left, HHS' chief technology officer.

In terms of their applicability to the field of tropical medicine, geographical information systems (GIS) have developed enormously in the last two decades. This article reviews some of the pertinent and representative applications of GIS, including the use of such systems and remote sensing for the mapping of Chagas disease and human helminthiases, the use of GIS in vaccine trials, and the global applications of GIS for health-information management, disease epidemiology, and pandemic planning. The future use of GIS as a decision-making tool and some barriers to the widespread implementation of such systems in developing settings are also discussed.

Public health systems have been developed over many years and are costly to maintain or replace. Service-oriented architectures (SOA) have provided a way for these systems to remain viable and responsive to increasing demands for information and analysis. As healthcare entities look for strategies to effectively achieve "meaningful use:" of their EHR systems, SOA will emerge as one key technical strategy for enabling this functionality. This paper offers two case studies of core public health systems in different jurisdictions and the strategies used with SOA to extend system life and to enable new and important features.

We set out to examine design conflict resolution tactics used in development of large information systems for health services and to outline the design consequences for these tactics. Discourse analysis methods were applied to data collected from meetings conducted during the development of a web-based system in a public health context. We found that low risk tactics were characterized by design issues being managed within the formal mandate and competences of the design group. In comparison, high risk tactics were associated with irresponsible compromises, i.e. decisions being passed on to others or to later phases of the design process. The consequence of this collective disregard of issues such as responsibility and legitimacy is that the system design will be impossible to implement in factual health service contexts. The results imply that downstream responsibility issues have to be continuously dealt with in system development in health services.

The German Federal Ministry of Health has funded National Reference Centres (NRC) for laboratory-based surveillance of selected infection pathogens and infections disease syndromes. This selection is based on the epidemiologic relevance of the pathogens, specific diagnostic requirements, antimicrobial resistance and need for public health measures. Currently there are 18 NRC, nominated for a duration of 3 years. Toward the end of a nomination period, each NRC is evaluated by an expert committee, based on the catalogue of core tasks. In order to expand the spectrum of competencies 47 consiliary laboratories on additional pathogens of special epidemiologic importance have been named. Their main function is to provide information and consultation on special diagnostic issues. In order to further improve the effectiveness and cooperation of the system Networks have been created. The aim of the Networks is to facilitate exchange of diagnostic methods and prevention concepts and to improve the geographic coverage of the services.