Objective: To evaluate evidence of the effectiveness of computer-generated health behavior interventions—clinical encounters “in absentia”—as extensi

Objective To describe the experiences of patients with type 2 diabetes in a web based disease management programme based on an interactive electronic medical record. Design Qualitative analysis of semistructured interviews with patients enrolled in a diabetes care module that included access to their electronic medical record, secure email, ability to upload blood glucose readings, an education site with endorsed content, and an interactive online diary for entering exercise, diet, and medication. Setting Patients' homes in Washington state, United States. Participants Nine participants aged 45-65 completed interviews before and after they used the programme. Results Six themes emerged: feeling that non-acute concerns are uniquely valued; enhanced sense of security about health and health care; frustration with unmet expectations; feeling more able to manage; valuing feedback; and difficulty fitting the programme into activities of daily life. Three themes—valuing non-acute concerns, feeling secure, and unmet expectations—have particular relevance to the design and use of web based tools for care of patients with diabetes and chronic medical conditions. Conclusion Participants' experiences support further study of open access to the electronic medical record and online communication between patients and their care providers. The development of web based disease management programmes should take into account the specific needs and expectations of patients, and patients and providers should have candid discussions about what web based care can and cannot provide.

Health care providers play a significant role in large scale health emergency planning, detection, response, recovery and communication with the public. The effectiveness of health care providers in emergency preparedness and response roles depends, in part, on public health agencies communicating information in a way that maximizes the likelihood that the message is delivered, received, deemed credible and, when appropriate, acted on. However, during an emergency, health care providers can become inundated with alerts and advisories through numerous national, state, local and professional communication channels. We conducted an alert fatigue study as a sub-study of a larger randomized controlled trial which aimed to identify the most effective methods of communicating public health messages between public health agencies and providers. We report an analysis of the effects of public health message volume/frequency on recall of specific message content and effect of rate of message communications on health care provider alert fatigue.

The research identified and assessed information needs and resources of public health nurses in a local health department. Semi-structured in-depth interviews were conducted with seventeen public health nurses at a local health department in rural Oregon. Interview transcripts were analyzed using a constant comparative method to assess the information nurses sought and used in their work. Public health nurses performed a wide variety of roles and associated tasks. Major themes that emerged from analyses of interview transcripts included: (1) differences in information needs depending on position and role; (2) colleagues as the most efficient and trusted source of information; (3) limitations of existing knowledge-based resources; (4) need for up-to-date and pertinent information; and (5) need for personal computers, basic communications software, and expanded Internet access. Lack of Internet access is a significant barrier to use of information resources, and information tools tailored to meet the needs diverse public health nursing roles and facilitate information sharing among colleagues are needed. Librarians and informaticians can assist by addressing these needs and improving the organization of content and interface design for commonly used websites.

Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces. Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar’s test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson’s goodness of fit statistic. We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001). Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.