Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Web Service Trust: Towards A Dynamic Assessment Framework

Trust in software services is a key prerequisite for the success and wide adoption of services-oriented computing (SOC) in an open Internet world. However, trust is poorly assessed by existing methods and technologies, especially in dynamically composed and deployed SOC systems. In this paper, we discuss current methods for assessing trust in service-oriented computing and identify gaps of current platforms, in particular with regards to runtime trust assessment. To address these gaps, we propose a model of runtime trust assessment of software services and introduce a framework for realizing the model. A key characteristic of our approach is the support that it offers for customizable assessment of trust based on evidence collected during the operation of software services and its ability to combine this evidence with subjective assessments coming from service clients

How Resilient Are Our Societies? Analyses, Models, and Preliminary Results

Traditional social organizations such as those for the management of healthcare and civil defence are the result of designs and realizations that matched well with an operational context considerably different from the one we are experiencing today: A simpler world, characterized by a greater amount of resources to match less users producing lower peaks of requests. The new context reveals all the fragility of our societies: unmanageability is just around the corner unless we do not complement the "old recipes" with smarter forms of social organization. Here we analyze this problem and propose a refinement to our fractal social organizations as a model for resilient cyber-physical societies. Evidence to our claims is provided by simulating our model in terms of multi-agent systems.Comment: Paper submitted for publication in the Proc. of SERENE 2015 (http://serene.disim.univaq.it/2015/

Fall prevention intervention technologies: A conceptual framework and survey of the state of the art

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.The Royal Society, grant Ref: RG13082

Patterns for service-oriented information exchange requirements

Service-Oriented Computing (SOC) is an emerging computing paradigm that supports loosely-coupled inter-enterprise interactions. SOC interactions are predominantly specified in a procedural manner that defines message sequences intermixing implementation with business requirements. In this paper we present a set of patterns concerning requirements of information exchange between participants engaging in service-oriented interactions. The patterns aim at explicating and elaborating the business requirements driving the interaction and separating them from implementation concerns