Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care

<p>Abstract</p> <p>Background</p> <p>Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.</p> <p>Discussion</p> <p>While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.</p> <p>Summary</p> <p>Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?</p

Using a Tetradic Network Technique and a Transaction Cost Economic Analysis to illustrate an economic model for an open access medical journal

There is a crisis in scholarly publishing. The value of the scholarly information is frequently much less than the cost of providing that information. Consequently, libraries are suffering and scholars do not have access to information that they need. However, certain for-profit publishers and scientific societies are benefiting substantially from the current system. The Internet has demonstrated the potential to change this structure. The Budapest, Berlin and Bethesda initiatives show there is significant worldwide interest to replace the current controlled system with one that allows open access of scholarly information to anyone with Internet access. An examination of the scholarly publishing process is offered using a Tetradic Network Technique (TNT) and a Transaction Cost Economic (TCE) analysis as applied to a traditional subscription-based, print medical journal, Medical Physics, and a Web-based, open access medical journal, the Journal of Applied Clinical Medical Physics. The analysis identifies stakeholders and considers transaction and production costs. TCE analysis is performed between each of the following: Libraries, Scholars, Publishers and Societies, for a total of six transaction exchanges for both the traditional and the open access journal. This analysis allows costs to be compared more easily between the two types of journals, and provides the basis for a model online journal pro forma. Results demonstrate that while production costs remain approximately equivalent for the traditional and open access journal, total transaction costs are reduced by a factor of between 5 and 10 for the open access journal. While the cost of producing an eight-page article in a traditional medical journal is approximately US$2500, the cost of publishing the same article in an open access journal is less than US$500. Recommendations are offered that illustrate how an open access online journal may be produced by a university for approximately the cost of several library print journal subscriptions and physical storage of the printed material. Universities may therefore benefit through greater involvement with the scholarly publishing process. There are several considerations and recommendations that one may draw from this investigation. Universities pay for scholarly research, and then pay again to obtain access to published results. University libraries, always a significant cost center, are now in financial crisis. Scientific societies and large publishers gain under the traditional scholarly publication model. The copyright is essential; the one that holds the copyright holds the power in scholarly publishing. Modern open access initiatives state that scholars should retain copyright and publish online. Universities should require promotion and tenure committees to give equal weight to open access publications. Universities should go into the publishing business with scientific societies and control dissemination of scholarly knowledge for the public good

Launching Adversarial Attacks against Network Intrusion Detection Systems for IoT

As the internet continues to be populated with new devices and emerging technologies, the attack surface grows exponentially. Technology is shifting towards a profit-driven Internet of Things market where security is an afterthought. Traditional defending approaches are no longer sufficient to detect both known and unknown attacks to high accuracy. Machine learning intrusion detection systems have proven their success in identifying unknown attacks with high precision. Nevertheless, machine learning models are also vulnerable to attacks. Adversarial examples can be used to evaluate the robustness of a designed model before it is deployed. Further, using adversarial examples is critical to creating a robust model designed for an adversarial environment. Our work evaluates both traditional machine learning and deep learning models’ robustness using the Bot-IoT dataset. Our methodology included two main approaches. First, label poisoning, used to cause incorrect classification by the model. Second, the fast gradient sign method, used to evade detection measures. The experiments demonstrated that an attacker could manipulate or circumvent detection with significant probability