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.
The relation of water quality to hydrogeology and land use was evaluated using analysis of water samples from 71 wells in the northern part of the Potomac-Raritan-Magothy aquifer system in New Jersey. The sampling network was evaluated for variations in hydrogeology. Well depths, pumping rates, and the number of wells in the confined and unconfined parts of the aquifer system did not differ among land-use groups. The influences of hydrogeologic factors on water quality were evaluated without considering land use. Shallow wells had the highest specific conductance and major ion concentrations. Water from wells in the unconfined part of the aquifer system had the highest dissolved organic carbon concentration. Dissolved oxygen and nitrate concentrations were lowest, trace metals concentrations were highest, and phenols were detected most frequently in groundwater from undeveloped land. Major ions and trace metals concentrations were lowest, dissolved oxygen and copper concentrations were highest, and pesticides were most frequently detected in groundwater from agricultural land. Nitrate concentrations were highest and orthophosphate, nitrite, and purgeable organics were detected most frequently in groundwater from urban land. These water quality data were compared to data from the same aquifer system in southern New Jersey. Frequencies of detection of purgeable organics among land-use groups were similar in the northern and southern areas.
Telemedicine is increasingly being used to provide consultation for healthcare in rural areas. Little work has been done with dementia although preliminary research suggests that clinical diagnosis performed via telemedicine consultation is valid. We implemented a program to provide multidisciplinary, state-of-the-art diagnosis of cognitive impairment by video-telemedicine (VTM) integrated into a clinical setting.Patients at a rural veteran's community clinic were referred by their local provider for evaluation of memory complaints by the multidisciplinary team of the San Francisco Veterans Administration (SFVA) Memory Disorders Clinic (MDC). The evaluation was integrated into the usual clinic structure and included a neurological evaluation and neuropsychological testing by the MDC team via video assisted by a remote clinician at the community clinic.We evaluated 15 new patients referred to our multidisciplinary clinic. In each case, the VTM format permitted the MDC team to arrive at a working diagnosis; 12 patients with dementia, two with mild cognitive impairment, and one cognitively normal. Relevant treatment recommendations were made to the patients and caregivers. The evaluation results were discussed with providers who joined the MDC postclinic conference via VTM. In the majority of cases, recommendations were followed and there was satisfaction with VTM by providers and patients.VTM is emerging as an effective way to provide consultation and care to rural residents who may not have access to specialty services and can be integrated into current clinical settings.
There are currently over 5 million people with Alzheimer's disease in the United States. Exposure to the unique needs of this population is critical for those entering or considering careers in health care. Initial programs targeting medical students, have expanded to include diverse undergraduate and graduate students. In 1997, the Northwestern University Buddy Program™ paired medical students with persons with mild dementia (PWD) for exposure to the experience of living with dementia through monthly visits and journal recording. Other university associated dementia centers have adapted the program. The Memory and Aging Center (MAC) at the University of California, San Francisco (UCSF) offers an elective entitled “Patient as Teacher” pairing graduate students in medicine, nursing, dentistry, physical therapy and pharmacy with PWD. The “ A Friend for Rachel” program at the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center matches undergraduate and post-baccalaureate students from Columbia University with PWD. A joint program between Health Partners and University of Minnesota, “Partners in Dementia” pairs first year medical students with PWD. All include student training in dementia basics and communication strategies, regularly scheduled social contacts and journaling about the experience. Data analysis includes thematic examination of journal data and pre-post measures of satisfaction, knowledge, attitudes and caregiver burden. The Northwestern program has recruited 241 dyads. The MAC has enrolled 33 students across disciplines. At Columbia, the program has trained and paired 100 students. The University of Minnesota/Health Partners program has enrolled 37 dyads. Journal submissions demonstrate changing beliefs and increased understanding of dementia and its impact on the person and family. Pre- and post-test data reveal increases in knowledge of dementia, empathy, positive attitudes and decreased stigma among medical students. Evaluations from PWD and their families reveal an opportunity to highlight remaining strengths and remain socially engaged while contributing to a young person's education. The original replicable experiential program, previously validated targeting medical students, has been adapted in multiple settings to meet the needs of undergraduate and graduate students with similar positive results for the student, person with dementia and family.
