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Who Should Own Data Captured in Personal Health Records?

According to a survey by the Healthcare Information and Management Systems Society (HIMSS), 92 percent of health care IT professionals said patients should own the data captured in personal health records. Four percent of respondents said providers should own PHR data, while 1% said the company supplying the PHR should own the data.

The survey also found that nearly half of respondents said that privacy and security issues are the biggest barrier to the use of a PHR. Twenty-four percent of respondents said that the biggest barrier to PHR use is that their clinician does not use electronic records. Thirty percent of respondents said they access a PHR, while 76% of respondents said they believe PHRs need to be integrated with an electronic health record to have value in patient treatment.

Results are based on an April online survey of 675 health care IT professionals.

Source: HIMSS Vantage Point

HIMSS Vantage Point (pdf)

Structured Clinical Interview Training And Virtual Patients

Virtual Human Agent (VHA) technology has evolved to a point where researchers may begin developing mental health applications that make use of virtual reality patients. In an ongoing study from the University of Southern California of virtual patients (VP). Researchers have developed an approach that allows novice mental health clinicians to conduct an interview with a virtual character that emulates an adolescent male with conduct disorder. This study illustrates the ways in which a variety of core research components can facilitate the rapid development of mental health applications.

Effective interview skills are a core competency for psychiatry residents and developing psychotherapists. Although schools commonly make use of standardized patients to teach interview skills, the diversity of the scenarios standardized patients can characterize is limited by availability of human actors. There are also economic issues related to the investment of time and money needed to train standardized patients. Thus, using the Virtual Human Agent (VHA) technology, a different approach to developing mental health applications using virtual reality patients may be one answer to standardization.

Study

Objective structured clinical interview training using a virtual human patient.
Parsons TD, Kenny P, Ntuen CA, Pataki CS, Pato MT, Rizzo AA, St-George C, Sugar J.
Stud Health Technol Inform. 2008;132:357-62.

Virtual World For Addiction Cravings

Research funded by National Institutes of Health, the National Institute on Drug Abuse and the National Institutes for Alcohol Abuse and Alcoholism from University of Houston and published in Addictive Behaviors Journal, demonstrates that a virtual reality (VR) environment can provide the climate necessary to spark an alcohol craving so that patients can practice how to say "no" in a realistic and safe setting.

The lead author Patrick Bordnick points out that "as a therapist, I can tell you to pretend my office is a bar, and I can ask you to close your eyes and imagine the environment, but you’ll know that it’s not real, yet in this virtual environment you are at a bar or at a party or in a real-life situation. What we found was that participants had real-life responses."

Researchers studied 40 alcohol-dependent individuals who were not receiving treatment (32 men and eight women). Wearing a VR helmet, each was guided through 18 minutes of virtual social environments that included drinking. The participant’s drink of choice was included in each scene. Using a game pad, each rated his or her cravings and attention to the alcohol details in each room. Each then was interviewed following the experience. The study found that the VR environments were real enough that their cravings were intensified and demonstrates the value of using virtual reality as a tool for assessing and treating addictions. Future studies should explore the importance of environmental settings and other cues on cravings and relapse.

Journal Abstract

Human Brain Appears "Hard-Wired" for Hierarchy

Researchers at the National Institutes of Health have conducted imaging studies that have identified how the brain reacts to social status. They believe that social hierarchies strongly influence motivation as well as physical and mental health and that different brain regions are activated when a person moves up or down a pecking order or views perceived social superiors or inferiors.

To find out, the NIMH researchers created an artificial social hierarchy in which 72 participants played an interactive computer game for money. They were assigned a status that they were told was based on their playing skill. In fact, the game outcomes were predetermined and the other "players" were simulated by computer. While their brain activity was monitored by fMRI, participants intermittently saw pictures and scores of an inferior and a superior "player" they thought were simultaneously playing in other rooms.

Although they knew the perceived players' scores would not affect their own outcomes or reward — and were instructed to ignore them — participants' brain activity and behavior were highly influenced by their position in the implied hierarchy.

The researchers point out that the 'processing of hierarchical information seems to be hard-wired, occurring even outside of an explicitly competitive environment.'

Key study findings included:

* The area that signals an event's importance, called the ventral striatum, responded to the prospect of a rise or fall in rank as much as it did to the monetary reward, confirming the high value accorded social status.

* Just viewing a superior human "player," as opposed to a perceived inferior one or a computer, activated an area near the front of the brain that appears to size people up — making interpersonal judgments and assessing social status. A circuit involving the mid-front part of the brain that processes the intentions and motives of others and emotion processing areas deep in the brain activated when the hierarchy became unstable, allowing for upward and downward mobility.

* Performing better than the superior "player" activated areas higher and toward the front of the brain controlling action planning, while performing worse than an inferior "player" activated areas lower in the brain associated with emotional pain and frustration.

* The more positive the mood experienced by participants while at the top of an unstable hierarchy, the stronger was activity in this emotional pain circuitry when they viewed an outcome that threatened to move them down in status. In other words, people who felt more joy when they won also felt more pain when they lost.

The researchers are planning follow-up studies to explore brain activity in response to the experimental social hierarchy in patients with mental illnesses like schizophrenia or autism, which are marked by social and thinking deficits. The researchers will also be exploring whether particular gene variants might differentially affect brain responses in similar experiments.

Source: NIMH