From The Chair Hello, Group.

Student Working Group NewsAmerican Medical Informatics Association/mbrcenter/wg/st/July 2007 Volume 4, Number 3 The AMIA Working Group News is published 5-6 times ayear by the Student Working Group of the AmericanMedical Informatics Association. Visit our web site for moreinformation or to learn how to get involved./mbrcenter/wg/stChair………………...…Catherine CravenMembers-at-Large……….....Y ang GongSaira HaqueDavid KaelberAnand KumarEditor-in-Chief……….…Michael Grasso From The ChairHello, Group.It’s nomination timefor the fall election! Wehave many Student WGExecutive Committeeleadership positions forwhich we must nominatecandidates. Nominationsmay be made by any Student WG member.You may nominate yourself, so don’t be shyabout it.All candidates and their nominatorsmust read our Student WG OperatingGuidelines regarding election eligibility priorto nomination: /mbrcenter/wg/st/docs/swgoperatingguidelines.pdf. Afterreading the guidelines, submit yournomination to the Student WG NominationsCommittee Chair, Saira Haque, atsnhaque@, by the end of the day,August 15.The officer position of Chair-Elect is upfor nomination. It is a three-year commit-ment: Chair-Elect in 2008, Chair in 2009and Past-Chair in 2010.Other open positions include all fiveMembers-at-Large positions, which willserve for a two-year term during 2008-2009.The Member-at-large positions are asfollows:Doctoral (PhD student);Doctoral (professional student, i.e.MD/DO/DVM/DDS);Fellow (any type of fellow/resident);International (non-U.S. student), and;Anyone n a master's program.In addition, we have some excitingnews. In May, the AMIA Board of Directorsapproved a new Student WG-electedposition, that of a non-voting StudentRepresentative to the AMIA Board ofDirectors. We owe a debt of gratitude to theboard for their vision regarding theimportance of student member input to ourassociation, and for having the confidencein our Student WG to create this officialposition.We also owe a special thank you toKaren Greenwood, AMIA Executive VicePresident, for supporting the Student WGover the years and through a number ofiterations in our efforts to secure thisposition. A thank you also goes to ourrecent Past-Chairs Alberto Caban, RonaldCornet, and especially, Chris Lehmann, whoall participated in this effort, and whoseleadership demonstrated to the Board thatour Student WG is prepared to fulfill theresponsibilities and duties accompanyingthis position.The Student Representative to the AMIABoard involves a two-year commitmentduring 2008-2009. Nominations for this...Continued on page 2.From The Chair (continued) position are also now open to eligible candidates.A last important position will also vacate at the end of this year – that of the AMIA Student WG News Editor-in-Chief. This is an appointed two-year position rather than an elected one. I will put out an official call for potential appointees later in the year. However, if you think you might be interested in this rewarding, high-profile position, please contact me directly and let me know now.As always, if you’ve got questions, don’t hesitate to ask.This is a great group of go-getters; I’m really looking forward to seeing who among you will step up to the plate.Best regards,Catherine Craven2006-2007 Student WG ChairWelch Medical LibrarySchool of MedicineJohns HopkinsUniversitycatherine.craven@ Member MilestonesEDLink - Linking Emergency Departments in the Milwaukee County,WisconsinWisconsin Department of Health and Family Services and Wisconsin Health Information Exchange (WHIE) initiated a project called "Emergency Department Linking (EDLink)Project". WHIE is anon-profit organization,with a broad-basedgovernance group, thatis an evolving providerof regional healthinformation exchangeservices.The EDLink project is the first step toward implementation of a secure health information exchange system that will enhance care coordination and provide needed medical information to clinicians when patients present for care. In the first phase of implementation, the EDLink project will provide emergency physicians immediate access to past medical history for patients that register for care at their facilities. This will be accomplished in a manner that is virtually transparent to current workflow. The EDLink project shall follow a structured development path with specific milestones. The first phase of the project will commence on April 1, 2007 and will end March 31, 2009.The goals of the EDLink project will beto demonstrate improvements in health care quality, including decreased redundancy of testing, improved decision making by clinicians, reductions in medical errors and improvements in cost efficiency. An independent evaluation of the EDLink project will be provided by a team comprised of experienced academic researchers from the University of Wisconsin in Madison and the Medical College of Wisconsin. The evaluation of the project will include the following components:System performance, including server performance and ED performance.Workflow outcomes specific to the data transmission and report, server management, and clinical throughput.Patient outcomes including inappro-priate ED visits and other clinicalparameters.More detailed information about the evaluation activities of the project can be found at the following site./EDLink/ EDLink_index.htmMustafa OzkaynakDepartment of Industrial and Systems EngineeringUniversity of Wisconsin-Madisonmozkaynak@Member Milestones (continued) RATools Analyzer: A Software Packagefor Analyzing Resequencing Array (RA)DatasetsAuthors: Craige WM, Zwick MEMicroarray-based resequencing tech-nologies can rapidly generate enormous quantities of DNA sequence data enabling population genomic studies of microbial organisms. These data can be used to characterize variations and phylogenetic relationships between bacterial strains. Michael Craige hasdeveloped asoftware package tospeed the analysisof these datasets.This tool canautomaticallyidentify and countthe number offolders containingRA data while performing file manipulations for subsequent analysis by other software tools. We have used these tools to analyze RA DNA sequences from 42 diverse Bacillus species (including B. anthracis, B. cereus, B. thuringensis) in order to elucidate the complex phylogenetic relationships among these microbial strains.Michael W. CraigeDepartment of Human GeneticsEmory University School of Medicinemcraige@University of Missouri-Columbia Ph.D.Program in Health InformaticsThe Ph.D. in health informatics at the University of Missouri-Columbia prepares individuals for research and scholarly careers in the application of information technology to health systems. Demand is high for individuals with skills in health and clinical informatics and graduates will have the ability to become independent investigators on faculties in informatics, health services management, medicine, nursing and other health professions, or in commercial and public research institutions.The doctoral program draws on the considerable resources and strengths of the Department of Health Management and Informatics and otheracademic programsat the University ofMissouri to offer astrong and flexibleprogram of study.The program isdesigned for studentswho wish to becomefuture researchersand thought leaders in health systems being rapidly transformed through information technology. The program's areas of emphasis include health systems informatics, clinical informatics, consumer health informatics, and public health informatics. Core research areas include program evaluation, information architecture, decision support systems, anddata mining.The doctoral program is a joint programof the departments of Health Managementand Informatics, Computer Science, and Industrial Engineering. A core curriculum provides all students with a foundation of knowledge and tools in computer sciences, statistics and health systems, after whichthey complete further coursework in their chosen emphasis area. The integrated program assures broad exposure to the fieldand fosters new insights and innovate research concepts.Students are accepted into the programwith diverse backgrounds and varying degrees of experience. Acceptance into the program is not precluded by minor deficiencies in background, but is conditional on the completion of prerequisite coursework.Yang GongHealth Management and InformaticsSchool of MedicineUniversity of Missouri-Columbiagongyang@Student WG Journal ClubEmergency Response Information Systems: Emerging Trends and Technologies Communications of the ACM. 2007 Mar:50(3)The March 2007 issue of the Communications of theACM summarizes thestate of the art inemergency response [1].Guest editors Bartel Vande Walle and MurrayTuroff highlight the needto rethink the role ofinformation and communication technologies (ICTs) in emergency responsein the aftermath of recent disasters like Katrina and the Indian Ocean tsunamis. Emergency response information systemsthat address two key requirements – accurate and timely information access andrapid and coherent coordination – are long overdue. The issue contains 9 articles on awide range of emerging technologies and trends in disaster response such as decision-support systems, agent-based systems, online forums, open standards, interoperability, and open source disaster management software.The human and computer as a team in emergency management systemsFaced with making decisions in a tighttime-frame with incomplete information and information overload, disaster responders need tools to help them make sense of the whole picture. Carver and Turoff note that those involved in emergency response exhibit “cognitive absorption” akin to game players. They feel they are exercising control over the situation, are highly motivated and focused, and frequently improvise to solve the problem. However, when role players experience loss of controlof the situation and missing information, thestate of cognitive absorption is reduced andtheir efficiency decreases. Thus, computer systems designed to help humans deal with disasters must provide access to accurate and timely information, encourage and facilitate creativity and improvisation, enhance the ability to focus attention, and provide mechanisms to build trust between team-members responding to a disaster. Decision-making in emergency response Due to the potential pitfalls of human decision-making during a disaster, decision support systems (DSS) are being developedto help human decision-makers. French and Turoff stress the need to fit DSS to emergency response by tailoring them to the purpose and context. DSS not only needto provide alternative courses of action based on past similar events, but they also need to support balancing of objectives for decision-makers. During the chaos that ensues in a disaster situation, the validity of data is often called into question and DSS need to be designed to select correct data from conflicting data reports. Collaboration among different agencies is important for effective response and DSS tools can be integrated with communication and visualization aids to build collaborative understanding of the situation. Also, in emergencies, there isn’t sufficient explicit knowledge coded in databases and hence collaborative knowledge management tools need to be developed to help responders share and manage tacit knowledge of team members.Agent-based systems for disaster managementAgent-based technologies have the potential to support collaboration between geographically distributed team members. Fiedrich and Burghardt highlight two major research areas in agent technology: agent-based simulation systems and agent-based decision support systems. Agent-based simulation systems model human and system behavior during and after disasters. These systems help understand the dynamics of response to a disaster and can be used to train responders. Networks of agents can help maintain shared situational awareness during disasters by extracting and sharing relevant information about the incident. Agents can also be used to formintegrated networks of legacy information systems, mobile and sensor devices, and human decision makers to help distributed parties collaborate during a disaster. Despite these opportunities, there have been few instances of actual application of agent-based systems in disaster response. Some challenges in this area are to develop disaster-related ontologies and to improve capabilities of agents to change plans on the fly. We have developed R-CAST-MED,a team-based agent architecture based on theories of naturalistic decision-making and shared mental models, to help humans with decision-making during crisis response [1]. Collaborative adhocracies and mixing-and-matching of technologiesWhile Fiedrich and Burghardt stress the need to enhance shared understanding and build situational awareness between responders, Mendonca et al. warn against the fallacy of aiming to achieve a common operational picture and situational awareness. They stress that not all actors involved in crisis response need access toall information. Our own fieldwork in understanding EMS and ED personnel’s use of ICTs in disaster response revealed the same – that responders feel that it mightbe useful to distribute information differentially in keeping with organizational hierarchy and roles. Mendoca et al. draw attention to two factors that impact the fit between technology and response tasks – degree of improvisation required during the task, and the degree to which ICTs need tobe combined during the task. Large-scale emergencies lead to improvisation and formation of ad hoc agencies and organizations. Responders may take on new roles, form new organizational structures, and use existing technologies in new and innovative ways. Thus, there is a need for emergent interoperability of ICTs, that is, a real-time mixing and matching of diverse ICTs to enable response activities. Communication ChallengesManoj and Baker highlight three categories of communication challenges during disasters: technological, sociological and organizational. The main technological challenge is rapid deployment of communication systems regardless of whether the communication network was destroyed or previously non-existent. Another important challenge is facilitating multi-organizational radio interoperability. Some solutions to technological problemsare dual-use technology that can operate in both normal and disaster mode and architectural and protocol redundancy that make systems fail-proof. Sociological challenges relate to issues of trust and emotion during high stress situations which affect sharing and dissemination of information. Also, the lack of a common vocabulary causes communication problems. Lastly, organizational challenges arise due to the fact that everyday hierarchy must give way to flatter, ad-hoc operation ofthe organizations involved.Online forums to support grassroots participation in responseThe availability of the Internet and mobile, networked ICTs are empowering citizens to participate in crisis response. Online forums help coordinate community-based response and extend the opportunityfor grassroots social action. Palen et al. provide details of how community-developed websites helped share information about missing people, food, shelter, employment and relief efforts after hurricane Katrina. A visual wiki using a Google maps interface was used to textually annotate the status of building and geographical landmarks. Similar websites and wikis emerged in the wake of the Southern California wildfires and the avianflu epidemic. There is a need to appreciatethe role of the public in response efforts andfind means to incorporate information from and coordinate efforts with citizens. However, we need to be careful about disseminating incorrect information, which could jeopardize response efforts.Open standards for public warning systemsPublic warning systems help authorities send information about hazards to affected populations before or after the incident. However warnings sent from differentauthorities with different routines, regulations, and research can lead to chaos. Botterell and Addams-Moring describe the Common Alerting Protocol (CAP), an Extendable Markup Language (XML)-based data format that enables integrated approaches to public warning. Based on research into how individuals process and assess warning messages, the CAP format provides a neutral template for interoperability of warning systems. The next step is the integration of warning systems and the Internet to form ‘peer-to-peer warning systems. One of the key challenges in this area is to design standard public warning symbols (visual, auditory, and tactile), which would be internationally understandable and reproducible on most ICTs.Role of Open source softwareLarge-scale disaster management should ideally be shared, managed, and owned globally. Currion et al. describe Sahana, an award-winning free and open source disaster management information system developed in Sri Lanka in the immediate aftermath of the Indian Ocean tsunami. Sahana was developed by 40 volunteer organizations and about 100 students helped deploy the system and useit to collect data for 26,000 affected families. Sahana is built as a network of interconnected, independent components that interact via a set of shared databasesto provide Web-based information services. Each component is designed to address a particular coordination problem in disaster response. Data can be exported in XML format and stored on a USB removable memory device, allowing for data sharing and manual transmission at locations where there is no connectivity. With the key characteristics of an open-access approach, low-cost deployment, and easy adaptability, open source disaster management systems like Sahana will play an increasingly important role in the humanitarian sector. Conclusion: Multi-level research agenda for crisis responseResearch opportunities in emergency response systems span individual, group, organizational, and societal levels. At the individual level, there is a need to design user-centered systems that keep in mind lessons learnt from poor automation in the human-computer interaction domain. Emergency response systems should not behave autonomously, provide inadequate feedback, be clumsy or obstructive to use.At the group level, collaboration and information sharing can be enhanced by agent-based systems and decision support systems that help team members share mental models and maintain situational awareness. At the organizational level thereis the need to develop common ontologies, vocabularies, and interoperability of devices and standards used for communication. Finally, there is the need to harness the power of community self-organization by supporting online forums, open standards, and open source software for disaster management.References[1] Zhu S, Abraham J, Paul SA, Reddy M, Yen J, Pfaff M, deFlitch CJ. R-CAST-MED: Applying intelligent agents to support emergency medical decision making teams. Proceedings of the 11th Artificial Intelligence in Medicine Conference, (AIME’07), Amsterdam, The Netherlands. Sharoda A. PaulPenn State Universityspaul@From The EditorDon’t forget to shareyour milestones and othercontributions with the group!Michael GrassoStudent Working Group Editor-in-Chief University of Marylandmgras001@。