Personal Health Informatics Research Articles

Co-design personal sleep health technology for and with university students.

University students often experience sleep disturbances and disorders. Personal digital technologies present a great opportunity for sleep health promotion targeting this population. However, studies that engage university students in designing and implementing digital sleep health technologies are scarce. This study sought to understand how we could build digital sleep health technologies that meet the needs of university students through a co-design process. We conducted three co-design workshops with 51 university students to identify design opportunities and to generate features for sleep health apps through workshop activities. The generated ideas were organized using the stage-based model of self-tracking so that our findings could be well-situated within the context of personal health informatics. Our findings contribute new design opportunities for sleep health technologies targeting university students along the dimensions of sleep environment optimization, online community, gamification, generative AI, materializing sleep with learning, and personalization.

Examining public views on decentralised health data sharing.

In recent years, researchers have begun to explore the use of Distributed Ledger Technologies (DLT), also known as blockchain, in health data sharing contexts. However, there is a significant lack of research that examines public attitudes towards the use of this technology. In this paper, we begin to address this issue and present results from a series of focus groups which explored public views and concerns about engaging with new models of personal health data sharing in the UK. We found that participants were broadly in favour of a shift towards new decentralised models of data sharing. Retaining 'proof' of health information stored about patients and the capacity to provide permanent audit trails, enabled by immutable and transparent properties of DLT, were regarded as particularly valuable for our participants and prospective data custodians. Participants also identified other potential benefits such as supporting people to become more health data literate and enabling patients to make informed decisions about how their data was shared and with whom. However, participants also voiced concerns about the potential to further exacerbate existing health and digital inequalities. Participants were also apprehensive about the removal of intermediaries in the design of personal health informatics systems.

Personal Health Informatics: New Tools and Roles for Health Care.

Technological advancements have introduced wearable and passive monitoring tools that can capture aspects of daily living, health and well-being in homes and communities. Personal Health Informatics is the study of any information system, tool or platform designed for individuals and their families/ communities with the goal to facilitate decision making, access to information, education, managing health, prevent disease, and improve communication whereby the individual patient or consumer is the end user whose needs and preferences inform the design and implementation of the system. Examples of such tools include digital phenotyping, consumer genomics and smart homes. Such platforms capture patient generated health data and allow for proactive models of care, whereby patterns or trends are analyzed to identify opportunities for tailored interventions. Future research needs to address the impact of personal health informatics systems on health outcomes, shared decision making and patient empowerment. We discuss new roles and opportunities that arise with the growth of this field, including the role of the personal health data navigator who can guide and assist patients and families in navigating the complex digital landscape in order to most effectively utilize inclusive personal health informatics tools.

An Evidence-Based HIV Risk-Reduction Intervention for Young African American Women in the US South Using mHealth: Adaptation and Development Study.

BackgroundYoung African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women’s CoOp (WC) is an HIV risk–reduction intervention that is proven to be efficacious in various face-to-face formats.ObjectiveThis study aims to adapt the delivery method of an evidence-based intervention, the WC, from an in-person format to a self-guided mobile health (mHealth) format while ensuring that core elements are maintained for intervention comparability and fidelity.MethodsSeveral adaptation phases were conducted by using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability testing and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study.ResultsThe team converted the seven elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, cue card presentations of the materials delivered by the intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal-setting activities. In these cases, the subject matter experts and app developers worked together to find comparable analogs to be used within the app. Once developed, tested, and finalized, the mHealth WC app was deployed into local health departments as part of a randomized trial.ConclusionsThis systematic adaptation process created an accurate mHealth equivalent of an existing, in-person behavioral health intervention. Although participants’ reception of the app during the formative developmental phase was overall positive, maintaining fidelity to the in-person delivery compromised the natural capabilities of a mobile app, such as further gamification, different types of interactivity, and integrated notifications and messaging, which could be helpful for participants’ adherence to the intervention schedule. Given the development and implementation of the app, the next step is to examine the impact of the app and its efficacy in HIV and substance use risk-reduction.

"They don't always think about that": Translational Needs in the Design of Personal Health Informatics Applications.

Personal health informatics continues to grow in both research and practice, revealing many challenges of designing applications that address people's needs in their health, everyday lives, and collaborations with clinicians. Research suggests strategies to address such challenges, but has struggled to translate these strategies into design practice. This study examines translation of insights from personal health informatics research into resources to support designers. Informed by a review of relevant literature, we present our development of a prototype set of design cards intended to support designers in re-thinking potential assumptions about personal health informatics. We examined our design cards in semi-structured interviews, first with 12 student designers and then with 12 health-focused professional designers and researchers. Our results and discussion reveal tensions and barriers designers encounter, the potential for translational resources to inform the design of health-related technologies, and a need to support designers in addressing challenges of knowledge, advocacy, and evidence in designing for health.

A Review on Strategies for Data Collection, Reflection, and Communication in Eating Disorder Apps.

Eating disorders (EDs) constitute a mental illness with the highest mortality. Today, mobile health apps provide promising means to ED patients for managing their condition. Apps enable users to monitor their eating habits, thoughts, and feelings, and offer analytic insights for behavior change. However, not only have scholars critiqued the clinical validity of these apps, their underlying design principles are not well understood. Through a review of 34 ED apps, we uncovered 11 different data types ED apps collect, and 9 strategies they employ to support collection and reflection. Drawing upon personal health informatics and visualization frameworks, we found that most apps did not adhere to best practices on what and how data should be collected from and reflected to users, or how data-driven insights should be communicated. Our review offers suggestions for improving the design of ED apps such that they can be useful and meaningful in ED recovery.

Sociocultural Dimensions of Tracking Health and Taking Care

The field of personal health informatics has received increasing attention within the CSCW and HCI communities as health tracking becomes more affordable, accessible, and pervasive. Chronic disease management, in particular, presents tremendous potential for intervention given patients' ability to now actively participate in their care through tracking. The focus on 'personal' in health informatics, however, obfuscates the role of other cultural and ecological factors that might shape health tracking behaviors, and important information from alternative sources could be ignored by virtue of being subjective, complex, or simply hard to collect. To dig deeper into these negative spaces that may go untracked, uncover potential sources of important health information, and more completely understand current tracking practices, we embarked on an interview study with patients with cardiac diseases in Bangalore, India. In this paper, we present these patients' current health management approaches that are culturally situated, identifying both motivations and barriers to tracking, their attitudes towards online information, as well as cultural and ecological influences on their perceptions of cardiac care. We then discuss the interplay between our findings and current notions of, and approaches towards, patient empowerment and datafication of health.

Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study.

BackgroundWith the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise.ObjectiveWe developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population.MethodsWe developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected.ResultsOf the 55 students in the intervention group, 27 (49%) students in cohort 2 and 25 (45%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period.ConclusionsRams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation.

Fibromyalgia Impact Reduction Using Online Personal Health Informatics: Longitudinal Observational Study.

BackgroundPersonal health informatics have the potential to help patients discover personalized health management strategies that influence outcomes. Fibromyalgia (FM) is a complex chronic illness requiring individualized strategies that may be informed by analysis of personal health informatics data. An online health diary program with dynamic feedback was developed to assist patients with FM in identifying symptom management strategies that predict their personal outcomes, and found reduced symptom levels associated with program use.ObjectiveThe aim of this study was to determine longitudinal associations between program use and functional impact of FM as measured by scores on a standardized assessment instrument, the Fibromyalgia Impact Questionnaire (FIQ).MethodsParticipants were self-identified as diagnosed with FM and recruited via online FM advocacy websites. Participants used an online health diary program (“SMARTLog”) to report symptom ratings, behaviors, and management strategies used. Based on single-subject analysis of the accumulated data over time, individualized recommendations (“SMARTProfile”) were then provided by the automated feedback program. Indices of program use comprised of cumulative numbers of SMARTLogs completed and SMARTProfiles received. Participants included in this analysis met a priori criteria of sufficient program use to generate SMARTProfiles (ie, ≥22 SMARTLogs completed). Users completed the FIQ at baseline and again each subsequent month of program use as follow-up data for analysis. Kendall tau-b, a nonparametric statistic that measures both the strength and direction of an ordinal association between two repeated measured variables, was computed between all included FIQ scores and both indices of program use for each subject at the time of each completed FIQ.ResultsA total of 76 users met the a priori use criteria. The mean baseline FIQ score was 61.6 (SD 14.7). There were 342 FIQ scores generated for longitudinal analysis via Kendall tau-b. Statistically significant inverse associations were found over time between FIQ scores and (1) the cumulative number of SMARTLogs completed (tau-b=–0.135, P<.001); and (2) the cumulative number of SMARTProfiles received (tau-b=–0.133, P<.001). Users who completed 61 or more SMARTLogs had mean follow-up scores of 49.9 (n=25, 33% of the sample), an 18.9% drop in FM impact. Users who generated 11 or more new SMARTProfiles had mean follow-up scores of 51.8 (n=23, 30% of the sample), a 15.9% drop.ConclusionsSignificant inverse associations were found between FIQ scores and both indices of program use, with FIQ scores declining as use increased. Based on established criteria for rating FM severity, the top one-third of users in terms of use had clinically significant reductions from “severe” to “moderate” FM impact. These findings underscore the value of self-management interventions with low burden, high usability, and high perceived relevance to the user.Trial RegistrationClinicalTrials.gov NCT02515552; https://clinicaltrials.gov/ct2/show/NCT02515552

Developing a Third-Party Analytics Application Using Australia's National Personal Health Records System: Case Study.

BackgroundMy Health Record (MyHR) is Australia’s national electronic health record (EHR) system. Poor usability and functionality have resulted in low utility, affecting enrollment and participation rates by both patients and clinicians alike. Similar to apps on mobile phone app stores, innovative third-party applications of MyHR platform data can enhance the usefulness of the platform, but there is a paucity of research into the processes involved in developing third-party applications that integrate and use data from EHR systems.ObjectiveThe research describes the challenges involved in pioneering the development of a patient and clinician Web-based software application for MyHR and insights resulting from this experience.MethodsThis research uses a case study approach, investigating the development and implementation of Actionable Intime Insights (AI2), a third-party application for MyHR, which translates Medicare claims records stored in MyHR into a clinically meaningful timeline visualization of health data for both patients and clinicians. This case study identifies the challenges encountered by the Personal Health Informatics team from Flinders University in the MyHR third-party application development environment.ResultsThe study presents a nuanced understanding of different data types and quality of data in MyHR and the complexities associated with developing secondary-use applications. Regulatory requirements associated with utilization of MyHR data, restrictions on visualizations of data, and processes of testing third-party applications were encountered during the development of the application.ConclusionsThis study identified several processes, technical and regulatory barriers which, if addressed, can make MyHR a thriving ecosystem of health applications. It clearly identifies opportunities and considerations for the Australian Digital Health Agency and other national bodies wishing to encourage the development of new and innovative use cases for national EHRs.

Towards Informing Human-centricICT Standardizationfor Data-driven Societies

Information and communication technology (ICT) standards play a crucial role towards harnessing technological developments and shaping the technology landscape. ICT standards development is largely driven by standards developing organizations or standards setting organizations that represent and are informed by the perspectives and interests of the ICT private sector and the public sector. Thus the shaping of the standards is mostly driven by the business, technical, and legal impetus, towards facilitating greater market influence, coordination, integration, interoperability, and legal conformity. The technocentric, business-focused perspective to ICT developments, and corollary to ICT standards development, is distinct from and can be orthogonal to the human-centric perspective that elevates the role and centrality of the human concerns over the technology and business concerns. Notwithstanding the crucial role of business and technology, it remains that at the centre of the 21st century data-driven societies are individuals and end-users who are the primary actants and agents within the technology and data ecosystems. This gives motivation for infusing the human perspectives and values into technology development as well as into ICT standards development. This is more pronounced for cases where the business and technocentric interests are at odds and opposed to the human interests, such as, the need for increased datafication to support Big Data developments versus the need for individuals’privacy preservation. In this research, which is framed through a case study of personal health informatics in the context of sustainable development (i.e., sustainable development goal on “health and wellbeing” – SDG3) indicators monitoring, we have undertaken a survey to investigate the human-centric values and attitudes associated with the collection and use of personal data. From this inquiry, the paper highlights and surfaces: individuals attitudes and perceptions around monitoring of social indicators; key considerations associated with data ownership, privacy and confidentiality of data, as well as sharing of personal data within the data ecosystem. The paper then discusses how these findings could inform and be infused into the development of technology artefacts and standards, towards a realization of more human-centric data-informed societies.

Wellbeing Understanding in High Quality Healthcare Informatics and Telepractice.

The proper use of healthcare informatics technology and multidimensional conceptual clarity are fundamental to create and boost outstanding clinical and telepractice results. Avoiding even terminology ambiguities is mandatory for high quality of care service. For instance, well-being or wellbeing is a different way to write the same concept only, or there is a good deal of ambiguity around the meanings of these terms the way they are written. In personal health, healthcare and healthcare informatics, this kind of ambiguity and lack of conceptual clarity has been called out repeatedly over the past 50 years. It is time to get the right, terse scenario. We present a brief review to develop and achieve ultimate wellbeing understanding for practical high quality healthcare informatics and telepractice application. This article presents an innovative point of view on deeper wellbeing understanding towards its increased clinical effective application.

Personal Health Informatics: The Evolving Paradigm of Patient Self Care

INTRODUCTION Biomedical informatics is a broad field that has been defined many times (Sullivan, 2001; Lorenzi, 2000; Van Bemmel & Musen, 1997). Biomedical informatics is the union of bioinformatics and medical informatics. Bioinformatics differs from medical informatics, in the same way that research differs from clinical medicine. A subset of medical informatics is the patient care aspect, known as clinical informatics. Clinical informatics relates to patient care and technology. Clinical informatics can further be described as the union of multiple aspects of patient care, involving physicians, patients and others, also known as consumers. Consumer informatics is a subset of clinical informatics and has been well defined (Ferguson, 2001; Houston, Chang, Brown, & Kukafka, 2001; Dey, 2004), with the underlying theme being that consumers are using information technology to search, find and locate quality online health information (Kaplan & Brennan, 2001). Personal health informatics is also a subset of clinical informatics which differs from consumer informatics by focusing on the individual patient, rather than a consumer. Consumer informatics is broad, encompassing many different types of users, whereas, personal informatics is narrow and entails only specific patient related self management. This article will serve to define the field of personal health informatics in relation to patients' attitudes, technologies and their applications for health information management of individual patients in order to maintain a healthy lifestyle. BACKGROUND The availability of online patient information, new resources, desire for self management and care is the basis of personal health informatics. Patients have a desire to diagnose, treat and manage their own healthcare needs. By making resources available online, patients are now able to educate themselves and understand the complexities of modern medicine. Modern medicine cannot be understood unless there is a clear distinction and comprehension between a disease and an illness (Kleinman, Eisenberg, & Good, 1978). Diseases are pathologic processes that necessitate clinical intervention by a physician (medical or surgical) in order to maintain patient health. Diseases range from simple to complex. Illnesses are temporary, self limiting conditions that provide an inconvenience to the patients, such as viral infections, difficulty sleeping, runny nose, etc. The difference between a disease and an illness is the pathological course. Diseases can lead to terminal states in a patient unless treated. Illness lead to temporary states of physical discomfort, which patients can normally allow to run their course, regardless of intervention, the physical state will return to baseline. Illnesses do not always require (medical or surgical) interventions, however, many patients seek advice on how to manage such symptoms and inconveniences. Online resources enable patients to educate themselves, to manage their health, and to ultimately distinguish between disease and illness, enabling them to either seek professional advice or self management and care. PATIENT RELATIONSHIPS The medical relationship of patient, physicians and their resources has changed over the years. From the early days of paternalistic medicine, to very self serving patients and their own desire for optimal health, much has been written on the evolution and change in the patient-physician care model (Conti & Gensini, 2008; Kaba & Sooriakumaran, 2007; Lazaro & Gracia, 2006). From the early days of medicine until today, the physician-patient relationship has been a sacred and protected entity. New technologies are allowing patients to change that relationship. Where technology used to be the addition (or value added component) to the modern relationship, now the physician is the value added component (Rohm & Rohm, 2007). Patients are beginning to go directly to health information technology prior to consultations with their physicians. …

Personal Health and Consumer Informatics

The rapid evolution in the world-wide use of Social Media tools suggests the emergence of a global phenomenon that may have implications in the Personal Health and Consumer Health Informatics domains. However the impact of these tools on health outcomes is not known. The goal of this research was to review the randomized controlled trial (RCT) evidence of the impact of health oriented Social Media informatics tools on health outcomes. Evaluations of Social Media consumer health tools were systematically reviewed. Research was limited to studies published in the English language, published in Medline, published in the calendar year 2012 and limited to studies that utilized a RCT methodological design. Two high quality Randomized Controlled Trials among over 600 articles published in Medline were identified. These studies indicate that Social Media interventions may be able to significantly improve pain control among patients with chronic pain and enhance weight loss maintenance among individuals attempting to lose weight. Significantly more research needs to be done to confirm these early findings, evaluate additional health outcomes and further evaluate emerging health oriented Social Media interventions. Chronic pain and weight control have both socially oriented determinants. These studies suggest that understanding the social component of a disease may ultimately provide novel therapeutic targets and socio-clinical interventional strategies.

Personal Health and Consumer Informatics

To summarize current outstanding research in the field of Personal Health and Consumers Informatics. A selection of excellent research articles published in 2011 in the field of Personal Health Informatics and Consumer Informatics. This selection of articles shows that Personal Health Informatics is changing. Indeed, the different solutions tended to the doctors and their interaction, but also tended to the patient in order for him to be more active in his own medical healthcare. The consumer section highlights the development of the social network and the possible limitations.

Critical Advances in Bridging Personal Health Informatics and Clinical Informatics

To provide a survey over significant developments in the area of linking personal health informatics and clinical informatics, to give insights into critical advances and to discuss open problems and opportunities in this area. A scoping review over the literature published in scientific journals and relevant conference proceedings in the intersection between personal health informatics and clinical informatics over the years 2010 and 2011 was performed. The publications analyzed are related to two main topics, namely "Sharing information and collaborating through personal health records, portals and social networks" and "Integration of personal health systems with clinical information systems". For the first topic, results are presented according to five different themes: "Patient expectations and attitudes", "Real use experiences", "Changes for care providers", "Barriers to adoption" and "Proposed technical infrastructures". For the second topic, two different themes were found, namely "Technical architectures and interoperability" and "Security, safety and privacy issues". Results show a number of gaps between the information needs of patients and the information care provider organizations provide to them as well as the lack of a trusted technical, ethical and regulatory framework regarding information sharing. Despite recent developments in the areas of personal health informatics and clinical informatics both fields have diverging needs. To support both clinical work processes and empower patients to effectively handle self-care, a number of issues remain unsolved. Open issues include privacy and confidentiality, including trusted sharing of health information and building collaborative environments between patients, their families and care providers. There are further challenges to meet around health and technology literacy as well as to overcome structural and organizational barriers. Frameworks for evaluating personal health informatics applications and pervasive health technology are needed to build up an evidence basis.

Personal Health Informatics. Editorial

To provide an editorial introduction to the 2012 IMIA Yearbook of Medical Informatics with an overview of its contents and contributors. A brief overview of the main theme, and an outline of the purposes, contents, format, and acknowledgment of contributions for the 2012 IMIA Yearbook. This 2012 issue of the IMIA Yearbook highlights important developments in personal health informatics, impacting the activities in research, education and practice in this interdisciplinary field. There has been steady progress towards introducing individualization or personalization into informatics systems by taking advantage of the increasing amounts of personal information that is relevant to medical decisions and application in clinical practice. At the same time, there are serious issues about the limits of existing systems being able to effectively personalize information within both practical and ethical constraints so critical to the practice of medicine. Recent literature bearing on these questions includes the selected papers published during the past 12 months, and articles reported by IMIA Working Groups on these topics. Surveys of the main research sub-fields in biomedical informatics in the Yearbook provide an overview of progress and current challenges across the spectrum of the discipline, focusing on the challenges and opportunities involved in personal health informatics.

Special Section: Personal Health and Consumer Informatics

Special Section: Personal Health and Consumer Informatics

Smartphone as a Personal, Pervasive Health Informatics Services Platform: Literature Review

The article provides an overview of current trends in personal sensor, signal and imaging informatics, that are based on emerging mobile computing and communications technologies enclosed in a smartphone and enabling the provision of personal, pervasive health informatics services. The article reviews examples of these trends from the PubMed and Google scholar literature search engines, which, by no means claim to be complete, as the field is evolving and some recent advances may not be documented yet. There exist critical technological advances in the surveyed smartphone technologies, employed in provision and improvement of diagnosis, acute and chronic treatment and rehabilitation health services, as well as in education and training of healthcare practitioners. However, the most emerging trend relates to a routine application of these technologies in a prevention/wellness sector, helping its users in self-care to stay healthy. Smartphone-based personal health informatics services exist, but still have a long way to go to become an everyday, personalized healthcare-provisioning tool in the medical field and in a clinical practice. Key main challenge for their widespread adoption involve lack of user acceptance striving from variable credibility and reliability of applications and solutions as they a) lack evidence- based approach; b) have low levels of medical professional involvement in their design and content; c) are provided in an unreliable way, influencing negatively its usability; and, in some cases, d) being industry-driven, hence exposing bias in information provided, for example towards particular types of treatment or intervention procedures.

Knowledge Representation and Management: Towards Patient Health Self-management

To summarize excellent current research in the field of knowledge representation and management (KRM). A synopsis of the articles selected for the IMIA Yearbook 2012 is provided and an attempt to highlight the current trends in the field of health management is sketched. Among the five selected papers, two confirm the benefit of exploiting open-source language toolkits for the automatic extraction of medical concepts, assertions and/or relationships from clinical texts. One paper aims at exploiting domain-specific terminologies to improve the parsing of biomedical noun phrases, and another one aims at discovering rare diseases associations embedded into disparate textual sources. Finally, the last paper describes a collaborative search approach integrated into a homegrown EHR search engine. This selected set of papers confirms that natural language processing, as well as knowledge extraction, discovering and retrieval, are still active and fruitful research fields. Although these papers are not directly focusing on personal health informatics applications,, important features are highlighted and tailored to fit the requirements of patient health self-management. Delivering timely, friendly and secure access to functional, accurate, up-to-date and sustainable personal health records is a significant challenging task for supporting self-managed healthcare.