William M Tierney

University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States

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Publications (385)1639.53 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies have measured individuals' willingness to share personal information stored in electronic health records (EHRs) with health care providers, but none has measured preferences among patients when they are allowed to determine the parameters of provider access. Patients were given the ability to control access by doctors, nurses, and other staff in a primary care clinic to personal information stored in an EHR. Patients could restrict access to all personal data or to specific types of sensitive information, and could restrict access for a specific time period. Patients also completed a survey regarding their understanding of and opinions regarding the process. Of 139 eligible patients who were approached, 105 (75.5 %) were enrolled, and preferences were collected from all 105 (100 %). Sixty patients (57 %) did not restrict access for any providers. Of the 45 patients (43 %) who chose to limit the access of at least one provider, 36 restricted access only to all personal information in the EHR, while nine restricted access of some providers to a subset of the their personal information. Thirty-four (32.3 %) patients blocked access to all personal information by all doctors, nurses, and/or other staff, 26 (24.8 %) blocked access by all doctors and/or nurses, and five (4.8 %) denied access to all doctors, nurses, and staff. A significant minority of patients chose to restrict access by their primary care providers to personal information contained in an EHR, and few chose to restrict access to specific types of information. More research is needed to identify patient goals and understanding of the implications when facing decisions of this sort, and to identify the impact of patient education regarding information contained in EHRs and their use in the clinical care setting.
    Journal of general internal medicine. 12/2014;
  • Kelly Caine, William M Tierney
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    ABSTRACT: Information collection, storage, and management is central to the practice of health care. For centuries, patients' and providers' expectations kept medical records confidential between providers and patients. With the advent of electronic health records, patient health information has become more widely available to providers and health care managers and has broadened its potential use beyond individual patient care. Adhering to the principles of Fair Information Practice, including giving patients control over the availability and use of their individual health records, would improve care by fostering the sharing of sensitive information between patients and providers. However, adherence to such principles could put patients at risk for unsafe care as a result of both missed opportunities for providing needed care as well as provision of contraindicated care, as it would prevent health care providers from having full access to health information. Patients' expectations for the highest possible quality and safety of care, therefore, may be at odds with their desire to limit provider access to their health records. Conversely, provider expectations that patients would willingly seek care for embarrassing conditions and disclose sensitive information may be at odds with patients' information privacy rights. An open dialogue between patients and providers will be necessary to balance respect for patient rights with provider need for patient information.
    Journal of General Internal Medicine 12/2014; · 3.28 Impact Factor
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    ABSTRACT: Electronic health records change the landscape of patient data sharing and privacy by increasing the amount of information collected and stored and the number of potential recipients. Patients desire granular control over who receives what information in their electronic health record (EHR), but there are no current patient interfaces that allow them to record their preferences for EHR access. Our aim was to derive the user needs of patients regarding the design of a user interface that records patients' individual choices about who can access data in their EHRs. We used semi-structured interviews. The study was conducted in Central Indiana. Thirty patients with data stored in an EHR, the majority of whom (70 %) had highly sensitive health EHR data, were included in the study. We conducted a thematic and quantitative analysis of transcribed interview data. Patients rarely knew what data were in their EHRs, but would have liked to know. They also wanted to be able to control who could access what information in their EHR and wanted to be notified when their data we re accessed. We derived six implications for the design of a patient-centered tool to allow individual choice in the disclosure of EHR: easy patient access to their EHRs; an overview of current EHR sharing permissions; granular, hierarchical control over EHR access; EHR access controls based on dates; contextual privacy controls; and notification when their EHRs are accessed.
    Journal of General Internal Medicine 12/2014; · 3.28 Impact Factor
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    ABSTRACT: Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions. Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 %) returned 261 times, during which providers viewed their EHRs 126 times (48 %). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 %) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p = 0.01). Although 54 % of providers agreed that patients should have control over who sees their EHR information, 58 % believed restricting EHR access could harm provider-patient relationships and 71 % felt quality of care would suffer. Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.
    Journal of General Internal Medicine 12/2014; · 3.28 Impact Factor
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    ABSTRACT: Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient-control over EHR data displays was complex and required ethical, clinical, database, and programming expertise and difficult choices to overcome technical and health system constraints. Assessing patients' preferences for access to their EHRs and applying them in clinical practice requires wide-ranging technical, clinical, and bioethical expertise, to make tough choices to overcome significant technical and organization challenges.
    Journal of General Internal Medicine 12/2014; · 3.28 Impact Factor
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    ABSTRACT: Doublecortin-like kinase 1 (DCLK1), a putative tumor stem cell marker has been shown to be highly expressed in the stromal and epithelial compartments in colon and pancreatic cancer as well as Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC).
    Digestive Diseases and Sciences 10/2014; · 2.26 Impact Factor
  • William M. Tierney
    Gastrointestinal Endoscopy. 09/2014; 80(3):492–494.
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    ABSTRACT: Background Anti-spasmodic drugs may facilitate mucosal inspection during colonoscopy. The impact of hyoscine N-butyl-bromide (HBB) on polyp detection rate (PDR) and adenoma detection rate (ADR) is unclear.Methods We conducted a reproducible literature search of multiple databases. Two reviewers independently compared manuscripts for PDR, ADR, advanced adenoma detection rate (AADR), and rates of complications. Pooling was conducted by fixed-effects and random-effects models. Relative risk (RR) estimates were calculated (95% CI). I-squared index (I2) assessed heterogeneity.ResultsPatient demographics were comparable. The pooled analysis showed a trend toward improving PDR and ADR among the HBB group compared with the placebo group but failed to reach statistical significance, (46% vs. 43%, RR = 1.08 [0.94, 1.25], p = 0.27), (31% vs. 28%, RR= 1.12 [0.97, 1.29], p=0.11) respectively.ConclusionsHBB during colonoscopy may provide marginal improvements in ADR and PDR. However, heterogeneity in the available data precludes firm conclusions at this time.
    Digestive Endoscopy 08/2014; · 1.61 Impact Factor
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    ABSTRACT: Background. Removal of large stones can be challenging and frequently requires the use of mechanical lithotripsy (ML). Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy (ES) is a technique that appears to be safe and effective. However, data comparing ES + EPLBD with ES alone have not conclusively shown superiority of either technique. Objective. To assess comparative efficacies and rate of adverse events of these methods. Method. Studies were identified by searching nine medical databases for reports published between 1994 and 2013, using a reproducible search strategy. Only studies comparing ES and ES + EPLBD with regard to large bile duct stone extraction were included. Pooling was conducted by both fixed-effects and random-effects models. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Results. Seven studies (involving 902 patients) met the inclusion criteria; 3 of 7 studies were prospective trials. Of the 902 patients, 463 were in the ES + EPLBD group, whereas 439 underwent ES alone. There were no differences noted between the groups with regard to overall stone clearance (98% versus 95%, RR = 1.01 [0.97, 1.05]; P = 0.60) and stone clearance at the 1st session (87% versus 79%, RR = 1.11 [0.98, 1.25]; P = 0.11). ES + EPLBD was associated with a reduced need for ML compared to ES alone (15% versus 32%; RR = 0.49 [0.32, 0.74]; P = 0.0008) and was also associated with a reduction in the overall rate of adverse events (11% versus 18%; RR = 0.58 [0.41, 0.81]; P = 0.001). Conclusions. ES + EPLBD has similar efficacy to ES alone while significantly reducing the need for ML. Further, ES + EPLBD appears to be safe, with a lower rate of adverse events than traditional ES. ES + EPLBD should be considered as a first-line technique in the management of large bile duct stones.
    Diagnostic and Therapeutic Endoscopy 01/2014; 2014:309618.
  • Matthew Austin, Mark Mellow, William M. Tierney
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    ABSTRACT: In recent years, Clostridium difficile infections has become more frequent, more severe, more refractory to standard treatment, and more likely to recur. Current antibiotic treatment regimens for Clostridium difficile infection alter the normal gut flora, which provide colonization resistance against Clostridium difficile. Over the past few years, there has been a marked increase in the knowledge of the gut microbiota, and its role in health maintenance and disease causation. This has, fortuitously, coincided with the use of a unique microbial replacement therapy, fecal microbiota transplantation, in the treatment of patients with multiple recurrent Clostridium difficile infections. We briefly review current knowledge of the gut microbiota's functions. We then review the indications for use of fecal microbiota transplantation in Clostridium difficile infection, the techniques employed, and results of treatment. Fecal microbiota transplantation has been shown to be efficacious for patients with multiply recurrent Clostridium difficile infections (reported cure rates of 90%), with an excellent short-term safety profile and has been included in the American College of Gastroenterology treatment guidelines for this troublesome disease.
    The American journal of medicine 01/2014; · 5.30 Impact Factor
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    ABSTRACT: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a "Points to Consider" (P2C) document, and convened a national expert panel to review and critique the P2C. We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions ("Points") that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. The P2C is intended to clarify what is at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion.
    International Journal of Medical Informatics 09/2013; · 2.06 Impact Factor
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    ABSTRACT: The Indiana Global Health Research Working Conference of October 2012 was convened by a planning committee representing Indiana's research-intensive universities (Indiana University, Purdue University, and the University of Notre Dame). The event was organized as an open-space meeting with six thematic emphases and pre-conference keynote papers. Within their domains of common interest, attendees developed forme fruste research project abstracts that represent a future-oriented agenda for global health research. The organizational principles and purposes of this meeting are explicated with a concluding commentary on the agenda for research.
    Journal of General Internal Medicine 06/2013; · 3.28 Impact Factor
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    ABSTRACT: In the context of a long-term institutional 'twinning' partnership initiated by Indiana and Moi Universities more than 22 years ago, a vibrant program of research has arisen and grown in size and stature. The history of the AMPATH (Academic Model Providing Access to Healthcare) Research Program is described, with its distinctive attention to Kenyan-North American equity, mutual benefit, policies that support research best practices, peer review within research working groups/cores, contributions to clinical care, use of healthcare informatics, development of research infrastructure and commitment to research workforce capacity. In the development and management of research within our partnership, we describe a number of significant challenges we have encountered that require ongoing attention, many of which are "good problems" occasioned by the program's success and growth. Finally, we assess the special value a partnership program like ours has created and end by affirming the importance of organizational diversity, solidarity of purpose, and resilience in the 'research enterprise.'
    Journal of General Internal Medicine 06/2013; · 3.28 Impact Factor
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    ABSTRACT: To evaluate the impact of clinician-targeted computer-generated reminders on compliance with HIV care guidelines in a resource-limited setting. We conducted this randomized, controlled trial in an HIV referral clinic in Kenya caring for HIV-infected and HIV-exposed children (<14 years of age). For children randomly assigned to the intervention group, printed patient summaries containing computer-generated patient-specific reminders for overdue care recommendations were provided to the clinician at the time of the child's clinic visit. For children in the control group, clinicians received the summaries, but no computer-generated reminders. We compared differences between the intervention and control groups in completion of overdue tasks, including HIV testing, laboratory monitoring, initiating antiretroviral therapy, and making referrals. During the 5-month study period, 1611 patients (49% female, 70% HIV-infected) were eligible to receive at least 1 computer-generated reminder (ie, had an overdue clinical task). We observed a fourfold increase in the completion of overdue clinical tasks when reminders were availed to providers over the course of the study (68% intervention vs 18% control, P < .001). Orders also occurred earlier for the intervention group (77 days, SD 2.4 days) compared with the control group (104 days, SD 1.2 days) (P < .001). Response rates to reminders varied significantly by type of reminder and between clinicians. Clinician-targeted, computer-generated clinical reminders are associated with a significant increase in completion of overdue clinical tasks for HIV-infected and exposed children in a resource-limited setting.
    PEDIATRICS 03/2013; 131(3):e789-96. · 4.47 Impact Factor
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    ABSTRACT: Background and study aims: It is uncertain if needle gauge impacts the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass lesions. Our aim was to use meta-analysis to more robustly define the diagnostic accuracy of EUS-FNA for pancreatic masses using 22 G and 25 G needles. Patients and methods: Studies were identified by searching nine medical databases for reports published between 1994 and 2011, using a reproducible search strategy comprised of relevant terms. Only studies comparing the overall diagnostic accuracy of 22 G vs. 25 G EUS needles that used surgical histology or at least 6 months clinical follow up for a gold standard were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. When required, the original investigators were contacted to provide additional data. Pooling was conducted by both fixed-effects and random-effects models. Diagnostic characteristics (sensitivity, specificity, positive and negative likelihood ratios) with 95 % confidence intervals (CIs) were calculated.Results: Eight studies involving 1292 subjects met the defined inclusion criteria. Of the 1292 patients, 799 were in the 22 G group and 565 were in the 25 G group (both needles were used in 72 patients). The pooled sensitivity and specificity of the 22 G needle were 0.85 (95 %CI 0.82 - 0.88) and 1 (95 %CI 0.98 - 1) respectively. The pooled sensitivity and specificity of the 25 G needle were 0.93 (95 %CI 0.91 - 0.96) and 0.97 (95 %CI 0.93 - 0.99) respectively. The bivariate generalized linear random-effect model indicated that the 25 G needle is associated with a higher sensitivity (P = 0.0003) but comparable specificity (P = 0.97) to the 22 G needle.Conclusions: This meta-analysis suggests 25 G needle systems are more sensitive than 22 G needles for diagnosing pancreatic malignancy.
    Endoscopy 01/2013; · 5.74 Impact Factor
  • Gastrointestinal endoscopy 01/2013; 77(1):1-6. · 6.71 Impact Factor
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    ABSTRACT: Electronic Medical Records (EMR) are thought to improve healthcare through a variety of means. However, the study of EMR implementation in resource-poor settings has been minimal. Moi Teaching and Referral Hospital (MTRH) is the second largest tertiary care centre in Kenya, hosting a busy antenatal clinic serving Eldoret and surrounding regions. The recent transition from written to electronic antenatal records at MTRH permits the opportunity to study whether this change improves quality of care, in terms of: Time: Does the patient or healthcare worker spend the same amount of time at the encounter? Satisfaction: Is the patient or healthcare worker more or less satisfied with the encounter? Completeness: Does the antenatal record do a better job of recording key information in the antenatal history? Our Objective wasto determine the effects of EMR implementation on an antenatal clinic in a resource-limited setting.
    Studies in health technology and informatics 01/2013; 192:1222.
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    ABSTRACT: This cohort study utilized data from a large HIV treatment program in western Kenya to describe the impact of active tuberculosis (TB) on clinical outcomes among African patients on antiretroviral therapy (ART). We included all patients initiating ART between March 2004 and November 2007. Clinical (signs and symptoms), radiological (chest radiographs) and laboratory (mycobacterial smears, culture and tissue histology) criteria were used to record the diagnosis of TB disease in the program's electronic medical record system. We assessed the impact of TB disease on mortality, loss to follow-up (LTFU) and incident AIDS-defining events (ADEs) through Cox models and CD4 cell and weight response to ART by non-linear mixed models. We studied 21,242 patients initiating ART-5,186 (24%) with TB; 62% female; median age 37 years. There were proportionately more men in the active TB (46%) than in the non-TB (35%) group. Adjusting for baseline HIV-disease severity, TB patients were more likely to die (hazard ratio - HR = 1.32, 95% CI 1.18-1.47) or have incident ADEs (HR = 1.31, 95% CI: 1.19-1.45). They had lower median CD4 cell counts (77 versus 109), weight (52.5 versus 55.0 kg) and higher ADE risk at baseline (CD4-adjusted odds ratio = 1.55, 95% CI: 1.31-1.85). ART adherence was similarly good in both groups. Adjusting for gender and baseline CD4 cell count, TB patients experienced virtually identical rise in CD4 counts after ART initiation as those without. However, the overall CD4 count at one year was lower among patients with TB (251 versus 269 cells/µl). Clinically detected TB disease is associated with greater mortality and morbidity despite salutary response to ART. Data suggest that identifying HIV patients co-infected with TB earlier in the HIV-disease trajectory may not fully address TB-related morbidity and mortality.
    PLoS ONE 01/2013; 8(1):e53022. · 3.53 Impact Factor
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    ABSTRACT: Introduction: Electronic health records (EHRs) are receiving a lot of attention for their potential to improve care. Objective: To develop and implement EHRs in the antenatal clinic (ANC) of a teaching and referral hospital in Western Kenya. Results: A multidisciplinary team developed a phased implementation of EHRs in the ANC as part of a CDC-funded effort to develop and implement primary care EHRs in lower level and referral facilities in Kenya comprising a clinic registration system and initial- and return-visit encounter forms that captured and reported data required for reporting. This was successfully done, the EHR fully implemented in the ANC including a reminder system to enhance adherence to care guidelines. Conclusions: It is possible to implement EHRs in a referral hospital ANC.
    Studies in health technology and informatics 01/2013; 192:1126.

Publication Stats

10k Citations
1,639.53 Total Impact Points


  • 2005–2014
    • University of Oklahoma Health Sciences Center
      • • Department of Internal Medicine
      • • Section of Gastroenterology and Nutrition
      Oklahoma City, Oklahoma, United States
    • Portland VA Medical Center
      Portland, Oregon, United States
  • 2013
    • University of Toronto
      Toronto, Ontario, Canada
    • Moi Teaching and Referral Hospital
      Olteret, Uasin Gishu, Kenya
  • 1987–2013
    • Regenstrief Institute, Inc.
      Indianapolis, Indiana, United States
  • 2011
    • Kansas State University
      Kansas, United States
  • 2010
    • University of California, Davis
      Davis, California, United States
  • 2003–2010
    • Moi University
      • • Department of Medicine
      • • Department of Epidemiology and Nutrition
      Nairobi, Nairobi Province, Kenya
    • Indiana University-Purdue University Fort Wayne
      Fort Wayne, Indiana, United States
  • 1985–2010
    • Indiana University-Purdue University Indianapolis
      • Department of Medicine
      Indianapolis, Indiana, United States
  • 2009
    • Philadelphia ZOO
      Philadelphia, Pennsylvania, United States
    • University of Chichester
      Chichester, England, United Kingdom
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 2008
    • VA Puget Sound Health Care System
      Washington, Washington, D.C., United States
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, MA, United States
  • 1998–2008
    • Saint Louis University
      • College for Public Health & Social Justice
      Saint Louis, MI, United States
  • 2007
    • West Chester University
      • Department of Health
      West Chester, PA, United States
  • 1991–2007
    • Richard L. Roudebush VA Medical Center
      Indianapolis, Indiana, United States
  • 2006
    • American Society for Gastrointestinal Endoscopy
      Oak Brook, Illinois, United States
  • 1994–2005
    • Indiana University-Purdue University School of Medicine
      • Department of Medicine
      Indianapolis, IN, United States
  • 1998–2003
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
  • 1999
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
  • 1990–1998
    • Purdue University
      • Department of Pharmacy Practice
      West Lafayette, Indiana, United States
  • 1997
    • Eli Lilly
      Indianapolis, Indiana, United States
    • University of Washington Seattle
      • Department of Family Medicine
      Seattle, WA, United States