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we design, develop, and operate information systems to improve individual and population health.

What We Do

CIRG designs, develops, builds, and operates information systems that securely manage health information for projects in the Clinical, Public Health, and Global Health Informatics domains.

Our collaborators are based at the University of Washington, in national and state governments, and at health care and research organizations across the US and around the world. Our team is lead by Dr. Bill Lober, whose background is in emergency medicine and computer engineering, and our staff consists of software developers, system programmers, experts in interaction design/usability and health data system operations, and both graduate and undergraduate students.

contact us: lober@uw.edu +1.206.616.6685


Who We Are

(click our pictures to learn more about the team)

Faculty & Staff



Clinical Informatics

Computerized Patient Reported Outcomes   An open source platform for multi-platform Patient Reported Outcomes, using a wide range of custom surveys and validated instruments, including PROMIS measures. Since 2000, cPRO was developed in collaboration with Donna Berry, Heidi Crane, and the Movember Foundation. Specific applications build on cPRO support research and clincial care for patients being treated for cancer, chronic pain, HIV, or those undergoing surgery.

mPOWEr   A mobile application using photos to enhance post-discharge communication between patients and providers. Developed in collaboration with Heather Evans since 2015, patients use mPOWEr as a diary of post-operative healing and a patient-centered communication tool with their care teams. Clinicians use mPOWEr as a longitudinal assessment tool for potential surgical wound infections, and as a platform for team communications.


Global Health Informatics

eSaude   Supporting the eSaude community in Mozambique in developing and implementing a Mozambican specific configuration of the OpenMRS EMR software and its integration into a national eHealth architecture.

Past Projects

OpenELIS Global   Open Source Lab Information System implemented in Haiti, Cote d’Ivoire, and Vietnam. Approximately 30 sites worldwide

iSante – Electronic Medical Record   A web-based, formerly open source, electronic medical record originally developed for HIV care and extended to primary care and maternal and child health, and deployed broadly in over 80 government facilities in Haiti. (last updated 2011)

KenyaEMR   Open Source, module-based implementation of OpenMRS medical record for a widespread Kenya MOH implementation.

Kenya Health Informatics   Wide-spread EMR implementation and extending interoperability using open source tools with other HIS components within the national eHealth Architecture.


Public Health Informatics

Interoperability for Public Health   Since 2006, we have developed public health interoperability software to demonstrate use cases in surveillance and case reporting. We develop using standards based profiles (ihe.net), and test our work with commercial vendor systems. Then, on behalf of CDC and Washington Department of Health, we demonstrate novel data integration examples at conferences such as HIMSS, CDC PHIC, CSTE, and ISDS, showing how informatics supports the essential services of public health .

Past Projects

Gossamer Health   Open Source surveillance system used to implement the “cloud” version of the Distribute surveillance system.

PHENIX   A voluntary data sharing surveillance project based on Gossamer Health software


Open Source Software

A fair amount of what we do is open source, either through projects we initiate or through projects where we are primary contributors. A fair amount of what we do is not open source, for one reason or another, but here’s a list of some projects which might be of interest.

2008-present cPRO – Patient Reported Outcomes


A system that delivers standard and customized survey instruments to web, tablet, and mobile platforms, and which accommodates both research and clinical workflows.

2014-present eSaude - Mozambique National Electronic Medical Record


CIRG provides support and technical assistance to team of programmers from five HIV care and treatment implementing organizations in Mozambique, who are jointly developing a shared distribution of OpenMRS to address needs in HIV, Maternal and Child, and Primary Care, as well as providing a reliable data source for population health and program monitoring.

2006-2016 OpenELIS/Global – Lab Information System


Building on the OpenELIS system developed by the Association of Public Health Laboratories and a group of state health departments, we developed new version of this system tailored to meet the needs of clinical and reference laboratories in resource poor settings. Our version of the system is now implemented in three countries.

2012-2014 KenyaEMR – Ministry of Health Electronic Medical Record


A distribution of the open source OpenMRS electronic medical record designed to needs of the Kenyan Ministry of Heath, and incorporating novel approaches to installation and maintenance to facilitate deployment and operations in resource poor settings. Developed by a distributed team of Kenyan and Seattle-based programmers.

2010-2012 Gossamer – Syndromic Surveillance


A system for syndrome based surveillance of anonymized clinical visit information, developed in response to the information sharing goals of public health agencies, and then nationally deployed in response to the H1N1 (“swine-flu”) pandemic of 2009-10.

2005-2011 iSante – Electronic Medical Record


A web-based electronic medical record originally developed for HIV care and extended to primary care and maternal and child health, and deployed broadly in over 80 government facilities in Haiti.

2000-2002 IML – Image Markup Language


An image annotation system exploring the feasibility of using eXtended Markup Language to represent image markup and textual annotation. The 2000 publication of this work described its use to annotate an atlas of anatomic images.



Refereed Journal Articles

Sanger, P. C., Hartzler, A., Han, S. M., Armstrong, C. A. L., Stewart, M. R., Lordon, R. J., Lober, W. B., Evans, H. E. (2014). Patient Perspectives on Post-Discharge Surgical Site Infections: Towards a Patient-Centered Mobile Health Solution. PLoS One. In press.‏

Fredericksen, R., Feldman, B. J., Brown, T., Schmidt, S., Crane, P. K., Harrington, R. D., Dhanireddy, S., McReynolds, J., Lober, W. B., Bangsberg, D. R., Kitahata, M. M., Crane, H. M. (2014). Unannounced Telephone-Based Pill Counts: A Valid and Feasible Method for Monitoring Adherence. AIDS and Behavior. 2014 Oct 21. [Epub ahead of print] PMID: 25331265

Berry, D. L., Hong, F., Halpenny, B., Partridge, A. H., Fann, J. R., Wolpin, S., Lober, W. B., Bush. B., Parvathaneni, U., Back, Amtmann, D., Ford, R. (2014). Electronic self-report assessment for cancer and self-care support: results of a multicenter randomized trial. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 32(3), 199–205. doi:10.1200/JCO.2013.48.6662

Crane, H. M., Heckbert, S. R., Drozd, D. R., Budoff, M. J., Delaney, J. A. C., Rodriguez, C., Paramsothy, P., Lober, W.B., Burkholder, G., Willig, J. H., … Kitahata, M. M., Centers for AIDS Research Network of Integrated Clinical Systems Cohort Investigators. (2014). Lessons Learned From the Design and Implementation of Myocardial Infarction Adjudication Tailored for HIV Clinical Cohorts. American Journal of Epidemiology, 179(8), 996–1005. doi:10.1093/aje/kwu010

Lober, W. B., Reeder, B., Painter, I., Revere, D., Goldov, K., Bugni, P. F., McReynolds, J., Olson, D. R. (2014). Technical Description of the Distribute Project: A Community-based Syndromic Surveillance System Implementation. Online Journal of Public Health Informatics, 5(3), 224. doi:10.5210/ojphi.v5i3.4938

Wolpin, S. E., Halpenny, B., Whitman, G., McReynolds, J., Stewart, M., Lober, W. B., & Berry, D. L. (2014). Development and usability testing of a web-based cancer symptom and quality-of-life support intervention. Health Informatics Journal. doi:10.1177/1460458213495744

Matheson, A. I., Baseman, J. G., Wagner, S. H., O’Malley, G. E., Puttkammer, N. H., Emmanuel, E., Zamor, G., Frédéric, R., Coq, N. R., & Lober, W. B. (2012). Implementation and expansion of an electronic medical record for HIV care and treatment in Haiti: an assessment of system use and the impact of large-scale disruptions. International journal of medical informatics, 81(4), 244–256. doi:10.1016/j.ijmedinf.2012.01.011

Fredericksen, R., Crane, P. K., Tufano, J., Ralston, J., Schmidt, S., Brown, T., Layman, D., Harrington, R. D., Dhamireddy, S., Stone, T., Lober, W., Kitahata, M. M., & Crane, H. (2012). Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults. Journal of AIDS and HIV Research, 4(2), 47–55. doi:10.5897/JAHR11.046

Hills, R. A., Revere, D., Altamore, R., Abernethy, N. F., & Lober, W. B. (2012). Timeliness and data element completeness of immunization data in Washington State in 2010: a comparison of data exchange methods. AMIA Annu Symp Proc, 2012, 340–349.

Reeder, B., Revere, D., Hills, R. A., Baseman, J. G., & Lober, W. B. (2012). Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance. Online journal of public health informatics, 4(3). doi:10.5210/ojphi.v4i3.4277

Berry, D. L., Halpenny, B., Hong, F., Wolpin, S., Lober, W. B., Russell, K. J., Ellis, W. J., Govindarajulu, U., Bosco, J., Davison, B. J., Bennett, G., Terris, M. K., Barsevick, A., Lin, D. W., Yang, C. C., & Swanson, G. (2011). The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: A multi-center randomized trial. Urologic oncology. doi:10.1016/j.urolonc.2011.10.004

Berry, D. L., Blumenstein, B. A., Halpenny, B., Wolpin, S., Fann, J. R., Austin-Seymour, M., Bush, N., Karras, B. T., Lober, W. B., & McCorkle, R. (2011). Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. Journal of clinical oncology, 29(8), 1029–1035. doi:10.1200/JCO.2010.30.3909

Kim, E.-H., Coumar, A., Lober, W. B., & Kim, Y. (2011). Addressing mental health epidemic among university students via web-based, self-screening, and referral system: a preliminary study. IEEE transactions on information technology in biomedicine: a publication of the IEEE Engineering in Medicine and Biology Society, 15(2), 301–307. doi:10.1109/TITB.2011.2107561

Hills, R. A., Baseman, J. G., Revere, D., Boge, C. L. K., Oberle, M. W., Doctor, J. N., & Lober, W. B. (2011). Applying the XForms Standard to Public Health Case Reporting and Alerting. Online journal of public health informatics, 3(2). doi:10.5210/ojphi.v3i2.3656

Olson, D. R., Paladini, M., Lober, W. B., Buckeridge, D. L., & ISDS Distribute Working Group. (2011). Applying a New Model for Sharing Population Health Data to National Syndromic Influenza Surveillance: DiSTRIBuTE Project Proof of Concept, 2006 to 2009. PLoS currents, 3, RRN1251. doi:10.1371/currents.RRN1251

Painter, I., Eaton, J., Revere, D., Olson, D., & Lober, B. (2011). Generation of prediction intervals to assess data quality in the Distribute system using quantile regression. In 2011 JSM Proceedings, Statistics in Defense and National Security Section. (p. pp 5172–5179).

Reeder, B., Revere, D., Olson, D. R., & Lober, W. B. (2011). Perceived usefulness of a distributed community-based syndromic surveillance system: a pilot qualitative evaluation study. BMC research notes, 4, 187. doi:10.1186/1756-0500-4-187

Chapman, W. W., Dowling, J. N., Baer, A., Buckeridge, D. L., Cochrane, D., Conway, M. A., Elkin, P., Espino, J., Gunn, J. E., Hales, C. M., Hutwagner, L., Keller, M., Larson, C., Noe, R., Okhmatovskaia, A., Olson, K., Paladini, M., Scholer, M., Sniegoski, C., Thompson, D., & Lober, B. (2010). Developing syndrome definitions based on consensus and current use. Journal of the American Medical Informatics Association: JAMIA, 17(5), 595–601. doi:10.1136/jamia.2010.003210

Wolpin, S., Berry, D. L., Kurth, A., & Lober, W. B. (2010). Improving health literacy: a Web application for evaluating text-to-speech engines. Computers, informatics, nursing: CIN, 28(4), 198–204. doi:10.1097/NCN.0b013e3181e1ddca

Van Eaton, E. G., McDonough, K., Lober, W. B., Johnson, E. A., Pellegrini, C. A., & Horvath, K. D. (2010). Safety of using a computerized rounding and sign-out system to reduce resident duty hours. Academic medicine: journal of the Association of American Medical Colleges, 85(7), 1189–1195. doi:10.1097/ACM.0b013e3181e0116f

Lawrence, S. T., Willig, J. H., Crane, H. M., Ye, J., Aban, I., Lober, W., Nevin, C. R., Batey, D. S., Mugavero, M. J., McCullumsmith, C., Wright, C., Kitahata, M., Raper, J. L., Saag, M. S., & Schumacher, J. E. (2010). Routine, self-administered, touch-screen, computer-based suicidal ideation assessment linked to automated response team notification in an HIV primary care setting. Clinical infectious diseases, 50(8), 1165–1173. doi:10.1086/651420

Berry, D. L., Halpenny, B., Wolpin, S., Davison, B. J., Ellis, W. J., Lober, W. B., McReynolds, J., & Wulff, J. (2010). Development and evaluation of the personal patient profile-prostate (P3P), a Web-based decision support system for men newly diagnosed with localized prostate cancer. Journal of medical Internet research, 12(4), e67. doi:10.2196/jmir.1576

Hills, R. A., Reeder, B., Revere, D., Lober, W. B., & Abernethy, N. F. (2010). Immunization information and population data sources: the information needs of public health practitioners. In Proceedings of the 1st ACM International Health Informatics Symposium (pp. 459–463). New York, NY, USA: ACM. doi:10.1145/1882992.1883063

Lober, W. B., Revere, D., & Hills, R. (2010). A Lab-EMR interoperability profile as an eHealth architecture component for resource-constrained settings. Studies in health technology and informatics, 160(Pt 1), 257–261.

Fann, J. R., Berry, D. L., Wolpin, S., Austin-Seymour, M., Bush, N., Halpenny, B., Lober, W. B., & McCorkle, R. (2009). Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer. Psycho-oncology, 18(1), 14–22. doi:10.1002/pon.1368

Kim, E.-H., Stolyar, A., Lober, W. B., Herbaugh, A. L., Shinstrom, S. E., Zierler, B. K., Soh, C. B., & Kim, Y. (2009). Challenges to using an electronic personal health record by a low-income elderly population. Journal of medical Internet research, 11(4), e44. doi:10.2196/jmir.1256

Wolpin, S., Berry, D., Austin-Seymour, M., Bush, N., Fann, J. R., Halpenny, B., Lober, W. B., & McCorkle, R. (2008). Acceptability of an Electronic Self-Report Assessment Program for patients with cancer. Computers, informatics, nursing: CIN, 26(6), 332–338. doi:10.1097/01.NCN.0000336464.79692.6a

Kitahata, M. M., Rodriguez, B., Haubrich, R., Boswell, S., Mathews, W. C., Lederman, M. M., Lober, W. B., Van Rompaey, S. E., Crane, H. M., Moore, R. D., Bertram, M., Kahn, J. O., & Saag, M. S. (2008). Cohort profile: the Centers for AIDS Research Network of Integrated Clinical Systems. International journal of epidemiology, 37(5), 948–955. doi:10.1093/ije/dym231

Hills, R. A., Lober, W. B., & Painter, I. S. (2008). Biosurveillance, Case Reporting, and Decision Support: Public Health Interactions with a Health Information Exchange. (D. Zeng, H. Chen, H. Rolka, & B. Lober, Eds.)Biosurveillance and Biosecurity Proceedings, 5354, 10–21. doi:dx.doi.org/10.1007/978-3-540-89746-0_2

Doctor, J. N., Baseman, J. G., Lober, W. B., Davies, J., Kobayashi, J., Karras, B. T., & Fuller, S. (2008). Time-tradeoff utilities for identifying and evaluating a minimum data set for time-critical biosurveillance. Medical decision making: an international journal of the Society for Medical Decision Making, 28(3), 351–358. doi:10.1177/0272989X08317011

Lober, W. B., Quiles, C., Wagner, S., Cassagnol, R., Lamothes, R., Alexis, D. R. P., Joseph, P., Sutton, P., Puttkammer, N., & Kitahata, M. M. (2008). Three years experience with the implementation of a networked electronic medical record in Haiti. AMIA Annu Symp Proc, 434–438.

Crane, H. M., Lober, W., Webster, E., Harrington, R. D., Crane, P. K., Davis, T. E., & Kitahata, M. M. (2007). Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Current HIV research, 5(1), 109–118.

Kim, E.-H., Stolyar, A., Lober, W. B., Herbaugh, A. L., Shinstrom, S. E., Zierler, B. K., Soh, C. B., & Kim, Y. (2007). Usage patterns of a personal health record by elderly and disabled users. AMIA Annu Symp Proc, 409–413.

Berry, D. L., Wolpin, S. E., Lober, W. B., Ellis, W. J., Russell, K. J., & Davison, B. J. (2006). Actual use and perceived usefulness of a web-based, decision support program for men with prostate cancer. Studies in health technology and informatics, 122, 781–782.

Karras, B. T., Wolpin, S., Lober, W. B., Bush, N., Fann, J. R., & Berry, D. L. (2006). Electronic Self-report Assessment–Cancer (ESRA-C): Working towards an integrated survey system. Studies in health technology and informatics, 122, 514–518.

Lober, W. B., Zierler, B., Herbaugh, A., Shinstrom, S. E., Stolyar, A., Kim, E. H., & Kim, Y. (2006). Barriers to the use of a personal health record by an elderly population. AMIA Annu Symp Proc, 514–518.

Van Eaton, E. G., Horvath, K. D., Lober, W. B., Rossini, A. J., & Pellegrini, C. A. (2005). A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. Journal of the American College of Surgeons, 200(4), 538–545. doi:10.1016/j.jamcollsurg.2004.11.009

Berry, D. L., Trigg, L. J., Lober, W. B., Karras, B. T., Galligan, M. L., Austin-Seymour, M., & Martin, S. (2004). Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing. Oncology nursing forum, 31(5), E75–83. doi:10.1188/04.ONF.E75-E83

Lober, W. B., Trigg, L., & Karras, B. (2004). Information system architectures for syndromic surveillance. MMWR. Morbidity and mortality weekly report, 53 Suppl, 203–208.

Van Eaton, E. G., Horvath, K. D., Lober, W. B., & Pellegrini, C. A. (2004). Organizing the transfer of patient care information: the development of a computerized resident sign-out system. Surgery, 136(1), 5–13. doi:10.1016/j.surg.2004.04.018

Mandl, K. D., Overhage, J. M., Wagner, M. M., Lober, W. B., Sebastiani, P., Mostashari, F., Pavlin, J. A., Gesteland, P. H., Treadwell, T., Koski, E., Hutwagner, L., Buckeridge, D. L., Aller, R. D., & Grannis, S. (2004). Implementing syndromic surveillance: a practical guide informed by the early experience. Journal of the American Medical Informatics Association: JAMIA, 11(2), 141–150. doi:10.1197/jamia.M1356

Lober, W. B., Baer, A., Karras, B. T., & Duchin, J. S. (2004). Collection and integration of clinical data for surveillance. Studies in health technology and informatics, 107(Pt 2), 1211–1215.

Lober, W. B., Trigg, L. J., Karras, B. T., Bliss, D., Ciliberti, J., Stewart, L., & Duchin, J. S. (2003). Syndromic surveillance using automated collection of computerized discharge diagnoses. Journal of urban health: bulletin of the New York Academy of Medicine, 80(2 Suppl 1), i97–106.

Travers, D. A., Waller, A., Haas, S. W., Lober, W. B., & Beard, C. (2003). Emergency Department data for bioterrorism surveillance: electronic data availability, timeliness, sources and standards. AMIA Annu Symp Proc, 664–668.

Lober, W. B., Karras, B. T., Wagner, M. M., Overhage, J. M., Davidson, A. J., Fraser, H., Trigg, L. J., Mandl, K. D., Espino, J. U., & Tsui, F.-C. (2002). Roundtable on bioterrorism detection: information system-based surveillance. Journal of the American Medical Informatics Association: JAMIA, 9(2), 105–115.

Karras, B. T., Huq, S., Bliss, D., & Lober, W. B. (2002). National Pharmaceutical Stockpile drill analysis using XML data collection on wireless Java phones. AMIA Annu Symp Proc, 365–369.

Lober, W. B., Trigg, L. J., Bliss, D., & Brinkley, J. M. (2001). IML: An image markup language. AMIA Annu Symp Proc, 403–407.