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2000, Proceedings / AMIA ... Annual Symposium. AMIA Symposium
A growing of health-care organizations are in the process of modifying their clinical information systems (CIS) to support browser-based access. Consequently, care-providers are expected to modify their workflow to take advantage of the new technology. Intuitive interfaces, fast response and new functionality are few of the features used to promote endorsement of the change. In parallel, administrators are required to constantly assess user compliance and intervene where necessary to prevent rejection. Such monitoring translates to frequent surveys, analysis of logs and prudent utilization of user-groups. These methods tend to further burden users, suffer from "post-hoc" temporality and are difficult to maintain. In this paper we suggest an alternative approach to such data acquisition. "CareQuest" is an interactive Web-based service that can be woven into clinical applications without coding. It acquires information from the clinician at the relevant point in he...
JMIR medical informatics, 2014
Computer-based clinical decision support (CDS) is an important component of the electronic health record (EHR). As an increasing amount of CDS is implemented, it will be important that this be accomplished in a fashion that assists in clinical decision making without imposing unacceptable demands and burdens upon the provider's practice. The objective of our study was to explore an approach that allows CDS to be clinician-friendly from a variety of perspectives, to build a prototype implementation that illustrates features of the approach, and to gain experience with a pilot framework for assessment. The paper first discusses the project's design philosophy and goals. It then describes a prototype implementation (Neuropath/CDS) that explores the approach in the domain of neuropathic pain and in the context of the US Veterans Administration EHR. Finally, the paper discusses a framework for assessing the approach, illustrated by a pilot assessment of Neuropath/CDS. The paper d...
International journal of …, 2001
The World Wide Web provides an unprecedented opportunity for widespread access to health-care applications by both patients and providers. The development of new methods for assessing the effectiveness and usability of these systems is becoming a critical issue. This paper describes the distance evaluation (i.e. 'televaluation') of emerging Web-based information technologies. In health informatics evaluation, there is a need for application of new ideas and methods from the fields of cognitive science and usability engineering. A framework is presented for conducting evaluations of health-care information technologies that integrates a number of methods, ranging from deployment of on-line questionnaires (and Web-based forms) to remote video-based usability testing of user interactions with clinical information systems. Examples illustrating application of these techniques are presented for the assessment of a patient clinical information system (PatCIS), as well as an evaluation of use of Web-based clinical guidelines. Issues in designing, prototyping and iteratively refining evaluation components are discussed, along with description of a 'virtual' usability laboratory.
Proceedings Amia Annual Symposium Amia Symposium, 2002
We hypothesize that when clinicians review clinical data in an electronic medical record, the information needs that arise are predictable, based on a number oJ situational factors. Because our theory does not say, exactly, what those needs are, we are using an empirical approach (observation) to detecting and categorizing them. For each need, we can construct an "infobutton" that links the clinical data to an on- line information resource. We have constructed an Infobutton Manager to match the data being reviewed by clinicians with context-appropriate infobuttons. This paper describes how the theory, observations, and practical solutions can come together to improve clinician decision making by resolving information needs.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2008
Clinical decision support systems (CDSS) have the potential to reduce adverse medical events, but improper design can introduce new forms of error. CDSS pertaining to community acquired pneumonia and neutropenic fever were studied to determine whether usability of the graphical user interface might contribute to potential adverse medical events. Automated screen capture of 4 CDSS being used by volunteer emergency physicians was analyzed using structured methods. 422 events were recorded over 56 sessions. In total, 169 negative comments, 55 positive comments, 130 neutral comments, 21 application events, 34 problems, 6 slips, and 5 mistakes were identified. Three mistakes could have had life-threatening consequences. Evaluation of CDSS will be of utmost importance in the future with increasing use of electronic health records. Usability engineering principles can identify interface problems that may lead to potential medical adverse events, and should be incorporated early in the soft...
Encyclopedia of Healthcare Information Systems
Healthcare is characterized by a highly complex environment where the process of patient care requires an unusual amount of communication between different healthcare professionals (HCPs). For a better patient care, the various HCPs have to cooperate, a processed often called shared care (Garde & Knaup, 2006; Schabetsberger, Ammenwerth, Andreatta, Gratl, Haux, & Lechleitner, 2006). Nowadays, there is an increasing incorporation of a heterogeneous set of Information Systems (ISs)—paper-based and computer-based—on the daily work of HCPs, in order to retrieve information about patients (Coiera, 2003; Van-Bemmel & Musen, 1997). The complexity of the patient care process combined with the heterogeneity of the information resources leads to a paradigm of data redundancy in the healthcare services in general, and hemophilia care in particular.
2015
Frequent turnover of staff in medical clinics creates challenges in the maintenance of clinical protocols, workflows, and information management. Care coordination between providers in such a setting can be complex; disruptions in communication may lead to poorer health outcomes and patient satisfaction. Furthermore, protocols change frequently in response to new guidelines, which demands rapid updates to maintain compliance. To address these challenges, we developed an intuitive, end-user editable web-based knowledge management system optimized for use on mobile devices. The resulting system served as a point of care information storage and retrieval tool that providers can reference quickly for operational tasks. Since launch, the platform has allowed our clinic to consolidate knowledge banks, standardize staff training, and streamline information flow during clinic, and is now used extensively by clinic staff. During a one-year period, 175 new pages have been created and 1686 edi...
Methods of information in medicine, 1999
The electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.
2019
The impact of new information and communication technologies on our societies is universal. They have the advantage of being transversal and affecting all sectors, notably health. E-health, a multidisciplinary field of research, is growing significantly and is nowadays necessary for systems of healthcare. The determinants of this breakthrough in healthcare remain the age demographic of the population coupled with the inadequacy of the health workforce, without ignoring the rising costs of care. This is reflected in the continuing rise in the number of people with addictions, as chronic diseases become more acute, creating a huge need for appropriate technologies. The circumstances are therefore conducive to reflection leading to the modeling of more innovative solutions for effective patient care. The NICT's incursion in the medical field is most often seen as the introduction of tools designed to guarantee or even improve the quality of healthcare services, so our research comb...
Infrastructures and Processes for E-Health Systems
This chapter discusses the role of e-health in creating persistent clinical encounters to extend the scope of health care beyond its conventional boundaries utilizing social networking technology to create what the authors’ term ‘user driven health care’. It points out the necessity to direct the development of health information systems such that they serve as important vehicles between patient and health professional users in communicating and sharing information other than their role in automated alerts and responses. A project is described that plans to create a system of online sharing of health information in a user driven manner that necessarily becomes persistent due to being stored in electronic health records.
Radiography, 2000
A computer-based information system for obstetric ultrasound patients, their partners and accompanying person ('target population') was developed and evaluated. System development and evaluation involved the target population and relevant health care workers ('stakeholders'). The system was evaluated in a 22-month clinical trial. This was conducted in a community medical practice and an obstetric ultrasound waiting room. Over 4000 online questionnaires were completed; 30 interviews and 50 observations were conducted with the target population and 'reflective comments' were received from nine health care professionals. The target population liked the system and found it easy to use. It provided them with useful information. They also indicated it should be located at a range of health care and non-health care sites. Personal contact with a health care professional was still considered essential; the computer was viewed as an additional but not exclusive source of information. Children seemed to gain information from it and together with adults they were entertained by it. The interactive nature of the system and its media (e.g. video) were highly valued; in particular the online knowledge assessment questionnaires were considered important. Information about target population subject knowledge, acquired from the assessment questionnaires, was automatically stored to disk. This information could easily be interrogated to identify areas of misunderstanding. Such information may then be used to assist in more appropriate allocation of informational and educational resources. Factors had to be optimized for the system to be utilized; examples include the need to locate the system in a quiet area and two sets of headphones had to be provided. The study showed that computer-based information systems are a valuable method of informing people about health care but system design needs to capitalize on factors that enhance learning.
International Journal of Medical Informatics, 2011
Medical informatics Computer systems evaluation Questionnaires Task performance User-computer interface Electronic health record Patient care a b s t r a c t Objective: In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field. Methods: A national web questionnaire study was conducted in Finland in spring 2010 with 3929 physicians actively working in patient care. For the purposes of the study, we described three dimensions of clinical ICT system usability that reflect the physicians' viewpoint on system usage: (1) compatibility between clinical ICT systems and physicians' tasks, (2) ICT support for information exchange, communication and collaboration in clinical work, and (3) interoperability and reliability. The dimensions derive from the definitions of usability and clinical context of use analysis, and reflect the ability of ICT systems to have a positive impact on patient care by supporting physicians in achieving their goals with a pleasant user experience. The research data incorporated 32 statements with a five-point Likert-scale on physicians' experiences on usability of their currently used ICT systems and a summative question about school grade given to electronic health record (EHR) systems.
Journal of the American Medical Informatics Association, 2009
This study sought to investigate user interactions with an electronic health records (EHR) system by uncovering hidden navigational patterns in the EHR usage data automatically recorded as clinicians navigated through the system's software user interface (UI) to perform different clinical tasks. Design: A homegrown EHR was adapted to allow real-time capture of comprehensive UI interaction events. These events, constituting time-stamped event sequences, were used to replay how the EHR was used in actual patient care settings. The study site is an ambulatory primary care clinic at an urban teaching hospital. Internal medicine residents were the primary EHR users. Measurements: Computer-recorded event sequences reflecting the order in which different EHR features were sequentially accessed. Methods: We apply sequential pattern analysis (SPA) and a first-order Markov chain model to uncover recurring UI navigational patterns. Results: Of 17 main EHR features provided in the system, SPA identified 3 bundled features: "Assessment and Plan" and "Diagnosis," "Order" and "Medication," and "Order" and "Laboratory Test." Clinicians often accessed these paired features in a bundle together in a continuous sequence. The Markov chain analysis revealed a global navigational pathway, suggesting an overall sequential order of EHR feature accesses. "History of Present Illness" followed by "Social History" and then "Assessment and Plan" was identified as an example of such global navigational pathways commonly traversed by the EHR users. Conclusion: Users showed consistent UI navigational patterns, some of which were not anticipated by system designers or the clinic management. Awareness of such unanticipated patterns may help identify undesirable user behavior as well as reengineering opportunities for improving the system's usability.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 2000
The advent of Internet-based information systems has provided unprecedented opportunity for the widespread access to medical information. However, issues related to the evaluation of such systems to ensure their usability, effectiveness and to assess their effect on the provider-patient relationship pose a considerable challenge. This paper describes a framework for the distance evaluation of web-based information technologies. The methods are described in the context of an ongoing evaluation of a system known as PatCIS, designed to be accessed by patients from home for obtaining health information, and for management of chronic diseases. We employ a multi-method approach that involves collection of a rich data set, including Web-based questionnaires, automatic logging of user activity and e-mail communication with users. Our work in evaluation design is influenced from research in the areas of cognitive science and the field of usability engineering which aims to characterize the i...
International Journal of Medical Informatics, 2019
Objective: To characterise the use of an electronic medication safety dashboard by exploring and contrasting interactions from primary users (i.e. pharmacists) who were leading the intervention and secondary users (i.e. non-pharmacist staff) who used the dashboard to engage in safe prescribing practices. Materials and methods: We conducted a 10-month observational study in which 35 health professionals used an instrumented medication safety dashboard for audit and feedback purposes in clinical practice as part of a wider intervention study. We modelled user interaction by computing features representing exploration and dwell time through user interface events that were logged on a remote database. We applied supervised learning algorithms to classify primary against secondary users. Results: We observed values for accuracy above 0.8, indicating that 80% of the time we were able to distinguish a primary user from a secondary user. In particular, the Multilayer Perceptron (MLP) yielded the highest values of precision (0.88), recall (0.86) and F-measure (0.86). The behaviour of primary users was distinctive in that they spent less time between mouse clicks (lower dwell time) on the screens showing the overview of the practice and trends. Secondary users exhibited a higher dwell time and more visual search activity (higher exploration) on the screens displaying patients at risk and visualisations. Discussion and conclusion: We were able to distinguish the interactive behaviour of primary and secondary users of a medication safety dashboard in primary care using timestamped mouse events. Primary users were more competent on population health monitoring activities, while secondary users struggled on activities involving a detailed breakdown of the safety of patients. Informed by these findings, we propose workflows that group these activities and adaptive nudges to increase user engagement.
2017 SIG-Health Pre-ICIS Workshop, 2017
Health care is a domain characterized by low and slow adoption of IS compared to other domains, such as manufacturing or avionics. It seems to be promising to transfer existing (design) knowledge and solutions from these domains to the HIS context to increase effectiveness of HIS by, for example, improving usability of HIS and accessibility to assistive technology. Inattention to usability and accessibility of HIS will result in ineffective use of HIS, user dissatisfaction with HIS, the emergence of workarounds, and, ultimately, in a potentially decreased quality of care. One concept in IS research that can address these challenges is user assistance. With our research, we aim to enable users to better understand the functional capabilities of HIS, to effectively master their tasks using HIS, and, ultimately, to increase their performance.
Journal of Mason graduate research, 2015
Perspectives in health information management / AHIMA, American Health Information Management Association, 2011
In 2008, a clinical information tool was developed and embedded in the electronic health record system of an academic medical center. In 2009, the initial information tool, Clinical-e, was superseded by a portal called Clinical Focus, with a single search box enabling a federated search of selected online information resources. To measure the usefulness and impact of Clinical Focus, a survey was used to gather feedback about users' experience with this clinical resource. The survey determined what type of clinicians were using this tool and assessed user satisfaction and perceived impact on patient care decision making. Initial survey results suggest the majority of respondents found Clinical Focus easy to navigate, the content easy to read, and the retrieved information relevant and complete. The majority would recommend Clinical Focus to their colleagues. Results indicate that this tool is a promising area for future development.
Proceedings a Conference of the American Medical Informatics Association Amia Annual Fall Symposium Amia Fall Symposium, 1996
Nine WWW-based interfaces to clinical information systems were reviewed. Five have progressedpast the proof ofconcept phase and into alpha testing in the clinical environment. All keyfeatures desirable in an advanced clinical information were present in at least one interface, however many implementations were rudimentary. Much human computer interface research and WWW tool development needs to occur before implementation ofa WWW-based interface to a clinical information system should be considered for a mission-critical, production environment.
JMIR research protocols, 2016
Aging of the European population and interest in a healthy population in western countries have contributed to an increase in the number of health surveys, where the role of survey design, data collection, and data analysis methodology is clear and recognized by the whole scientific community. Survey methodology has had to couple with the challenges deriving from data collection through information and communications technology (ICT). Telemedicine systems have not used patients as a source of information, often limiting them to collecting only biometric data. A more effective telemonitoring system would be able to collect objective and subjective data (biometric parameters and symptoms reported by the patients themselves), and to control the quality of subjective data collected: this goal be achieved only by using and merging competencies from both survey methodology and health research. The objective of our study was to propose new metrics to control the quality of data, along with...
Journal of Innovation in Health Informatics, 2009
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