Systematic Review of Medical Informatics-Supported Medication Decision Making.

PubMed

Melton, Brittany L

2017-01-01

This systematic review sought to assess the applications and implications of current medical informatics-based decision support systems related to medication prescribing and use. Studies published between January 2006 and July 2016 which were indexed in PubMed and written in English were reviewed, and 39 studies were ultimately included. Most of the studies looked at computerized provider order entry or clinical decision support systems. Most studies examined decision support systems as a means of reducing errors or risk, particularly associated with medication prescribing, whereas a few studies evaluated the impact medical informatics-based decision support systems have on workflow or operations efficiency. Most studies identified benefits associated with decision support systems, but some indicate there is room for improvement.

Impact of vendor computerized physician order entry on patients with renal impairment in community hospitals.

PubMed

Leung, Alexander A; Schiff, Gordon; Keohane, Carol; Amato, Mary; Simon, Steven R; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan; Zimlichman, Eyal; Seger, Diane L; Yoon, Catherine; Bates, David W

2013-10-01

Adverse drug events (ADEs) are common among hospitalized patients with renal impairment. To determine whether computerized physician order entry (CPOE) systems with clinical decision support capabilities reduce the frequency of renally related ADEs in hospitals. Quasi-experimental study of 1590 adult patients with renal impairment who were admitted to 5 community hospitals in Massachusetts from January 2005 to September 2010, preimplementation and postimplementation of CPOE. Varying levels of clinical decision support, ranging from basic CPOE only (sites 4 and 5), rudimentary clinical decision support (sites 1 and 2), and advanced clinical decision support (site 3). Primary outcome was the rate of preventable ADEs from nephrotoxic and/or renally cleared medications. Similarly, secondary outcomes were the rates of overall ADEs and potential ADEs. There was a 45% decrease in the rate of preventable ADEs following implementation (8.0/100 vs 4.4/100 admissions; P < 0.01), and the impact was related to the level of decision support. Basic CPOE was not associated with any significant benefit (4.6/100 vs 4.3/100 admissions; P = 0.87). There was a nonsignificant decrease in preventable ADEs with rudimentary clinical decision support (9.1/100 vs 6.4/100 admissions; P = 0.22). However, substantial reduction was seen with advanced clinical decision support (12.4/100 vs 0/100 admissions; P = 0.01). Despite these benefits, a significant increase in potential ADEs was found for all systems (55.5/100 vs 136.8/100 admissions; P < 0.01). Vendor-developed CPOE with advanced clinical decision support can reduce the occurrence of preventable ADEs but may be associated with an increase in potential ADEs. © 2013 Society of Hospital Medicine.

A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

PubMed

Abidi, Samina

2017-10-26

Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

Designing Computerized Decision Support That Works for Clinicians and Families

PubMed Central

Fiks, Alexander G.

2011-01-01

Evidence-based decision-making is central to the practice of pediatrics. Clinical trials and other biomedical research provide a foundation for this process, and practice guidelines, drawing from their results, inform the optimal management of an increasing number of childhood health problems. However, many clinicians fail to adhere to guidelines. Clinical decision support delivered using health information technology, often in the form of electronic health records, provides a tool to deliver evidence-based information to the point of care and has the potential to overcome barriers to evidence-based practice. An increasing literature now informs how these systems should be designed and implemented to most effectively improve outcomes in pediatrics. Through the examples of computerized physician order entry, as well as the impact of alerts at the point of care on immunization rates, the delivery of evidence-based asthma care, and the follow-up of children with attention deficit hyperactivity disorder, the following review addresses strategies for success in using these tools. The following review argues that, as decision support evolves, the clinician should no longer be the sole target of information and alerts. Through the Internet and other technologies, families are increasingly seeking health information and gathering input to guide health decisions. By enlisting clinical decision support systems to deliver evidence-based information to both clinicians and families, help families express their preferences and goals, and connect families to the medical home, clinical decision support may ultimately be most effective in improving outcomes. PMID:21315295

D-WISE: Diabetes Web-Centric Information and Support Environment: conceptual specification and proposed evaluation.

PubMed

Abidi, Samina; Vallis, Michael; Raza Abidi, Syed Sibte; Piccinini-Vallis, Helena; Imran, Syed Ali

2014-06-01

To develop and evaluate Diabetes Web-Centric Information and Support Environment (D-WISE) that offers 1) a computerized decision-support system to assist physicians to A) use the Canadian Diabetes Association clinical practice guidelines (CDA CPGs) to recommend evidence-informed interventions; B) offer a computerized readiness assessment strategy to help physicians administer behaviour-change strategies to help patients adhere to disease self-management programs; and 2) a patient-specific diabetes self-management application, accessible through smart mobile devices, that offers behaviour-change interventions to engage patients in self-management. The above-mentioned objectives were pursued through a knowledge management approach that involved 1) Translation of paper-based CDA CPGs and behaviour-change models as computerized decision-support tools that will assist physicians to offer evidence-informed and personalized diabetes management and behaviour-change strategies; 2) Engagement of patients in their diabetes care by generating a diabetes self-management program that takes into account their preferences, challenges and needs; 3) Empowering patients to self-manage their condition by providing them with personalized educational and motivational messages through a mobile self-management application. The theoretical foundation of our research is grounded in behaviour-change models and healthcare knowledge management. We used 1) knowledge modelling to computerize the paper-based CDA CPGs and behaviour-change models, in particular, the behaviour-change strategy elements of A) readiness-to-change assessments; B) motivation-enhancement interventions categorized along the lines of patients' being ready, ambivalent or not ready; and C) self-efficacy enhancement. The CDA CPGs and the behaviour-change models are modelled and computerized in terms of A) a diabetes management ontology that serves as the knowledge resource for all the services offered by D-WISE; B) decision support services that use logic-based reasoning algorithms to utilize the knowledge encoded within the diabetes management ontology to assist physicians by recommending patient-specific diabetes-management interventions and behaviour-change strategies; C) a mobile diabetes self-management application to engage and educate diabetes patients to self-manage their condition in a home-based setting while working in concert with their family physicians. We have been successful in creating and conducting a usability assessment of the physician decision support tool. These results will be published once the patient self- management application has been evaluated. D-WISE will be evaluated through pilot studies measuring 1) the usability of the e-Health interventions; and 2) the impact of the interventions on patients' behaviour changes and diabetes control. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Patient-oriented Computerized Clinical Guidelines for Mobile Decision Support in Gestational Diabetes.

PubMed

García-Sáez, Gema; Rigla, Mercedes; Martínez-Sarriegui, Iñaki; Shalom, Erez; Peleg, Mor; Broens, Tom; Pons, Belén; Caballero-Ruíz, Estefanía; Gómez, Enrique J; Hernando, M Elena

2014-03-01

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients' self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient's access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients' personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients' acceptance of the whole system. © 2014 Diabetes Technology Society.

Mixed results in the safety performance of computerized physician order entry.

PubMed

Metzger, Jane; Welebob, Emily; Bates, David W; Lipsitz, Stuart; Classen, David C

2010-04-01

Computerized physician order entry is a required feature for hospitals seeking to demonstrate meaningful use of electronic medical record systems and qualify for federal financial incentives. A national sample of sixty-two hospitals voluntarily used a simulation tool designed to assess how well safety decision support worked when applied to medication orders in computerized order entry. The simulation detected only 53 percent of the medication orders that would have resulted in fatalities and 10-82 percent of the test orders that would have caused serious adverse drug events. It is important to ascertain whether actual implementations of computerized physician order entry are achieving goals such as improved patient safety.

Information technology and medication safety: what is the benefit?

PubMed Central

Kaushal, R; Bates, D

2002-01-01



 Medication errors occur frequently and have significant clinical and financial consequences. Several types of information technologies can be used to decrease rates of medication errors. Computerized physician order entry with decision support significantly reduces serious inpatient medication error rates in adults. Other available information technologies that may prove effective for inpatients include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions. In outpatients, computerization of prescribing and patient oriented approaches such as personalized web pages and delivery of web based information may be important. Public and private mandates for information technology interventions are growing, but further development, application, evaluation, and dissemination are required. PMID:12486992

Computerized Adaptive Test vs. decision trees: Development of a support decision system to identify suicidal behavior.

PubMed

Delgado-Gomez, D; Baca-Garcia, E; Aguado, D; Courtet, P; Lopez-Castroman, J

2016-12-01

Several Computerized Adaptive Tests (CATs) have been proposed to facilitate assessments in mental health. These tests are built in a standard way, disregarding useful and usually available information not included in the assessment scales that could increase the precision and utility of CATs, such as the history of suicide attempts. Using the items of a previously developed scale for suicidal risk, we compared the performance of a standard CAT and a decision tree in a support decision system to identify suicidal behavior. We included the history of past suicide attempts as a class for the separation of patients in the decision tree. The decision tree needed an average of four items to achieve a similar accuracy than a standard CAT with nine items. The accuracy of the decision tree, obtained after 25 cross-validations, was 81.4%. A shortened test adapted for the separation of suicidal and non-suicidal patients was developed. CATs can be very useful tools for the assessment of suicidal risk. However, standard CATs do not use all the information that is available. A decision tree can improve the precision of the assessment since they are constructed using a priori information. Copyright © 2016 Elsevier B.V. All rights reserved.

A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients With Type 2 Diabetes Mellitus

PubMed Central

Spat, Stephan; Donsa, Klaus; Beck, Peter; Höll, Bernhard; Mader, Julia K.; Schaupp, Lukas; Augustin, Thomas; Chiarugi, Franco; Lichtenegger, Katharina M.; Plank, Johannes; Pieber, Thomas R.

2016-01-01

Background: Diabetes management requires complex and interdisciplinary cooperation of health care professionals (HCPs). To support this complex process, IT-support is recommended by clinical guidelines. The aim of this article is to report on results from a clinical feasibility study testing the prototype of a mobile, tablet-based client-server system for computerized decision and workflow support (GlucoTab®) and to discuss its impact on hypoglycemia prevention. Methods: The system was tested in a monocentric, open, noncontrolled intervention study in 30 patients with type 2 diabetes mellitus (T2DM). The system supports HCPs in performing a basal-bolus insulin therapy. Diabetes therapy, adverse events, software errors and user feedback were documented. Safety, efficacy and user acceptance of the system were investigated. Results: Only 1.3% of blood glucose (BG) measurements were <70 mg/dl and only 2.6% were >300 mg/dl. The availability of the system (97.3%) and the rate of treatment activities documented with the system (>93.5%) were high. Only few suggestions from the system were overruled by the users (>95.7% adherence). Evaluation of the 3 anonymous questionnaires showed that confidence in the system increased over time. The majority of users believed that treatment errors could be prevented by using this system. Conclusions: Data from our feasibility study show a significant reduction of hypoglycemia by implementing a computerized system for workflow and decision support for diabetes management, compared to a paper-based process. The system was well accepted by HCPs, which is shown in the user acceptance analysis and that users adhered to the insulin dose suggestions made by the system. PMID:27810995

Economics of infection control surveillance technology: cost-effective or just cost?

PubMed

Furuno, Jon P; Schweizer, Marin L; McGregor, Jessina C; Perencevich, Eli N

2008-04-01

Previous studies have suggested that informatics tools, such as automated alert and decision support systems, may increase the efficiency and quality of infection control surveillance. However, little is known about the cost-effectiveness of these tools. We focus on 2 types of economic analyses that have utility in assessing infection control interventions (cost-effectiveness analysis and business-case analysis) and review the available literature on the economics of computerized infection control surveillance systems. Previous studies on the effectiveness of computerized infection control surveillance have been limited to assessments of whether these tools increase the sensitivity and specificity of surveillance over traditional methods. Furthermore, we identified only 2 studies that assessed the costs associated with computerized infection control surveillance. Thus, it remains unknown whether computerized infection control surveillance systems are cost-effective and whether use of these systems improves patient outcomes. The existing data are insufficient to allow for a summary conclusion on the cost-effectiveness of infection control surveillance technology. All future studies of computerized infection control surveillance systems should aim to collect outcomes and economic data to inform decision making and assist hospitals with completing business-cases analyses.

Accuracy of a computerized clinical decision-support system for asthma assessment and management.

PubMed

Hoeksema, Laura J; Bazzy-Asaad, Alia; Lomotan, Edwin A; Edmonds, Diana E; Ramírez-Garnica, Gabriela; Shiffman, Richard N; Horwitz, Leora I

2011-05-01

To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic. Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009. CDSS and physician assessments of asthma severity, control, and treatment step. Both the clinician and the computerized CDSS generated assessments of asthma control in 767/1032 (74.3%) return patients, assessments of asthma severity in 100/167 (59.9%) new patients, and recommendations for treatment step in 66/167 (39.5%) new patients. Clinicians agreed with the CDSS in 543/767 (70.8%) of control assessments, 37/100 (37%) of severity assessments, and 19/66 (29%) of step recommendations. External review classified 72% of control disagreements (21% of all control assessments), 56% of severity disagreements (37% of all severity assessments), and 76% of step disagreements (54% of all step recommendations) as CDSS errors. The remaining disagreements resulted from pulmonologist error or ambiguous guidelines. Many CDSS flaws, such as attributing all 'cough' to asthma, were easily remediable. Pediatric pulmonologists failed to follow guidelines in 8% of return visits and 18% of new visits. The authors relied on chart notes to determine clinical reasoning. Physicians may have changed their assessments after seeing CDSS recommendations. A computerized CDSS performed relatively accurately compared to clinicians for assessment of asthma control but was inaccurate for treatment. Pediatric pulmonologists failed to follow guideline-based care in a small proportion of patients.

Using Human Factors Methods to Design a New Interface for an Electronic Medical Record

PubMed Central

Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Asch, Steven M.; Doebbeling, Bradley N.; Render, Marta L.

2007-01-01

The Veterans Health Administration (VHA) is a leader in development and use of electronic patient records and clinical decision support. The VHA is currently reengineering a somewhat dated platform for its Computerized Patient Record System (CPRS). This process affords a unique opportunity to implement major changes to the current design and function of the system. We report on two human factors studies designed to provide input and guidance during this reengineering process. One study involved a card sort to better understand how providers tend to cognitively organize clinical data, and how that understanding can help guide interface design. The other involved a simulation to assess the impact of redesign modifications on computerized clinical reminders, a form of clinical decision support in the CPRS, on the learnability of the system for first-time users. PMID:18693914

The Development and Validation of a Special Education Intelligent Administration Support Program. Final Report.

ERIC Educational Resources Information Center

Utah State Univ., Logan. Center for Persons with Disabilities.

This project studied the effects of implementing a computerized management information system developed for special education administrators. The Intelligent Administration Support Program (IASP), an expert system and database program, assisted in information acquisition and analysis pertaining to the district's quality of decisions and procedures…

Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review.

PubMed

Staszewska, Anna; Zaki, Pearl; Lee, Joon

2017-10-06

Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness. ©Anna Staszewska, Pearl Zaki, Joon Lee. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 06.10.2017.

A cognitive task analysis of information management strategies in a computerized provider order entry environment.

PubMed

Weir, Charlene R; Nebeker, Jonathan J R; Hicken, Bret L; Campo, Rebecca; Drews, Frank; Lebar, Beth

2007-01-01

Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.

Towards ethical decision support and knowledge management in neonatal intensive care.

PubMed

Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

2004-01-01

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

Implementing an evidence-based computerized decision support system linked to electronic health records to improve care for cancer patients: the ONCO-CODES study protocol for a randomized controlled trial.

PubMed

Moja, Lorenzo; Passardi, Alessandro; Capobussi, Matteo; Banzi, Rita; Ruggiero, Francesca; Kwag, Koren; Liberati, Elisa Giulia; Mangia, Massimo; Kunnamo, Ilkka; Cinquini, Michela; Vespignani, Roberto; Colamartini, Americo; Di Iorio, Valentina; Massa, Ilaria; González-Lorenzo, Marien; Bertizzolo, Lorenzo; Nyberg, Peter; Grimshaw, Jeremy; Bonovas, Stefanos; Nanni, Oriana

2016-11-25

Computerized decision support systems (CDSSs) are computer programs that provide doctors with person-specific, actionable recommendations, or management options that are intelligently filtered or presented at appropriate times to enhance health care. CDSSs might be integrated with patient electronic health records (EHRs) and evidence-based knowledge. The Computerized DEcision Support in ONCOlogy (ONCO-CODES) trial is a pragmatic, parallel group, randomized controlled study with 1:1 allocation ratio. The trial is designed to evaluate the effectiveness on clinical practice and quality of care of a multi-specialty collection of patient-specific reminders generated by a CDSS in the IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) hospital. We hypothesize that the intervention can increase clinician adherence to guidelines and, eventually, improve the quality of care offered to cancer patients. The primary outcome is the rate at which the issues reported by the reminders are resolved, aggregating specialty and primary care reminders. We will include all the patients admitted to hospital services. All analyses will follow the intention-to-treat principle. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in cancer hospitals, thereby informing healthcare policy about the potential role of CDSS use. Furthermore, the study will inform whether CDSS may facilitate the integration of primary care in cancer settings, known to be usually limited. The increasing use of and familiarity with advanced technology among new generations of physicians may support integrated approaches to be tested in pragmatic studies determining the optimal interface between primary and oncology care. ClinicalTrials.gov, NCT02645357.

Evolution and Evaluation of ECG Interpretation Systems-An Illustration of the Validation of Decision Support Systems

PubMed Central

van Bemmel, Jan H.; Kors, Jan A.; Willems, Jos L.; van Herpen, Gerard

1990-01-01

The last decade has shown a growing interest in medical decision making, strongly stimulated by the advent of artificial intelligence. This wave of interest is not the first one; it was preceded by other models and approaches to medical decision support. However, not all developments have resulted in equally successful decision support systems. Positive exceptions are the interpretation systems for ECGs that evolved all the way from very primitive attempts to well-accepted and highly-computerized clinical systems for which a major evaluation study (CSE, Common Standards for Quantitative Electrocardiography) is finalized in 1990. The evolution and the evaluation of the systems that took part in this study, is the subject of this paper.

Evaluation of Internet-Based Clinical Decision Support Systems

PubMed Central

Thomas, Karl W; Dayton, Charles S

1999-01-01

Background Scientifically based clinical guidelines have become increasingly used to educate physicians and improve quality of care. While individual guidelines are potentially useful, repeated studies have shown that guidelines are ineffective in changing physician behavior. The Internet has evolved as a potentially useful tool for guideline education, dissemination, and implementation because of its open standards and its ability to provide concise, relevant clinical information at the location and time of need. Objective Our objective was to develop and test decision support systems (DSS) based on clinical guidelines which could be delivered over the Internet for two disease models: asthma and tuberculosis (TB) preventive therapy. Methods Using open standards of HTML and CGI, we developed an acute asthma severity assessment DSS and a preventative tuberculosis treatment DSS based on content from national guidelines that are recognized as standards of care. Both DSS's are published on the Internet and operate through a decision algorithm developed from the parent guidelines with clinical information provided by the user at the point of clinical care. We tested the effectiveness of each DSS in influencing physician decisions using clinical scenario testing. Results We first validated the asthma algorithm by comparing asthma experts' decisions with the decisions reached by nonpulmonary nurses using the computerized DSS. Using the DSS, nurses scored the same as experts (89% vs. 88%; p = NS). Using the same scenario test instrument, we next compared internal medicine residents using the DSS with residents using a printed version of the National Asthma Education Program-2 guidelines. Residents using the computerized DSS scored significantly better than residents using the paper-based guidelines (92% vs. 84%; p <0.002). We similarly compared residents using the computerized TB DSS to residents using a printed reference card; the residents using the computerized DSS scored significantly better (95.8% vs. 56.6% correct; p<0.001). Conclusions Previous work has shown that guidelines disseminated through traditional educational interventions have minimal impact on physician behavior. Although computerized DSS have been effective in altering physician behavior, many of these systems are not widely available. We have developed two clinical DSS's based on national guidelines and published them on the Internet. Both systems improved physician compliance with national guidelines when tested in clinical scenarios. By providing information that is coupled to relevant activity, we expect that these widely available DSS's will serve as effective educational tools to positively impact physician behavior. PMID:11720915

Critical factors influencing physicians' intention to use computerized clinical practice guidelines: an integrative model of activity theory and the technology acceptance model.

PubMed

Hsiao, Ju-Ling; Chen, Rai-Fu

2016-01-16

With the widespread use of information communication technologies, computerized clinical practice guidelines are developed and considered as effective decision supporting tools in assisting the processes of clinical activities. However, the development of computerized clinical practice guidelines in Taiwan is still at the early stage and acceptance level among major users (physicians) of computerized clinical practice guidelines is not satisfactory. This study aims to investigate critical factors influencing physicians' intention to computerized clinical practice guideline use through an integrative model of activity theory and the technology acceptance model. The survey methodology was employed to collect data from physicians of the investigated hospitals that have implemented computerized clinical practice guidelines. A total of 505 questionnaires were sent out, with 238 completed copies returned, indicating a valid response rate of 47.1 %. The collected data was then analyzed by structural equation modeling technique. The results showed that attitudes toward using computerized clinical practice guidelines (γ = 0.451, p < 0.001), organizational support (γ = 0.285, p < 0.001), perceived usefulness of computerized clinical practice guidelines (γ = 0.219, p < 0.05), and social influence (γ = 0.213, p < 0.05) were critical factors influencing physicians' intention to use computerized clinical practice guidelines, and these factors can explain 68.6 % of the variance in intention to use computerized clinical practice guidelines. This study confirmed that some subject (human) factors, environment (organization) factors, tool (technology) factors mentioned in the activity theory should be carefully considered when introducing computerized clinical practice guidelines. Managers should pay much attention on those identified factors and provide adequate resources and incentives to help the promotion and use of computerized clinical practice guidelines. Through the appropriate use of computerized clinical practice guidelines, the clinical benefits, particularly in improving quality of care and facilitating the clinical processes, will be realized.

Accounting Information Systems in Healthcare: A Review of the Literature.

PubMed

Hammour, Hadal; Househ, Mowafa; Razzak, Hira Abdul

2017-01-01

As information technology progresses in Saudi Arabia, the manual accounting systems have become graduallyinadequate for decision needs. Subsequently, private and public healthcare divisions in Saudi Arabia perceive Computerized accounting information system (CAIS) as a vehicle to safeguard efficient and effective flow of information during the analysis, processes, and recording of financial data. Efficient and effective flow of information improvesthe decision making of staff, thereby improving the capability of health care sectors to reduce cost of the medical services.In this paper, we define computerized accounting systems from the point of view of health informatics. Also, the challenges and benefits of supporting CAIS applications in hospitals of Saudi Arabia. With these elements, we conclude that CAIS in Saudi Arabia can serve as a valuable tool for evaluating and controlling the cost of medical services in healthcare sectors. Supplementary education on the significance of having systems of computerized accounting within hospitals for nurses, doctors, and accountants with other health care staff is warranted in future.

An Integrated Computerized Triage System in the Emergency Department

PubMed Central

Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

2008-01-01

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients. PMID:18999190

A Cognitive Task Analysis of Information Management Strategies in a Computerized Provider Order Entry Environment

PubMed Central

Weir, Charlene R.; Nebeker, Jonathan J.R.; Hicken, Bret L.; Campo, Rebecca; Drews, Frank; LeBar, Beth

2007-01-01

Objective Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Design Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Measurements Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Results Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Conclusion Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system. PMID:17068345

Effectiveness of computerized clinical decision support systems for asthma and chronic obstructive pulmonary disease in primary care: a systematic review.

PubMed

Fathima, Mariam; Peiris, David; Naik-Panvelkar, Pradnya; Saini, Bandana; Armour, Carol Lyn

2014-12-02

The use of computerized clinical decision support systems may improve the diagnosis and ongoing management of chronic diseases, which requires recurrent visits to multiple health professionals, disease and medication monitoring and modification of patient behavior. The aim of this review was to systematically review randomized controlled trials evaluating the effectiveness of computerized clinical decision systems (CCDSS) in the care of people with asthma and COPD. Randomized controlled trials published between 2003 and 2013 were searched using multiple electronic databases Medline, EMBASE, CINAHL, IPA, Informit, PsychINFO, Compendex, and Cochrane Clinical Controlled Trials Register databases. To be included, RCTs had to evaluate the role of the CCDSSs for asthma and/or COPD in primary care. Nineteen studies representing 16 RCTs met our inclusion criteria. The majority of the trials were conducted in patients with asthma. Study quality was generally high. Meta-analysis was not conducted because of methodological and clinical heterogeneity. The use of CCDSS improved asthma and COPD care in 14 of the 19 studies reviewed (74%). Nine of the nineteen studies showed statistically significant (p < 0.05) improvement in the primary outcomes measured. The majority of the studies evaluated health care process measures as their primary outcomes (10/19). Evidence supports the effectiveness of CCDSS in the care of people with asthma. However there is very little information of its use in COPD care. Although there is considerable improvement in the health care process measures and clinical outcomes through the use of CCDSSs, its effects on user workload and efficiency, safety, costs of care, provider and patient satisfaction remain understudied.

Exploring the possibility of modeling a genetic counseling guideline using agile methodology.

PubMed

Choi, Jeeyae

2013-01-01

Increased demand of genetic counseling services heightened the necessity of a computerized genetic counseling decision support system. In order to develop an effective and efficient computerized system, modeling of genetic counseling guideline is an essential step. Throughout this pilot study, Agile methodology with United Modeling Language (UML) was utilized to model a guideline. 13 tasks and 14 associated elements were extracted. Successfully constructed conceptual class and activity diagrams revealed that Agile methodology with UML was a suitable tool to modeling a genetic counseling guideline.

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

PubMed

Heffner, John E; Brower, Kathleen; Ellis, Rosemary; Brown, Shirley

2004-07-01

The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.

PubMed

Kawamoto, Kensaku; Lobach, David F

2003-01-01

Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) most effective at modifying clinician behavior. For this review, two independent reviewers systematically identified randomized controlled trials that evaluated the effectiveness of CPOE-based CDSSs in changing clinician behavior. Furthermore, each included study was assessed for the presence of 14 CDSS features. We screened 10,023 citations and included 11 studies. Of the 10 studies comparing a CPOE-based CDSS intervention against a non-CDSS control group, 7 reported a significant desired change in professional practice. Moreover, meta-regression analysis revealed that automatic provision of the decision support was strongly associated with improved professional practice (adjusted odds ratio, 23.72; 95% confidence interval, 1.75-infiniti). Thus, we conclude that automatic provision of decision support is a critical feature of successful CPOE-based CDSS interventions.

Significant reduction in red blood cell transfusions in a general hospital after successful implementation of a restrictive transfusion policy supported by prospective computerized order auditing.

PubMed

Yerrabothala, Swaroopa; Desrosiers, Kevin P; Szczepiorkowski, Zbigniew M; Dunbar, Nancy M

2014-10-01

Our hospital transfusion policy was recently revised to recommend single-unit red blood cell transfusion (RBC TXN) for nonbleeding inpatients when the hemoglobin (Hb) level is not more than 7 g/dL. Our computerized provider order entry system was reconfigured to provide real-time decision support using prospective computerized order auditing based on the most recent Hb level and to remove the single-click ordering option for 2-unit RBC TXNs to enhance compliance. This study was undertaken to assess the impact of these changes on hospital transfusion practice. This study analyzed the total number of transfusion events, proportion of single and 2-unit transfusions and the Hb transfusion trigger in the preimplementation period (October 2011-March 2012) compared to the postimplementation period (October 2012-March 2013). In the postimplementation period the total number of RBC units transfused/1000 patient-days decreased from 60.8 to 44.2 (p < 0.0001). The proportion of 2-unit TXNs decreased from 47% to 15% (p < 0.0001). We also observed significant decreases in pretransfusion Hb triggers. Implementation of restrictive transfusion policy supported by prospective computerized order auditing has resulted in significantly decreased RBC utilization at our institution. © 2014 AABB.

Assessment of readiness for clinical decision support to aid laboratory monitoring of immunosuppressive care at U.S. liver transplant centers.

PubMed

Jacobs, J; Weir, C; Evans, R S; Staes, C

2014-01-01

Following liver transplantation, patients require lifelong immunosuppressive care and monitoring. Computerized clinical decision support (CDS) has been shown to improve post-transplant immunosuppressive care processes and outcomes. The readiness of transplant information systems to implement computerized CDS to support post-transplant care is unknown. a) Describe the current clinical information system functionality and manual and automated processes for laboratory monitoring of immunosuppressive care, b) describe the use of guidelines that may be used to produce computable logic and the use of computerized alerts to support guideline adherence, and c) explore barriers to implementation of CDS in U.S. liver transplant centers. We developed a web-based survey using cognitive interviewing techniques. We surveyed 119 U.S. transplant programs that performed at least five liver transplantations per year during 2010-2012. Responses were summarized using descriptive analyses; barriers were identified using qualitative methods. Respondents from 80 programs (67% response rate) completed the survey. While 98% of programs reported having an electronic health record (EHR), all programs used paper-based manual processes to receive or track immunosuppressive laboratory results. Most programs (85%) reported that 30% or more of their patients used external laboratories for routine testing. Few programs (19%) received most external laboratory results as discrete data via electronic interfaces while most (80%) manually entered laboratory results into the EHR; less than half (42%) could integrate internal and external laboratory results. Nearly all programs had guidelines regarding pre-specified target ranges (92%) or testing schedules (97%) for managing immunosuppressive care. Few programs used computerized alerting to notify transplant coordinators of out-of-range (27%) or overdue laboratory results (20%). Use of EHRs is common, yet all liver transplant programs were largely dependent on manual paper-based processes to monitor immunosuppression for post-liver transplant patients. Similar immunosuppression guidelines provide opportunities for sharing CDS once integrated laboratory data are available.

Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System

PubMed Central

Beccaro, M. A. Del; Villanueva, R.; Knudson, K. M.; Harvey, E. M.; Langle, J. M.; Paul, W.

2010-01-01

Objective We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. Measurement/Results Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors. Conclusion We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors PMID:23616845

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

PubMed

Militello, Laura G; Saleem, Jason J; Borders, Morgan R; Sushereba, Christen E; Haverkamp, Donald; Wolf, Steven P; Doebbeling, Bradley N

2016-03-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise

PubMed Central

Militello, Laura G.; Saleem, Jason J.; Borders, Morgan R.; Sushereba, Christen E.; Haverkamp, Donald; Wolf, Steven P.; Doebbeling, Bradley N.

2016-01-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration’s EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability. PMID:26973441

Evaluation of a Computerized Clinical Information System (Micromedex).

PubMed Central

Lundsgaarde, H. P.; Moreshead, G. E.

1991-01-01

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database. PMID:1807583

Evaluation of a Computerized Clinical Information System (Micromedex).

PubMed

Lundsgaarde, H P; Moreshead, G E

1991-01-01

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database.

Computerized Decision Support System Improves Fluid Resuscitation Outcomes Following Severe Burns: An Original Study

DTIC Science & Technology

2011-01-01

clinical decision- making paradigms, coupled with regula- tory and technical limitations, is just one of the hurdles that has kept advanced information...responses to assist care personnel during the resuscitation phase. CDSSs have been successfully used in the clinical setting for several years (23–24...because of clinical complications, death, or other factors were excluded. The control cohort included only patients who sur- vived for the initial 24

Medication-related clinical decision support in computerized provider order entry systems: a review.

PubMed

Kuperman, Gilad J; Bobb, Anne; Payne, Thomas H; Avery, Anthony J; Gandhi, Tejal K; Burns, Gerard; Classen, David C; Bates, David W

2007-01-01

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals. Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

What can Natural Language Processing do for Clinical Decision Support?

PubMed Central

Demner-Fushman, Dina; Chapman, Wendy W.; McDonald, Clement J.

2009-01-01

Computerized Clinical Decision Support (CDS) aims to aid decision making of health care providers and the public by providing easily accessible health-related information at the point and time it is needed. Natural Language Processing (NLP) is instrumental in using free-text information to drive CDS, representing clinical knowledge and CDS interventions in standardized formats, and leveraging clinical narrative. The early innovative NLP research of clinical narrative was followed by a period of stable research conducted at the major clinical centers and a shift of mainstream interest to biomedical NLP. This review primarily focuses on the recently renewed interest in development of fundamental NLP methods and advances in the NLP systems for CDS. The current solutions to challenges posed by distinct sublanguages, intended user groups, and support goals are discussed. PMID:19683066

Sustained User Engagement in Health Information Technology: The Long Road from Implementation to System Optimization of Computerized Physician Order Entry and Clinical Decision Support Systems for Prescribing in Hospitals in England.

PubMed

Cresswell, Kathrin M; Lee, Lisa; Mozaffar, Hajar; Williams, Robin; Sheikh, Aziz

2017-10-01

To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. Six hospitals in England, United Kingdom. Qualitative case study. We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals. Thematic analysis was initially undertaken within individual cases, followed by cross-case comparisons. We conducted 173 interviews, conducted 24 observations, and collected 17 documents between 2011 and 2015. We found that perceived individual and safety benefits among different user groups tended to facilitate engagement in some, while other less engaged groups developed resistance and unsanctioned workarounds if systems were perceived to be inadequate. We identified both the opportunity and need for sustained engagement across user groups around system enhancement (e.g., through customizing software) and the development of user competencies and effective use. There is an urgent need to move away from an episodic view of engagement focused on the preimplementation phase, to more continuous holistic attempts to engage with and respond to end-users. © Health Research and Educational Trust.

The effectiveness of computerized drug-lab alerts: a systematic review and meta-analysis.

PubMed

Bayoumi, Imaan; Al Balas, Mosab; Handler, Steven M; Dolovich, Lisa; Hutchison, Brian; Holbrook, Anne

2014-06-01

Inadequate lab monitoring of drugs is a potential cause of ADEs (adverse drug events) which is remediable. To determine the effectiveness of computerized drug-lab alerts to improve medication-related outcomes. Citations from the Computerized Clinical Decision Support System Systematic Review (CCDSSR) and MMIT (Medications Management through Health Information Technology) databases, which had searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts from 1974 to March 27, 2013. Randomized controlled trials (RCTs) of clinician-targeted computerized drug lab alerts conducted in any healthcare setting. Two reviewers performed full text review to determine study eligibility. A single reviewer abstracted data and evaluated validity of included studies using Cochrane handbook domains. Thirty-six studies met the inclusion criteria (25 single drug studies with 22,504 participants, 14 targeting anticoagulation; 11 multi-drug studies with 56,769 participants). ADEs were reported as an outcome in only four trials, all targeting anticoagulants. Computerized drug-lab alerts did not reduce ADEs (OR 0.89, 95% CI 0.79-1.00, p=0.05), length of hospital stay (SMD 0.00, 95%CI -0.93 to 0.93, p=0.055, 1 study), likelihood of hypoglycemia (OR 1.29, 95% CI 0.31-5.37) or likelihood of bleeding, but were associated with increased likelihood of prescribing changes (OR 1.73, 95% CI 1.21-2.47) or lab monitoring (OR 1.47, 95% confidence interval 1.12-1.94) in accordance with the alert. There is no evidence that computerized drug-lab alerts are associated with important clinical benefits, but there is evidence of improvement in selected clinical surrogate outcomes (time in therapeutic range for vitamin K antagonists), and changes in process outcomes (lab monitoring and prescribing decisions). Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Identifying design considerations for a shared decision aid for use at the point of outpatient clinical care: An ethnographic study at an inner city clinic.

PubMed

Hajizadeh, Negin; Perez Figueroa, Rafael E; Uhler, Lauren M; Chiou, Erin; Perchonok, Jennifer E; Montague, Enid

2013-03-06

Computerized decision aids could facilitate shared decision-making at the point of outpatient clinical care. The objective of this study was to investigate whether a computerized shared decision aid would be feasible to implement in an inner-city clinic by evaluating the current practices in shared decision-making, clinicians' use of computers, patient and clinicians' attitudes and beliefs toward computerized decision aids, and the influence of time on shared decision-making. Qualitative data analysis of observations and semi-structured interviews with patients and clinicians at an inner-city outpatient clinic. The findings provided an exploratory look at the prevalence of shared decision-making and attitudes about health information technology and decision aids. A prominent barrier to clinicians engaging in shared decision-making was a lack of perceived patient understanding of medical information. Some patients preferred their clinicians make recommendations for them rather than engage in formal shared decision-making. Health information technology was an integral part of the clinic visit and welcomed by most clinicians and patients. Some patients expressed the desire to engage with health information technology such as viewing their medical information on the computer screen with their clinicians. All participants were receptive to the idea of a decision aid integrated within the clinic visit although some clinicians were concerned about the accuracy of prognostic estimates for complex medical problems. We identified several important considerations for the design and implementation of a computerized decision aid including opportunities to: bridge clinician-patient communication about medical information while taking into account individual patients' decision-making preferences, complement expert clinician judgment with prognostic estimates, take advantage of patient waiting times, and make tasks involved during the clinic visit more efficient. These findings should be incorporated into the design and implementation of a computerized shared decision aid at an inner-city hospital.

Use of mobile devices in the emergency department: A scoping review.

PubMed

Dexheimer, Judith W; Borycki, Elizabeth M

2015-12-01

Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated. © The Author(s) 2014.

The evolution of the market for commercial computerized physician order entry and computerized decision support systems for prescribing.

PubMed

Mozaffar, Hajar; Williams, Robin; Cresswell, Kathrin; Morrison, Zoe; Bates, David W; Sheikh, Aziz

2016-03-01

To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals. Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England. The authors collected data from semi-structured interviews with 11 individuals from 4 vendors, including the 2 most entrenched suppliers, and 6 adopter hospitals, and 21 h of ethnographic observation of 2 user groups, and 1 vendor event. The research and analysis was informed by insights from studies of the evolution of technology fields and the emergence of generic COTS enterprise solutions. Four key themes emerged: (1) adoption of systems that had been developed outside of England, (2) vendors' configuration and customization strategies, (3) localized adopter practices vs generic systems, and (4) unrealistic adopter demands. Evidence for our over-arching finding concerning the current immaturity of the market was derived from vendors' strategies, adopters' reactions to the technology, and policy makers' incomplete insights. The CPOE/CDS market in England is still in an emergent phase. The rapid entrance of diverse products, triggered by federal policy initiatives, has resulted in premature adoption of systems that do not yet adequately meet the needs of hospitals. Vendors and adopters lacked understanding of how to design and implement generic solutions to meet diverse user needs. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.

PubMed

Roshanov, Pavel S; Misra, Shikha; Gerstein, Hertzel C; Garg, Amit X; Sebaldt, Rolf J; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.

Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review

PubMed Central

2011-01-01

Background The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes. PMID:21824386

Computerized Support of the Pretrial Confinement Decision-Making Process in the Marine Corps.

DTIC Science & Technology

1988-03-01

Books Inc., Blue Ridge Summit, Pennsylvania, 1986. 7. Pressman , R.S., Software Engineering: A Practitioner’s Approach, Second Edition, McGraw-Hill Book...Lieutenant Commander Barry Frew, Code 54Fw 2 Naval Postgraduate School Monterey, California 93943-500 150 NIN U1 W 40 I U n

Modeling the Bullying Prevention Program Preferences of Educators: A Discrete Choice Conjoint Experiment

ERIC Educational Resources Information Center

Cunningham, Charles E.; Vaillancourt, Tracy; Rimas, Heather; Deal, Ken; Cunningham, Lesley; Short, Kathy; Chen, Yvonne

2009-01-01

We used discrete choice conjoint analysis to model the bullying prevention program preferences of educators. Using themes from computerized decision support lab focus groups (n = 45 educators), we composed 20 three-level bullying prevention program design attributes. Each of 1,176 educators completed 25 choice tasks presenting experimentally…

A Pilot Study of a Computerized Decision Support System to Detect Invasive Fungal Infection in Pediatric Hematology/Oncology Patients.

PubMed

Bartlett, Adam; Goeman, Emma; Vedi, Aditi; Mostaghim, Mona; Trahair, Toby; O'Brien, Tracey A; Palasanthiran, Pamela; McMullan, Brendan

2015-11-01

Computerized decision support systems (CDSSs) can provide indication-specific antimicrobial recommendations and approvals as part of hospital antimicrobial stewardship (AMS) programs. The aim of this study was to assess the performance of a CDSS for surveillance of invasive fungal infections (IFIs) in an inpatient hematology/oncology cohort. Between November 1, 2012, and October 31, 2013, pediatric hematology/oncology inpatients diagnosed with an IFI were identified through an audit of the CDSS and confirmed by medical record review. The results were compared to hospital diagnostic-related group (DRG) coding for IFI throughout the same period. A total of 83 patients were prescribed systemic antifungals according to the CDSS for the 12-month period. The CDSS correctly identified 19 patients with IFI on medical record review, compared with 10 patients identified by DRG coding, of whom 9 were confirmed to have IFI on medical record review. CDSS was superior to diagnostic coding in detecting IFI in an inpatient pediatric hematology/oncology cohort. The functionality of CDSS lends itself to inpatient infectious diseases surveillance but depends on prescriber adherence.

Cognitive Analysis of Decision Support for Antibiotic Prescribing at the Point of Ordering in a Neonatal Intensive Care Unit

PubMed Central

Sheehan, Barbara; Kaufman, David; Stetson, Peter; Currie, Leanne M.

2009-01-01

Computerized decision support systems have been used to help ensure safe medication prescribing. However, the acceptance of these types of decision support has been reported to be low. It has been suggested that decreased acceptance may be due to lack of clinical relevance. Additionally, cognitive fit between the user interface and clinical task may impact the response of clinicians as they interact with the system. In order to better understand clinician responses to such decision support, we used cognitive task analysis methods to evaluate clinical alerts for antibiotic prescribing in a neonatal intensive care unit. Two methods were used: 1) a cognitive walkthrough; and 2) usability testing with a ‘think-aloud’ protocol. Data were analyzed for impact on cognitive effort according to categories of cognitive distance. We found that responses to alerts may be context specific and that lack of screen cues often increases cognitive effort required to use a system. PMID:20351922

Will Decision Support in Medications Order Entry Save Money? A Return On Investment Analysis of the Case of the Hong Kong Hospital Authority

PubMed Central

Fung, Kin Wah; Vogel, Lynn Harold

2003-01-01

The computerized medications order entry system currently used in the public hospitals of Hong Kong does not have decision support features. Plans are underway to add decision support to this system to alert physicians on drug-allergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical dosages. A return on investment analysis is done on this enhancement, both as an examination of whether there is a positive return on the investment and as a contribution to the ongoing discussion of the use of return on investment models in health care information technology investments. It is estimated that the addition of decision support will reduce adverse drug events by 4.2 – 8.4%. Based on this estimate, a total net saving of $44,000 – $586,000 is expected over five years. The breakeven period is estimated to be between two to four years. PMID:14728171

Health technology assessment review: Computerized glucose regulation in the intensive care unit - how to create artificial control

PubMed Central

2009-01-01

Current care guidelines recommend glucose control (GC) in critically ill patients. To achieve GC, many ICUs have implemented a (nurse-based) protocol on paper. However, such protocols are often complex, time-consuming, and can cause iatrogenic hypoglycemia. Computerized glucose regulation protocols may improve patient safety, efficiency, and nurse compliance. Such computerized clinical decision support systems (Cuss) use more complex logic to provide an insulin infusion rate based on previous blood glucose levels and other parameters. A computerized CDSS for glucose control has the potential to reduce overall workload, reduce the chance of human cognitive failure, and improve glucose control. Several computer-assisted glucose regulation programs have been published recently. In order of increasing complexity, the three main types of algorithms used are computerized flowcharts, Proportional-Integral-Derivative (PID), and Model Predictive Control (MPC). PID is essentially a closed-loop feedback system, whereas MPC models the behavior of glucose and insulin in ICU patients. Although the best approach has not yet been determined, it should be noted that PID controllers are generally thought to be more robust than MPC systems. The computerized Cuss that are most likely to emerge are those that are fully a part of the routine workflow, use patient-specific characteristics and apply variable sampling intervals. PMID:19849827

Knowledge Translation of the PERC Rule for Suspected Pulmonary Embolism: A Blueprint for Reducing the Number of CT Pulmonary Angiograms.

PubMed

Drescher, Michael J; Fried, Jeremy; Brass, Ryan; Medoro, Amanda; Murphy, Timothy; Delgado, João

2017-10-01

Computerized decision support decreases the number of computed tomography pulmonary angiograms (CTPA) for pulmonary embolism (PE) ordered in emergency departments, but it is not always well accepted by emergency physicians. We studied a department-endorsed, evidence-based clinical protocol that included the PE rule-out criteria (PERC) rule, multi-modal education using principles of knowledge translation (KT), and clinical decision support embedded in our order entry system, to decrease the number of unnecessary CTPA ordered. We performed a historically controlled observational before-after study for one year pre- and post-implementation of a departmentally-endorsed protocol. We included patients > 18 in whom providers suspected PE and who did not have a contraindication to CTPA. Providers entered clinical information into a diagnostic pathway via computerized order entry. Prior to protocol implementation, we provided education to ordering providers. The primary outcome measure was the number of CTPA ordered per 1,000 visits one year before vs. after implementation. CTPA declined from 1,033 scans for 98,028 annual visits (10.53 per 1,000 patient visits (95% CI [9.9-11.2]) to 892 scans for 101,172 annual visits (8.81 per 1,000 patient visits (95% CI [8.3-9.4]) p<0.001. The absolute reduction in PACT ordered was 1.72 per 1,000 visits (a 16% reduction). Patient characteristics were similar for both periods. Knowledge translation clinical decision support using the PERC rule significantly reduced the number of CTPA ordered.

Towards meaningful medication-related clinical decision support: recommendations for an initial implementation.

PubMed

Phansalkar, S; Wright, A; Kuperman, G J; Vaida, A J; Bobb, A M; Jenders, R A; Payne, T H; Halamka, J; Bloomrosen, M; Bates, D W

2011-01-01

Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

Who Can Afford a Computerized Bookstore? Almost Anyone.

ERIC Educational Resources Information Center

Miller, Charles

1982-01-01

The decision to computerize operations in the DeAnza Community College bookstore was followed by a number of decisions about financing options (purchase, lease/purchase, lease, timesharing). A timesharing agreement was reached with a local bank, with no capital outlay and at a cost equivalent to an accountant's position. (MSE)

Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial

PubMed Central

Sequist, Thomas D.; Ayanian, John Z.; Shaykevich, Shimon; Fairchild, David G.; Orav, E. John; Bates, David W.

2008-01-01

BACKGROUND We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients. METHODS We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients’ race/ethnicity using interaction terms. MEASUREMENTS AND MAIN RESULTS Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients’ demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P < 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13–1.72]) and the effects of the intervention did not differ by patients’ race and ethnicity. CONCLUSIONS CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed. PMID:18373141

A Recommendation Algorithm for Automating Corollary Order Generation

PubMed Central

Klann, Jeffrey; Schadow, Gunther; McCoy, JM

2009-01-01

Manual development and maintenance of decision support content is time-consuming and expensive. We explore recommendation algorithms, e-commerce data-mining tools that use collective order history to suggest purchases, to assist with this. In particular, previous work shows corollary order suggestions are amenable to automated data-mining techniques. Here, an item-based collaborative filtering algorithm augmented with association rule interestingness measures mined suggestions from 866,445 orders made in an inpatient hospital in 2007, generating 584 potential corollary orders. Our expert physician panel evaluated the top 92 and agreed 75.3% were clinically meaningful. Also, at least one felt 47.9% would be directly relevant in guideline development. This automated generation of a rough-cut of corollary orders confirms prior indications about automated tools in building decision support content. It is an important step toward computerized augmentation to decision support development, which could increase development efficiency and content quality while automatically capturing local standards. PMID:20351875

A recommendation algorithm for automating corollary order generation.

PubMed

Klann, Jeffrey; Schadow, Gunther; McCoy, J M

2009-11-14

Manual development and maintenance of decision support content is time-consuming and expensive. We explore recommendation algorithms, e-commerce data-mining tools that use collective order history to suggest purchases, to assist with this. In particular, previous work shows corollary order suggestions are amenable to automated data-mining techniques. Here, an item-based collaborative filtering algorithm augmented with association rule interestingness measures mined suggestions from 866,445 orders made in an inpatient hospital in 2007, generating 584 potential corollary orders. Our expert physician panel evaluated the top 92 and agreed 75.3% were clinically meaningful. Also, at least one felt 47.9% would be directly relevant in guideline development. This automated generation of a rough-cut of corollary orders confirms prior indications about automated tools in building decision support content. It is an important step toward computerized augmentation to decision support development, which could increase development efficiency and content quality while automatically capturing local standards.

Affective influences on partner choice: role of mood in social decisions.

PubMed

Forgas, J P

1991-11-01

Does mood influence our information search and decision strategies when choosing a partner? In Experiment 1 (N = 60), sad Ss preferred rewarding to competent partners and remembered information supporting that choice better. In Experiment 2 (N = 96), mood effects on information selectivity, decision speed, and processing strategy in partner choices were found. In Experiment 3 (N = 42), a computerized stimulus presentation revealed mood-induced differences in the latency, self-exposure, and eventual recall of interpersonal information. These results are interpreted as evidence for mood-induced selectivity in information search and decision strategies when making realistic partner choices. The implications of the findings for research on interpersonal relations and for contemporary affect-cognition theories are considered.

Emergency physicians' attitudes and preferences regarding computed tomography, radiation exposure, and imaging decision support.

PubMed

Griffey, Richard T; Jeffe, Donna B; Bailey, Thomas

2014-07-01

Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians' (EPs') preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. A 42-item, Web-based survey of EPs was developed and used to measure EPs' attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach's alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient's cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients' cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients' cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs' greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP's decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization. © 2014 by the Society for Academic Emergency Medicine.

Emergency Physicians’ Attitudes and Preferences Regarding Computed Tomography, Radiation Exposure, and Imaging Decision Support

PubMed Central

Griffey, Richard T.; Jeffe, Donna B.; Bailey, Thomas

2014-01-01

Objectives Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians’ (EPs’) preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. Methods A 42-item, Web-based survey of EPs was developed and used to measure EPs’ attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach’s alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. Results Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient’s cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients’ cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients’ cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs’ greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP’s decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. Conclusions Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization. PMID:25125272

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... computerized support enforcement systems. 307.15 Section 307.15 Public Welfare Regulations Relating to Public... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS § 307.15 Approval of advance planning documents for computerized support enforcement systems. (a...

M.E.T.R.O.-Apex Gaming Simulation, Volume 28 (OS/360 Version).

ERIC Educational Resources Information Center

Michigan Univ., Ann Arbor. Environmental Simulation Lab.

Operator's instructions and technical support materials needed for processing the M.E.T.R.O.-APEX (Air Pollution Exercise) game decisions on an IBM 360 computer are compiled in this volume. M.E.T.R.O.-APEX is a computerized college and professional level "real world" simulation of a community with urban and rural problems, industrial activities,…

[Use of the computer as a tool for the implementation of the nursing process--the experience of the Sâo Paulo/UNIFESP].

PubMed

de Barros, Alba Lúcia; Fakih, Flávio Trevisani; Michel, Jeanne Liliane

2002-01-01

This article reports the pathway used to build a prototype of a computer nurse's clinical decision making support system, using NANDA, NIC and NOC classifications, as an auxiliary tool in the insertion of nursing data in the computerized patient record of Hospital São Paulo/UNIFESP.

Effectiveness of Computerized Decision Support Systems Linked to Electronic Health Records: A Systematic Review and Meta-Analysis

PubMed Central

Kwag, Koren H.; Lytras, Theodore; Bertizzolo, Lorenzo; Brandt, Linn; Pecoraro, Valentina; Rigon, Giulio; Vaona, Alberto; Ruggiero, Francesca; Mangia, Massimo; Iorio, Alfonso; Kunnamo, Ilkka; Bonovas, Stefanos

2014-01-01

We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I2 = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I2 = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. PMID:25322302

Automation of orbit determination functions for National Aeronautics and Space Administration (NASA)-supported satellite missions

NASA Technical Reports Server (NTRS)

Mardirossian, H.; Beri, A. C.; Doll, C. E.

1990-01-01

The Flight Dynamics Facility (FDF) at Goddard Space Flight Center (GSFC) provides spacecraft trajectory determination for a wide variety of National Aeronautics and Space Administration (NASA)-supported satellite missions, using the Tracking Data Relay Satellite System (TDRSS) and Ground Spaceflight and Tracking Data Network (GSTDN). To take advantage of computerized decision making processes that can be used in spacecraft navigation, the Orbit Determination Automation System (ODAS) was designed, developed, and implemented as a prototype system to automate orbit determination (OD) and orbit quality assurance (QA) functions performed by orbit operations. Based on a machine-resident generic schedule and predetermined mission-dependent QA criteria, ODAS autonomously activates an interface with the existing trajectory determination system using a batch least-squares differential correction algorithm to perform the basic OD functions. The computational parameters determined during the OD are processed to make computerized decisions regarding QA, and a controlled recovery process is activated when the criteria are not satisfied. The complete cycle is autonomous and continuous. ODAS was extensively tested for performance under conditions resembling actual operational conditions and found to be effective and reliable for extended autonomous OD. Details of the system structure and function are discussed, and test results are presented.

Automation of orbit determination functions for National Aeronautics and Space Administration (NASA)-supported satellite missions

NASA Technical Reports Server (NTRS)

Mardirossian, H.; Heuerman, K.; Beri, A.; Samii, M. V.; Doll, C. E.

1989-01-01

The Flight Dynamics Facility (FDF) at Goddard Space Flight Center (GSFC) provides spacecraft trajectory determination for a wide variety of National Aeronautics and Space Administration (NASA)-supported satellite missions, using the Tracking Data Relay Satellite System (TDRSS) and Ground Spaceflight and Tracking Data Network (GSTDN). To take advantage of computerized decision making processes that can be used in spacecraft navigation, the Orbit Determination Automation System (ODAS) was designed, developed, and implemented as a prototype system to automate orbit determination (OD) and orbit quality assurance (QA) functions performed by orbit operations. Based on a machine-resident generic schedule and predetermined mission-dependent QA criteria, ODAS autonomously activates an interface with the existing trajectory determination system using a batch least-squares differential correction algorithm to perform the basic OD functions. The computational parameters determined during the OD are processed to make computerized decisions regarding QA, and a controlled recovery process isactivated when the criteria are not satisfied. The complete cycle is autonomous and continuous. ODAS was extensively tested for performance under conditions resembling actual operational conditions and found to be effective and reliable for extended autonomous OD. Details of the system structure and function are discussed, and test results are presented.

Independent Research and Independent Exploratory Development at the Navy Personnel Research and Development Center--Fiscal Year 1984.

DTIC Science & Technology

1985-04-01

decision aids consider the cognitive skills of human operators. Data are required on the kinds of decision strategies they invoke, their limitations in...basic electronics, memory for procedural tasks, and career-role learning by officers. Computerized decision aids for surveillance tasks and opportunities...of Navy retention incentives. Computerized aids for plain English in military documents and for tactical action officer training were also developed in

Decision support in psychiatry – a comparison between the diagnostic outcomes using a computerized decision support system versus manual diagnosis

PubMed Central

Bergman, Lars G; Fors, Uno GH

2008-01-01

Background Correct diagnosis in psychiatry may be improved by novel diagnostic procedures. Computerized Decision Support Systems (CDSS) are suggested to be able to improve diagnostic procedures, but some studies indicate possible problems. Therefore, it could be important to investigate CDSS systems with regard to their feasibility to improve diagnostic procedures as well as to save time. Methods This study was undertaken to compare the traditional 'paper and pencil' diagnostic method SCID1 with the computer-aided diagnostic system CB-SCID1 to ascertain processing time and accuracy of diagnoses suggested. 63 clinicians volunteered to participate in the study and to solve two paper-based cases using either a CDSS or manually. Results No major difference between paper and pencil and computer-supported diagnosis was found. Where a difference was found it was in favour of paper and pencil. For example, a significantly shorter time was found for paper and pencil for the difficult case, as compared to computer support. A significantly higher number of correct diagnoses were found in the diffilt case for the diagnosis 'Depression' using the paper and pencil method. Although a majority of the clinicians found the computer method supportive and easy to use, it took a longer time and yielded fewer correct diagnoses than with paper and pencil. Conclusion This study could not detect any major difference in diagnostic outcome between traditional paper and pencil methods and computer support for psychiatric diagnosis. Where there were significant differences, traditional paper and pencil methods were better than the tested CDSS and thus we conclude that CDSS for diagnostic procedures may interfere with diagnosis accuracy. A limitation was that most clinicians had not previously used the CDSS system under study. The results of this study, however, confirm that CDSS development for diagnostic purposes in psychiatry has much to deal with before it can be used for routine clinical purposes. PMID:18261222

Adaptive Decision Aiding in Computer-Assisted Instruction: Adaptive Computerized Training System (ACTS).

ERIC Educational Resources Information Center

Hopf-Weichel, Rosemarie; And Others

This report describes results of the first year of a three-year program to develop and evaluate a new Adaptive Computerized Training System (ACTS) for electronics maintenance training. (ACTS incorporates an adaptive computer program that learns the student's diagnostic and decision value structure, compares it to that of an expert, and adapts the…

Electronic information and clinical decision support for prescribing: state of play in Australian general practice

PubMed Central

Robertson, Jane; Moxey, Annette J; Newby, David A; Gillies, Malcolm B; Williamson, Margaret; Pearson, Sallie-Anne

2011-01-01

Background. Investments in eHealth worldwide have been mirrored in Australia, with >90% of general practices computerized. Recent eHealth incentives promote the use of up to date electronic information sources relevant to general practice with flexibility in mode of access. Objective. To determine GPs’ access to and use of electronic information sources and computerized clinical decision support systems (CDSSs) for prescribing. Methods. Semi-structured interviews were conducted with 18 experienced GPs and nine GP trainees in New South Wales, Australia in 2008. A thematic analysis of interview transcripts was undertaken. Results. Information needs varied with clinical experience, and people resources (specialists, GP peers and supervisors for trainees) were often preferred over written formats. Experienced GPs used a small number of electronic resources and accessed them infrequently. Familiarity from training and early clinical practice and easy access were dominant influences on resource use. Practice time constraints meant relevant information needed to be readily accessible during consultations, requiring integration or direct access from prescribing software. Quality of electronic resource content was assumed and cost a barrier for some GPs. Conclusions. The current Australian practice incentives do not prescribe which information resources GPs should use. Without integration into practice computing systems, uptake and routine use seem unlikely. CDSS developments must recognize the time pressures of practice, preference for integration and cost concerns. Minimum standards are required to ensure that high-quality information resources are integrated and regularly updated. Without standards, the anticipated benefits of computerization on patient safety and health outcomes will be uncertain. PMID:21109619

Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review.

PubMed

Hemens, Brian J; Holbrook, Anne; Tonkin, Marita; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit. We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements. CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two ‘early adopter’ hospitals

PubMed Central

Cresswell, Kathrin M; Bates, David W; Williams, Robin; Morrison, Zoe; Slee, Ann; Coleman, Jamie; Robertson, Ann; Sheikh, Aziz

2014-01-01

Objective To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in ‘early adopter’ hospitals. Materials and methods In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS. We used a combination of documentary analysis of the implementation plans, audiorecorded semistructured interviews with system users, and observations of strategic meetings and systems usage. Results We collected 11 documents, conducted 43 interviews, and conducted a total of 21.5 h of observations. We identified three major themes: (1) impacts on individual users, including greater legibility of prescriptions, but also some accounts of increased workloads; (2) the introduction of perceived new safety risks related to accessibility and usability of hardware and software, with users expressing concerns that some problems such as duplicate prescribing were more likely to occur; and (3) realizing organizational benefits through secondary uses of data. Conclusions We identified little difference in the medium-term consequences of a CPOE and a CDS system. It is important that future studies investigate the medium- and longer-term consequences of CPOE and CDS systems in a wider range of hospitals. PMID:24431334

Implementing an evidence-based computerized decision support system to improve patient care in a general hospital: the CODES study protocol for a randomized controlled trial.

PubMed

Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos

2016-07-07

Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT02577198?term=NCT02577198&rank=1.

Knowledge translation of the American College of Emergency Physicians' clinical policy on syncope using computerized clinical decision support.

PubMed

Melnick, Edward R; Genes, Nicholas G; Chawla, Neal K; Akerman, Meredith; Baumlin, Kevin M; Jagoda, Andy

2010-06-01

To influence physician practice behavior after implementation of a computerized clinical decision support system (CDSS) based upon the recommendations from the 2007 ACEP Clinical Policy on Syncope. This was a pre-post intervention with a prospective cohort and retrospective controls. We conducted a medical chart review of consecutive adult patients with syncope. A computerized CDSS prompting physicians to explain their decision-making regarding imaging and admission in syncope patients based upon ACEP Clinical Policy recommendations was embedded into the emergency department information system (EDIS). The medical records of 410 consecutive adult patients presenting with syncope were reviewed prior to implementation, and 301 records were reviewed after implementation. Primary outcomes were physician practice behavior demonstrated by admission rate and rate of head computed tomography (CT) imaging before and after implementation. There was a significant difference in admission rate pre- and post-intervention (68.1% vs. 60.5% respectively, p = 0.036). There was no significant difference in the head CT imaging rate pre- and post-intervention (39.8% vs. 43.2%, p = 0.358). There were seven physicians who saw ten or more patients during the pre- and post-intervention. Subset analysis of these seven physicians' practice behavior revealed a slight significant difference in the admission rate pre- and post-intervention (74.3% vs. 63.9%, p = 0.0495) and no significant difference in the head CT scan rate pre- and post-intervention (42.9% vs. 45.4%, p = 0.660). The introduction of an evidence-based CDSS based upon ACEP Clinical Policy recommendations on syncope correlated with a change in physician practice behavior in an urban academic emergency department. This change suggests emergency medicine clinical practice guideline recommendations can be incorporated into the physician workflow of an EDIS to enhance the quality of practice.

Development of a Tailored Intervention With Computerized Clinical Decision Support to Improve Quality of Care for Patients With Knee Osteoarthritis: Multi-Method Study.

PubMed

Van de Velde, Stijn; Kortteisto, Tiina; Spitaels, David; Jamtvedt, Gro; Roshanov, Pavel; Kunnamo, Ilkka; Aertgeerts, Bert; Vandvik, Per Olav; Flottorp, Signe

2018-06-11

Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time. ©Stijn Van de Velde, Tiina Kortteisto, David Spitaels, Gro Jamtvedt, Pavel Roshanov, Ilkka Kunnamo, Bert Aertgeerts, Per Olav Vandvik, Signe Flottorp. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 11.06.2018.

Direct and Electronic Health Record Access to the Clinical Decision Support for Immunizations in the Minnesota Immunization Information System.

PubMed

Rajamani, Sripriya; Bieringer, Aaron; Wallerius, Stephanie; Jensen, Daniel; Winden, Tamara; Muscoplat, Miriam Halstead

2016-01-01

Immunization information systems (IIS) are population-based and confidential computerized systems maintained by public health agencies containing individual data on immunizations from participating health care providers. IIS hold comprehensive vaccination histories given across providers and over time. An important aspect to IIS is the clinical decision support for immunizations (CDSi), consisting of vaccine forecasting algorithms to determine needed immunizations. The study objective was to analyze the CDSi presentation by IIS in Minnesota (Minnesota Immunization Information Connection [MIIC]) through direct access by IIS interface and by access through electronic health records (EHRs) to outline similarities and differences. The immunization data presented were similar across the three systems examined, but with varying ability to integrate data across MIIC and EHR, which impacts immunization data reconciliation. Study findings will lead to better understanding of immunization data display, clinical decision support, and user functionalities with the ultimate goal of promoting IIS CDSi to improve vaccination rates.

Information systems: the key to evidence-based health practice.

PubMed Central

Rodrigues, R. J.

2000-01-01

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

A Medical Decision Support System for the Space Station Health Maintenance Facility

PubMed Central

Ostler, David V.; Gardner, Reed M.; Logan, James S.

1988-01-01

NASA is developing a Health Maintenance Facility (HMF) to provide the equipment and supplies necessary to deliver medical care in the Space Station. An essential part of the Health Maintenance Facility is a computerized Medical Decision Support System (MDSS) that will enhance the ability of the medical officer (“paramedic” or “physician”) to maintain the crew's health, and to provide emergency medical care. The computer system has four major functions: 1) collect and integrate medical information into an electronic medical record from Space Station medical officers, HMF instrumentation, and exercise equipment; 2) provide an integrated medical record and medical reference information management system; 3) manage inventory for logistical support of supplies and secure pharmaceuticals; 4) supply audio and electronic mail communications between the medical officer and ground based flight surgeons. ImagesFigure 1

Using old technology to implement modern computer-aided decision support for primary diabetes care.

PubMed Central

Hunt, D. L.; Haynes, R. B.; Morgan, D.

2001-01-01

BACKGROUND: Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. OBJECTIVE: To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. IMPLEMENTATION: The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. CONCLUSION: Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices. PMID:11825194

Using old technology to implement modern computer-aided decision support for primary diabetes care.

PubMed

Hunt, D L; Haynes, R B; Morgan, D

2001-01-01

Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices.

Effectiveness of Computer Automation for the Diagnosis and Management of Childhood Type 2 Diabetes: A Randomized Clinical Trial.

PubMed

Hannon, Tamara S; Dugan, Tamara M; Saha, Chandan K; McKee, Steven J; Downs, Stephen M; Carroll, Aaron E

2017-04-01

Type 2 diabetes (T2D) is increasingly common in young individuals. Primary prevention and screening among children and adolescents who are at substantial risk for T2D are recommended, but implementation of T2D screening practices in the pediatric primary care setting is uncommon. To determine the feasibility and effectiveness of a computerized clinical decision support system to identify pediatric patients at high risk for T2D and to coordinate screening for and diagnosis of prediabetes and T2D. This cluster-randomized clinical trial included patients from 4 primary care pediatric clinics. Two clinics were randomized to the computerized clinical decision support intervention, aimed at physicians, and 2 were randomized to the control condition. Patients of interest included children, adolescents, and young adults 10 years or older. Data were collected from January 1, 2013, through December 1, 2016. Comparison of physician screening and follow-up practices after adding a T2D module to an existing computer decision support system. Electronic medical record (EMR) data from patients 10 years or older were reviewed to determine the rates at which pediatric patients were identified as having a body mass index (BMI) at or above the 85th percentile and 2 or more risk factors for T2D and underwent screening for T2D. Medical records were reviewed for 1369 eligible children (712 boys [52.0%] and 657 girls [48.0%]; median [interquartile range] age, 12.9 [11.2-15.3]), of whom 684 were randomized to the control group and 685 to the intervention group. Of these, 663 (48.4%) had a BMI at or above the 85th percentile. Five hundred sixty-five patients (41.3%) met T2D screening criteria, with no difference between control and intervention sites. The T2D module led to a significant increase in the percentage of patients undergoing screening for T2D (89 of 283 [31.4%] vs 26 of 282 [9.2%]; adjusted odds ratio, 4.6; 95% CI, 1.5-14.7) and a greater proportion attending a scheduled follow-up appointment (45 of 153 [29.4%] vs 38 of 201 [18.9%]; adjusted odds ratio, 1.8; 95% CI, 1.5-2.2). Use of a computerized clinical decision support system to automate the identification and screening of pediatric patients at high risk for T2D can help overcome barriers to the screening process. The support system significantly increased screening among patients who met the American Diabetes Association criteria and adherence to follow-up appointments with primary care clinicians. clinicaltrials.gov Identifier: NCT01814787.

Standard practices for computerized clinical decision support in community hospitals: a national survey

PubMed Central

McCormack, James L; Sittig, Dean F; Wright, Adam; McMullen, Carmit; Bates, David W

2012-01-01

Objective Computerized provider order entry (CPOE) with clinical decision support (CDS) can help hospitals improve care. Little is known about what CDS is presently in use and how it is managed, however, especially in community hospitals. This study sought to address this knowledge gap by identifying standard practices related to CDS in US community hospitals with mature CPOE systems. Materials and Methods Representatives of 34 community hospitals, each of which had over 5 years experience with CPOE, were interviewed to identify standard practices related to CDS. Data were analyzed with a mix of descriptive statistics and qualitative approaches to the identification of patterns, themes and trends. Results This broad sample of community hospitals had robust levels of CDS despite their small size and the independent nature of many of their physician staff members. The hospitals uniformly used medication alerts and order sets, had sophisticated governance procedures for CDS, and employed staff to customize CDS. Discussion The level of customization needed for most CDS before implementation was greater than expected. Customization requires skilled individuals who represent an emerging manpower need at this type of hospital. Conclusion These results bode well for robust diffusion of CDS to similar hospitals in the process of adopting CDS and suggest that national policies to promote CDS use may be successful. PMID:22707744

Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.

PubMed

Souza, Nathan M; Sebaldt, Rolf J; Mackay, Jean A; Prorok, Jeanette C; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Evidence supports the effectiveness of CCDSSs for screening and treatment of dyslipidaemia in primary care with less consistent evidence for CCDSSs used in screening for cancer and mental health-related conditions, vaccinations, and other preventive care. CCDSS effects on patient outcomes, safety, costs of care, and provider satisfaction remain poorly supported.

Coupling computer-interpretable guidelines with a drug-database through a web-based system – The PRESGUID project

PubMed Central

Dufour, Jean-Charles; Fieschi, Dominique; Fieschi, Marius

2004-01-01

Background Clinical Practice Guidelines (CPGs) available today are not extensively used due to lack of proper integration into clinical settings, knowledge-related information resources, and lack of decision support at the point of care in a particular clinical context. Objective The PRESGUID project (PREScription and GUIDelines) aims to improve the assistance provided by guidelines. The project proposes an online service enabling physicians to consult computerized CPGs linked to drug databases for easier integration into the healthcare process. Methods Computable CPGs are structured as decision trees and coded in XML format. Recommendations related to drug classes are tagged with ATC codes. We use a mapping module to enhance computerized guidelines coupling with a drug database, which contains detailed information about each usable specific medication. In this way, therapeutic recommendations are backed up with current and up-to-date information from the database. Results Two authoritative CPGs, originally diffused as static textual documents, have been implemented to validate the computerization process and to illustrate the usefulness of the resulting automated CPGs and their coupling with a drug database. We discuss the advantages of this approach for practitioners and the implications for both guideline developers and drug database providers. Other CPGs will be implemented and evaluated in real conditions by clinicians working in different health institutions. PMID:15053828

Evaluation of computerized decision support for oral anticoagulation management based in primary care.

PubMed

Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

1996-09-01

Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability.

Effects of computerized decision support systems on blood glucose regulation in critically ill surgical patients.

PubMed

Fogel, Sandy L; Baker, Christopher C

2013-04-01

The use of computerized decision support systems (CDSS) in glucose control for critically ill surgical patients has been reported in both diabetic and nondiabetic patients. Prospective studies evaluating its effect on glucose control are, however, lacking. The objective of this study was to evaluate patient-specific computerized IV insulin dosing on blood glucose levels (BGLs) by comparing patients treated pre-CDSS with those treated post-CDSS. A prospective study was performed in 4 surgical ICUs and 1 progressive care unit comparing patient data pre- and post-implementation of CDSS. The primary outcomes measures were the impact of the CDSS on glycemic control in this population and on reducing the incidence of severe hypoglycemia. Data on 1,682 patient admissions were evaluated, which corresponded to 73,290 BGLs post-CDSS compared with 44,972 BGLs pre-CDSS. The percentage of hyperglycemic events improved, with BGLs of >150 mg/dL decreasing by 50% compared with 6-month historical controls during the 18-month study period from July 2010 through December 2011. This was true for all 5 units individually (p < 0.0001, by one sample sign test). In addition, severe hypoglycemia (defined as BGL <40 mg/dL) decreased from 1% to 0.05% after implementing CDSS (p < 0.0001 by 2-sided binomial test). Patients whose BGLs were managed using CDSS were statistically significantly more likely to have a glucose reading under control (<150 mg/dL) than in the 6-month historical controls and to avoid serious hypoglycemia (p < 0.0001). Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

PubMed

Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W

2013-07-01

In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.

Incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models.

PubMed

Garibaldi, Jonathan M; Zhou, Shang-Ming; Wang, Xiao-Ying; John, Robert I; Ellis, Ian O

2012-06-01

It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), p<0.001. We conclude that non-stationary fuzzy models provide a valuable new approach that may be applied to clinical decision support systems in any application domain. Copyright © 2012 Elsevier Inc. All rights reserved.

"Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa.

PubMed

Blank, Antje; Prytherch, Helen; Kaltschmidt, Jens; Krings, Andreas; Sukums, Felix; Mensah, Nathan; Zakane, Alphonse; Loukanova, Svetla; Gustafsson, Lars L; Sauerborn, Rainer; Haefeli, Walter E

2013-04-10

Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.

“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa

PubMed Central

2013-01-01

Background Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”. Results The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration http://www.clinicaltrials.gov/NCT01409824. PMID:23574764

EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support

PubMed Central

2013-01-01

Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet. PMID:23842038

Gaming against medical errors: methods and results from a design game on CPOE.

PubMed

Kanstrup, Anne Marie; Nøhr, Christian

2009-01-01

The paper presents design game as a technique for participatory design for a Computerized Decision Support System (CDSS) for minimizing medical errors. Design game is used as a technique for working with the skills of users, the complexity of the use practice and the negotiation of design here within the challenging domain of medication. The paper presents a developed design game based on game inspiration from a computer game, theoretical inspiration on electronic decision support, and empirical grounding in scenarios of medical errors. The game has been played in a two-hour workshop with six clinicians. The result is presented as a list of central themes for design of CDSS and derived design principles from these themes. These principles are currently under further exploration in follow up prototype based activities.

Effects of a computerized cardiac teletriage decision support system on nurse performance: results of a controlled human factors experiment using a mid-fidelity prototype.

PubMed

Somoza, Kirsten Carroll; Momtahan, Kathryn; Lindgaard, Gitte

2007-01-01

A gap exists in cardiac care between known best practices and the actual level of care administered. To help bridge this gap, a proof of concept interface for a PDA-based decision support system (DSS) was designed for cardiac care nurses engaged in teletriage. This interface was developed through a user-centered design process. Quality of assessment, quality of recommendations, and number of questions asked were measured. Cardiac floor nurses' assessment quality performance, but not their recommendation quality performance, improved with the DSS. Nurses asked more questions with the DSS than without it, and these additional questions were predominantly classifiable as essential or beneficial to a good assessment. The average participant satisfaction score with the DSS was above neutral.

Duplicate laboratory test reduction using a clinical decision support tool.

PubMed

Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice

2014-05-01

Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

Redesign of a computerized clinical reminder for colorectal cancer screening: a human-computer interaction evaluation

PubMed Central

2011-01-01

Background Based on barriers to the use of computerized clinical decision support (CDS) learned in an earlier field study, we prototyped design enhancements to the Veterans Health Administration's (VHA's) colorectal cancer (CRC) screening clinical reminder to compare against the VHA's current CRC reminder. Methods In a controlled simulation experiment, 12 primary care providers (PCPs) used prototypes of the current and redesigned CRC screening reminder in a within-subject comparison. Quantitative measurements were based on a usability survey, workload assessment instrument, and workflow integration survey. We also collected qualitative data on both designs. Results Design enhancements to the VHA's existing CRC screening clinical reminder positively impacted aspects of usability and workflow integration but not workload. The qualitative analysis revealed broad support across participants for the design enhancements with specific suggestions for improving the reminder further. Conclusions This study demonstrates the value of a human-computer interaction evaluation in informing the redesign of information tools to foster uptake, integration into workflow, and use in clinical practice. PMID:22126324

Invited review: Helping dairy farmers to improve economic performance utilizing data-driving decision support tools.

PubMed

Cabrera, V E

2018-01-01

The objective of this review paper is to describe the development and application of a suite of more than 40 computerized dairy farm decision support tools contained at the University of Wisconsin-Madison (UW) Dairy Management website http://DairyMGT.info. These data-driven decision support tools are aimed to help dairy farmers improve their decision-making, environmental stewardship and economic performance. Dairy farm systems are highly dynamic in which changing market conditions and prices, evolving policies and environmental restrictions together with every time more variable climate conditions determine performance. Dairy farm systems are also highly integrated with heavily interrelated components such as the dairy herd, soils, crops, weather and management. Under these premises, it is critical to evaluate a dairy farm following a dynamic integrated system approach. For this approach, it is crucial to use meaningful data records, which are every time more available. These data records should be used within decision support tools for optimal decision-making and economic performance. Decision support tools in the UW-Dairy Management website (http://DairyMGT.info) had been developed using combination and adaptation of multiple methods together with empirical techniques always with the primary goal for these tools to be: (1) highly user-friendly, (2) using the latest software and computer technologies, (3) farm and user specific, (4) grounded on the best scientific information available, (5) remaining relevant throughout time and (6) providing fast, concrete and simple answers to complex farmers' questions. DairyMGT.info is a translational innovative research website in various areas of dairy farm management that include nutrition, reproduction, calf and heifer management, replacement, price risk and environment. This paper discusses the development and application of 20 selected (http://DairyMGT.info) decision support tools.

Central Heating Plant site characterization report, Marine Corps Combat Development Command, Quantico, Virginia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1990-08-01

This report presents the methodology and results of a characterization of the operation and maintenance (O M) environment at the US Marine Corps (USMC) Quantico, Virginia, Central Heating Plant (CHP). This characterization is part of a program intended to provide the O M staff with a computerized artificial intelligence (AI) decision support system that will assist the plant staff in more efficient operation of their plant. 3 refs., 12 figs.

Thinking Together: Modeling Clinical Decision-Support as a Sociotechnical System

PubMed Central

Hussain, Mustafa I.; Reynolds, Tera L.; Mousavi, Fatemeh E.; Chen, Yunan; Zheng, Kai

2017-01-01

Computerized clinical decision-support systems are members of larger sociotechnical systems, composed of human and automated actors, who send, receive, and manipulate artifacts. Sociotechnical consideration is rare in the literature. This makes it difficult to comparatively evaluate the success of CDS implementations, and it may also indicate that sociotechnical context receives inadequate consideration in practice. To facilitate sociotechnical consideration, we developed the Thinking Together model, a flexible diagrammatical means of representing CDS systems as sociotechnical systems. To develop this model, we examined the literature with the lens of Distributed Cognition (DCog) theory. We then present two case studies of vastly different CDSSs, one almost fully automated and the other with minimal automation, to illustrate the flexibility of the Thinking Together model. We show that this model, informed by DCog and the CDS literature, are capable of supporting both research, by enabling comparative evaluation, and practice, by facilitating explicit sociotechnical planning and communication. PMID:29854164

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

PubMed Central

2012-01-01

Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors. PMID:22333210

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: a randomized clinical trial.

PubMed

Dexheimer, Judith W; Abramo, Thomas J; Arnold, Donald H; Johnson, Kevin; Shyr, Yu; Ye, Fei; Fan, Kang-Hsien; Patel, Neal; Aronsky, Dominik

2014-11-01

The use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision. We performed a prospective, randomized controlled trial in an urban, tertiary care pediatric ED. All patients 2-18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system. Patients identified to have an asthma exacerbation were randomized to intervention or control. For intervention patients, asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage, and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets. Control patients received standard asthma management. The primary outcome measure was the time from triage to disposition decision. The Bayesian network identified 1339 patients with asthma exacerbations, of which 788 had an asthma diagnosis determined by an ED physician-established reference standard (positive predictive value 69.9%). The median time to disposition decision did not differ among the intervention (228 min; IQR=(141, 326)) and control group (223 min; IQR=(129, 316)); (p=0.362). The hospital admission rate was unchanged between intervention (25%) and control groups (26%); (p=0.867). ED length of stay did not differ among intervention (262 min; IQR=(165, 410)) and control group (247 min; IQR=(163, 379)); (p=0.818). The control and intervention groups were similar in regards to time to disposition; the computerized management system did not add additional wait time. The time to disposition decision did not change; however the management system integrated several different information systems to support clinicians' communication. Copyright © 2014. Published by Elsevier Ireland Ltd.

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS..., organization, services and constraints related to the computerized support enforcement system; (4) The APD must... design, development, installation or enhancement; (5) The APD must contain a description of each...

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS..., organization, services and constraints related to the computerized support enforcement system; (4) The APD must... design, development, installation or enhancement; (5) The APD must contain a description of each...

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS..., organization, services and constraints related to the computerized support enforcement system; (4) The APD must... design, development, installation or enhancement; (5) The APD must contain a description of each...

Losing a dime with a satisfied mind: positive affect predicts less search in sequential decision making.

PubMed

von Helversen, Bettina; Mata, Rui

2012-12-01

We investigated the contribution of cognitive ability and affect to age differences in sequential decision making by asking younger and older adults to shop for items in a computerized sequential decision-making task. Older adults performed poorly compared to younger adults partly due to searching too few options. An analysis of the decision process with a formal model suggested that older adults set lower thresholds for accepting an option than younger participants. Further analyses suggested that positive affect, but not fluid abilities, was related to search in the sequential decision task. A second study that manipulated affect in younger adults supported the causal role of affect: Increased positive affect lowered the initial threshold for accepting an attractive option. In sum, our results suggest that positive affect is a key factor determining search in sequential decision making. Consequently, increased positive affect in older age may contribute to poorer sequential decisions by leading to insufficient search. 2013 APA, all rights reserved

Computerized Cognition Laboratory.

ERIC Educational Resources Information Center

Motes, Michael A.; Wiegmann, Douglas A.

1999-01-01

Describes a software package entitled the "Computerized Cognition Laboratory" that helps integrate the teaching of cognitive psychology and research methods. Allows students to explore short-term memory, long-term memory, and decision making. Can also be used to teach the application of several statistical procedures. (DSK)

HL7 Structured Product Labeling - electronic prescribing information for provider order entry decision support.

PubMed

Schadow, Gunther

2005-01-01

Prescribing errors are an important cause of adverse events, and lack of knowledge of the drug is a root cause for prescribing errors. The FDA is issuing new regulations that will make the drug labels much more useful not only to physicians, but also to computerized order entry systems that support physicians to practice safe prescribing. For this purpose, FDA works with HL7 to create the Structured Product Label (SPL) standard that includes a document format as well as a drug knowledge representation, this poster introduces the basic concepts of SPL.

Driving out errors through tight integration between software and automation.

PubMed

Reifsteck, Mark; Swanson, Thomas; Dallas, Mary

2006-01-01

A clear case has been made for using clinical IT to improve medication safety, particularly bar-code point-of-care medication administration and computerized practitioner order entry (CPOE) with clinical decision support. The equally important role of automation has been overlooked. When the two are tightly integrated, with pharmacy information serving as a hub, the distinctions between software and automation become blurred. A true end-to-end medication management system drives out errors from the dockside to the bedside. Presbyterian Healthcare Services in Albuquerque has been building such a system since 1999, beginning by automating pharmacy operations to support bar-coded medication administration. Encouraged by those results, it then began layering on software to further support clinician workflow and improve communication, culminating with the deployment of CPOE and clinical decision support. This combination, plus a hard-wired culture of safety, has resulted in a dramatically lower mortality and harm rate that could not have been achieved with a partial solution.

A system to improve medication safety in the setting of acute kidney injury: initial provider response.

PubMed

McCoy, Allison B; McCoy, Allison Beck; Peterson, Josh F; Gadd, Cynthia S; Gadd, Cindy; Danciu, Ioana; Waitman, Lemuel R

2008-11-06

Clinical decision support systems can decrease common errors related to inappropriate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a comprehensive medication safety intervention with varying levels of workflow intrusiveness within computerized provider order entry to continuously monitor for and alert providers about early-onset acute kidney injury. Initial provider response to the interventions shows potential success in improving medication safety and suggests future enhancements to increase effectiveness.

Views of general practitioners on the use of STOPP&START in primary care: a qualitative study.

PubMed

Dalleur, O; Feron, J-M; Spinewine, A

2014-08-01

STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice. We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes. Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes. Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.

Computerized Physician Order Entry

PubMed Central

Khanna, Raman; Yen, Tony

2014-01-01

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks. PMID:24381708

Core drug-drug interaction alerts for inclusion in pediatric electronic health records with computerized prescriber order entry.

PubMed

Harper, Marvin B; Longhurst, Christopher A; McGuire, Troy L; Tarrago, Rod; Desai, Bimal R; Patterson, Al

2014-03-01

The study aims to develop a core set of pediatric drug-drug interaction (DDI) pairs for which electronic alerts should be presented to prescribers during the ordering process. A clinical decision support working group composed of Children's Hospital Association (CHA) members was developed. CHA Pharmacists and Chief Medical Information Officers participated. Consensus was reached on a core set of 19 DDI pairs that should be presented to pediatric prescribers during the order process. We have provided a core list of 19 high value drug pairs for electronic drug-drug interaction alerts to be recommended for inclusion as high value alerts in prescriber order entry software used with a pediatric patient population. We believe this list represents the most important pediatric drug interactions for practical implementation within computerized prescriber order entry systems.

Apply creative thinking of decision support in electrical nursing record.

PubMed

Hao, Angelica Te-Hui; Hsu, Chien-Yeh; Li-Fang, Huang; Jian, Wen-Shan; Wu, Li-Bin; Kao, Ching-Chiu; Lu, Mei-Show; Chang, Her-Kung

2006-01-01

The nursing process consists of five interrelated steps: assessment, diagnosis, planning, intervention, and evaluation. In the nursing process, the nurse collects a great deal of data and information. The amount of data and information may exceed the amount the nurse can process efficiently and correctly. Thus, the nurse needs assistance to become proficient in the planning of nursing care, due to the difficulty of simultaneously processing a large set of information. Computer systems are viewed as tools to expand the capabilities of the nurse's mind. Using computer technology to support clinicians' decision making may provide high-quality, patient-centered, and efficient healthcare. Although some existing nursing information systems aid in the nursing process, they only provide the most fundamental decision support--i.e., standard care plans associated with common nursing diagnoses. Such a computerized decision support system helps the nurse develop a care plan step-by-step. But it does not assist the nurse in the decision-making process. The decision process about how to generate nursing diagnoses from data and how to individualize the care plans still reminds of the nurse. The purpose of this study is to develop a pilot structure in electronic nursing record system integrated with international nursing standard for improving the proficiency and accuracy of plan of care in clinical pathway process. The proposed pilot systems not only assist both student nurses and nurses who are novice in nursing practice, but also experts who need to work in a practice area which they are not familiar with.

Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success.

PubMed

Murphy, Elizabeth V

2014-06-01

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the "meaningful use" of electronic medical record systems. An important component of the "Meaningful Use" legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Value impact assessment: A preliminary assessment of improvement opportunities at the Quantico Central Heating Plant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brambley, M.R.; Weakley, S.A.

1990-09-01

This report presents the results of a preliminary assessment of opportunities for improvement at the US Marine Corps (USMC) Quantico, Virginia, Central Heating Plant (CHP). This study is part of a program intended to provide the CHP staff with a computerized Artificial Intelligence (AI) decision support system that will assist in a more efficient, reliable, and safe operation of their plant. As part of the effort to provide the AI decision support system, a team of six scientists and engineers from the Pacific Northwest Laboratory (PNL) visited the plant to characterize the conditions and environment of the CHP. This assessmentmore » resulted in a list of potential performance improvement opportunities at the CHP. In this report, 12 of these opportunities are discussed and qualitatively analyzed. 70 refs., 7 figs., 6 tabs.« less

Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.

PubMed

Leong, T Y; Kaiser, K; Miksch, S

2007-01-01

Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

Application of a computerized environmental information system to master and sector planning

NASA Technical Reports Server (NTRS)

Stewart, J. C.

1978-01-01

A computerized composite mapping system developed as an aid in the land use decision making process is described. Emphasis is placed on consideration of the environment in urban planning. The presence of alluvium, shallow bedrock, surface water, and vegetation growth are among the environmental factors considered. An analysis of the Shady Grove Sector planning is presented as an example of the use of computerized composite mapping for long range planning.

Information in medical decision making: how consistent is our management?

PubMed

Lorence, Daniel P; Spink, Amanda; Jameson, Robert

2002-01-01

The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

Leveraging Electronic Tablets for General Pediatric Care

PubMed Central

McKee, S.; Dugan, T.M.; Downs, S.M.

2015-01-01

Summary Background We have previously shown that a scan-able paper based interface linked to a computerized clinical decision support system (CDSS) can effectively screen patients in pediatric waiting rooms and support the physician using evidence based care guidelines at the time of clinical encounter. However, the use of scan-able paper based interface has many inherent limitations including lacking real time communication with the CDSS and being prone to human and system errors. An electronic tablet based user interface can not only overcome these limitations, but may also support advanced functionality for clinical and research use. However, use of such devices for pediatric care is not well studied in clinical settings. Objective In this pilot study, we enhance our pediatric CDSS with an electronic tablet based user interface and evaluate it for usability as well as for changes in patient questionnaire completion rates. Methods Child Health Improvement through Computers Leveraging Electronic Tablets or CHICLET is an electronic tablet based user interface. It is developed to augment the existing scan-able paper interface to our CDSS. For the purposes of this study, we deployed CHICLET in one outpatient pediatric clinic. Usability factors for CHICLET were evaluated via caregiver and staff surveys. Results When compared to the scan-able paper based interface, we observed an 18% increase or 30% relative increase in question completion rates using CHICLET. This difference was statistically significant. Caregivers and staff survey results were positive for using CHICLET in clinical environment. Conclusions Electronic tablets are a viable interface for capturing patient self-report in pediatric waiting rooms. We further hypothesize that the use of electronic tablet based interfaces will drive advances in computerized clinical decision support and create opportunities for patient engagement. PMID:25848409

Ethics and the Computerization of Pharmacy.

ERIC Educational Resources Information Center

McCarthy, Robert L.; Perrolle, Judith A.

1991-01-01

The current and potential impact of computerization on pharmacy practice is discussed, focusing on ethical dilemmas in the pharmacist-patient relationship, confidentiality of records, and the role of artificial intelligence in decision making about drug therapy. Case studies for use by teachers of pharmaceutical ethics are provided. (Author/MSE)

Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects.

PubMed

Andersson Hagiwara, Magnus; Andersson Gäre, Boel; Elg, Mattias

2016-01-01

To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

Computer-Aided Diagnosis for Breast Ultrasound Using Computerized BI-RADS Features and Machine Learning Methods.

PubMed

Shan, Juan; Alam, S Kaisar; Garra, Brian; Zhang, Yingtao; Ahmed, Tahira

2016-04-01

This work identifies effective computable features from the Breast Imaging Reporting and Data System (BI-RADS), to develop a computer-aided diagnosis (CAD) system for breast ultrasound. Computerized features corresponding to ultrasound BI-RADs categories were designed and tested using a database of 283 pathology-proven benign and malignant lesions. Features were selected based on classification performance using a "bottom-up" approach for different machine learning methods, including decision tree, artificial neural network, random forest and support vector machine. Using 10-fold cross-validation on the database of 283 cases, the highest area under the receiver operating characteristic (ROC) curve (AUC) was 0.84 from a support vector machine with 77.7% overall accuracy; the highest overall accuracy, 78.5%, was from a random forest with the AUC 0.83. Lesion margin and orientation were optimum features common to all of the different machine learning methods. These features can be used in CAD systems to help distinguish benign from worrisome lesions. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

Item Selection Criteria with Practical Constraints for Computerized Classification Testing

ERIC Educational Resources Information Center

Lin, Chuan-Ju

2011-01-01

This study compares four item selection criteria for a two-category computerized classification testing: (1) Fisher information (FI), (2) Kullback-Leibler information (KLI), (3) weighted log-odds ratio (WLOR), and (4) mutual information (MI), with respect to the efficiency and accuracy of classification decision using the sequential probability…

Guidelines for the Development of Computerized Student Information Systems.

ERIC Educational Resources Information Center

Armes, Nancy, Ed.; And Others

Designed to provide guidelines for the development of computerized student information systems, this report raises policy issues and questions to be resolved at the campus level and describes a variety of computer-generated reports and records that can assist in educational decision making and planning. Introductory material discusses the…

45 CFR 307.13 - Security and confidentiality for computerized support enforcement systems in operation after...

Code of Federal Regulations, 2010 CFR

2010-10-01

... ENFORCEMENT SYSTEMS § 307.13 Security and confidentiality for computerized support enforcement systems in... systems in operation after October 1, 1997. (a) Information integrity and security. Have safeguards... 45 Public Welfare 2 2010-10-01 2010-10-01 false Security and confidentiality for computerized...

Computerized physician order entry: promise, perils, and experience.

PubMed

Khanna, Raman; Yen, Tony

2014-01-01

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks.

Exploiting Semantic Web Technologies to Develop OWL-Based Clinical Practice Guideline Execution Engines.

PubMed

Jafarpour, Borna; Abidi, Samina Raza; Abidi, Syed Sibte Raza

2016-01-01

Computerizing paper-based CPG and then executing them can provide evidence-informed decision support to physicians at the point of care. Semantic web technologies especially web ontology language (OWL) ontologies have been profusely used to represent computerized CPG. Using semantic web reasoning capabilities to execute OWL-based computerized CPG unties them from a specific custom-built CPG execution engine and increases their shareability as any OWL reasoner and triple store can be utilized for CPG execution. However, existing semantic web reasoning-based CPG execution engines suffer from lack of ability to execute CPG with high levels of expressivity, high cognitive load of computerization of paper-based CPG and updating their computerized versions. In order to address these limitations, we have developed three CPG execution engines based on OWL 1 DL, OWL 2 DL and OWL 2 DL + semantic web rule language (SWRL). OWL 1 DL serves as the base execution engine capable of executing a wide range of CPG constructs, however for executing highly complex CPG the OWL 2 DL and OWL 2 DL + SWRL offer additional executional capabilities. We evaluated the technical performance and medical correctness of our execution engines using a range of CPG. Technical evaluations show the efficiency of our CPG execution engines in terms of CPU time and validity of the generated recommendation in comparison to existing CPG execution engines. Medical evaluations by domain experts show the validity of the CPG-mediated therapy plans in terms of relevance, safety, and ordering for a wide range of patient scenarios.

Guidelines for maternal and neonatal "point of care": needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso.

PubMed

Zakane, S Alphonse; Gustafsson, Lars L; Tomson, Göran; Loukanova, Svetla; Sié, Ali; Nasiell, Josefine; Bastholm-Rahmner, Pia

2014-06-01

In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern Asia. Our study is nested into the QUALMAT project and seeks to improve the quality of maternal care services through the introduction of a computerized clinical decision support system (CDSS) to help healthcare workers in rural areas. Healthcare information technology applications in low-income countries may improve healthcare provision but recent studies demonstrate unintended consequences with underuse or resistance to CDSS and that the fit between the system and the clinical needs does present challenges. To explore and describe perceived needs and attitudes among healthcare workers to access WHO guidelines using CDSS in maternal and neonatal care in rural Burkina Faso. Data were collected with semi-structured interviews in two rural districts in Burkina Faso with 45 informants. Descriptive statistics were used for the analysis of the quantitative part of the interview corresponding to informants' background. Qualitative data were analyzed using manifest content analysis. Four main findings emerged: (a) an appreciable willingness among healthcare workers for and a great interest to adapt and use modern technologies like computers to learn more in the workplace, (b) a positive attitude to easy access of guidelines and implementation of decision-support using computers in the workplace, (c) a fear that the CDSS would require more working time and lead to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive instructions to fully implement. The findings can be divided into aspects of motivators and barriers in relation to how the CDSS is perceived and to be used. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design, during implementation and maintenance of the CDSS at point of care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

An Evaluation of the Usability of a Computerized Decision Support System for Nursing Homes

PubMed Central

Fossum, M.; Ehnfors, M.; Fruhling, A.; Ehrenberg, A.

2011-01-01

Background Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices. Objective This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents. Methods We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis. Results Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers. Conclusion Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS. PMID:23616886

C-A4-01: Computerized Clinical Decision Support During Drug Ordering for Long-term Care Residents With Renal Insufficiency

PubMed Central

Field, Terry S; Rochon, Paula; Lee, Monica; Gavendo, Linda; Baril, Joann L; Gurwitz, Jerry H

2010-01-01

Objective: To determine whether a computerized clinical decision support system (CDSS) providing patient specific recommendations in real- time improves the quality of prescribing for long-term care residents with renal insufficiency. Design: A randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units. Measurement: The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: recommended medication doses; recommended administration frequencies; recommendations to avoid the drug; 4) warnings of missing information. Results: The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 1.1). For the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often than a relative risk 1.2 (1.0, 1.4). By tracking personnel time and expenditures, we estimated the cost of developing the CDSS as $48,668.57. Drug costs saved during the 12 months of the trial are estimated at $2,137. Conclusion: Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions. However, patient well-being and quality of care rather than the business case related to cost savings are likely to be the key drivers for adoption of this HIT application.

Decision support tool for diagnosing the source of variation

NASA Astrophysics Data System (ADS)

Masood, Ibrahim; Azrul Azhad Haizan, Mohamad; Norbaya Jumali, Siti; Ghazali, Farah Najihah Mohd; Razali, Hazlin Syafinaz Md; Shahir Yahya, Mohd; Azlan, Mohd Azwir bin

2017-08-01

Identifying the source of unnatural variation (SOV) in manufacturing process is essential for quality control. The Shewhart control chart patterns (CCPs) are commonly used to monitor the SOV. However, a proper interpretation of CCPs associated to its SOV requires a high skill industrial practitioner. Lack of knowledge in process engineering will lead to erroneous corrective action. The objective of this study is to design the operating procedures of computerized decision support tool (DST) for process diagnosis. The DST is an embedded tool in CCPs recognition scheme. Design methodology involves analysis of relationship between geometrical features, manufacturing process and CCPs. The DST contents information about CCPs and its possible root cause error and description on SOV phenomenon such as process deterioration in tool bluntness, offsetting tool, loading error, and changes in materials hardness. The DST will be useful for an industrial practitioner in making effective troubleshooting.

Clinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success

PubMed Central

Murphy, Elizabeth V.

2014-01-01

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the “meaningful use” of electronic medical record systems. An important component of the “Meaningful Use” legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study. PMID:24910564

Use of a computerized decision support system for primary and secondary prevention of work-related MSD disability.

PubMed

Womack, Sarah K; Armstrong, Thomas J

2005-09-01

The present study evaluates the effectiveness of a decision support system used to evaluate and control physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs in the plant. Additionally, the database users were able to record comments about the jobs and related control issues. The researchers investigated the utility and effectiveness of the software by analyzing its use over a 20-month period. Of the 197 comments entered by the users, 25% pertained to primary prevention, 75% pertained to secondary prevention, and 94 comments (47.7%) described ergonomic interventions. Use of the software tool improved primary and secondary prevention by improving the quality and efficiency of the ergonomic job analysis process.

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

PubMed

Devine, Emily Beth; Lee, Chia-Ju; Overby, Casey L; Abernethy, Neil; McCune, Jeannine; Smith, Joe W; Tarczy-Hornoch, Peter

2014-07-01

Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers. Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making. Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Evaluation of the validity of the Psychology Experiment Building Language tests of vigilance, auditory memory, and decision making.

PubMed

Piper, Brian; Mueller, Shane T; Talebzadeh, Sara; Ki, Min Jung

2016-01-01

Background. The Psychology Experimental Building Language (PEBL) test battery (http://pebl.sourceforge.net/) is a popular application for neurobehavioral investigations. This study evaluated the correspondence between the PEBL and the non-PEBL versions of four executive function tests. Methods. In one cohort, young-adults (N = 44) completed both the Conner's Continuous Performance Test (CCPT) and the PEBL CPT (PCPT) with the order counter-balanced. In a second cohort, participants (N = 47) completed a non-computerized (Wechsler) and a computerized (PEBL) Digit Span (WDS or PDS) both Forward and Backward. Participants also completed the Psychological Assessment Resources or the PEBL versions of the Iowa Gambling Task (PARIGT or PEBLIGT). Results. The between-test correlations were moderately high (reaction time r = 0.78, omission errors r = 0.65, commission errors r = 0.66) on the CPT. DS Forward was significantly greater than DS Backward on the WDS (p < .0005) and the PDS (p < .0005). The total WDS score was moderately correlated with the PDS (r = 0.56). The PARIGT and the PEBLIGTs showed a very similar pattern for response times across blocks, development of preference for Advantageous over Disadvantageous Decks, and Deck selections. However, the amount of money earned (score-loan) was significantly higher in the PEBLIGT during the last Block. Conclusions. These findings are broadly supportive of the criterion validity of the PEBL measures of sustained attention, short-term memory, and decision making. Select differences between workalike versions of the same test highlight how detailed aspects of implementation may have more important consequences for computerized testing than has been previously acknowledged.

Combined single photon emission computerized tomography and conventional computerized tomography: Clinical value for the shoulder surgeons?

PubMed Central

Hirschmann, Michael T.; Schmid, Rahel; Dhawan, Ranju; Skarvan, Jiri; Rasch, Helmut; Friederich, Niklaus F.; Emery, Roger

2011-01-01

With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as new diagnostic radiologic modality, and discuss its limitations. SPECT/CT may facilitate the establishment of diagnosis, process of decision making, and further treatment for complex shoulder pathologies. Some of these advantages were highlighted in cases that are frequently seen in most shoulder clinics. PMID:22058640

Benefits of information technology-enabled diabetes management.

PubMed

Bu, Davis; Pan, Eric; Walker, Janice; Adler-Milstein, Julia; Kendrick, David; Hook, Julie M; Cusack, Caitlin M; Bates, David W; Middleton, Blackford

2007-05-01

To determine the financial and clinical benefits of implementing information technology (IT)-enabled disease management systems. A computer model was created to project the impact of IT-enabled disease management on care processes, clinical outcomes, and medical costs for patients with type 2 diabetes aged >25 years in the U.S. Several ITs were modeled (e.g., diabetes registries, computerized decision support, remote monitoring, patient self-management systems, and payer-based systems). Estimates of care process improvements were derived from published literature. Simulations projected outcomes for both payer and provider organizations, scaled to the national level. The primary outcome was medical cost savings, in 2004 U.S. dollars discounted at 5%. Secondary measures include reduction of cardiovascular, cerebrovascular, neuropathy, nephropathy, and retinopathy clinical outcomes. All forms of IT-enabled disease management improved the health of patients with diabetes and reduced health care expenditures. Over 10 years, diabetes registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer-centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million, and integrated provider-patient systems saved $16.9 billion. IT-enabled diabetes management has the potential to improve care processes, delay diabetes complications, and save health care dollars. Of existing systems, provider-centered technologies such as diabetes registries currently show the most potential for benefit. Fully integrated provider-patient systems would have even greater potential for benefit. These benefits must be weighed against the implementation costs.

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review.

PubMed

Zandstra, D; Busser, J A S; Aarts, J W M; Nieboer, T E

2017-04-01

This review studies women's preferences for shared decision-making about heavy menstrual bleeding treatment and evaluates interventions that support shared decision-making and their effectiveness. PubMed, Cochrane, Embase, Medline and ClinicalTrials.gov were searched. Three research questions were predefined: 1) What is the range of perspectives gathered in studies that examine women facing a decision related to heavy menstrual bleeding management?; 2) What types of interventions have been developed to support shared decision-making for women experiencing heavy menstrual bleeding?; and 3) In what way might women benefit from interventions that support shared decision-making? All original studies were included if the study population consisted of women experiencing heavy menstrual bleeding. We used the TIDieR (Template for Intervention: Description and Replication) checklist to assess the quality of description and the reproducibility of interventions. Interventions were categorized using Grande et al. guidelines and collated and summarized outcomes measures into three categories: 1) patient-reported outcomes; 2) observer-reported outcomes; and 3) doctor-reported outcomes. Fifteen studies were included. Overall, patients preferred to decide together with their doctor (74%). Women's previsit preference was the strongest predictor for treatment choice in two studies. Information packages did not have a statistically significant effect on treatment choice or satisfaction. However, adding a structured interview or decision aid to increase patient involvement did show a positive effect on treatment choice and results, patient satisfaction and shared decision-making related outcomes. In conclusion shared decision-making is becoming more important in the care of women with heavy menstrual bleeding. Structured interviews or well-designed (computerized) tools such as decision aids seem to facilitate this process, but there is room for improvement. A shared treatment choice is only possible after careful provision of information, elicitation of patients' preferences and integrating those preferences. Interventions should be designed accordingly. Copyright © 2017 Elsevier B.V. All rights reserved.

Hypothesis-confirming information search strategies and computerized information-retrieval systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jacobs, S.M.

A recent trend in information-retrieval systems technology is the development of on-line information retrieval systems. One objective of these systems has been to attempt to enhance decision effectiveness by allowing users to preferentially seek information, thereby facilitating the reduction or elimination of information overload. These systems do not necessarily lead to more-effective decision making, however. Recent research in information-search strategy suggests that when users are seeking information subsequent to forming initial beliefs, they may preferentially seek information to confirm these beliefs. It seems that effective computer-based decision support requires an information retrieval system capable of: (a) retrieving a subset ofmore » all available information, in order to reduce information overload, and (b) supporting an information search strategy that considers all relevant information, rather than merely hypothesis-confirming information. An information retrieval system with an expert component (i.e., a knowledge-based DSS) should be able to provide these capabilities. Results of this study are non conclusive; there was neither strong confirmatory evidence nor strong disconfirmatory evidence regarding the effectiveness of the KBDSS.« less

45 CFR 307.10 - Functional requirements for computerized support enforcement systems in operation by October 1...

Code of Federal Regulations, 2010 CFR

2010-10-01

... to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT... payments; (6) Computing and distributing incentive payments to political subdivisions which share in the...

The effect of the electronic medical record on nurses' work.

PubMed

Robles, Jane

2009-01-01

The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication.

The Child Well-Being Scales as a Clinical Tool and a Management Information System.

ERIC Educational Resources Information Center

Lyons, Peter; Doueck, Howard J.; Koster, Andrew J.; Witzky, Melissa K.; Kelly, Patricia L.

1999-01-01

Describes implementation of a computerized version of the Child Welfare League of America's Child Well-Being Scales by a family services agency in southern Ontario. Reviews results obtained from 172 families to illustrate the potential for using computerized risk assessment as an aid in clinical, supervisory, and management decision-making…

A Computerized Information System Model for Decision Making for the Oklahoma State Department of Vocational and Technical Education.

ERIC Educational Resources Information Center

Smith, Hubert Gene

The objectives of the study presented in the dissertation were to identify present and anticipated information requirements of the various departments within the Oklahoma State Department of Vocational and Technical Education, to design a computerized information system model utilizing an integrated systems concept to meet information…

Effect of enhanced information, values clarification, and removal of financial barriers on use of prenatal genetic testing: a randomized clinical trial.

PubMed

Kuppermann, Miriam; Pena, Sherri; Bishop, Judith T; Nakagawa, Sanae; Gregorich, Steven E; Sit, Anita; Vargas, Juan; Caughey, Aaron B; Sykes, Susan; Pierce, Lasha; Norton, Mary E

2014-09-24

Prenatal genetic testing guidelines recommend providing patients with detailed information to allow informed, preference-based screening and diagnostic testing decisions. The effect of implementing these guidelines is not well understood. To analyze the effect of a decision-support guide and elimination of financial barriers to testing on use of prenatal genetic testing and decision making among pregnant women of varying literacy and numeracy levels. Randomized trial conducted from 2010-2013 at prenatal clinics at 3 county hospitals, 1 community clinic, 1 academic center, and 3 medical centers of an integrated health care delivery system in the San Francisco Bay area. Participants were English- or Spanish-speaking women who had not yet undergone screening or diagnostic testing and remained pregnant at 11 weeks' gestation (n = 710). A computerized, interactive decision-support guide and access to prenatal testing with no out-of-pocket expense (n = 357) or usual care as per current guidelines (n = 353). The primary outcome was invasive diagnostic test use, obtained via medical record review. Secondary outcomes included testing strategy undergone, and knowledge about testing, risk comprehension, and decisional conflict and regret at 24 to 36 weeks' gestation. Women randomized to the intervention group, compared with those randomized to the control group, were less likely to have invasive diagnostic testing (5.9% vs 12.3%; odds ratio [OR], 0.45 [95% CI, 0.25-0.80]) and more likely to forgo testing altogether (25.6% vs 20.4%; OR, 3.30 [95% CI, 1.43-7.64], reference group screening followed by invasive testing). Women randomized to the intervention group also had higher knowledge scores (9.4 vs 8.6 on a 15-point scale; mean group difference, 0.82 [95% CI, 0.34-1.31]) and were more likely to correctly estimate the amniocentesis-related miscarriage risk (73.8% vs 59.0%; OR, 1.95 [95% CI, 1.39-2.75]) and their estimated age-adjusted chance of carrying a fetus with trisomy 21 (58.7% vs 46.1%; OR, 1.66 [95% CI, 1.22-2.28]). Significant differences did not emerge in decisional conflict or regret. Full implementation of prenatal testing guidelines using a computerized, interactive decision-support guide in the absence of financial barriers to testing resulted in less test use and more informed choices. If validated in additional populations, this approach may result in more informed and preference-based prenatal testing decision making and fewer women undergoing testing. clinicaltrials.gov Identifier: NCT00505596.

Application of Adaptive Decision Aiding Systems to Computer-Assisted Instruction. Final Report, January-December 1974.

ERIC Educational Resources Information Center

May, Donald M.; And Others

The minicomputer-based Computerized Diagnostic and Decision Training (CDDT) system described combines the principles of artificial intelligence, decision theory, and adaptive computer assisted instruction for training in electronic troubleshooting. The system incorporates an adaptive computer program which learns the student's diagnostic and…

Personalization and Patient Involvement in Decision Support Systems: Current Trends

PubMed Central

Sacchi, L.; Lanzola, G.; Viani, N.

2015-01-01

Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857

45 CFR 307.11 - Functional requirements for computerized support enforcement systems in operation by October 1...

Code of Federal Regulations, 2011 CFR

2011-10-01

... violence or child abuse); (xi) Indication of an order; (xii) Locate request type (optional); (xiii) Locate... to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT...

45 CFR 307.11 - Functional requirements for computerized support enforcement systems in operation by October 1...

Code of Federal Regulations, 2013 CFR

2013-10-01

... violence or child abuse); (xi) Indication of an order; (xii) Locate request type (optional); (xiii) Locate... to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT...

45 CFR 307.11 - Functional requirements for computerized support enforcement systems in operation by October 1...

Code of Federal Regulations, 2012 CFR

2012-10-01

... violence or child abuse); (xi) Indication of an order; (xii) Locate request type (optional); (xiii) Locate... to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT...

Basic physiological systems indicator's informative assessment for children and adolescents obesity diagnosis tasks

NASA Astrophysics Data System (ADS)

Marukhina, O. V.; Berestneva, O. G.; Emelyanova, Yu A.; Romanchukov, S. V.; Petrova, L.; Lombardo, C.; Kozlova, N. V.

2018-05-01

The healthcare computerization creates opportunities to the clinical decision support system development. In the course of diagnosis, doctor manipulates a considerable amount of data and makes a decision in the context of uncertainty basing upon the first-hand experience and knowledge. The situation is exacerbated by the fact that the knowledge scope in medicine is incrementally growing, but the decision-making time does not increase. The amount of medical malpractice is growing and it leads to various negative effects, even the mortality rate increase. IT-solution's development for clinical purposes is one of the most promising and efficient ways to prevent these effects. That is why the efforts of many IT specialists are directed to the doctor's heuristics simulating software or expert-based medical decision-making algorithms development. Thus, the objective of this study is to develop techniques and approaches for the body physiological system's informative value assessment index for the obesity degree evaluation based on the diagnostic findings.

CPOE: a clear purpose plus top-notch technical support equals high physician adoption.

PubMed

Birk, Susan

2010-01-01

As with any fundamental change, the transition to computerized physician order entry [CPOE] is not a risk-free endeavor, major questions hover around this facet of the arduous and controversial paper-to-electronic conversion currently preoccupying the healthcare industry: Could physician over-reliance on electronic prompts actually lead to an increase in some types of medical errors? Could automated workstations ultimately hinder safety and the delivery of quality care by diminishing face-to-face communication and nuanced discussions? In an ironic twist, could electronic solutions insidiously leach creativity, intuition and judgment from good medicine by keeping physicians tied to tools that consume their time but do not offer effective clinical decision support?

Clinical Information Systems - From Yesterday to Tomorrow.

PubMed

Gardner, R M

2016-06-30

To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author's personal experience with developing the HELP system were also used. There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.

Reliability of a Computerized Neurocognitive Test in Baseline Concussion Testing of High School Athletes.

PubMed

MacDonald, James; Duerson, Drew

2015-07-01

Baseline assessments using computerized neurocognitive tests are frequently used in the management of sport-related concussions. Such testing is often done on an annual basis in a community setting. Reliability is a fundamental test characteristic that should be established for such tests. Our study examined the test-retest reliability of a computerized neurocognitive test in high school athletes over 1 year. Repeated measures design. Two American high schools. High school athletes (N = 117) participating in American football or soccer during the 2011-2012 and 2012-2013 academic years. All study participants completed 2 baseline computerized neurocognitive tests taken 1 year apart at their respective schools. The test measures performance on 4 cognitive tasks: identification speed (Attention), detection speed (Processing Speed), one card learning accuracy (Learning), and one back speed (Working Memory). Reliability was assessed by measuring the intraclass correlation coefficient (ICC) between the repeated measures of the 4 cognitive tasks. Pearson and Spearman correlation coefficients were calculated as a secondary outcome measure. The measure for identification speed performed best (ICC = 0.672; 95% confidence interval, 0.559-0.760) and the measure for one card learning accuracy performed worst (ICC = 0.401; 95% confidence interval, 0.237-0.542). All tests had marginal or low reliability. In a population of high school athletes, computerized neurocognitive testing performed in a community setting demonstrated low to marginal test-retest reliability on baseline assessments 1 year apart. Further investigation should focus on (1) improving the reliability of individual tasks tested, (2) controlling for external factors that might affect test performance, and (3) identifying the ideal time interval to repeat baseline testing in high school athletes. Computerized neurocognitive tests are used frequently in high school athletes, often within a model of baseline testing of asymptomatic individuals before the start of a sporting season. This study adds to the evidence that suggests in this population such testing may lack sufficient reliability to support clinical decision making.

Evaluation of the validity of the Psychology Experiment Building Language tests of vigilance, auditory memory, and decision making

PubMed Central

Mueller, Shane T.; Talebzadeh, Sara; Ki, Min Jung

2016-01-01

Background. The Psychology Experimental Building Language (PEBL) test battery (http://pebl.sourceforge.net/) is a popular application for neurobehavioral investigations. This study evaluated the correspondence between the PEBL and the non-PEBL versions of four executive function tests. Methods. In one cohort, young-adults (N = 44) completed both the Conner’s Continuous Performance Test (CCPT) and the PEBL CPT (PCPT) with the order counter-balanced. In a second cohort, participants (N = 47) completed a non-computerized (Wechsler) and a computerized (PEBL) Digit Span (WDS or PDS) both Forward and Backward. Participants also completed the Psychological Assessment Resources or the PEBL versions of the Iowa Gambling Task (PARIGT or PEBLIGT). Results. The between-test correlations were moderately high (reaction time r = 0.78, omission errors r = 0.65, commission errors r = 0.66) on the CPT. DS Forward was significantly greater than DS Backward on the WDS (p < .0005) and the PDS (p < .0005). The total WDS score was moderately correlated with the PDS (r = 0.56). The PARIGT and the PEBLIGTs showed a very similar pattern for response times across blocks, development of preference for Advantageous over Disadvantageous Decks, and Deck selections. However, the amount of money earned (score–loan) was significantly higher in the PEBLIGT during the last Block. Conclusions. These findings are broadly supportive of the criterion validity of the PEBL measures of sustained attention, short-term memory, and decision making. Select differences between workalike versions of the same test highlight how detailed aspects of implementation may have more important consequences for computerized testing than has been previously acknowledged. PMID:27014512

A pathway to personalization of integrated treatment: informatics and decision science in psychiatric rehabilitation.

PubMed

Spaulding, William; Deogun, Jitender

2011-09-01

Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome.

An Analysis of a Computerized System for Managing Curriculum Decisions and Tracking Student Progress in a Home-Based Pre-School Education Project.

ERIC Educational Resources Information Center

Lutz, John E.; And Others

The degree of success of the computerized Child-Based Information System (CBIS) was analyzed in two areas--presenting, delivering, and managing a developmental curriculum; and recording, filing, and monitoring child tracking data, including requirements for Individualized Education Plans (IEP's). Preschool handicapped and high-risk children and…

APEX: A Computerized Simulation Game as the Basis for an Undergraduate Interdisciplinary Course.

ERIC Educational Resources Information Center

Tannenbaum, Robert S.

APEX is a computerized gaming simulation; it is also the name of an interdisciplinary course in environmental problems in urban areas introduced at the School of Health Science, Hunter College of the City University of New York. In the course, students assume the roles of decision makers in both the private and public sectors. They receive data…

Placement Decisions for First-Time-in-College Students Using the Computerized Placement Test. Information Capsule.

ERIC Educational Resources Information Center

Bashford, Joanne

This information capsule explores the effectiveness of score ranges on the Computerized Placement Test (CPT), used to assess the skills of entry-level students at Miami-Dade Community College and place first-time-in-college students in classes. Data are provided for students entering in Fall terms 1996 and 1997 showing the number of students…

Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.

PubMed

Zuckerberg, Gabriel S; Scott, Andrew V; Wasey, Jack O; Wick, Elizabeth C; Pawlik, Timothy M; Ness, Paul M; Patel, Nishant D; Resar, Linda M S; Frank, Steven M

2015-07-01

Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs. For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization. Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines. © 2015 AABB.

Evaluation of a Computerized Decision Support Intervention to Decrease Use of Anti-Pseudomonal Carbapenems in Penicillin Allergic Patients

PubMed Central

Caplinger, Christina; Smith, Garret; Remington, Richard; Madaras-Kelly, Karl

2016-01-01

Allergies to β-lactam antibiotics are commonly documented in hospitalized patients; however, true allergy is uncommon. Cross-reactivity rates for advanced generation cephalosporins and carbapenems are low; particularly for patients without a history of symptoms consistent with type 1 hypersensitivity. We observed that providers preferentially prescribed antipseudomonal carbapenems (APC) over advanced generation cephalosporins for patients with β-lactam allergy history, including those with low risk for antimicrobial-resistant infections. Information was inserted into the computerized decision support system (CDSS) to aid clinicians in assessing β-lactam cross-reactivity risk and selecting appropriate therapy. A retrospective evaluation was conducted in a small hospital to assess the impact of the CDSS changes in APC prescribing. Inpatients (n = 68) who received at least one APC dose during hospitalization over a 13 month pre-intervention period were compared to inpatients who received an APC during the 15 month post-intervention period (n = 59) for documented APC indications and β-lactam allergy history. APC initiations were measured and corrected per 1000 patient-days; interrupted time-series analysis was performed to assess changes in use before and after implementation. Aggregate monthly APC initiations decreased from 7.01 to 6.14 per 1000 patient-days after the implementation (p = 0.03). Post-intervention APC initiations for patients with low-risk β-lactam histories decreased from 92% to 83% (p = 0.17). No adverse events were observed in patients with low-risk β-lactam histories. The intervention was associated with a reduction in APC initiations. PMID:27025522

Tackling inpatient penicillin allergies: Assessing tools for antimicrobial stewardship.

PubMed

Blumenthal, Kimberly G; Wickner, Paige G; Hurwitz, Shelley; Pricco, Nicholas; Nee, Alexandra E; Laskowski, Karl; Shenoy, Erica S; Walensky, Rochelle P

2017-07-01

Reported penicillin allergy rarely reflects penicillin intolerance. Failure to address inpatient penicillin allergies results in more broad-spectrum antibiotic use, treatment failures, and adverse drug events. We aimed to determine the optimal approach to penicillin allergies among medical inpatients. We evaluated internal medicine inpatients reporting penicillin allergy in 3 periods: (1) standard of care (SOC), (2) penicillin skin testing (ST), and (3) computerized guideline application with decision support (APP). The primary outcome was use of a penicillin or cephalosporin, comparing interventions to SOC using multivariable logistic regression. There were 625 patients: SOC, 148; ST, 278; and APP, 199. Of 278 ST patients, 179 (64%) were skin test eligible; 43 (24%) received testing and none were allergic. In the APP period, there were 292 unique Web site views; 112 users (38%) completed clinical decision support. Although ST period patients did not have increased odds of penicillin or cephalosporin use overall (adjusted odds ratio [aOR] 1.3; 95% CI, 0.8-2.0), we observed significant increased odds of penicillin or cephalosporin use overall in the APP period (aOR, 1.8; 95% CI, 1.1-2.9) and in a per-protocol analysis of the skin tested subset (aOR, 5.7; 95% CI, 2.6-12.5). Both APP and ST-when completed-increased the use of penicillin and cephalosporin antibiotics among inpatients reporting penicillin allergy. While the skin tested subset showed an almost 6-fold impact, the computerized guideline significantly increased penicillin or cephalosporin use overall nearly 2-fold and was readily implemented. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Drug knowledge expressed as computable semantic triples.

PubMed

Elkin, Peter L; Carter, John S; Nabar, Manasi; Tuttle, Mark; Lincoln, Michael; Brown, Steven H

2011-01-01

The majority of questions that arise in the practice of medicine relate to drug information. Additionally, adverse reactions account for as many as 98,000 deaths per year in the United States. Adverse drug reactions account for a significant portion of those errors. Many authors believe that clinical decision support associated with computerized physician order entry has the potential to decrease this adverse drug event rate. This decision support requires knowledge to drive the process. One important and rich source of drug knowledge is the DailyMed product labels. In this project we used computationally extracted SNOMED CT™ codified data associated with each section of each product label as input to a rules engine that created computable assertional knowledge in the form of semantic triples. These are expressed in the form of "Drug" HasIndication "SNOMED CT™". The information density of drug labels is deep, broad and quite substantial. By providing a computable form of this information content from drug labels we make these important axioms (facts) more accessible to computer programs designed to support improved care.

Adapting Nielsen’s Design Heuristics to Dual Processing for Clinical Decision Support

PubMed Central

Taft, Teresa; Staes, Catherine; Slager, Stacey; Weir, Charlene

2016-01-01

The study objective was to improve the applicability of Nielson’s standard design heuristics for evaluating electronic health record (EHR) alerts and linked ordering support by integrating them with Dual Process theory. Through initial heuristic evaluation and a user study of 7 physicians, usability problems were identified. Through independent mapping of specific usability criteria to support for each of the Dual Cognitive processes (S1 and S2) and deliberation, agreement was reached on mapping criteria. Finally, usability errors from the heuristic and user study were mapped to S1 and S2. Adding a dual process perspective to specific heuristic analysis increases the applicability and relevance of computerized health information design evaluations. This mapping enables designers to measure that their systems are tailored to support attention allocation. System 1 will be supported by improving pattern recognition and saliency, and system 2 through efficiency and control of information access. PMID:28269915

Adapting Nielsen's Design Heuristics to Dual Processing for Clinical Decision Support.

PubMed

Taft, Teresa; Staes, Catherine; Slager, Stacey; Weir, Charlene

2016-01-01

The study objective was to improve the applicability of Nielson's standard design heuristics for evaluating electronic health record (EHR) alerts and linked ordering support by integrating them with Dual Process theory. Through initial heuristic evaluation and a user study of 7 physicians, usability problems were identified. Through independent mapping of specific usability criteria to support for each of the Dual Cognitive processes (S1 and S2) and deliberation, agreement was reached on mapping criteria. Finally, usability errors from the heuristic and user study were mapped to S1 and S2. Adding a dual process perspective to specific heuristic analysis increases the applicability and relevance of computerized health information design evaluations. This mapping enables designers to measure that their systems are tailored to support attention allocation. System 1 will be supported by improving pattern recognition and saliency, and system 2 through efficiency and control of information access.

Rate of electronic health record adoption in South Korea: A nation-wide survey.

PubMed

Kim, Young-Gun; Jung, Kyoungwon; Park, Young-Taek; Shin, Dahye; Cho, Soo Yeon; Yoon, Dukyong; Park, Rae Woong

2017-05-01

The adoption rate of electronic health record (EHR) systems in South Korea has continuously increased. However, in contrast to the situation in the United States (US), where there has been a national effort to improve and standardize EHR interoperability, no consensus has been established in South Korea. The goal of this study was to determine the current status of EHR adoption in South Korean hospitals compared to that in the US. All general and tertiary teaching hospitals in South Korea were surveyed regarding their EHR status in 2015 with the same questionnaire as used previously. The survey form estimated the level of adoption of EHR systems according to 24 core functions in four categories (clinical documentation, result view, computerized provider order entry, and decision supports). The adoption level was classified into comprehensive and basic EHR systems according to their functionalities. EHRs and computerized physician order entry systems were used in 58.1% and 86.0% of South Korean hospitals, respectively. Decision support systems and problem list documentation were the functions most frequently missing from comprehensive and basic EHR systems. The main barriers cited to adoption of EHR systems were the cost of purchasing (48%) and the ongoing cost of maintenance (11%). The EHR adoption rate in Korean hospitals (37.2%) was higher than that in US hospitals in 2010 (15.1%), but this trend was reversed in 2015 (58.1% vs. 75.2%). The evidence suggests that these trends were influenced by the level of financial and political support provided to US hospitals after the HITECH Act was passed in 2009. The EHR adoption rate in Korea has increased, albeit more slowly than in the US. It is logical to suggest that increased funding and support tied to the HITECH Act in the US partly explains the difference in the adoption rates of EHRs in both countries. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial.

PubMed

Peiris, David; Usherwood, Tim; Panaretto, Kathryn; Harris, Mark; Hunt, Jennifer; Redfern, Julie; Zwar, Nicholas; Colagiuri, Stephen; Hayman, Noel; Lo, Serigne; Patel, Bindu; Lyford, Marilyn; MacMahon, Stephen; Neal, Bruce; Sullivan, David; Cass, Alan; Jackson, Rod; Patel, Anushka

2015-01-01

Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥ 35 years and others aged ≥ 45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38,725 patients (mean age, 61.0 years; 42% men) was 17.5 months. Mean monthly staff support was <1 hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio; 1.25; 95% confidence interval, 1.04-1.50; P=0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10,308; 56.8% versus 51.2%; P=0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7%; P<0.001), lipid-lowering (19.2% versus 4.8%; P<0.001), and blood pressure-lowering medications (23.3% versus 12.1%; P=0.02). In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910. © 2015 American Heart Association, Inc.

Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?

PubMed

Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

2014-01-01

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change.

Evaluation of real-time clinical decision support systems for platelet and cryoprecipitate orders.

PubMed

Collins, Ryan A; Triulzi, Darrell J; Waters, Jonathan H; Reddy, Vivek; Yazer, Mark H

2014-01-01

To evaluate cryoprecipitate and platelet ordering practices after the implementation of real-time clinical decision support systems (CDSSs) in a computerized physician order entry (CPOE) system. Uniform platelet and cryoprecipitate transfusion thresholds were implemented at 11 hospitals in a regional health care system with a common CPOE system. Over 6 months, a variety of information was collected on the ordering physicians and the number of alerts generated by the CDSSs when these products were ordered outside of the institutional guidelines. There were 1,889 orders for platelets and 152 orders for cryoprecipitate placed in 6 months. Of these, 1,102 (58.3%) platelet and 74 (48.7%) cryoprecipitate orders triggered an alert. The proportion of orders canceled after an alert was generated ranged from 13.5% to 17.9% for platelets and 0% to 50.0% for cryoprecipitate orders. CDSS alerts reduce, but do not eliminate, platelet and cryoprecipitate transfusions that do not meet institutional guidelines.

Technological innovations in the development of cardiovascular clinical information systems.

PubMed

Hsieh, Nan-Chen; Chang, Chung-Yi; Lee, Kuo-Chen; Chen, Jeen-Chen; Chan, Chien-Hui

2012-04-01

Recent studies have shown that computerized clinical case management and decision support systems can be used to assist surgeons in the diagnosis of disease, optimize surgical operation, aid in drug therapy and decrease the cost of medical treatment. Therefore, medical informatics has become an extensive field of research and many of these approaches have demonstrated potential value for improving medical quality. The aim of this study was to develop a web-based cardiovascular clinical information system (CIS) based on innovative techniques, such as electronic medical records, electronic registries and automatic feature surveillance schemes, to provide effective tools and support for clinical care, decision-making, biomedical research and training activities. The CIS developed for this study contained monitoring, surveillance and model construction functions. The monitoring layer function provided a visual user interface. At the surveillance and model construction layers, we explored the application of model construction and intelligent prognosis to aid in making preoperative and postoperative predictions. With the use of the CIS, surgeons can provide reasonable conclusions and explanations in uncertain environments.

Reducing duplicate testing: a comparison of two clinical decision support tools.

PubMed

Procop, Gary W; Keating, Catherine; Stagno, Paul; Kottke-Marchant, Kandice; Partin, Mary; Tuttle, Robert; Wyllie, Robert

2015-05-01

Unnecessary duplicate laboratory testing is common and costly. Systems-based means to avert unnecessary testing should be investigated and employed. We compared the effectiveness and cost savings associated with two clinical decision support tools to stop duplicate testing. The Hard Stop required telephone contact with the laboratory and justification to have the duplicate test performed, whereas the Smart Alert allowed the provider to bypass the alert at the point of order entry without justification. The Hard Stop alert was significantly more effective than the Smart Alert (92.3% vs 42.6%, respectively; P < .0001). The cost savings realized per alert activation was $16.08/alert for the Hard Stop alert vs $3.52/alert for the Smart Alert. Structural and process changes that require laboratory contact and justification for duplicate testing are more effective than interventions that allow providers to bypass alerts without justification at point of computerized physician order entry. Copyright© by the American Society for Clinical Pathology.

ECHO: A Computer Based Test for the Measurement of Individualistic, Cooperative, Defensive, and Aggressive Models of Behavior. Occasional Paper No. 30.

ERIC Educational Resources Information Center

Krus, David J.; And Others

This paper describes a test which attempts to measure a group of personality traits by analyzing the actual behavior of the participant in a computer-simulated game. ECHO evolved from an extension and computerization of Horstein and Deutsch's allocation game. The computerized version of ECHO requires subjects to make decisions about the allocation…

17 CFR 201.141 - Orders and decisions: Service of orders instituting proceedings and other orders and decisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... (3) Record of service. The Secretary shall maintain a record of service on parties (in hard copy or computerized format), identifying the party given notice, the method of service, the date of service, the...

45 CFR 307.0 - Scope of this part.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) The requirement for computerized support enforcement systems; (b) The functional requirements that a statewide computerized support enforcement system must meet; (c) Security and confidentiality requirements... to approving an advance planning document (APD); (e) The requirements and procedures for the...

Patient and physician predictors of patient receipt of therapies recommended by a computerized decision support system when initially prescribed broad-spectrum antibiotics: a cohort study

PubMed Central

Lye, David C.; Arah, Onyebuchi A

2016-01-01

Objective Antibiotic computerized decision support systems (CDSSs) were developed to guide antibiotic decisions, yet prescriptions of CDSS-recommended antibiotics have remained low. Our aim was to identify predictors of patients' receipt of empiric antibiotic therapies recommended by a CDSS when the prescribing physician had an initial preference for using broad-spectrum antibiotics. Methods We conducted a prospective cohort study in a 1 500-bed tertiary-care hospital in Singapore. We included all patients admitted from October 1, 2011 through September 30, 2012, who were prescribed piperacillin-tazobactam or carbapenem for empiric therapy and auto-triggered to receive antibiotic recommendations by the in-house antibiotic CDSS. Relevant data on the patient, prescribing and attending physicians were collected via electronic linkages of medical records and administrative databases. To account for clustering, we used multilevel logistic regression models to explore factors associated with receipt of CDSS-recommended antibiotic therapy. Results One-quarter of the 1 886 patients received CDSS-recommended antibiotics. More patients treated for pneumonia (33.2%) than sepsis (12.1%) and urinary tract infections (7.1%) received CDSS-recommended antibiotic therapies. The prescribing physician – but not the attending physician or clinical specialty – accounted for some (13.3%) of the variation. Prior hospitalization (odds ratio [OR] 1.32, 95% CI, 1.01-1.71), presumed pneumonia (OR 6.77, 95% CI, 3.28-13.99), intensive care unit (ICU) admission (OR 0.38, 95% CI, 0.21-0.66), and renal impairment (OR 0.70, 95% CI, 0.52-0.93) were factors associated with patients’ receipt of CDSS-recommended antibiotic therapies. Conclusions We observed that ICU admission and renal impairment were negative predictors of patients’ receipt of CDSS-recommended antibiotic therapies. Patients admitted to ICU and those with renal impairment might have more complex clinical conditions that require a physician's assessment in addition to antibiotic CDSS. PMID:26342216

The role of standardized data and terminological systems in computerized clinical decision support systems: literature review and survey.

PubMed

Ahmadian, Leila; van Engen-Verheul, Mariette; Bakhshi-Raiez, Ferishta; Peek, Niels; Cornet, Ronald; de Keizer, Nicolette F

2011-02-01

Clinical decision support systems (CDSSs) should be seamlessly integrated with existing clinical information systems to enable automatic provision of advice at the time and place where decisions are made. It has been suggested that a lack of agreed data standards frequently hampers this integration. We performed a literature review to investigate whether CDSSs used standardized (i.e. coded or numerical) data and which terminological systems have been used to code data. We also investigated whether a lack of standardized data was considered an impediment for CDSS implementation. Articles reporting an evaluation of a CDSS that provided a computerized advice based on patient-specific data items were identified based on a former literature review on CDSS and on CDSS studies identified in AMIA's 'Year in Review'. Authors of these articles were contacted to check and complete the extracted data. A questionnaire among the authors of included studies was used to determine the obstacles in CDSS implementation. We identified 77 articles published between 1995 and 2008. Twenty-two percent of the evaluated CDSSs used only numerical data. Fifty one percent of the CDSSs that used coded data applied an international terminology. The most frequently used international terminology were the ICD (International Classification of Diseases), used in 68% of the cases and LOINC (Logical Observation Identifiers Names and Codes) in 12% of the cases. More than half of the authors experienced barriers in CDSS implementation. In most cases these barriers were related to the lack of electronically available standardized data required to invoke or activate the CDSS. Many CDSSs applied different terminological systems to code data. This diversity hampers the possibility of sharing and reasoning with data within different systems. The results of the survey confirm the hypothesis that data standardization is a critical success factor for CDSS development. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Diabetes Information Technology: Designing Informatics Systems to Catalyze Change in Clinical Care

PubMed Central

Lester, William T.; Zai, Adrian H.; Chueh, Henry C.; Grant, Richard W.

2008-01-01

Current computerized reminder and decision support systems intended to improve diabetes care have had a limited effect on clinical outcomes. Increasing pressures on health care networks to meet standards of diabetes care have created an environment where information technology systems for diabetes management are often created under duress, appended to existing clinical systems, and poorly integrated into the existing workflow. After defining the components of diabetes disease management, the authors present an eight-step conceptual framework to guide the development of more effective diabetes information technology systems for translating clinical information into clinical action. PMID:19885355

Planning: supporting and optimizing clinical guidelines execution.

PubMed

Anselma, Luca; Montani, Stefania

2008-01-01

A crucial feature of computerized clinical guidelines (CGs) lies in the fact that they may be used not only as conventional documents (as if they were just free text) describing general procedures that users have to follow. In fact, thanks to a description of their actions and control flow in some semiformal representation language, CGs can also take advantage of Computer Science methods and Information Technology infrastructures and techniques, to become executable documents, in the sense that they may support clinical decision making and clinical procedures execution. In order to reach this goal, some advanced planning techniques, originally developed within the Artificial Intelligence (AI) community, may be (at least partially) resorted too, after a proper adaptation to the specific CG needs has been carried out.

Balancing the benefits and costs of antibiotic drugs: the TREAT model.

PubMed

Leibovici, L; Paul, M; Andreassen, S

2010-12-01

TREAT is a computerized decision support system aimed at improving empirical antibiotic treatment of inpatients with suspected bacterial infections. It contains a model that balances, for each antibiotic choice (including 'no antibiotics'), expected benefit and expected costs. The main benefit afforded by appropriate, empirical, early antibiotic treatment in moderate to severe infections is a better chance of survival. Each antibiotic drug was consigned three cost components: cost of the drug and administration; cost of side effects; and costs of future resistance. 'No treatment' incurs no costs. The model worked well for decision support. Its analysis showed, yet again, that for moderate to severe infections, a model that does not include costs of resistance to future patients will always return maximum antibiotic treatment. Two major moral decisions are hidden in the model: how to take into account the limited life-expectancy and limited quality of life of old or very sick patients; and how to assign a value for a life-year of a future, unnamed patient vs. the present, individual patient. © 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.

Neural network modeling for surgical decisions on traumatic brain injury patients.

PubMed

Li, Y C; Liu, L; Chiu, W T; Jian, W S

2000-01-01

Computerized medical decision support systems have been a major research topic in recent years. Intelligent computer programs were implemented to aid physicians and other medical professionals in making difficult medical decisions. This report compares three different mathematical models for building a traumatic brain injury (TBI) medical decision support system (MDSS). These models were developed based on a large TBI patient database. This MDSS accepts a set of patient data such as the types of skull fracture, Glasgow Coma Scale (GCS), episode of convulsion and return the chance that a neurosurgeon would recommend an open-skull surgery for this patient. The three mathematical models described in this report including a logistic regression model, a multi-layer perceptron (MLP) neural network and a radial-basis-function (RBF) neural network. From the 12,640 patients selected from the database. A randomly drawn 9480 cases were used as the training group to develop/train our models. The other 3160 cases were in the validation group which we used to evaluate the performance of these models. We used sensitivity, specificity, areas under receiver-operating characteristics (ROC) curve and calibration curves as the indicator of how accurate these models are in predicting a neurosurgeon's decision on open-skull surgery. The results showed that, assuming equal importance of sensitivity and specificity, the logistic regression model had a (sensitivity, specificity) of (73%, 68%), compared to (80%, 80%) from the RBF model and (88%, 80%) from the MLP model. The resultant areas under ROC curve for logistic regression, RBF and MLP neural networks are 0.761, 0.880 and 0.897, respectively (P < 0.05). Among these models, the logistic regression has noticeably poorer calibration. This study demonstrated the feasibility of applying neural networks as the mechanism for TBI decision support systems based on clinical databases. The results also suggest that neural networks may be a better solution for complex, non-linear medical decision support systems than conventional statistical techniques such as logistic regression.

An Application of Computerized Axial Tomography (CAT) Technology to Mass Raid Tracking

DTIC Science & Technology

1989-08-01

ESD-TR-89-305 MTR-10542 An Application of Computerized Axial Tomography ( CAT ) Technology to Mass Raid Tracking By John K. Barr August 1989...NO 11. TITLE (Include Security Classification) An Application of Computerized Axial Tomography ( CAT ) Technology to Mass Raid Tracking 12...by block number) Computerized Axial Tomography ( CAT ) Scanner Electronic Support Measures (ESM) Fusion (continued) 19. ABSTRACT (Continue on

Clinical Information Systems – From Yesterday to Tomorrow

PubMed Central

2016-01-01

Summary Objectives To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Methods Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author’s personal experience with developing the HELP system were also used. Results There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Conclusions Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years. PMID:27362589

The Impact of Computerization on Library Support Staff: A Study of Support Staff in Academic Libraries in Wisconsin.

ERIC Educational Resources Information Center

Palmini, Cathleen C.

1994-01-01

Describes a survey of Wisconsin academic library support staff that explored the effects of computerization of libraries on work and job satisfaction. Highlights include length of employment; time spent at computer terminals; training; computer background; computers as timesavers; influence of automation on effectiveness; and job frustrations.…

Acute asthma severity identification of expert system flow in emergency department

NASA Astrophysics Data System (ADS)

Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat

2017-11-01

Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.

Rationale and design of the STAR randomized controlled trial to accelerate adoption of childhood obesity comparative effectiveness research.

PubMed

Taveras, Elsie M; Marshall, Richard; Horan, Christine M; Gillman, Matthew W; Hacker, Karen; Kleinman, Ken P; Koziol, Renata; Price, Sarah; Simon, Steven R

2013-01-01

Comparative effectiveness research (CER) evidence on childhood obesity provides the basis for effective screening and management strategies in pediatric primary care. The uses of health information technology including decision support tools in the electronic health records (EHRs), as well as remote and mobile support to families, offer the potential to accelerate the adoption of childhood obesity CER evidence. The Study of Technology to Accelerate Research (STAR) is a three-arm, cluster-randomized controlled trial being conducted in 14 pediatric offices in Massachusetts designed to enroll 800, 6 to 12 year old children with a body mass index (BMI)≥ 95th percentile seen in primary care at those practices. We will examine the extent to which computerized decision support tools in the EHR delivered to primary care providers at the point of care, with or without direct-to-parent support and coaching, will increase adoption of CER evidence for management of obese children. Direct-to-parent intervention components include telephone coaching and twice-weekly text messages. Point-of-care outcomes include obesity diagnosis, nutrition and physical activity counseling, and referral to weight management. One-year child-level outcomes include changes in BMI and improvements in diet, physical activity, screen time, and sleep behaviors, as well as cost and cost-effectiveness. STAR will determine the extent to which decision support tools in EHRs with or without direct-to-parent support will increase adoption of evidence-based obesity management strategies in pediatric practice and improve childhood obesity-related outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

Quality of travel health advice in a French travel medicine and vaccine center: a prospective observational study.

PubMed

Bouldouyre, Marie-Anne; De Verdière, Nathalie Colin; Pavie, Juliette; De Castro, Nathalie; Ponscarme, Diane; Hamane, Samia; Rachline, Anne; Ferret, Samuel; Molina, Jean-Michel

2012-01-01

The number of international trips undertaken by French citizens is rising and we wished to assess the appropriateness of advices given to travelers in a vaccine and travel medicine center in France. We conducted a 3-month prospective study in one center in Paris where prescriptions and advice to travelers are given by trained physicians in travel medicine who have access to a computerized decision support system (Edisan). A questionnaire was used to record trip characteristics, patients' demographics, and prescriptions. Main outcome measure was the adequacy of prescriptions for malaria prophylaxis, yellow fever, and hepatitis A vaccines to French guidelines. A total of 730 subjects were enrolled in this study, with a median age of 28 years. Travel destinations were sub-Saharan Africa (58%), Asia (21%), and South America (18%). Among the 608 patients (83%) traveling to malaria-endemic areas, malaria prophylaxis was in accordance with guidelines in 578/608 patients (95.1%, 95% CI: 93-96.5), and doxycycline was the regimen of choice (48%). Inappropriate malaria prophylaxis was given to eight patients, one of whom developed plasmodium falciparum malaria. All 413 patients (100%, 95% CI: 99-100) traveling to yellow fever-endemic areas who needed vaccination were correctly vaccinated. However, three patients received yellow fever vaccination without indication. Also, 442 of 454 patients (97.4%, 95% CI: 95.4-98.5) eligible to receive hepatitis A vaccination were immunized. Appropriate advice for malaria prophylaxis, yellow fever, and hepatitis A vaccinations was provided in a travel medicine and vaccine center where trained physicians used a computerized decision support system. Even in this setting, however, errors can occur and professional practices should be regularly assessed to improve health care. © 2012 International Society of Travel Medicine.

A Computerized Decision Support System for Depression in Primary Care

PubMed Central

Kurian, Benji T.; Trivedi, Madhukar H.; Grannemann, Bruce D.; Claassen, Cynthia A.; Daly, Ella J.; Sunderajan, Prabha

2009-01-01

Objective: In 2004, results from The Texas Medication Algorithm Project (TMAP) showed better clinical outcomes for patients whose physicians adhered to a paper-and-pencil algorithm compared to patients who received standard clinical treatment for major depressive disorder (MDD). However, implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate. A computerized decision support system (CDSS) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm. Method: This was a 2-group, parallel design, clinical trial (one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006. Fifty-five patients with MDD (DSM-IV criteria) with no significant difference in disease characteristics were enrolled, 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care. The study's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care. Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale (HDRS17) evaluated by an independent rater. Results: Patients treated by physicians employing CDSS had significantly greater symptom reduction, based on the HDRS17, than patients treated with usual care (P < .001). Conclusions: The CDSS algorithm, utilizing measurement-based care, was superior to usual care for patients with MDD in primary care settings. Larger randomized controlled trials are needed to confirm these findings. Trial Registration: clinicaltrials.gov Identifier: NCT00551083 PMID:19750065

A computerized decision support system for depression in primary care.

PubMed

Kurian, Benji T; Trivedi, Madhukar H; Grannemann, Bruce D; Claassen, Cynthia A; Daly, Ella J; Sunderajan, Prabha

2009-01-01

In 2004, results from The Texas Medication Algorithm Project (TMAP) showed better clinical outcomes for patients whose physicians adhered to a paper-and-pencil algorithm compared to patients who received standard clinical treatment for major depressive disorder (MDD). However, implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate. A computerized decision support system (CDSS) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm. This was a 2-group, parallel design, clinical trial (one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006. Fifty-five patients with MDD (DSM-IV criteria) with no significant difference in disease characteristics were enrolled, 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care. The study's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care. Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale (HDRS(17)) evaluated by an independent rater. Patients treated by physicians employing CDSS had significantly greater symptom reduction, based on the HDRS(17), than patients treated with usual care (P < .001). The CDSS algorithm, utilizing measurement-based care, was superior to usual care for patients with MDD in primary care settings. Larger randomized controlled trials are needed to confirm these findings. clinicaltrials.gov Identifier: NCT00551083.

National trends in safety performance of electronic health record systems in children's hospitals.

PubMed

Chaparro, Juan D; Classen, David C; Danforth, Melissa; Stockwell, David C; Longhurst, Christopher A

2017-03-01

To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period. Evaluation of the last available test for each institution was performed, assessing performance overall as well as by decision support category (eg, drug-drug, dosing limits). Longitudinal analysis of test performance was also carried out to assess the impact of testing and the overall trend of CPOE performance in pediatric hospitals. Pediatric CPOE systems were able to identify 62% of potential medication errors in the test scenarios, but ranged widely from 23-91% in the institutions tested. The highest scoring categories included drug-allergy interactions, dosing limits (both daily and cumulative), and inappropriate routes of administration. We found that hospitals with longer periods since their CPOE implementation did not have better scores upon initial testing, but after initial testing there was a consistent improvement in testing scores of 4 percentage points per year. Pediatric computerized physician order entry (CPOE) systems on average are able to intercept a majority of potential medication errors, but vary widely among implementations. Prospective and repeated testing using the Leapfrog Group's evaluation tool is associated with improved ability to intercept potential medication errors. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

The iSCREEN Electronic Diabetes Dashboard: A Tool to Improve Knowledge and Implementation of Pediatric Clinical Practice Guidelines.

PubMed

Zahanova, Stacy; Tsouka, Alexandra; Palmert, Mark R; Mahmud, Farid H

2017-12-01

Clinical practice guidelines (CPG) provide evidence-based recommendations for patient care but may not be optimally applied in clinical settings. As a pilot study, we evaluated the impact of a computerized, point-of-care decision support system (CDSS) on guideline knowledge and adherence in our diabetes clinic. iSCREEN, a CDSS, integrated with a province-wide electronic health record, was designed based on the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Evaluation data were gathered by retrospective chart review and clinician questionnaire prior to and after implementation of iSCREEN. Records of patients with type 1 diabetes, 14 to 18 years of age, were assessed for appropriate screening for complications and comorbidities. To assess guideline adherence, 50 charts were reviewed at 2 time periods (25 before and 25 after launch of iSCREEN). Results revealed improved frequency of appropriate screening for diabetic nephropathy (p=0.03) and retinopathy (p=0.04), accompanied by a decrease in under- and overscreening for these outcomes. To assess guideline knowledge, 58 surveys were collected (31 prior to and 27 after the launch of iSCREEN) from care providers in the field of pediatric diabetes. There was a trend toward improved guideline knowledge in all team members (p=0.06). Implementation of a de novo CDSS was associated with improved rates of appropriate screening for diabetes-related complications. A trend toward improvement in health professionals' knowledge of the guidelines was also observed. Evaluation of this point-of-care computerized decision support tool suggests that it may facilitate diabetes care by optimizing complication screening and CPG knowledge, with the potential for broader implementation. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Investigation of optimal use of computer-aided detection systems: the role of the "machine" in decision making process.

PubMed

Paquerault, Sophie; Hardy, Paul T; Wersto, Nancy; Chen, John; Smith, Robert C

2010-09-01

The aim of this study was to explore different computerized models (the "machine") as a means to achieve optimal use of computer-aided detection (CAD) systems and to investigate whether these models can play a primary role in clinical decision making and possibly replace a clinician's subjective decision for combining his or her own assessment with that provided by a CAD system. Data previously collected from a fully crossed, multiple-reader, multiple-case observer study with and without CAD by seven observers asked to identify simulated small masses on two separate sets of 100 mammographic images (low-contrast and high-contrast sets; ie, low-contrast and high-contrast simulated masses added to random locations on normal mammograms) were used. This allowed testing two relative sensitivities between the observers and CAD. Seven models that combined detection assessments from CAD standalone, unaided read, and CAD-aided read (second read and concurrent read) were developed using the leave-one-out technique for training and testing. These models were personalized for each observer. Detection performance accuracies were analyzed using the area under a portion of the free-response receiver-operating characteristic curve (AUFC), sensitivity, and number of false-positives per image. For the low-contrast set, the use of computerized models resulted in significantly higher AUFCs compared to the unaided read mode for all readers, whereas the increased AUFCs between CAD-aided (second and concurrent reads; ie, decisions made by the readers) and unaided read modes were statistically significant for a majority, but not all, of the readers (four and five of the seven readers, respectively). For the high-contrast set, there were no significant trends in the AUFCs whether or not a model was used to combine the original reading modes. Similar results were observed when using sensitivity as the figure of merit. However, the average number of false-positives per image resulting from the computerized models remained the same as that obtained from the unaided read modes. Individual computerized models (the machine) that combine image assessments from CAD standalone, unaided read, and CAD-aided read can increase detection performance compared to the reading done by the observer. However, relative sensitivity (ie, the difference in sensitivity between CAD standalone and unaided read) was a critical factor that determined incremental improvement in decision making, whether made by the observer or using computerized models. Published by Elsevier Inc.

Organizational Decision Making

DTIC Science & Technology

1975-08-01

the lack of formal techniques typically used by large organizations, digress on the advantages of formal over informal... optimization ; for example one might do a number of optimization calculations, each time using a different measure of effectiveness as the optimized ...final decision. The next level of computer application involves the use of computerized optimization techniques. Optimization

A computerized system for portrayal of landscape alterations

Treesearch

A. E. Stevenson; J. A. Conley; J. B. Carey

1979-01-01

The growing public awareness of and participation in the visual resource decision process has stimulated interest to find improved means of accurately and realistically displaying proposed alterations. The traditional artist renderings often lack the accuracy and objectivity needed for critical decisions. One approach, using computer graphics, led to the MOSAIC system...

A Simulation of Strategic Decision Making in Situational Stereotype Conditions for Entrepreneurial Companies.

ERIC Educational Resources Information Center

West, G. Page, III; Wilson, E. Vance

1995-01-01

Examines simulation in entrepreneurial research, reviews cognitive structures and theories, and presents a computerized simulation of strategic decision-making in situational stereotype conditions for entrepreneurial companies. The study suggests repeated exposure to a pattern recognition issue in entrepreneurship may lead to a broader…

The Future of Computerized Decision Making

DTIC Science & Technology

2014-12-01

complex, historically reserved for governing bodies or market places where the collective human experience and intelligence come to play. Other decision...access. In all cases, we should think about this carefully first: what data are really important for our goals and what data should be ignored or not even...stored? The answer to these questions involves human intelligence and understanding before the data-to-decision process begins.

Integration of evidence-based knowledge management in microsystems: a tele-ICU experience.

PubMed

Rincon, Teresa A

2012-01-01

The Institute of Medicine's proposed 6 aims to improve health care are timely, safe, effective, efficient, equitable, and patient-centered care. Unfortunately, it also asserts that improvements in these 6 dimensions cannot be achieved within the existing framework of care systems. These systems are based on unrealistic expectations on human cognition and vigilance, and demonstrate a lack of dependence on computerized systems to support care processes and put information at the point of use. Knowledge-based care and evidence-based clinical decision-making need to replace the unscientific care that is being delivered in health care. Building care practices on evidence within an information technology platform is needed to support sound clinical decision-making and to influence organizational adoption of evidence-based practice in health care. Despite medical advances and evidence-based recommendations for treatment of severe sepsis, it remains a significant cause of mortality and morbidity in the world. It is a complex disease state that has proven difficult to define, diagnose, and treat. Supporting bedside teams with real-time knowledge and expertise to target early identification of severe sepsis and compliance to Surviving Sepsis Campaign, evidence-based practice bundles are important to improving outcomes. Using a centralized, remote team of expert nurses and an open-source software application to advance clinical decision-making and execution of the severe sepsis bundle will be examined.

Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study.

PubMed

Subramanian, Sujha; Hoover, Sonja; Wagner, Joann L; Donovan, Jennifer L; Kanaan, Abir O; Rochon, Paula A; Gurwitz, Jerry H; Field, Terry S

2012-01-01

In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30 days of use for a chronic drug and 10 days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180 days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering.

45 CFR 307.30 - Federal financial participation at the 90 percent rate for statewide computerized support...

Code of Federal Regulations, 2011 CFR

2011-10-01

... planning, design, development, installation or enhancement of a computerized support enforcement system as... APD approved by the Office; and (6) The State or local government has ownership rights in software, software modifications and associated documentation that is designed, developed, installed, or enhanced...

Radar Detection Models in Computer Supported Naval War Games

DTIC Science & Technology

1979-06-08

revealed a requirement for the effective centralized manage- ment of computer supported war game development and employment in the U.S. Navy. A...considerations and supports the requirement for centralized Io 97 management of computerized war game development . Therefore it is recommended that a central...managerial and fiscal authority be estab- lished for computerized tactical war game development . This central authority should ensure that new games

Computerized decision support system for mass identification in breast using digital mammogram: a study on GA-based neuro-fuzzy approaches.

PubMed

Das, Arpita; Bhattacharya, Mahua

2011-01-01

In the present work, authors have developed a treatment planning system implementing genetic based neuro-fuzzy approaches for accurate analysis of shape and margin of tumor masses appearing in breast using digital mammogram. It is obvious that a complicated structure invites the problem of over learning and misclassification. In proposed methodology, genetic algorithm (GA) has been used for searching of effective input feature vectors combined with adaptive neuro-fuzzy model for final classification of different boundaries of tumor masses. The study involves 200 digitized mammograms from MIAS and other databases and has shown 86% correct classification rate.

A Review of the Factors Associated with the Adoption of Accounting Information Systems in Gulf Countries.

PubMed

Hammour, Hadal; Househ, Mowafa; Razzak, Hira Abdul

2017-01-01

This review attempts to elucidate the significance of accounting information systems within healthcare settings in the Gulf regions. Information and communication technologies (ICT) has provided accounting system the ability to help an organization use and develop computerized systems to record and track financial transactions. Accounting information systems, if well implemented, can permit healthcare sectors in the Gulf regions to produce reports that can support the decision making process. Additional abilities of an accounting information systems include faster processing, enriched accuracy, amplified functionality, and improved external reporting. Training of hospital staff can help in enhancing the use of accounting information systems in gulf hospitals.

NewYork-Presbyterian Hospital: translating innovation into practice.

PubMed

Johnson, Trudy; Currie, Gail; Keill, Patricia; Corwin, Steven J; Pardes, Herbert; Cooper, Mary Reich

2005-10-01

NewYork-Presbyterian (NYP) Hospital, a 2,242-bed not-for-profit academic medical center, was formed by a merger of The New York Hospital and The Presbyterian Hospital in the City of New York. It is also the flagship for the NewYork-Presbyterian Healthcare System, with 37 acute care facilities and 18 others. The hospital embeds safety in the culture through strategic initiatives and enhances service and efficiency using Six Sigma and other techniques to drive adoption of improvements. Goals are selected in alignment with the annual strategic initiatives, which are chosen on the basis of satisfaction surveys, patient and family complaints, community advisory groups, and performance measures, among other sources. A new business intelligence system enables online, dynamic analysis of performance results, replacing static paper reports. Advanced features in the clinical information systems include computerized physician order entry; interactive clinical alerts for decision support; a real-time infection control tracking system; and a clinical data warehouse supporting data mining and analysis for quality improvement, decision making, and education. To achieve clinical, service, and operational excellence, NYP focuses on all Institute of Medicine quality aims.

Enrollment Planning Using Computer Decision Model: A Case Study at Grambling State University.

ERIC Educational Resources Information Center

Ghosh, Kalyan; Lundy, Harold W.

Achieving enrollment goals continues to be a major administrative concern in higher education. Enrollment management can be assisted through the use of computerized planning and forecast models. Although commercially available Markov transition type curve fitting models have been developed and used, a microcomputer-based decision planning model…

Assessing Sensorimotor Function Following ISS with Computerized Dynamic Posturography.

PubMed

Wood, Scott J; Paloski, William H; Clark, Jonathan B

2015-12-01

Postflight postural ataxia reflects both the control strategies adopted for movement in microgravity and the direct effects of deconditioning. Computerized dynamic posturography (CDP) has been used during the first decade of the International Space Station (ISS) expeditions to quantify the initial postflight decrements and recovery of postural stability. The CDP data were obtained on 37 crewmembers as part of their pre- and postflight medical examinations. Sensory organization tests evaluated the ability to make effective use of (or suppress inappropriate) visual, vestibular, and somatosensory information for balance control. This report focuses on eyes closed conditions with either a fixed or sway-referenced base of support, with the head erect or during pitch-head tilts (± 20° at 0.33 Hz). Equilibrium scores were derived from peak-to-peak anterior-posterior sway. Motor-control tests were also used to evaluate a crewmember's ability to automatically recover from unexpected support-surface perturbations. The standard Romberg condition was the least sensitive. Dynamic head tilts led to increased incidence of falls and revealed significantly longer recovery than head-erect conditions. Improvements in postflight postural performance during the later expeditions may be attributable to higher preflight baselines and/or advanced exercise capabilities aboard the ISS. The diagnostic assessment of postural instability is more pronounced during unstable-support conditions requiring active head movements. In addition to supporting return-to-duty decisions by flight surgeons, the CDP provides a standardized sensorimotor measure that can be used to evaluate the effectiveness of countermeasures designed to either minimize deconditioning on orbit or promote reconditioning upon return to Earth.

The Design and Development of a Computerized Tool Support for Conducting Senior Projects in Software Engineering Education

ERIC Educational Resources Information Center

Chen, Chung-Yang; Teng, Kao-Chiuan

2011-01-01

This paper presents a computerized tool support, the Meetings-Flow Project Collaboration System (MFS), for designing, directing and sustaining the collaborative teamwork required in senior projects in software engineering (SE) education. Among many schools' SE curricula, senior projects serve as a capstone course that provides comprehensive…

45 CFR 307.30 - Federal financial participation at the 90 percent rate for statewide computerized support...

Code of Federal Regulations, 2010 CFR

2010-10-01

... applicable matching rate.) (c) HHS rights to software. The Department of Health and Human Services reserves a...), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT... APD approved by the Office; and (6) The State or local government has ownership rights in software...

Computerized Information and Support for Patients with Breast Cancer or HIV Infection.

ERIC Educational Resources Information Center

Rolnick, Sharon J.; Owens, Betta; Botta, Renee; Sathe, Laurie; Hawkins, Robert; Cooper, Leah; Kelley, Mary; Gustafson, David

1999-01-01

Use of the Comprehensive Health Enhancement Support System, a computerized information system, by patients with breast cancer or HIV was compared. Groups differed in the frequency of access and use of certain aspects (e.g., discussion groups). Identification of patient concerns provided useful information for system improvements. (SK)

A Tentative Career Development Curriculum and Its Implications for the Patterning of Supervisory Responsibilities in the Information System for Vocational Decisions. Information System for Vocational Decisions. Project Report Number 10.

ERIC Educational Resources Information Center

Fletcher, Wallace J.; And Others

The goals of the Information System for Vocational Decisions (ISVD), a computerized vocational development program which emphasized goal setting and purposeful action, are related to a tentative curriculum context called a Career Development Program. This Program is learner centered with process and subject matter a function of individual…

Supporting Patient Care in the Emergency Department with a Computerized Whiteboard System

PubMed Central

Aronsky, Dominik; Jones, Ian; Lanaghan, Kevin; Slovis, Corey M.

2008-01-01

Efficient information management and communication within the emergency department (ED) is essential to providing timely and high-quality patient care. The ED whiteboard (census board) usually serves as an ED’s central access point for operational and patient-related information. This article describes the design, functionality, and experiences with a computerized ED whiteboard, which has the ability to display relevant operational and patient-related information in real time. Embedded functionality, additional whiteboard views, and the integration with ED and institutional information system components, such as the computerized patient record or the provider order entry system, provide rapid access to more detailed information. As an information center, the computerized whiteboard supports our ED environment not only for providing patient care, but also for operational, educational, and research activities. PMID:18096913

Application of Fuzzy Logic in Oral Cancer Risk Assessment

PubMed Central

SCROBOTĂ, Ioana; BĂCIUȚ, Grigore; FILIP, Adriana Gabriela; TODOR, Bianca; BLAGA, Florin; BĂCIUȚ, Mihaela Felicia

2017-01-01

Background: The mapping of the malignization mechanism is still incomplete, but oxidative stress is strongly correlated to carcinogenesis. In our research, using fuzzy logic, we aimed to estimate the oxidative stress related-cancerization risk of the oral potentially malignant disorders. Methods: Serum from 16 patients diagnosed (clinical and histopathological) with oral potentially malignant disorders (Dept. of Cranio-Maxillofacial Surgery and Radiology, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania) was processed fluorometric for malondialdehyde and proton donors assays (Dept. of Physiology,”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania). The values were used as inputs, they were associated linguistic terms using MIN-MAX method and 25 IF-THEN inference rules were generated to estimate the output value, the cancerization risk appreciated on a scale from 1 to 10 - IF malondialdehyde is very high and donors protons are very low THEN the cancer risk is reaching the maximum value (Dept. of Industrial Engineering, Faculty of Managerial and Technological Engineering, University of Oradea, Oradea, Romania) (2012–2014). Results: We estimated the cancerization risk of the oral potentially malignant disorders by implementing the multi-criteria decision support system based on serum malondialdehyde and proton donors’ values. The risk was estimated as a concrete numerical value on a scale from 1 to 10 depending on the input numerical/linguistic value. Conclusion: The multi-criteria decision support system proposed by us, integrated into a more complex computerized decision support system, could be used as an important aid in oral cancer screening and establish future medical decision in oral potentially malignant disorders. PMID:28560191

Application of Fuzzy Logic in Oral Cancer Risk Assessment.

PubMed

Scrobotă, Ioana; Băciuț, Grigore; Filip, Adriana Gabriela; Todor, Bianca; Blaga, Florin; Băciuț, Mihaela Felicia

2017-05-01

The mapping of the malignization mechanism is still incomplete, but oxidative stress is strongly correlated to carcinogenesis. In our research, using fuzzy logic, we aimed to estimate the oxidative stress related-cancerization risk of the oral potentially malignant disorders. Serum from 16 patients diagnosed (clinical and histopathological) with oral potentially malignant disorders (Dept. of Cranio-Maxillofacial Surgery and Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania) was processed fluorometric for malondialdehyde and proton donors assays (Dept. of Physiology,"Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania). The values were used as inputs, they were associated linguistic terms using MIN-MAX method and 25 IF-THEN inference rules were generated to estimate the output value, the cancerization risk appreciated on a scale from 1 to 10 - IF malondialdehyde is very high and donors protons are very low THEN the cancer risk is reaching the maximum value (Dept. of Industrial Engineering, Faculty of Managerial and Technological Engineering, University of Oradea, Oradea, Romania) (2012-2014). We estimated the cancerization risk of the oral potentially malignant disorders by implementing the multi-criteria decision support system based on serum malondialdehyde and proton donors' values. The risk was estimated as a concrete numerical value on a scale from 1 to 10 depending on the input numerical/linguistic value. The multi-criteria decision support system proposed by us, integrated into a more complex computerized decision support system, could be used as an important aid in oral cancer screening and establish future medical decision in oral potentially malignant disorders.

Computerized Tests of Team Performance and Crew Coordination Suitable for Military/Aviation Settings.

PubMed

Lawson, Ben D; Britt, Thomas W; Kelley, Amanda M; Athy, Jeremy R; Legan, Shauna M

2017-08-01

The coordination of team effort on shared tasks is an area of inquiry. A number of tests of team performance in challenging environments have been developed without comparison or standardization. This article provides a systematic review of the most accessible and usable low-to-medium fidelity computerized tests of team performance and determines which are most applicable to military- and aviation-relevant research, such as studies of group command, control, communication, and crew coordination. A search was conducted to identify computerized measures of team performance. In addition to extensive literature searches (DTIC, Psychinfo, PubMed), the authors reached out to team performance researchers at conferences and through electronic communication. Identified were 57 potential tests according to 6 specific selection criteria (e.g., the requirement for automated collection of team performance and coordination processes, the use of military-relevant scenarios). The following seven tests (listed alphabetically) were considered most suitable for military needs: Agent Enabled Decision Group Environment (AEDGE), C3Conflict, the C3 (Command, Control, & Communications) Interactive Task for Identifying Emerging Situations (NeoCITIES), Distributed Dynamic Decision Making (DDD), Duo Wondrous Original Method Basic Awareness/Airmanship Test (DuoWOMBAT), the Leader Development Simulator (LDS), and the Planning Task for Teams (PLATT). Strengths and weaknesses of these tests are described and recommendations offered to help researchers identify the test most suitable for their particular needs. Adoption of a few standard computerized test batteries to study team performance would facilitate the evaluation of interventions intended to enhance group performance in multiple challenging military and aerospace operational environments.Lawson BD, Britt TW, Kelley AM, Athy JR, Legan SM. Computerized tests of team performance and crew coordination suitable for military/aviation settings. Aerosp Med Hum Perform. 2017; 88(8):722-729.

45 CFR 307.31 - Federal financial participation at the 80 percent rate for computerized support enforcement systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... applicable matching rate.) (c) HHS rights to software. The Department of Health and Human Services reserves a...), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT... APD approved by the Office; and (6) The State or local government has ownership rights in software...

Computers and Management Structure: Some Empirical Findings Re-examined

ERIC Educational Resources Information Center

Robey, Daniel

1977-01-01

Studies that relate computerization to either centralization or decentralization of organizational decision making are reviewed. Four issues are addressed that relate to conceptual or methodological problems. (Author/MLF)

NEFP Decision Process: "A Computer Simulation for Planning School Finance Programs." User Manual.

ERIC Educational Resources Information Center

Boardman, Gerald R.; And Others

The National Educational Finance Project has developed a computerized model designed to simulate the consequences of alternative decisions in regard to the financing of public elementary and secondary education. This manual describes a users orientation to that model. The model was designed as an operational prototype for States to use in a…

Lost in Search: (Mal-)Adaptation to Probabilistic Decision Environments in Children and Adults

ERIC Educational Resources Information Center

Betsch, Tilmann; Lehmann, Anne; Lindow, Stefanie; Lang, Anna; Schoemann, Martin

2016-01-01

Adaptive decision making in probabilistic environments requires individuals to use probabilities as weights in predecisional information searches and/or when making subsequent choices. Within a child-friendly computerized environment (Mousekids), we tracked 205 children's (105 children 5-6 years of age and 100 children 9-10 years of age) and 103…

Processes and Factors Underlying Adolescent Males' Attitudes and Decision-Making in Relation to an Unplanned Pregnancy

ERIC Educational Resources Information Center

Condon, John T.; Corkindale, Carolyn J.; Russell, Alan; Quinlivan, Julie A.

2006-01-01

This research examined adolescent males' decision-making when confronted with a hypothetical unplanned pregnancy in a sexual partner. An innovative methodology, involving a computerized simulation game was utilized with 386 Australian males (mean age of 15 years). Data were gathered from responses made during the simulation, and questionnaires…

Use of an Online Clinical Process Support System as an Aid to Identification and Management of Developmental and Mental Health Problems.

PubMed

Howard, Barbara J; Sturner, Raymond

2017-12-01

To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening. An online clinical process support system (CHADIS) shows promise in addressing these issues. Use of a comprehensive panel of online pre-visit screens; linked decision support to provide moment-of-care training; and post-visit activities and resources for patient-specific education, monitoring and care coordination is an efficient way to make the entire process of screening and follow up care feasible in primary care. CHADIS fulfills these requirements and provides Maintenance of Certification credit to physicians as well as added income for screening efforts.

What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation.

PubMed

Liberati, Elisa G; Ruggiero, Francesca; Galuppo, Laura; Gorli, Mara; González-Lorenzo, Marien; Maraldi, Marco; Ruggieri, Pietro; Polo Friz, Hernan; Scaratti, Giuseppe; Kwag, Koren H; Vespignani, Roberto; Moja, Lorenzo

2017-09-15

Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as "positions." The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians' perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians' reasoning and fostering organizational learning. Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians' attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.

A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial.

PubMed

Roy, Pierre-Marie; Durieux, Pierre; Gillaizeau, Florence; Legall, Catherine; Armand-Perroux, Aurore; Martino, Ludovic; Hachelaf, Mohamed; Dubart, Alain-Eric; Schmidt, Jeannot; Cristiano, Mirko; Chretien, Jean-Marie; Perrier, Arnaud; Meyer, Guy

2009-11-17

Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines. To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department. Cluster randomized trial. Assignment was by random-number table, providers were not blinded, and outcome assessment was automated. (ClinicalTrials.gov registration number: NCT00188032). 20 emergency departments in France. 1103 and 1768 consecutive outpatients with suspected pulmonary embolism. After a preintervention period involving 20 centers and 1103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1015 patients). Appropriateness of diagnostic work-up, defined as any sequence of tests that yielded a posttest probability less than 5% or greater than 85% (primary outcome) or as strict adherence to guideline recommendations (secondary outcome); number of tests per patient (secondary outcome). The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group (mean tests per patient, 1.76 [SD, 0.98] vs. 2.25 [SD, 1.04]; P < 0.001). The study was not designed to show a difference in the clinical outcomes of patients during follow-up. A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department.

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia

PubMed Central

El.Mahalli, Azza; El-Khafif, Sahar H.; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended. PMID:26903780

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia.

PubMed

El Mahalli, Azza; El-Khafif, Sahar H; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended.

Computerized pharmacy surveillance and alert system for drug-related problems.

PubMed

Ferrández, O; Urbina, O; Grau, S; Mateu-de-Antonio, J; Marin-Casino, M; Portabella, J; Mojal, S; Riu, M; Salas, E

2017-04-01

Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment. Most of these applications have utilized a small range of drugs with alerts and/or types of alert. The objective of this study was to describe the implementation of a PWS integrated in the electronic medical record (EMR). The PWS was developed in 2003-2004. Pharmacological information to generate drug alerts was entered on demographic data, drug dosage, laboratory tests related to the prescribed drug and drug combinations (interactions, duplications and necessary combinations). The PWS was applied in the prescription reviews conducted in patients admitted to the hospital in 2012. Information on 83% of the drugs included in the pharmacopeia was introduced into the PWS, allowing detection of 2808 potential DRPs, representing 79·1% of all potential DRPs detected during the study period. Twenty per cent of PWS DRPs were clinically relevant, requiring pharmacist intervention. The PWS detected most potential DRPs, thus increasing inpatient safety. The detection ability of the PWS was higher than that reported for other tools described in the literature. © 2017 John Wiley & Sons Ltd.

Computerized provider order entry systems.

PubMed

2001-01-01

Computerized provider order entry (CPOE) systems are designed to replace a hospital's paper-based ordering system. They allow users to electronically write the full range of orders, maintain an online medication administration record, and review changes made to an order by successive personnel. They also offer safety alerts that are triggered when an unsafe order (such as for a duplicate drug therapy) is entered, as well as clinical decision support to guide caregivers to less expensive alternatives or to choices that better fit established hospital protocols. CPOE systems can, when correctly configured, markedly increase efficiency and improve patient safety and patient care. However, facilities need to recognize that currently available CPOE systems require a tremendous amount of time and effort to be spent in customization before their safety and clinical support features can be effectively implemented. What's more, even after they've been customized, the systems may still allow certain unsafe orders to be entered. Thus, CPOE systems are not currently a quick or easy remedy for medical errors. ECRI's Evaluation of CPOE systems--conducted in collaboration with the Institute for Safe Medication Practices (ISMP)--discusses these and other related issues. It also examines and compares CPOE systems from three suppliers: Eclipsys Corp., IDX Systems Corp., and Siemens Medical Solutions Health Services Corp. Our testing focuses primarily on the systems' interfacing capabilities, patient safeguards, and ease of use.

Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial.

PubMed

Taveras, Elsie M; Marshall, Richard; Kleinman, Ken P; Gillman, Matthew W; Hacker, Karen; Horan, Christine M; Smith, Renata L; Price, Sarah; Sharifi, Mona; Rifas-Shiman, Sheryl L; Simon, Steven R

2015-06-01

Evidence of effective treatment of childhood obesity in primary care settings is limited. To examine the extent to which computerized clinical decision support (CDS) delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and quality of care. We conducted a cluster-randomized, 3-arm clinical trial. We enrolled 549 children aged 6 to 12 years with a BMI at the 95% percentile or higher from 14 primary care practices in Massachusetts from October 1, 2011, through June 30, 2012. Patients were followed up for 1 year (last follow-up, August 30, 2013). In intent-to-treat analyses, we used linear mixed-effects models to account for clustering by practice and within each person. In 5 practices randomized to CDS, pediatric clinicians received decision support on obesity management, and patients and their families received an intervention for self-guided behavior change. In 5 practices randomized to CDS + coaching, decision support was augmented by individualized family coaching. The remaining 4 practices were randomized to usual care. Smaller age-associated change in BMI and the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity during the 1-year follow-up. At baseline, mean (SD) patient age and BMI were 9.8 (1.9) years and 25.8 (4.3), respectively. At 1 year, we obtained BMI from 518 children (94.4%) and HEDIS measures from 491 visits (89.4%). The 3 randomization arms had different effects on BMI over time (P = .04). Compared with the usual care arm, BMI increased less in children in the CDS arm during 1 year (-0.51 [95% CI, -0.91 to -0.11]). The CDS + coaching arm had a smaller magnitude of effect (-0.34 [95% CI, -0.75 to 0.07]). We found substantially greater achievement of childhood obesity HEDIS measures in the CDS arm (adjusted odds ratio, 2.28 [95% CI, 1.15-4.53]) and CDS + coaching arm (adjusted odds ratio, 2.60 [95% CI, 1.25-5.41]) and higher use of HEDIS codes for nutrition or physical activity counseling (CDS arm, 45%; CDS + coaching arm, 25%; P < .001 compared with usual care arm). An intervention that included computerized CDS for pediatric clinicians and support for self-guided behavior change for families resulted in improved childhood BMI. Both interventions improved the quality of care for childhood obesity. clinicaltrials.gov Identifier: NCT01537510.

Computerized Memory Training Leads to Sustained Improvement in Visuospatial Short-Term Memory Skills in Children with Down Syndrome

ERIC Educational Resources Information Center

Bennett, Stephanie J.; Holmes, Joni; Buckley, Sue

2013-01-01

This study evaluated the impact of a computerized visuospatial memory training intervention on the memory and behavioral skills of children with Down syndrome. Teaching assistants were trained to support the delivery of a computerized intervention program to individual children over a 10-16 week period in school. Twenty-one children aged 7-12…

[The movement computerized analysis as instrumental support for occupational doctors in evaluation of upper limb pathologies in engineering workers].

PubMed

D'Orso, M I; Centemeri, R; Oggionni, P; Latocca, R; Crippa, M; Vercellino, R; Riva, M; Cesana, G

2011-01-01

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful for workers coming back to work after a work-related or a not work-related accident of for handicapped workers at the beginning of a new work activity. We report a research carried out using computerized analysis of motion of upper limbs in 20 engineering workers.

A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system

PubMed Central

Colombet, Isabelle; Dart, Thierry; Leneveut, Laurence; Zunino, Sylvain; Ménard, Joël; Chatellier, Gilles

2003-01-01

Background Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. Methods The system called EsPeR (Personalised Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6–11 general practitioners. Physicians worked on several structured clinical scenari os with the help of EsPeR, and three senior investigators leaded structured discussion sessions. Results The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations. Conclusion Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials. PMID:14641924

The radiology digital dashboard: effects on report turnaround time.

PubMed

Morgan, Matthew B; Branstetter, Barton F; Lionetti, David M; Richardson, Jeremy S; Chang, Paul J

2008-03-01

As radiology departments transition to near-complete digital information management, work flows and their supporting informatics infrastructure are becoming increasingly complex. Digital dashboards can integrate separate computerized information systems and summarize key work flow metrics in real time to facilitate informed decision making. A PACS-integrated digital dashboard function designed to alert radiologists to their unsigned report queue status, coupled with an actionable link to the report signing application, resulted in a 24% reduction in the time between transcription and report finalization. The dashboard was well received by radiologists who reported high usage for signing reports. Further research is needed to identify and evaluate other potentially useful work flow metrics for inclusion in a radiology clinical dashboard.

Immunization Information System and Informatics to Promote Immunizations: Perspective From Minnesota Immunization Information Connection.

PubMed

Muscoplat, Miriam Halstead; Rajamani, Sripriya

2017-01-01

The vision for management of immunization information is availability of real-time consolidated data and services for all ages, to clinical, public health, and other stakeholders. This is being executed through Immunization Information Systems (IISs), which are population-based and confidential computerized systems present in most US states and territories. Immunization Information Systems offer many functionalities, such as immunization assessment reports, client follow-up, reminder/recall feature, vaccine management tools, state-supplied vaccine ordering, comprehensive immunization history, clinical decision support/vaccine forecasting and recommendations, data processing, and data exchange. This perspective article will present various informatics tools in an IIS, in the context of the Minnesota Immunization Information Connection.

IGT-Open: An open-source, computerized version of the Iowa Gambling Task.

PubMed

Dancy, Christopher L; Ritter, Frank E

2017-06-01

The Iowa Gambling Task (IGT) is commonly used to understand the processes involved in decision-making. Though the task was originally run without a computer, using a computerized version of the task has become typical. These computerized versions of the IGT are useful, because they can make the task more standardized across studies and allow for the task to be used in environments where a physical version of the task may be difficult or impossible to use (e.g., while collecting brain imaging data). Though these computerized versions of the IGT have been useful for experimentation, having multiple software implementations of the task could present reliability issues. We present an open-source software version of the Iowa Gambling Task (called IGT-Open) that allows for millisecond visual presentation accuracy and is freely available to be used and modified. This software has been used to collect data from human subjects and also has been used to run model-based simulations with computational process models developed to run in the ACT-R architecture.

A computerized bucking trainer for optimally bucking hardwoods

Treesearch

Scott Noble; Blair Orr; Philip A. Araman; John Baumgras; James B. Pickens

2000-01-01

The bucking of hardwood stems constitutes the initial manufacturing decision for hardwood lumber production. Each bucking cut creates a log of fixed grade and scale. The grade and scale of each log created by the bucker determines the quantity and quality of potential lumber, which determines the value of the log within a given market. As a result, bucking decisions...

Spacelab user implementation assessment study (software requirements analysis). Volume 1: Executive study

NASA Technical Reports Server (NTRS)

1976-01-01

The primary objective of this study was to develop an integrated approach for the development, implementation, and utilization of all software that is required to efficiently and cost-effectively support advanced technology laboratory flight and ground operations. It was recognized that certain aspects of the operations would be mandatory computerized services; computerization of other aspects would be optional. Thus, the analyses encompassed not only alternate computer utilization and implementations but trade studies of the programmatic effects of non-computerized versus computerized approaches to the operations. A general overview of the study is presented.

The Computerized Reference Department: Buying the Future.

ERIC Educational Resources Information Center

Kriz, Harry M.; Kok, Victoria T.

1985-01-01

Basis for systematic computerization of academic research library's reference, collection development, and collection management functions emphasizes productivity enhancement for librarians and support staff. Use of microcomputer and university's mainframe computer to develop applications of database management systems, electronic spreadsheets,…

Mousetrap: An integrated, open-source mouse-tracking package.

PubMed

Kieslich, Pascal J; Henninger, Felix

2017-10-01

Mouse-tracking - the analysis of mouse movements in computerized experiments - is becoming increasingly popular in the cognitive sciences. Mouse movements are taken as an indicator of commitment to or conflict between choice options during the decision process. Using mouse-tracking, researchers have gained insight into the temporal development of cognitive processes across a growing number of psychological domains. In the current article, we present software that offers easy and convenient means of recording and analyzing mouse movements in computerized laboratory experiments. In particular, we introduce and demonstrate the mousetrap plugin that adds mouse-tracking to OpenSesame, a popular general-purpose graphical experiment builder. By integrating with this existing experimental software, mousetrap allows for the creation of mouse-tracking studies through a graphical interface, without requiring programming skills. Thus, researchers can benefit from the core features of a validated software package and the many extensions available for it (e.g., the integration with auxiliary hardware such as eye-tracking, or the support of interactive experiments). In addition, the recorded data can be imported directly into the statistical programming language R using the mousetrap package, which greatly facilitates analysis. Mousetrap is cross-platform, open-source and available free of charge from https://github.com/pascalkieslich/mousetrap-os .

Computerized scoring algorithms for the Autobiographical Memory Test.

PubMed

Takano, Keisuke; Gutenbrunner, Charlotte; Martens, Kris; Salmon, Karen; Raes, Filip

2018-02-01

Reduced specificity of autobiographical memories is a hallmark of depressive cognition. Autobiographical memory (AM) specificity is typically measured by the Autobiographical Memory Test (AMT), in which respondents are asked to describe personal memories in response to emotional cue words. Due to this free descriptive responding format, the AMT relies on experts' hand scoring for subsequent statistical analyses. This manual coding potentially impedes research activities in big data analytics such as large epidemiological studies. Here, we propose computerized algorithms to automatically score AM specificity for the Dutch (adult participants) and English (youth participants) versions of the AMT by using natural language processing and machine learning techniques. The algorithms showed reliable performances in discriminating specific and nonspecific (e.g., overgeneralized) autobiographical memories in independent testing data sets (area under the receiver operating characteristic curve > .90). Furthermore, outcome values of the algorithms (i.e., decision values of support vector machines) showed a gradient across similar (e.g., specific and extended memories) and different (e.g., specific memory and semantic associates) categories of AMT responses, suggesting that, for both adults and youth, the algorithms well capture the extent to which a memory has features of specific memories. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Computational Planning in Facial Surgery.

PubMed

Zachow, Stefan

2015-10-01

This article reflects the research of the last two decades in computational planning for cranio-maxillofacial surgery. Model-guided and computer-assisted surgery planning has tremendously developed due to ever increasing computational capabilities. Simulators for education, planning, and training of surgery are often compared with flight simulators, where maneuvers are also trained to reduce a possible risk of failure. Meanwhile, digital patient models can be derived from medical image data with astonishing accuracy and thus can serve for model surgery to derive a surgical template model that represents the envisaged result. Computerized surgical planning approaches, however, are often still explorative, meaning that a surgeon tries to find a therapeutic concept based on his or her expertise using computational tools that are mimicking real procedures. Future perspectives of an improved computerized planning may be that surgical objectives will be generated algorithmically by employing mathematical modeling, simulation, and optimization techniques. Planning systems thus act as intelligent decision support systems. However, surgeons can still use the existing tools to vary the proposed approach, but they mainly focus on how to transfer objectives into reality. Such a development may result in a paradigm shift for future surgery planning. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The quality case for information technology in healthcare

PubMed Central

Bates, David W

2002-01-01

Background As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired. Discussion One major opportunity for improving quality relates to increasing the use of information technology, or IT. Health care organizations currently invest less in IT than in any other information-intensive industry, and not surprisingly current systems are relatively primitive, compared with industries such as banking or aviation. Nonetheless, a number of organizations have demonstrated that quality can be substantially improved in a variety of ways if IT use is increased in ways that improve care. Specifically, computerization of processes that are error-prone and computerized decision support may substantially improve both efficiency and quality, as well as dramatically facilitate quality measurement. This report discusses the current levels of IT and quality in health care, how quality improvement and management are currently done, the evidence that more IT might be helpful, a vision of the future, and the barriers to getting there. Summary This report suggests that there are five key policy domains that need to be addressed: standards, incentives, security and confidentiality, professional involvement, and research, with financial incentives representing the single most important lever. PMID:12396233

Testing and validation of computerized decision support systems.

PubMed

Sailors, R M; East, T D; Wallace, C J; Carlson, D A; Franklin, M A; Heermann, L K; Kinder, A T; Bradshaw, R L; Randolph, A G; Morris, A H

1996-01-01

Systematic, through testing of decision support systems (DSSs) prior to release to general users is a critical aspect of high quality software design. Omission of this step may lead to the dangerous, and potentially fatal, condition of relying on a system with outputs of uncertain quality. Thorough testing requires a great deal of effort and is a difficult job because tools necessary to facilitate testing are not well developed. Testing is a job ill-suited to humans because it requires tireless attention to a large number of details. For these reasons, the majority of DSSs available are probably not well tested prior to release. We have successfully implemented a software design and testing plan which has helped us meet our goal of continuously improving the quality of our DSS software prior to release. While requiring large amounts of effort, we feel that the process of documenting and standardizing our testing methods are important steps toward meeting recognized national and international quality standards. Our testing methodology includes both functional and structural testing and requires input from all levels of development. Our system does not focus solely on meeting design requirements but also addresses the robustness of the system and the completeness of testing.

Designing an architectural style for dynamic medical Cross-Organizational Workflow management system: an approach based on agents and web services.

PubMed

Bouzguenda, Lotfi; Turki, Manel

2014-04-01

This paper shows how the combined use of agent and web services technologies can help to design an architectural style for dynamic medical Cross-Organizational Workflow (COW) management system. Medical COW aims at supporting the collaboration between several autonomous and possibly heterogeneous medical processes, distributed over different organizations (Hospitals, Clinic or laboratories). Dynamic medical COW refers to occasional cooperation between these health organizations, free of structural constraints, where the medical partners involved and their number are not pre-defined. More precisely, this paper proposes a new architecture style based on agents and web services technologies to deal with two key coordination issues of dynamic COW: medical partners finding and negotiation between them. It also proposes how the proposed architecture for dynamic medical COW management system can connect to a multi-agent system coupling the Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE). The idea is to assist the health professionals such as doctors, nurses and pharmacists with decision making tasks, as determining diagnosis or patient data analysis without stopping their clinical processes in order to act in a coherent way and to give care to the patient.

Decision Support for Emergency Operations Centers

NASA Technical Reports Server (NTRS)

Harvey, Craig; Lawhead, Joel; Watts, Zack

2005-01-01

The Flood Disaster Mitigation Decision Support System (DSS) is a computerized information system that allows regional emergency-operations government officials to make decisions regarding the dispatch of resources in response to flooding. The DSS implements a real-time model of inundation utilizing recently acquired lidar elevation data as well as real-time data from flood gauges, and other instruments within and upstream of an area that is or could become flooded. The DSS information is updated as new data become available. The model generates realtime maps of flooded areas and predicts flood crests at specified locations. The inundation maps are overlaid with information on population densities, property values, hazardous materials, evacuation routes, official contact information, and other information needed for emergency response. The program maintains a database and a Web portal through which real-time data from instrumentation are gathered into the database. Also included in the database is a geographic information system, from which the program obtains the overlay data for areas of interest as needed. The portal makes some portions of the database accessible to the public. Access to other portions of the database is restricted to government officials according to various levels of authorization. The Flood Disaster Mitigation DSS has been integrated into a larger DSS named REACT (Real-time Emergency Action Coordination Tool), which also provides emergency operations managers with data for any type of impact area such as floods, fires, bomb

Computerized training for the hardwood sawmill industry: The edging and trimmer trainer (version 3.0)

Treesearch

Philip Araman; A Palmer; Matthew Winn; D Kline

2009-01-01

In the hardwood sawmill industry, decisions made at the various processing stages directly affect the value of the end product. In order to realize maximum product value, it is essential that employees be properly trained. The edging and trimming stage of lumber processing is one area where lack of proper training can result in poor manufacturing decisions and...

Research Needs for Human Factors.

DTIC Science & Technology

1983-01-19

the parties aggregate their perspectives through some structured interaction (Sachman, 1975; Steiner, 1972). This approach, well worked by students of...be thought of as an action, so may each action be thought of as a decision. Most students of decision making would probably agree with the hypothesis...structuring has become part of the training of some medical students . The user of computerized information retrieval systems (e.g., Prestel, Teletext) might

A computerized system to monitor resilience indicators in organizations.

PubMed

de Carvalho, Paulo Victor Rodrigues; de Souza, Alan Pinheiro; Gomes, Jose Orlando

2012-01-01

The concepts developed by resilience engineering allow the understanding and monitoring the functioning of organizations and, particularly, to map the role of human activities, in success or in failure, enabling a better comprehension about how people make decisions in unexpected situations. The capture of information about human activities in the various organization levels gives managers a deeper real-time understanding of what is influencing the people performance, providing awareness of the factors that influence positively or negatively the organizational goals initially projected. The monitoring is important because the correct functioning of complex systems depends on the knowledge that people have to perform their activities and how the system environment provides tools that actually support the human performance. Therefore, organizations should look forward through precursors in operating signals to identify possible problems or solutions in the structure of tasks and activities, safety, quality, schedule, rework, and maintenance. We apply the concepts of resilience engineering to understand the organization by the analysis of cognitive tasks and activities. The aim is the development of a computerized system to monitor human activities to produce indicators to access system resilience. The validation of the approach was made in a real organization and the results show the successful applicability of the system. Based on findings obtained after the experiment of the system in a real organization, and managers and workers opinions, it was possible to show that the use of system provided an anticipated (real-time) perception about how activities are effectively being performed, allowing managers and workers to make decisions more consistent with daily problems, and also to anticipate solutions to cope with unexpected situations.

Modeling uncertainty in computerized guidelines using fuzzy logic.

PubMed Central

Jaulent, M. C.; Joyaux, C.; Colombet, I.; Gillois, P.; Degoulet, P.; Chatellier, G.

2001-01-01

Computerized Clinical Practice Guidelines (CPGs) improve quality of care by assisting physicians in their decision making. A number of problems emerges since patients with close characteristics are given contradictory recommendations. In this article, we propose to use fuzzy logic to model uncertainty due to the use of thresholds in CPGs. A fuzzy classification procedure has been developed that provides for each message of the CPG, a strength of recommendation that rates the appropriateness of the recommendation for the patient under consideration. This work is done in the context of a CPG for the diagnosis and the management of hypertension, published in 1997 by the French agency ANAES. A population of 82 patients with mild to moderate hypertension was selected and the results of the classification system were compared to whose given by a classical decision tree. Observed agreement is 86.6% and the variability of recommendations for patients with close characteristics is reduced. PMID:11825196

The decision tree classifier - Design and potential. [for Landsat-1 data

NASA Technical Reports Server (NTRS)

Hauska, H.; Swain, P. H.

1975-01-01

A new classifier has been developed for the computerized analysis of remote sensor data. The decision tree classifier is essentially a maximum likelihood classifier using multistage decision logic. It is characterized by the fact that an unknown sample can be classified into a class using one or several decision functions in a successive manner. The classifier is applied to the analysis of data sensed by Landsat-1 over Kenosha Pass, Colorado. The classifier is illustrated by a tree diagram which for processing purposes is encoded as a string of symbols such that there is a unique one-to-one relationship between string and decision tree.

Decision-support information system to manage mass casualty incidents at a level 1 trauma center.

PubMed

Bar-El, Yaron; Tzafrir, Sara; Tzipori, Idan; Utitz, Liora; Halberthal, Michael; Beyar, Rafael; Reisner, Shimon

2013-12-01

Mass casualty incidents are probably the greatest challenge to a hospital. When such an event occurs, hospitals are required to instantly switch from their routine activity to conditions of great uncertainty and confront needs that exceed resources. We describe an information system that was uniquely designed for managing mass casualty events. The web-based system is activated when a mass casualty event is declared; it displays relevant operating procedures, checklists, and a log book. The system automatically or semiautomatically initiates phone calls and public address announcements. It collects real-time data from computerized clinical and administrative systems in the hospital, and presents them to the managing team in a clear graphic display. It also generates periodic reports and summaries of available or scarce resources that are sent to predefined recipients. When the system was tested in a nationwide exercise, it proved to be an invaluable tool for informed decision making in demanding and overwhelming situations such as mass casualty events.

Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review.

PubMed

Wu, Helen W; Davis, Paul K; Bell, Douglas S

2012-08-17

Greater use of computerized decision support (DS) systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS). Our systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1) provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2) involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level. Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective); allowing for contingent adaptations; and facilitating collaboration. The article provides examples of each feature. The DS literature also emphasizes the importance of organizational culture and training in implementation success. The literature contrasts "rational-analytic" vs. "naturalistic-intuitive" decision-making styles, but the best approach is often a balanced approach that combines both styles. It is also important for DS systems to enable exploration of multiple assumptions, and incorporation of new information in response to changing circumstances. Complex, high-level decision-making has common features across disciplines as seemingly disparate as defense, business, and healthcare. National efforts to advance the health information technology agenda through broader CDS adoption could benefit by applying the DS principles identified in this review.

Cost analysis of the development and implementation of a spatial decision support system for malaria elimination in Solomon Islands.

PubMed

Marston, Luke; Kelly, Gerard C; Hale, Erick; Clements, Archie C A; Hodge, Andrew; Jimenez-Soto, Eliana

2014-08-18

The goal of malaria elimination faces numerous challenges. New tools are required to support the scale up of interventions and improve national malaria programme capacity to conduct detailed surveillance. This study investigates the cost factors influencing the development and implementation of a spatial decision support system (SDSS) for malaria elimination in the two elimination provinces of Isabel and Temotu, Solomon Islands. Financial and economic costs to develop and implement a SDSS were estimated using the Solomon Islands programme's financial records. Using an ingredients approach, verified by stakeholders and operational reports, total costs for each province were quantified. A budget impact sensitivity analysis was conducted to investigate the influence of variations in standard budgetary components on the costs and to identify potential cost savings. A total investment of US$ 96,046 (2012 constant dollars) was required to develop and implement the SDSS in two provinces (Temotu Province US$ 49,806 and Isabel Province US$ 46,240). The single largest expense category was for computerized equipment totalling approximately US$ 30,085. Geographical reconnaissance was the most expensive phase of development and implementation, accounting for approximately 62% of total costs. Sensitivity analysis identified different cost factors between the provinces. Reduced equipment costs would deliver a budget saving of approximately 10% in Isabel Province. Combined travel costs represented the greatest influence on the total budget in the more remote Temotu Province. This study provides the first cost analysis of an operational surveillance tool used specifically for malaria elimination in the South-West Pacific. It is demonstrated that the costs of such a decision support system are driven by specialized equipment and travel expenses. Such factors should be closely scrutinized in future programme budgets to ensure maximum efficiencies are gained and available resources are allocated effectively.

Partial dependence of breast tumor malignancy on ultrasound image features derived from boosted trees

NASA Astrophysics Data System (ADS)

Yang, Wei; Zhang, Su; Li, Wenying; Chen, Yaqing; Lu, Hongtao; Chen, Wufan; Chen, Yazhu

2010-04-01

Various computerized features extracted from breast ultrasound images are useful in assessing the malignancy of breast tumors. However, the underlying relationship between the computerized features and tumor malignancy may not be linear in nature. We use the decision tree ensemble trained by the cost-sensitive boosting algorithm to approximate the target function for malignancy assessment and to reflect this relationship qualitatively. Partial dependence plots are employed to explore and visualize the effect of features on the output of the decision tree ensemble. In the experiments, 31 image features are extracted to quantify the sonographic characteristics of breast tumors. Patient age is used as an external feature because of its high clinical importance. The area under the receiver-operating characteristic curve of the tree ensembles can reach 0.95 with sensitivity of 0.95 (61/64) at the associated specificity 0.74 (77/104). The partial dependence plots of the four most important features are demonstrated to show the influence of the features on malignancy, and they are in accord with the empirical observations. The results can provide visual and qualitative references on the computerized image features for physicians, and can be useful for enhancing the interpretability of computer-aided diagnosis systems for breast ultrasound.

Development of a computerized assessment of clinician adherence to a treatment guideline for patients with bipolar disorder.

PubMed

Dennehy, Ellen B; Suppes, Trisha; John Rush, A; Lynn Crismon, M; Witte, B; Webster, J

2004-01-01

The adoption of treatment guidelines for complex psychiatric illness is increasing. Treatment decisions in psychiatry depend on a number of variables, including severity of symptoms, past treatment history, patient preferences, medication tolerability, and clinical response. While patient outcomes may be improved by the use of treatment guidelines, there is no agreed upon standard by which to assess the degree to which clinician behavior corresponds to those recommendations. This report presents a method to assess clinician adherence to the complex multidimensional treatment guideline for bipolar disorder utilized in the Texas Medication Algorithm Project. The steps involved in the development of this system are presented, including the reliance on standardized documentation, defining core variables of interest, selecting criteria for operationalization of those variables, and computerization of the assessment of adherence. The computerized assessment represents an improvement over other assessment methods, which have relied on laborious and costly chart reviews to extract clinical information and to analyze provider behavior. However, it is limited by the specificity of decisions that guided the adherence scoring process. Preliminary findings using this system with 2035 clinical visits conducted for the bipolar disorder module of TMAP Phase 3 are presented. These data indicate that this system of guideline adherence monitoring is feasible.

An Analysis of Minimum System Requirements to Support Computerized Adaptive Testing.

DTIC Science & Technology

1986-09-01

adaptive test ( CAT ); adaptive test ing A;4SRAC:’ (Continue on reverie of necessary and ident4f by block number) % This pape-r discusses the minimum system...requirements needed to develop a computerized adaptive test ( CAT ). It lists some of the benefits of adaptive testing, establishes a set of...discusses the minimum system requirements needed to develop a computerized adaptive test ( CAT ). It lists some of the benefits of adaptive testing

Build Your Own Inventory System. Annual Cost: $100.00 (Approximate). Fixed Assets, Materials and Supplies. The Practical Elements for a Computerized, Continuing Inventory System in Schools and Use in Determining a Measure for Instructional Cost.

ERIC Educational Resources Information Center

Payne, Arnold, Comp.

This publication presents performance flow charts and other accompanying forms that are elements of an economical computerized continuing inventory system. The system described here is intended to serve school systems as an adequate fixed asset system and to provide a computerized inventory model that offers support for costs of future educational…

The equivalence of computerized and paper-and-pencil psychological instruments: implications for measures of negative affect.

PubMed

Schulenberg, S E; Yutrzenka, B A

1999-05-01

The use of computerized psychological assessment is a growing practice among contemporary mental health professionals. Many popular and frequently used paper-and-pencil instruments have been adapted into computerized versions. Although equivalence for many instruments has been evaluated and supported, this issue is far from resolved. This literature review deals with recent research findings that suggest that computer aversion negatively impacts computerized assessment, particularly as it relates to measures of negative affect. There is a dearth of equivalence studies that take into account computer aversion's potential impact on the measurement of negative affect. Recommendations are offered for future research in this area.

Perceived value of applying Information Communication Technology to implement guidelines in developing countries; an online questionnaire study among public health workers.

PubMed

Machingura, Pasipanodya Ian; Adekola, Olawumi; Mueni, Eunice; Oaiya, Omo; Gustafsson, Lars L; Heller, Richard F

2014-01-01

Practice guidelines can be used to support healthcare decision making. We sought to identify the use, and barriers to the implementation, of electronic based guidelines to support decision-making in maternal and child healthcare (MCH) and the rational use of medicines, in developing countries. Graduates who had gained the Master of Public Health degree through the Peoples-uni (postgraduate public health education in developing countries) were sent an online survey questionnaire which had been piloted. Two reminders were sent to non-respondents at intervals of 10 days. Results were explored using descriptive analyses. 44 of the potential 48 graduates from 16 countries responded - most were from Africa. 82% and 89% of respondents were aware of guidelines on MCH and the rational use of medicines respectively. Electronic guidelines were more available in university hospitals than in provincial hospitals or rural care. All respondents thought that guidelines could improve the delivery of quality care, and 42 (95%) and 41 (93%) respectively thought that computers and mobile or smartphones could increase the use of guidelines in service delivery. Lack of access to computers, need to buy phone credit, need for training in the use of either computerized or phone based guidelines and fear of increased workload were potential barriers to use. There is support for the use of electronic guidelines despite limited availability and barriers to use in developing countries. These findings, and other literature, provide a guide as to how the further development of ICT based guidelines may be implemented to improve health care decision making.

A Nondeterministic Resource Planning Model in Education

ERIC Educational Resources Information Center

Yoda, Koji

1977-01-01

Discusses a simple technique for stochastic resource planning that, when computerized, can assist educational managers in the process of quantifying the future uncertainty, thereby, helping them make better decisions. The example used is a school lunch program. (Author/IRT)

A framework for considering business models.

PubMed

Anderson, James G

2003-01-01

Information technology (IT) such as computerized physician order entry, computer-based decision support and alerting systems, and electronic prescribing can reduce medical errors and improve the quality of health care. However, the business value of these systems is frequently questioned. At present a number of barriers exist to realizing the potential of IT to improve quality of care. Some of these barriers are: the ineffectiveness of existing error reporting systems, low investment in IT infrastructure, legal impediments to reforms, and the difficulty in demonstrating a sufficient return on investment to justify expenditures for quality improvement. This paper provides an overview of these issues, a framework for considering business models, and examples of successful implementations of IT to improve quality of patient care.

A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.

PubMed

Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

2015-04-16

Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.

The Effects of Computerized Information Systems on Juvenile Courts

ERIC Educational Resources Information Center

Albrecht, Gary L.

1976-01-01

Organizational theorists alternatively hypothesized that computerized information systems (CIS) will produce no necessary changes, centralization, or decentralization in juvenile courts. This hypothesis is supported by the results of a four year study on the phenomenon. Suggestions are offered for improving the juvenile judicial system through…

Preliminary testing of a just‐in‐time, user‐defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions

PubMed Central

Jibaja‐Weiss, Maria L.; Volk, Robert J.; Friedman, Lois C.; Granchi, Thomas S.; Neff, Nancy E.; Spann, Stephen J.; Robinson, Emily K.; Aoki, Noriaki; Robert Beck, J.

2006-01-01

Abstract Objective  To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. Design  Pre‐post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. Sample  Fifty‐one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. Intervention  A computerized decision aid that combines entertainment‐education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. Outcomes  Patients’ use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). Results  Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. Conclusions  A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients. PMID:16911136

The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia.

PubMed

Lichtner, Valentina; Dowding, Dawn; Closs, S José

2015-12-24

Assessment and management of pain in patients with dementia is known to be challenging, due to patients' cognitive and/or communication difficulties. In the UK, pain in hospital is managed through regular assessments, with the use of pain intensity scores as triggers for action. The aim of this study was to understand current pain assessment practices, in order to later inform the development of a decision support tool designed to improve the management of pain for people with dementia in hospital. An exploratory study was conducted in four hospitals in the UK (11 wards), with observations of patients with dementia (n = 31), interviews of staff (n = 52) and patients' family members (n = 4) and documentary analysis. A thematic analysis was carried out, structured along dimensions of decision making. This paper focuses on the emergent themes related to the use of assessment tools and pain intensity scores. A variety of tools were used to record pain intensity, usually with numerical scales. None of the tools in actual use had been specifically designed for patients with cognitive impairment. With patients with more severe dementia, the patient's body language and other cues were studied to infer pain intensity and then a score entered on behalf of the patient. Information regarding the temporality of pain and changes in pain experience (rather than a score at a single point in time) seemed to be most useful to the assessment of pain. Given the inherent uncertainty of the meaning of pain scores for patients with dementia, numerical scales were used with caution. Numerical scores triggered action but their meaning was relative - to the patient, to the clinician, to the time of recording and to the purpose of documenting. There are implications for use of data and computerized decision support systems design. Decision support interventions should include personalized alerting cut-off scores for individual patients, display pain scores over time and integrate professional narratives, mitigating uncertainties around single pain scores for patients with dementia.

The Design of Computerized Practice Fields for Problem Solving and Contextualized Transfer

ERIC Educational Resources Information Center

Riedel, Jens; Fitzgerald, Gail; Leven, Franz; Toenshoff, Burkhard

2003-01-01

Current theories of learning emphasize the importance of learner-centered, active, authentic, environments for meaningful knowledge construction. From this perspective, computerized case-based learning systems afford practice fields for learners to build domain knowledge and problem-solving skills and to support contextualized transfer of…

Collaboration Scripts for Enhancing Metacognitive Self-Regulation and Mathematics Literacy

ERIC Educational Resources Information Center

Chen, Cheng-Huan; Chiu, Chiung-Hui

2016-01-01

This study designed a set of computerized collaboration scripts for multi-touch supported collaborative design-based learning and evaluated its effects on multiple aspects of metacognitive self-regulation in terms of planning and controlling and mathematical literacy achievement at higher and lower levels. The computerized scripts provided a…

Dynamic Assessment of EFL Learners' Listening Comprehension via Computerized Concept Mapping

ERIC Educational Resources Information Center

Ebadi, Saman; Latif, Shokoufeh Vakili

2015-01-01

In Vygotsky's theory, learner's Zone of Proximal Development (ZPD) and autonomous performance could be further developed through social interaction with an expert. Computerized concept mapping enjoys the advantage of meeting learners' differences and therefore can be applied as a scaffold to support learning process.Taking a dynamic assessment…

Executable medical guidelines with Arden Syntax-Applications in dermatology and obstetrics.

PubMed

Seitinger, Alexander; Rappelsberger, Andrea; Leitich, Harald; Binder, Michael; Adlassnig, Klaus-Peter

2016-08-12

Clinical decision support systems (CDSSs) are being developed to assist physicians in processing extensive data and new knowledge based on recent scientific advances. Structured medical knowledge in the form of clinical alerts or reminder rules, decision trees or tables, clinical protocols or practice guidelines, score algorithms, and others, constitute the core of CDSSs. Several medical knowledge representation and guideline languages have been developed for the formal computerized definition of such knowledge. One of these languages is Arden Syntax for Medical Logic Systems, an International Health Level Seven (HL7) standard whose development started in 1989. Its latest version is 2.10, which was presented in 2014. In the present report we discuss Arden Syntax as a modern medical knowledge representation and processing language, and show that this language is not only well suited to define clinical alerts, reminders, and recommendations, but can also be used to implement and process computerized medical practice guidelines. This section describes how contemporary software such as Java, server software, web-services, XML, is used to implement CDSSs based on Arden Syntax. Special emphasis is given to clinical decision support (CDS) that employs practice guidelines as its clinical knowledge base. Two guideline-based applications using Arden Syntax for medical knowledge representation and processing were developed. The first is a software platform for implementing practice guidelines from dermatology. This application employs fuzzy set theory and logic to represent linguistic and propositional uncertainty in medical data, knowledge, and conclusions. The second application implements a reminder system based on clinically published standard operating procedures in obstetrics to prevent deviations from state-of-the-art care. A to-do list with necessary actions specifically tailored to the gestational week/labor/delivery is generated. Today, with the latest versions of Arden Syntax and the application of contemporary software development methods, Arden Syntax has become a powerful and versatile medical knowledge representation and processing language, well suited to implement a large range of CDSSs, including clinical-practice-guideline-based CDSSs. Moreover, such CDS is provided and can be shared as a service by different medical institutions, redefining the sharing of medical knowledge. Arden Syntax is also highly flexible and provides developers the freedom to use up-to-date software design and programming patterns for external patient data access. Copyright © 2016. Published by Elsevier B.V.

Computerized procedures system

DOEpatents

Lipner, Melvin H.; Mundy, Roger A.; Franusich, Michael D.

2010-10-12

An online data driven computerized procedures system that guides an operator through a complex process facility's operating procedures. The system monitors plant data, processes the data and then, based upon this processing, presents the status of the current procedure step and/or substep to the operator. The system supports multiple users and a single procedure definition supports several interface formats that can be tailored to the individual user. Layered security controls access privileges and revisions are version controlled. The procedures run on a server that is platform independent of the user workstations that the server interfaces with and the user interface supports diverse procedural views.

COMPUTERIZED RISK AND BIOACCUMULATION SYSTEM (VERSION 1.0)

EPA Science Inventory

CRABS is a combination of a rule-based expert system and more traditional procedural programming techniques. ule-based expert systems attempt to emulate the decision making process of human experts within a clearly defined subject area. xpert systems consist of an "inference engi...

Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics.

PubMed

Tsopra, Rosy; Jais, Jean-Philippe; Venot, Alain; Duclos, Catherine

2014-02-01

It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. We displayed clinical practice guidelines for antibiotic treatment via two types of interface, which we compared in a crossover design. General practitioners were asked to provide responses for 10 clinical cases and the System Usability Scale (SUS) for each interface. We assessed SUS scores, the number of correct responses, and the confidence level for each interface. SUS score and percentage confidence were significantly higher for the interface designed according to usability principles (81 vs 51, p=0.00004, and 88.8% vs 80.7%, p=0.004). The percentage of correct responses was similar for the two interfaces. The interface designed according to usability principles was perceived to be more usable and inspired greater confidence among physicians than the guided navigation interface. Consideration of usability principles in the construction of an interface--in particular 'effective information presentation', 'consistency', 'efficient interactions', 'effective use of language', and 'minimizing cognitive load'--seemed to improve perceived usability and confidence in the system.

Impact of a Computerized Antithrombotic Risk Assessment Tool on the Prescription of Thromboprophylaxis in Atrial Fibrillation: Hospital Setting.

PubMed

Pandya, E; Masood, N; Wang, Y; Krass, I; Bajorek, B

2018-01-01

The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient's stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers' treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using "nil therapy" or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the "most eligible" (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.

A decision support system for quality of life in head and neck oncology patients.

PubMed

Gonçalves, Joaquim J; Rocha, Alvaro M

2012-02-16

The assessment of Quality of Life (QoL) is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. The objective of this project is to develop an informational platform to achieve a patient self-assessment with standardized QoL measuring instruments, through friendly software, easy for the user to adapt, which should aid the study of QoL, by promoting the creation of databases and accelerating its statistical treatment and yet generating subsequent useful results in graphical format for the physician analyzes in an appointment immediately after the answers collection. First, a software platform was designed and developed in an action-research process with patients, physicians and nurses. The computerized patient self-assessment with standardized QoL measuring instruments was compared with traditional one, to verify if its use did not influence the patient's answers. For that, the Wilcoxon and t-Student tests were applied. After, we adopted and adapted the mathematic Rash model to make possible the use of QoL measure in the routine appointments. The results show that the computerized patient self-assessment does not influence the patient's answers and can be used as a suitable tool in the routine appointment, because indicates problems which are more difficult to identify in a traditional appointment, improving thus the physician's decisions. The possibility of representing graphically useful results that physician needs to analyze in the appointment, immediately after the answer collection, in an useful time, makes this QoL assessment platform a diagnosis instrument ready to be used routinely in clinical practice.

Dopamine Beta Hydroxylase Genotype Identifies Individuals Less Susceptible to Bias in Computer-Assisted Decision Making

PubMed Central

Parasuraman, Raja; de Visser, Ewart; Lin, Ming-Kuan; Greenwood, Pamela M.

2012-01-01

Computerized aiding systems can assist human decision makers in complex tasks but can impair performance when they provide incorrect advice that humans erroneously follow, a phenomenon known as “automation bias.” The extent to which people exhibit automation bias varies significantly and may reflect inter-individual variation in the capacity of working memory and the efficiency of executive function, both of which are highly heritable and under dopaminergic and noradrenergic control in prefrontal cortex. The dopamine beta hydroxylase (DBH) gene is thought to regulate the differential availability of dopamine and norepinephrine in prefrontal cortex. We therefore examined decision-making performance under imperfect computer aiding in 100 participants performing a simulated command and control task. Based on two single nucleotide polymorphism (SNPs) of the DBH gene, −1041 C/T (rs1611115) and 444 G/A (rs1108580), participants were divided into groups of low and high DBH enzyme activity, where low enzyme activity is associated with greater dopamine relative to norepinephrine levels in cortex. Compared to those in the high DBH enzyme activity group, individuals in the low DBH enzyme activity group were more accurate and speedier in their decisions when incorrect advice was given and verified automation recommendations more frequently. These results indicate that a gene that regulates relative prefrontal cortex dopamine availability, DBH, can identify those individuals who are less susceptible to bias in using computerized decision-aiding systems. PMID:22761865

Evaluating and selecting an information system, Part 1.

PubMed

Neal, T

1993-01-01

Initial steps in the process of evaluating and selecting a computerized information system for the pharmacy department are described. The first step in the selection process is to establish a steering committee and a project committee. The steering committee oversees the project, providing policy guidance, making major decisions, and allocating budgeted expenditures. The project committee conducts the departmental needs assessment, identifies system requirements, performs day-to-day functions, evaluates vendor proposals, trains personnel, and implements the system chosen. The second step is the assessment of needs in terms of personnel, workload, physical layout, and operating requirements. The needs assessment should be based on the department's mission statement and strategic plan. The third step is the development of a request for information (RFI) and a request for proposal (RFP). The RFI is a document designed for gathering preliminary information from a wide range of vendors; this general information is used in deciding whether to send the RFP to a given vendor. The RFP requests more detailed information and gives the purchaser's exact specifications for a system; the RFP also includes contractual information. To help ensure project success, many institutions turn to computer consultants for guidance. The initial steps in selecting a computerized pharmacy information system are establishing computerization committees, conducting a needs assessment, and writing an RFI and an RFP. A crucial early decision is whether to seek a consultant's expertise.

Automation, decision support, and expert systems in nephrology.

PubMed

Soman, Sandeep; Zasuwa, Gerard; Yee, Jerry

2008-01-01

Increasing data suggest that errors in medicine occur frequently and result in substantial harm to the patient. The Institute of Medicine report described the magnitude of the problem, and public interest in this issue, which was already large, has grown. The traditional approach in medicine has been to identify the persons making the errors and recommend corrective strategies. However, it has become increasingly clear that it is more productive to focus on the systems and processes through which care is provided. If these systems are set up in ways that would both make errors less likely and identify those that do occur and, at the same time, improve efficiency, then safety and productivity would be substantially improved. Clinical decision support systems (CDSSs) are active knowledge systems that use 2 or more items of patient data to generate case specific recommendations. CDSSs are typically designed to integrate a medical knowledge base, patient data, and an inference engine to generate case specific advice. This article describes how automation, templating, and CDSS improve efficiency, patient care, and safety by reducing the frequency and consequences of medical errors in nephrology. We discuss practical applications of these in 3 settings: a computerized anemia-management program (CAMP, Henry Ford Health System, Detroit, MI), vascular access surveillance systems, and monthly capitation notes in the hemodialysis unit.

R-WISE: A Computerized Environment for Tutoring Critical Literacy.

ERIC Educational Resources Information Center

Carlson, P.; Crevoisier, M.

This paper describes a computerized environment for teaching the conceptual patterns of critical literacy. While the full implementation of the software covers both reading and writing, this paper covers only the writing aspects of R-WISE (Reading and Writing in a Supportive Environment). R-WISE consists of a suite of computerized…

Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation.

PubMed

Camacho, Jhon; Medina Ch, Ana María; Landis-Lewis, Zach; Douglas, Gerald; Boyce, Richard

2018-04-13

The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. Our study will further the understanding of the role of mobile decision support systems in the implementation of clinical practice guidelines. Furthermore, we will provide qualitative evidence to aid decisions made by low- and middle-income countries' ministries of health about investments in these technologies. ©Jhon Camacho, Ana María Medina Ch, Zach Landis-Lewis, Gerald Douglas, Richard Boyce. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 13.04.2018.

Community-acquired pneumonia management and outcomes in the era of health information technology.

PubMed

Mecham, Ian D; Vines, Caroline; Dean, Nathan C

2017-11-01

Pneumonia continues to be a leading cause of hospitalization and mortality. Implementation of health information technology (HIT) can lead to cost savings and improved care. In this review, we examine the literature on the use of HIT in the management of community-acquired pneumonia. We also discuss barriers to adoption of technology in managing pneumonia, the reliability and quality of electronic health data in pneumonia research, how technology has assisted pneumonia diagnosis and outcomes research. The goal of using HIT is to develop and deploy generalizable, real-time, computerized clinical decision support integrated into usual pneumonia care. A friendly user interface that does not disrupt efficiency and demonstrates improved clinical outcomes should result in widespread adoption. © 2017 Asian Pacific Society of Respirology.

A Validation of an Intelligent Decision-Making Support System for the Nutrition Diagnosis of Bariatric Surgery Patients

PubMed Central

Martins, Cristina; Dias, João; Pinto, José S

2014-01-01

Background Bariatric surgery is an important method for treatment of morbid obesity. It is known that significant nutritional deficiencies might occur after surgery, such as, calorie-protein malnutrition, iron deficiency anemia, and lack of vitamin B12, thiamine, and folic acid. Objective The objective of our study was to validate a computerized intelligent decision support system that suggests nutritional diagnoses of patients submitted to bariatric surgery. Methods There were fifteen clinical cases that were developed and sent to three dietitians in order to evaluate and define a nutritional diagnosis. After this step, the cases were sent to four bariatric surgery expert dietitians who were aiming to collaborate on a gold standard. The nutritional diagnosis was to be defined individually, and any disagreements were solved through a consensus. The final result was used as the gold standard. Bayesian networks were used to implement the system, and database training was done with Shell Netica. For the system validation, a similar answer rate was calculated, as well as the specificity and sensibility. Receiver operating characteristic (ROC) curves were projected to each nutritional diagnosis. Results Among the four experts, the rate of similar answers found was 80% (48/60) to 93% (56/60), depending on the nutritional diagnosis. The rate of similar answers of the system, compared to the gold standard, was 100% (60/60). The system sensibility and specificity were 95.0%. The ROC curves projection showed that the system was able to represent the expert knowledge (gold standard), and to help them in their daily tasks. Conclusions The system that was developed was validated to be used by health care professionals for decision-making support in their nutritional diagnosis of patients submitted to bariatric surgery. PMID:25601419

Clinical guideline representation in a CDS: a human information processing method.

PubMed

Kilsdonk, Ellen; Riezebos, Rinke; Kremer, Leontien; Peute, Linda; Jaspers, Monique

2012-01-01

The Dutch Childhood Oncology Group (DCOG) has developed evidence-based guidelines for screening childhood cancer survivors for possible late complications of treatment. These paper-based guidelines appeared to not suit clinicians' information retrieval strategies; it was thus decided to communicate the guidelines through a Computerized Decision Support (CDS) tool. To ensure high usability of this tool, an analysis of clinicians' cognitive strategies in retrieving information from the paper-based guidelines was used as requirements elicitation method. An information processing model was developed through an analysis of think aloud protocols and used as input for the design of the CDS user interface. Usability analysis of the user interface showed that the navigational structure of the CDS tool fitted well with the clinicians' mental strategies employed in deciding on survivors screening protocols. Clinicians were more efficient and more complete in deciding on patient-tailored screening procedures when supported by the CDS tool than by the paper-based guideline booklet. The think-aloud method provided detailed insight into users' clinical work patterns that supported the design of a highly usable CDS system.

Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review

PubMed Central

2012-01-01

Background Greater use of computerized decision support (DS) systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS). Methods Our systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1) provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2) involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level. Results Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective); allowing for contingent adaptations; and facilitating collaboration. The article provides examples of each feature. The DS literature also emphasizes the importance of organizational culture and training in implementation success. The literature contrasts “rational-analytic” vs. “naturalistic-intuitive” decision-making styles, but the best approach is often a balanced approach that combines both styles. It is also important for DS systems to enable exploration of multiple assumptions, and incorporation of new information in response to changing circumstances. Conclusions Complex, high-level decision-making has common features across disciplines as seemingly disparate as defense, business, and healthcare. National efforts to advance the health information technology agenda through broader CDS adoption could benefit by applying the DS principles identified in this review. PMID:22900537

Treatment algorithms and protocolized care.

PubMed

Morris, Alan H

2003-06-01

Excess information in complex ICU environments exceeds human decision-making limits and likely contributes to unnecessary variation in clinical care, increasing the likelihood of clinical errors. I reviewed recent critical care clinical trials searching for information about the impact of protocol use on clinically pertinent outcomes. Several recently published clinical trials illustrate the importance of distinguishing efficacy and effectiveness trials. One of these trials illustrates the danger of conducting effectiveness trials before the efficacy of an intervention is established. The trials also illustrate the importance of distinguishing guidelines and inadequately explicit protocols from adequately explicit protocols. Only adequately explicit protocols contain enough detail to lead different clinicians to the same decision when faced with the same clinical scenario. Differences between guidelines and protocols are important. Guidelines lack detail and provide general guidance that requires clinicians to fill in many gaps. Computerized or paper-based protocols are detailed and, when used for complex clinical ICU problems, can generate patient-specific, evidence-based therapy instructions that can be carried out by different clinicians with almost no interclinician variability. Individualization of patient therapy can be preserved by these protocols when they are driven by individual patient data. Explicit decision-support tools (eg, guidelines and protocols) have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice. Guidelines and protocols that aid ICU decision makers should be more widely distributed.

A Study on Personal Record Management.

ERIC Educational Resources Information Center

Kansas State Dept. of Education, Topeka.

Personal record management practices must reflect contemporary concerns for the rights of the individual. Recent legislation, court decisions, and the rapid expansion of computerized record systems all point to the need for new procedures in personal record keeping. Although this paper is addressed particularly to educational agencies responsibile…

Computerizing Your Program.

ERIC Educational Resources Information Center

Curtis, Rick

This paper summarizes information about using computer hardware and software to aid in making purchase decisions that are based on user needs. The two major options in hardware are IBM-compatible machines and the Apple Macintosh line. The three basic software applications include word processing, database management, and spreadsheet applications.…

Political Participation in the Post-Industrial Age.

ERIC Educational Resources Information Center

Lehman-Wilzig, Sam

1983-01-01

In almost all democratic countries, a rising incidence of nonformal means of political communication, e.g., polls, pressure groups, demonstrations, suggests a need to broaden participation in political decision making. Outlines two possible approaches for achieving this goal: the dual weighted-vote system and computerized politics. (Author/CS)

Computerization of Synonymy Data from Biological Systematics. Museum Data Bank Research Report Number 9.

ERIC Educational Resources Information Center

Mello, James F.

An outline of biological systematics and the kind of data that comprise it is presented, together with a description of one data convention used in systematics and a method for computerizing synonymic and associated data. Systematics consist of descriptions of species, names applied to these species, and supportive field data such as geographic…

The Design and Development of a Computerized Attention-Training Game System for School-Aged Children

ERIC Educational Resources Information Center

Wang, Tsui-Ying; Huang, Ho-Chuan

2013-01-01

A computerized attention-training game system has been developed to support attention training for school-aged children. The present system offers various types of computer games that provide training in different aspects of attention, such as selective attention, sustained attention, and divided attention. The N-tier architecture of the Web-based…

The Couzens Machine. A Computerized Learning Exchange. Final Report, 1973-74.

ERIC Educational Resources Information Center

Davis, Ken, Comp.; Libengood, Richard, Comp.

The Couzens Machine is a computerized learning exchange and information service developed for the residents of Couzens Hall, a dormitory at the University of Michigan. Organized as a collective within the framework of a course and supported by an instructional development grant from the Center for Research on Learning and Teaching, the Couzens…

The VA Computerized Patient Record — A First Look

PubMed Central

Anderson, Curtis L.; Meldrum, Kevin C.

1994-01-01

In support of its in-house DHCP Physician Order Entry/Results Reporting application, the VA is developing the first edition of a Computerized Patient Record. The system will feature a physician-oriented interface with real time, expert system-based order checking, a controlled vocabulary, a longitudinal repository of patient data, HL7 messaging support, a clinical reminder and warning system, and full integration with existing VA applications including lab, pharmacy, A/D/T, radiology, dietetics, surgery, vitals, allergy tracking, discharge summary, problem list, progress notes, consults, and online physician order entry. PMID:7949886

Usability testing in medical informatics: cognitive approaches to evaluation of information systems and user interfaces.

PubMed Central

Kushniruk, A. W.; Patel, V. L.; Cimino, J. J.

1997-01-01

This paper describes an approach to the evaluation of health care information technologies based on usability engineering and a methodological framework from the study of medical cognition. The approach involves collection of a rich set of data including video recording of health care workers as they interact with systems, such as computerized patient records and decision support tools. The methodology can be applied in the laboratory setting, typically involving subjects "thinking aloud" as they interact with a system. A similar approach to data collection and analysis can also be extended to study of computer systems in the "live" environment of hospital clinics. Our approach is also influenced from work in the area of cognitive task analysis, which aims to characterize the decision making and reasoning of subjects of varied levels of expertise as they interact with information technology in carrying out representative tasks. The stages involved in conducting cognitively-based usability analyses are detailed and the application of such analysis in the iterative process of system and interface development is discussed. PMID:9357620

Cognitive analysis of physicians' medication ordering activity.

PubMed

Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine

2005-01-01

Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

Leveraging Health Information Technology to Improve Quality in Federal Healthcare.

PubMed

Weigel, Fred K; Switaj, Timothy L; Hamilton, Jessica

2015-01-01

Healthcare delivery in America is extremely complex because it is comprised of a fragmented and nonsystematic mix of stakeholders, components, and processes. Within the US healthcare structure, the federal healthcare system is poised to lead American medicine in leveraging health information technology to improve the quality of healthcare. We posit that through developing, adopting, and refining health information technology, the federal healthcare system has the potential to transform federal healthcare quality by managing the complexities associated with healthcare delivery. Although federal mandates have spurred the widespread use of electronic health records, other beneficial technologies have yet to be adopted in federal healthcare settings. The use of health information technology is fundamental in providing the highest quality, safest healthcare possible. In addition, health information technology is valuable in achieving the Agency for Healthcare Research and Quality's implementation goals. We conducted a comprehensive literature search using the Google Scholar, PubMed, and Cochrane databases to identify an initial list of articles. Through a thorough review of the titles and abstracts, we identified 42 articles as having relevance to health information technology and quality. Through our exclusion criteria of currency of the article, citation frequency, applicability to the federal health system, and quality of research supporting conclusions, we refined the list to 11 references from which we performed our analysis. The literature shows that the use of computerized physician order entry has significantly increased accurate medication dosage and decreased medication errors. The use of clinical decision support systems have significantly increased physician adherence to guidelines, although there is little evidence that indicates any significant correlation to patient outcomes. Research shows that interoperability and usability are continuing challenges for implementation. The Veterans Administration is the only entity within the federal health system that has published research on the use of health information technology to improve quality. The federal healthcare system has existing systems in place with computerized physician order entry systems and clinical decision support systems, but these should be advanced. Particular focus and attention should be placed on data mining capabilities, integrating the electronic health record across all aspects of care, using the electronic health record to improve quality at the point of care, and developing interoperable and usable health information technology.

Community Level Impact Assessment--Extension Applications.

ERIC Educational Resources Information Center

Woods, Mike D.; Doeksen, Gerald A.

Using the Oklahoma State University (OSU) computerized community simulation model, extension professionals can provide local decision makers with information derived from an impact model that is dynamic, community specific, and easy to adapt to different communities. The four main sections of the OSU model are an economic account, a capital…

Computerized intrapartum electronic fetal monitoring: analysis of the decision to deliver for fetal distress.

PubMed

Georgieva, Antoniya; Payne, Stephen J; Moulden, Mary; Redman, Christopher W G

2011-01-01

We applied computerized methods to assess the Electronic Fetal Monitoring (EFM) in labor. We analyzed retrospectively the last hour of EFM for 1,370 babies, delivered by emergency Cesarean sections before the onset of pushing (data collected at the John Radcliffe Hospital, Oxford, UK). There were two cohorts according to the reason for intervention: (a) fetal distress, n(1) = 524 and (b) failure to progress and/or malpresentation, n(2) = 846. The cohorts were compared in terms of classical EFM features (baseline, decelerations, variability and accelerations), computed by a dedicated Oxford system for automated analysis--OxSys. In addition, OxSys was employed to simulate current clinical guidelines for the classification of fetal monitoring, i.e. providing in real time a three-tier grading system of the EFM (normal, indeterminate, or abnormal). The computerized features and the simulated guidelines corresponded well to the clinical management and to the actual labor outcome (measured by umbilical arterial pH).

A Prototype Symbolic Model of Canonical Functional Neuroanatomy of the Motor System

PubMed Central

Rubin, Daniel L.; Halle, Michael; Musen, Mark; Kikinis, Ron

2008-01-01

Recent advances in bioinformatics have opened entire new avenues for organizing, integrating and retrieving neuroscientific data, in a digital, machine-processable format, which can be at the same time understood by humans, using ontological, symbolic data representations. Declarative information stored in ontological format can be perused and maintained by domain experts, interpreted by machines, and serve as basis for a multitude of decision-support, computerized simulation, data mining, and teaching applications. We have developed a prototype symbolic model of canonical neuroanatomy of the motor system. Our symbolic model is intended to support symbolic lookup, logical inference and mathematical modeling by integrating descriptive, qualitative and quantitative functional neuroanatomical knowledge. Furthermore, we show how our approach can be extended to modeling impaired brain connectivity in disease states, such as common movement disorders. In developing our ontology, we adopted a disciplined modeling approach, relying on a set of declared principles, a high-level schema, Aristotelian definitions, and a frame-based authoring system. These features, along with the use of the Unified Medical Language System (UMLS) vocabulary, enable the alignment of our functional ontology with an existing comprehensive ontology of human anatomy, and thus allow for combining the structural and functional views of neuroanatomy for clinical decision support and neuroanatomy teaching applications. Although the scope of our current prototype ontology is limited to a particular functional system in the brain, it may be possible to adapt this approach for modeling other brain functional systems as well. PMID:18164666

Development and initial evaluation of a treatment decision dashboard.

PubMed

Dolan, James G; Veazie, Peter J; Russ, Ann J

2013-04-21

For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care.Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making.

Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators.

PubMed

Cameron, Duncan H; Zucchero Sarracini, Carla; Rozmovits, Linda; Naglie, Gary; Herrmann, Nathan; Molnar, Frank; Jordan, John; Byszewski, Anna; Tang-Wai, David; Dow, Jamie; Frank, Christopher; Henry, Blair; Pimlott, Nicholas; Seitz, Dallas; Vrkljan, Brenda; Taylor, Rebecca; Masellis, Mario; Rapoport, Mark J

2017-09-01

Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators. A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver. An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Using computers to enable self-management of aphasia therapy exercises for word finding: the patient and carer perspective.

PubMed

Palmer, Rebecca; Enderby, Pam; Paterson, Gail

2013-01-01

Speech and language therapy (SLT) for aphasia can be difficult to access in the later stages of stroke recovery, despite evidence of continued improvement with sufficient therapeutic intensity. Computerized aphasia therapy has been reported to be useful for independent language practice, providing new opportunities for continued rehabilitation. The success of this option depends on its acceptability to patients and carers. To investigate factors that affect the acceptability of independent home computerized aphasia therapy practice. An acceptability study of computerized therapy was carried out alongside a pilot randomized controlled trial of computer aphasia therapy versus usual care for people more than 6 months post-stroke. Following language assessment and computer exercise prescription by a speech and language therapist, participants practised three times a week for 5 months at home with monthly volunteer support. Semi-structured interviews were conducted with 14 participants who received the intervention and ten carers (n = 24). Questions from a topic guide were presented and answered using picture, gesture and written support. Interviews were audio recorded, transcribed verbatim and analysed thematically. Three research SLTs identified and cross-checked themes and subthemes emerging from the data. The key themes that emerged were benefits and disadvantages of computerized aphasia therapy, need for help and support, and comparisons with face-to-face therapy. The independence, flexibility and repetition afforded by the computer was viewed as beneficial and the personalized exercises motivated participants to practise. Participants and carers perceived improvements in word-finding and confidence-talking. Computer practice could cause fatigue and interference with other commitments. Support from carers or volunteers for motivation and technical assistance was seen as important. Although some participants preferred face-to-face therapy, using a computer for independent language practice was perceived to be an acceptable alternative. Independent computerized aphasia therapy is acceptable to stroke survivors. Acceptability can be maximized by tailoring exercises to personal interests of the individual, ensuring access to support and giving consideration to fatigue and life style when recommending practice schedules. © 2013 Royal College of Speech and Language Therapists.

Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer: update to study protocol with follow-up extension.

PubMed

Sawka, Anna M; Straus, Sharon; Rodin, Gary; Thorpe, Kevin E; Ezzat, Shereen; Gafni, Amiram; Goldstein, David P

2015-07-14

Patient decision aids (P-DAs) are used to inform patients about healthcare choices, but there is limited knowledge about their longer term effects, beyond the time period of decision-making. We developed a computerized P-DA that explains the choice of radioactive iodine (RAI) adjuvant treatment or no RAI, for patients with low risk papillary thyroid cancer after total thyroidectomy. The original protocol for a randomized controlled trial, comparing the use of the P-DA (with usual care) to usual care alone, has been published in Trials http://www.trialsjournal.com/content/11/1/81. We found that P-DA (with usual care) significantly improved patients' medical knowledge at the time of decision-making (primary outcome) compared to usual care alone (control). In this update, we present the protocol for an extended follow-up study (15 to 23 months post-randomization), including qualitative and quantitative methods. The patient outcomes evaluated using quantitative questionnaires include: the degree to which patients feel well-informed about their RAI treatment choice, decision satisfaction, decision regret, cancer-related worry, mood, and trust in the treating physician. The qualitative component explores the experiences of RAI treatment decision-making, treatment satisfaction, and trial participation in a representative subgroup of patients. Extended follow-up study results will be described for the entire study population, and data will be compared between the P-DA and control groups. This mixed methods extended follow-up study will provide data on long term outcomes, relating to the use of a computerized P-DA in decision-making about adjuvant RAI treatment in early stage papillary thyroid cancer. Our results are intended to inform future research in this area, particularly relating to long term effects of the use of P-DAs in making healthcare choices. Clinicaltrials.gov identifier NCT01083550, registered 24 February 2010 and last updated 5 January 2015.

The Effects of Using Exploratory Computerized Environments in Grades 1 to 8 Mathematics: A Meta-Analysis of Research

ERIC Educational Resources Information Center

Sokolowski, Andrzej; Li, Yeping; Willson, Victor

2015-01-01

Background: The process of problem solving is difficult for students; thus, mathematics educators have made multiple attempts to seek ways of making this process more accessible to learners. The purpose of this study was to examine the effect size statistic of utilizing exploratory computerized environments (ECEs) to support the process of word…

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support

PubMed Central

2014-01-01

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). Conclusions CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care. PMID:24645674

Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support.

PubMed

North, Frederick; Richards, Debra D; Bremseth, Kimberly A; Lee, Mary R; Cox, Debra L; Varkey, Prathibha; Stroebel, Robert J

2014-03-20

Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care.

Computer versus paper system for recognition and management of sepsis in surgical intensive care.

PubMed

Croft, Chasen A; Moore, Frederick A; Efron, Philip A; Marker, Peggy S; Gabrielli, Andrea; Westhoff, Lynn S; Lottenberg, Lawrence; Jordan, Janeen; Klink, Victoria; Sailors, R Matthew; McKinley, Bruce A

2014-02-01

A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes. A system was designed to provide early recognition and guide patient-specific management of sepsis including (1) modified early warning signs-sepsis recognition score (MEWS-SRS; summative point score of ranges of vital signs, mental status, white blood cell count; after every 4 hours) by bedside nurse; (2) suspected site assessment (vascular access, lung, abdomen, urinary tract, soft tissue, other) at bedside by physician or extender; (3) sepsis management protocol (replicable, point-of-care decisions) at bedside by nurse, physician, and extender. The system was implemented first using paper and then a computerized system. Sepsis severity was defined using standard criteria. In January to May 2012, a paper system was used to manage 77 consecutive sepsis encounters (3.9 ± 0.5 cases per week) in 65 patients (77% male; age, 53 ± 2 years). In June to December 2012, a computerized system was used to manage 132 consecutive sepsis encounters (4.4 ± 0.4 cases per week) in 119 patients (63% male; age, 58 ± 2 years). MEWS-SRS elicited 683 site assessments, and 201 had sepsis diagnosis and protocol management. The predominant site of infection was abdomen (paper, 58%; computer, 53%). Recognition of early sepsis tended to occur more using the computerized system (paper, 23%; computer, 35%). Hospital mortality rate for surgical ICU sepsis (paper, 20%; computer, 14%) was less with the computerized system. A computerized sepsis management system improves care process and outcome. Early sepsis is recognized and managed with greater frequency compared with severe sepsis or septic shock. The system has a beneficial effect as a clinical standard of care for SICU patients. Therapeutic study, level III.

Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

PubMed

Patel, Minal R; Vichich, Jennifer; Lang, Ian; Lin, Jessica; Zheng, Kai

2017-04-01

The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics

PubMed Central

Tsopra, Rosy; Jais, Jean-Philippe; Venot, Alain; Duclos, Catherine

2014-01-01

Context It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. Objective The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. Materials and methods We displayed clinical practice guidelines for antibiotic treatment via two types of interface, which we compared in a crossover design. General practitioners were asked to provide responses for 10 clinical cases and the System Usability Scale (SUS) for each interface. We assessed SUS scores, the number of correct responses, and the confidence level for each interface. Results SUS score and percentage confidence were significantly higher for the interface designed according to usability principles (81 vs 51, p=0.00004, and 88.8% vs 80.7%, p=0.004). The percentage of correct responses was similar for the two interfaces. Discussion/conclusion The interface designed according to usability principles was perceived to be more usable and inspired greater confidence among physicians than the guided navigation interface. Consideration of usability principles in the construction of an interface—in particular ‘effective information presentation’, ‘consistency’, ‘efficient interactions’, ‘effective use of language’, and ‘minimizing cognitive load’—seemed to improve perceived usability and confidence in the system. PMID:24008427

Decision Making Processes and Outcomes

PubMed Central

Hicks Patrick, Julie; Steele, Jenessa C.; Spencer, S. Melinda

2013-01-01

The primary aim of this study was to examine the contributions of individual characteristics and strategic processing to the prediction of decision quality. Data were provided by 176 adults, ages 18 to 93 years, who completed computerized decision-making vignettes and a battery of demographic and cognitive measures. We examined the relations among age, domain-specific experience, working memory, and three measures of strategic information search to the prediction of solution quality using a 4-step hierarchical linear regression analysis. Working memory and two measures of strategic processing uniquely contributed to the variance explained. Results are discussed in terms of potential advances to both theory and intervention efforts. PMID:24282638

Radiation monitoring systems as a tool for assessment of accidental releases at the Chernobyl and Fukushima NPPs

NASA Astrophysics Data System (ADS)

Shershakov, Vjacheslav; Bulgakov, Vladimir

2013-04-01

The experience gained during mitigation of the consequences of the accidents at the Chernobyl and Fukushima NPPs has shown that what makes different the decision-making in case of nuclear accidents is that the greatest benefit from decision-making can be achieved in the early phase of an accident. Support to such process can be provided only by a real-time decision-making support system. In case of a nuclear accident the analysis of the situation and decision-making is not feasible without an operational radiation monitoring system, international data exchange and automated data processing, and the use of computerized decision-making support systems. With this in mind, in the framework of different international programs on the Chernobyl-related issues numerous projects were undertaken to study and develop a set of methods, algorithms and programs providing effective support to emergency response decision-making, starting from accident occurrence to decision-making regarding countermeasures to mitigate effects of radioactive contamination of the environment. The presentation focuses results of the analysis of radiation monitoring data and, on this basis, refining or, for many short-lived radionuclides, reconstructing the source term, modeling dispersion of radioactivity in the environment and assessing its impacts. The obtained results allowed adding and refining the existing estimates and in some cases reconstructing doses for the public on the territories contaminated as a result of the Chernobyl accident. The activities were implemented in two stages. In the first stage, several scenarios for dispersion of Chernobyl-related radioactivity were developed. For each scenario cesium-137 dispersion was estimated and these estimates were compared with measurement data. In the second stage, the scenario which showed the best agreement of calculations and measurements was used for modeling the dispersion of iodine-131and other short-lived radionuclides. The described approach was used for assessing the consequences at the Fukushima NPP. These results are also provided in the presentation. References 1. Kelly G.N., Ehrhardt J., Shershakov V.M.. Decision Support for Off-Site Emergency Preparedness in Europe. Radiation Protection Dosimetry, Vol. 64 Nos. 1-2, 1996, pp. 129-142. 2. Ehrhardt J., Shershakov V.M. Real-time on-line decision support systems (RODOS) for off-site emergency management following a nuclear accident. EUR 16533, 1996 3. Kelly G.N., Shershakov V.M. (Editors). Environmental contamination, radiation doses and health consequences after the ?hernobyl accident. Radiation Protection Dosimetry. Special Commemorative Issue.Vol. 64, 1996 4. Shershakov V.M. Computer information technology for support of radiation monitoring problems. OECD Proceedings of an International Workshop «Nuclear Emergency Data Management», Zurich, Switzerland, 1998, pp. 377-388 5. Pitkevich V.A., Duba V.V., Ivanov V.K., Tsyb A.F., Shershakov V.M., Golubenkov A.V., Borodin R.V., V.A., Kosykh V.S. Reconstruction of External Dose to the Inhabitants Living in the Contaminated Territory of Russia by the Results of the Accident at the Chernobyl NPP. Health Phys., Vol. 30, No. 1, pp. 54-68, 1995. 6. Shershakov V., Fesenko S., Kryshev I., Semioshkina T. Decision-Aiding Tools for Remediation Strategies. In: Radioactivity in the Environment, Volume 14, Remediation of Contaminated Environments, 2009, pp 41- 120, Elsevier Ltd.

Quantitative Analysis of Uncertainty in Medical Reporting: Creating a Standardized and Objective Methodology.

PubMed

Reiner, Bruce I

2018-04-01

Uncertainty in text-based medical reports has long been recognized as problematic, frequently resulting in misunderstanding and miscommunication. One strategy for addressing the negative clinical ramifications of report uncertainty would be the creation of a standardized methodology for characterizing and quantifying uncertainty language, which could provide both the report author and reader with context related to the perceived level of diagnostic confidence and accuracy. A number of computerized strategies could be employed in the creation of this analysis including string search, natural language processing and understanding, histogram analysis, topic modeling, and machine learning. The derived uncertainty data offers the potential to objectively analyze report uncertainty in real time and correlate with outcomes analysis for the purpose of context and user-specific decision support at the point of care, where intervention would have the greatest clinical impact.

Comparing student performance on paper- and computer-based math curriculum-based measures.

PubMed

Hensley, Kiersten; Rankin, Angelica; Hosp, John

2017-01-01

As the number of computerized curriculum-based measurement (CBM) tools increases, it is necessary to examine whether or not student performance can generalize across a variety of test administration modes (i.e., paper or computer). The purpose of this study is to compare math fact fluency on paper versus computer for 197 upper elementary students. Students completed identical sets of probes on paper and on the computer, which were then scored for digits correct, problems correct, and accuracy. Results showed a significant difference in performance between the two sets of probes, with higher fluency rates on the paper probes. Because decisions about levels of student support and interventions often rely on measures such as these, more research in this area is needed to examine the potential differences in student performance between paper-based and computer-based CBMs.

Automated classification of brain tumor type in whole-slide digital pathology images using local representative tiles.

PubMed

Barker, Jocelyn; Hoogi, Assaf; Depeursinge, Adrien; Rubin, Daniel L

2016-05-01

Computerized analysis of digital pathology images offers the potential of improving clinical care (e.g. automated diagnosis) and catalyzing research (e.g. discovering disease subtypes). There are two key challenges thwarting computerized analysis of digital pathology images: first, whole slide pathology images are massive, making computerized analysis inefficient, and second, diverse tissue regions in whole slide images that are not directly relevant to the disease may mislead computerized diagnosis algorithms. We propose a method to overcome both of these challenges that utilizes a coarse-to-fine analysis of the localized characteristics in pathology images. An initial surveying stage analyzes the diversity of coarse regions in the whole slide image. This includes extraction of spatially localized features of shape, color and texture from tiled regions covering the slide. Dimensionality reduction of the features assesses the image diversity in the tiled regions and clustering creates representative groups. A second stage provides a detailed analysis of a single representative tile from each group. An Elastic Net classifier produces a diagnostic decision value for each representative tile. A weighted voting scheme aggregates the decision values from these tiles to obtain a diagnosis at the whole slide level. We evaluated our method by automatically classifying 302 brain cancer cases into two possible diagnoses (glioblastoma multiforme (N = 182) versus lower grade glioma (N = 120)) with an accuracy of 93.1% (p < 0.001). We also evaluated our method in the dataset provided for the 2014 MICCAI Pathology Classification Challenge, in which our method, trained and tested using 5-fold cross validation, produced a classification accuracy of 100% (p < 0.001). Our method showed high stability and robustness to parameter variation, with accuracy varying between 95.5% and 100% when evaluated for a wide range of parameters. Our approach may be useful to automatically differentiate between the two cancer subtypes. Copyright © 2015 Elsevier B.V. All rights reserved.

EFFICIENTLY ESTABLISHING CONCEPTS OF INFERENTIAL STATISTICS AND HYPOTHESIS DECISION MAKING THROUGH CONTEXTUALLY CONTROLLED EQUIVALENCE CLASSES

PubMed Central

Fienup, Daniel M; Critchfield, Thomas S

2010-01-01

Computerized lessons that reflect stimulus equivalence principles were used to teach college students concepts related to inferential statistics and hypothesis decision making. Lesson 1 taught participants concepts related to inferential statistics, and Lesson 2 taught them to base hypothesis decisions on a scientific hypothesis and the direction of an effect. Lesson 3 taught the conditional influence of inferential statistics over decisions regarding the scientific and null hypotheses. Participants entered the study with low scores on the targeted skills and left the study demonstrating a high level of accuracy on these skills, which involved mastering more relations than were taught formally. This study illustrates the efficiency of equivalence-based instruction in establishing academic skills in sophisticated learners. PMID:21358904

Clinical utility of family history for cancer screening and referral in primary care: a report from the Family Healthware Impact Trial.

PubMed

Rubinstein, Wendy S; Acheson, Louise S; O'Neill, Suzanne M; Ruffin, Mack T; Wang, Catharine; Beaumont, Jennifer L; Rothrock, Nan

2011-11-01

To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change. We conducted a randomized clinical trial in primary care patients aged 35-65 years using Family Healthware, a self-administered, internet-based tool that collects family history for six common diseases including breast cancer, colon cancer, and ovarian cancer, stratifies risk into three tiers, and provides tailored prevention messages. Cancer screening adherence and consultation were measured at baseline and 6-month follow-up. Of 3283 participants, 34% were at strong or moderate risk of at least one of the cancers. Family Healthware identified additional participants for whom earlier screening (colon cancer, 4.4%; breast cancer, women ages: 35-39 years, 9%) or genetic assessment (colon cancer, 2.5%; breast cancer, 10%; and ovarian cancer, 4%) may be indicated. Fewer than half were already adherent with risk-based screening. Screening adherence improved for all risk categories with no difference between intervention and control groups. Consultation with specialists did not differ between groups. Family Healthware identified patients for intensified cancer prevention. Engagement of clinicians and patients, integration with clinical decision support, and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment.

Accurate and reproducible invasive breast cancer detection in whole-slide images: A Deep Learning approach for quantifying tumor extent

NASA Astrophysics Data System (ADS)

Cruz-Roa, Angel; Gilmore, Hannah; Basavanhally, Ajay; Feldman, Michael; Ganesan, Shridar; Shih, Natalie N. C.; Tomaszewski, John; González, Fabio A.; Madabhushi, Anant

2017-04-01

With the increasing ability to routinely and rapidly digitize whole slide images with slide scanners, there has been interest in developing computerized image analysis algorithms for automated detection of disease extent from digital pathology images. The manual identification of presence and extent of breast cancer by a pathologist is critical for patient management for tumor staging and assessing treatment response. However, this process is tedious and subject to inter- and intra-reader variability. For computerized methods to be useful as decision support tools, they need to be resilient to data acquired from different sources, different staining and cutting protocols and different scanners. The objective of this study was to evaluate the accuracy and robustness of a deep learning-based method to automatically identify the extent of invasive tumor on digitized images. Here, we present a new method that employs a convolutional neural network for detecting presence of invasive tumor on whole slide images. Our approach involves training the classifier on nearly 400 exemplars from multiple different sites, and scanners, and then independently validating on almost 200 cases from The Cancer Genome Atlas. Our approach yielded a Dice coefficient of 75.86%, a positive predictive value of 71.62% and a negative predictive value of 96.77% in terms of pixel-by-pixel evaluation compared to manually annotated regions of invasive ductal carcinoma.

Accurate and reproducible invasive breast cancer detection in whole-slide images: A Deep Learning approach for quantifying tumor extent.

PubMed

Cruz-Roa, Angel; Gilmore, Hannah; Basavanhally, Ajay; Feldman, Michael; Ganesan, Shridar; Shih, Natalie N C; Tomaszewski, John; González, Fabio A; Madabhushi, Anant

2017-04-18

With the increasing ability to routinely and rapidly digitize whole slide images with slide scanners, there has been interest in developing computerized image analysis algorithms for automated detection of disease extent from digital pathology images. The manual identification of presence and extent of breast cancer by a pathologist is critical for patient management for tumor staging and assessing treatment response. However, this process is tedious and subject to inter- and intra-reader variability. For computerized methods to be useful as decision support tools, they need to be resilient to data acquired from different sources, different staining and cutting protocols and different scanners. The objective of this study was to evaluate the accuracy and robustness of a deep learning-based method to automatically identify the extent of invasive tumor on digitized images. Here, we present a new method that employs a convolutional neural network for detecting presence of invasive tumor on whole slide images. Our approach involves training the classifier on nearly 400 exemplars from multiple different sites, and scanners, and then independently validating on almost 200 cases from The Cancer Genome Atlas. Our approach yielded a Dice coefficient of 75.86%, a positive predictive value of 71.62% and a negative predictive value of 96.77% in terms of pixel-by-pixel evaluation compared to manually annotated regions of invasive ductal carcinoma.

Accurate and reproducible invasive breast cancer detection in whole-slide images: A Deep Learning approach for quantifying tumor extent

PubMed Central

Cruz-Roa, Angel; Gilmore, Hannah; Basavanhally, Ajay; Feldman, Michael; Ganesan, Shridar; Shih, Natalie N.C.; Tomaszewski, John; González, Fabio A.; Madabhushi, Anant

2017-01-01

With the increasing ability to routinely and rapidly digitize whole slide images with slide scanners, there has been interest in developing computerized image analysis algorithms for automated detection of disease extent from digital pathology images. The manual identification of presence and extent of breast cancer by a pathologist is critical for patient management for tumor staging and assessing treatment response. However, this process is tedious and subject to inter- and intra-reader variability. For computerized methods to be useful as decision support tools, they need to be resilient to data acquired from different sources, different staining and cutting protocols and different scanners. The objective of this study was to evaluate the accuracy and robustness of a deep learning-based method to automatically identify the extent of invasive tumor on digitized images. Here, we present a new method that employs a convolutional neural network for detecting presence of invasive tumor on whole slide images. Our approach involves training the classifier on nearly 400 exemplars from multiple different sites, and scanners, and then independently validating on almost 200 cases from The Cancer Genome Atlas. Our approach yielded a Dice coefficient of 75.86%, a positive predictive value of 71.62% and a negative predictive value of 96.77% in terms of pixel-by-pixel evaluation compared to manually annotated regions of invasive ductal carcinoma. PMID:28418027

Education in the Workplace for the Physician: Clinical Management States as an Organizing Framework.

ERIC Educational Resources Information Center

Greenes, Robert A.

2000-01-01

Trends in health information technology include (1) improved access to patient care information; (2) methods for patient-doctor interaction and decision making; (3) computerized practice guidelines; and (4) the concept of patients being in clinical management states (CMS). Problem-specific environments and CMS-related resources should be the focus…

What Is An Expert System? ERIC Digest.

ERIC Educational Resources Information Center

Boss, Richard W.

This digest describes and defines the various components of an expert system, e.g., a computerized tool designed to enhance the quality and availability of knowledge required by decision makers. It is noted that expert systems differ from conventional applications software in the following areas: (1) the existence of the expert systems shell, or…

School Management and Evaluation System. Project Termination Report (PTR).

ERIC Educational Resources Information Center

Cincinnati Public Schools, OH.

Financed with ESEA Title III funds since 1970, the School Information System (SIS) was designed essentially to furnish school administrators with data and information with which to make better decisions. The basic means were to (1) build and improve a data bank, (2) prepare and disseminate computerized reports to the decisionmakers--especially…

The Effects of Goal-Contingent Payment on the Performance of a Complex Task.

ERIC Educational Resources Information Center

Campbell, Donald J.

1984-01-01

Using a complex, computerized decision-making task, 56 university students participated in a six-week, repeated measures, goal-setting project, involving different payment systems. Results indicated that goal-contingent payment is superior to hourly payment in influencing performance, even though the perceived valence of payment and the actual…

A Bayesian Tutoring System for Newtonian Mechanics: Can It Adapt to Different Learners?

ERIC Educational Resources Information Center

Pek, Peng-Kiat; Poh, Kim-Leng

2004-01-01

Newtonian mechanics is a core module in technology courses, but is difficult for many students to learn. Computerized tutoring can assist the teachers to provide individualized instruction. This article presents the application of decision theory to develop a tutoring system, "iTutor", to select optimal tutoring actions under uncertainty of…

Computerized Farm of the 21st Century.

ERIC Educational Resources Information Center

McGrann, James M.

Advancement in computer technology comes at a time when agriculture is in transition from a production-oriented to a business-oriented activity and will require new skills and knowledge if farmers are to be prepared for the future. Electronic technology applications on 21st century commercial farms and ranches will include farm decision support…

Design of Training Systems. Computerization of the Educational Technology Assessment Model. Volume 1.

ERIC Educational Resources Information Center

Duffy, Larry B.; And Others

The Educational Technology Assessment Model (ETAM) is a set of comprehensive procedures and variables for the analysis, synthesis, and decision making, in regard to the benefits, costs, and risks associated with introducing technical innovations in education and training. This final report summarizes the analysis, design, and development…

Structured product labeling improves detection of drug-intolerance issues.

PubMed

Schadow, Gunther

2009-01-01

This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved.

The Effect of a Clinical Decision Support System on Improving Adherence to Guideline in the Treatment of Atrial Fibrillation: An Interrupted Time Series Study.

PubMed

Sheibani, Reza; Sheibani, Mehdi; Heidari-Bakavoli, Alireza; Abu-Hanna, Ameen; Eslami, Saeid

2017-12-23

To evaluate the effect of a computerized Decision Support System (CDSS) on improving adherence to an anticoagulation guideline for the treatment of atrial fibrillation (AF). This study had an interrupted time series design. The adherence to the guideline was assessed at fortnightly (two weeks) intervals from January 2016 to January 2017, 6 months before and 6 months after intervention. Newly diagnosed patients with AF were included in the offices of ten cardiologists. Stroke and major bleeding risks were calculated by the CDSS which was implemented via a mobile application. Treatment recommendations based on the guideline were shown to cardiologists. The segmented regression model was used to evaluate the effect of CDSS on level and trend of guideline adherence for the treatment of AF. In our analysis, 373 patients were included. The trend of adherence to the anticoagulation guideline for the treatment of AF was stable in the pre-intervention phase. After the CDSS intervention, mean of the adherence to the guideline significantly increased from 48% to 65.5% (P-value < 0.0001). The trend of adherence to the guideline was stable in the post-intervention phase. Our results showed that the CDSS can improve adherence to the anticoagulation guideline for the treatment of AF. Registration ID: IRCT2016052528070N1.

Structured Product Labeling Improves Detection of Drug-intolerance Issues

PubMed Central

Schadow, Gunther

2009-01-01

Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Results Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved. PMID:18952933

Incentives and Barriers That Influence Clinical Computerization in Hong Kong: A Population-based Physician Survey

PubMed Central

Leung, Gabriel M.; Yu, Philip L. H.; Wong, Irene O. L.; Johnston, Janice M.; Tin, Keith Y. K.

2003-01-01

Objective: Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation. Design and Measurements: A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation. Results: Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and “push” vs “pull” factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive. Conclusion: This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems. PMID:12595409

A Concurrent Distributed System for Aircraft Tactical Decision Generation

NASA Technical Reports Server (NTRS)

McManus, John W.

1990-01-01

A research program investigating the use of artificial intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within Visual Range (WVR) air combat engagements is discussed. The application of AI programming and problem solving methods in the development and implementation of a concurrent version of the Computerized Logic For Air-to-Air Warfare Simulations (CLAWS) program, a second generation TDG, is presented. Concurrent computing environments and programming approaches are discussed and the design and performance of a prototype concurrent TDG system are presented.

Evaluation of Psychology Clinicians' Attitudes towards Computerized Cognitive Behavior Therapy, for Use in Their Future Clinical Practice, with Regard to Treating Those Suffering from Anxiety and Depression

ERIC Educational Resources Information Center

Dunne, Nivek

2017-01-01

Computerized Cognitive Behavioural Therapy (CCBT) is an empirically supported therapeutic modality used in the treatment of anxiety and depression. It is an important area of research considering there is much research lacking in this area, especially regarding trainee and qualified psychology clinicians' attitudes which are informative in terms…

Investigating the Efficacy of a Computerized Prompting Device to Assist Children with Autism Spectrum Disorder with Activities of Daily Living

ERIC Educational Resources Information Center

Bimbrahw, Justin; Boger, Jennifer; Mihailidis, Alex

2012-01-01

Learning to perform self-care skills can pose a major challenge for children with Autism Spectrum Disorder (ASD) as well as the parents and caregivers who support them. The computerized device described in this paper has been used by children with ASD and their carers to autonomously assist with self-care activities. The device uses computer…

Acute microflow changes after stop and restart of intra-aortic balloon pump in cardiogenic shock.

PubMed

Jung, Christian; Rödiger, Christoph; Fritzenwanger, Michael; Schumm, Julia; Lauten, Alexander; Figulla, Hans R; Ferrari, Markus

2009-08-01

The intra-aortic balloon counter pulsation (IABP) is the most frequently used method of mechanical cardiac support in cardiogenic shock (CS). Microcirculatory impairment correlates with outcome in critically ill patients. We therefore investigated the acute influence of IABP therapy on sublingual microflow in patients with CS. Sidestream darkfield intravitalmicroscopy was used in 13 patients with severe CS. The sublingual microvascular bed (10-100 microm) was examined according to current guidelines. We measured microflow in means of microvascular flow index at baseline and after intentional stop of IABP support. A computerized model was used for blinded off-line analysis. Microflow in vessels 10-50 microm in diameter was improved during IABP support (P < 0.001). Norepinephrine had a negative effect on the response to IABP related microflow improvement. Cardiac Perfusion Index (product of Cardiac Power index and microflow) correlated best with blood lactate levels. It was the aim of this study to evaluate the acute influence of IABP therapy on microflow in vivo. In this setting we found that IABP therapy improves sublingual microflow. Future studies should investigate Cardiac Perfusion Index under such conditions with respect to clinical decision making.

Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update.

PubMed

Bernards, Arnold T M; Berghmans, Bary C M; Slieker-Ten Hove, Marijke C Ph; Staal, J Bart; de Bie, Rob A; Hendriks, Erik J M

2014-02-01

Stress urinary incontinence (SUI) is the most common form of incontinence impacting on quality of life (QOL) and is associated with high financial, social, and emotional costs. The purpose of this study was to provide an update existing Dutch evidence-based clinical practice guidelines (CPGs) for physiotherapy management of patients with stress urinary incontinence (SUI) in order to support physiotherapists in decision making and improving efficacy and uniformity of care. A computerized literature search of relevant databases was performed to search for information regarding etiology, prognosis, and physiotherapy assessment and management in patients with SUI. Where no evidence was available, recommendations were based on consensus. Clinical application of CPGs and feasibility were reviewed. The diagnostic process consists of systematic history taking and physical examination supported by reliable and valid assessment tools to determine physiological potential for recovery. Therapy is related to different problem categories. SUI treatment is generally based on pelvic floor muscle exercises combined with patient education and counseling. An important strategy is to reduce prevalent SUI by reducing influencing risk factors. Scientific evidence supporting assessment and management of SUI is strong. The CPGs reflect the current state of knowledge of effective and tailor-made intervention in SUI patients.

A Comparison of Computer-Based Classification Testing Approaches Using Mixed-Format Tests with the Generalized Partial Credit Model

ERIC Educational Resources Information Center

Kim, Jiseon

2010-01-01

Classification testing has been widely used to make categorical decisions by determining whether an examinee has a certain degree of ability required by established standards. As computer technologies have developed, classification testing has become more computerized. Several approaches have been proposed and investigated in the context of…

Computerized Vocational Information and Decision-Making in Secured Environments in New York State.

ERIC Educational Resources Information Center

Heller, Barbara R.; Gross, Linda Chitayat

A study was conducted on the use of the Guidance Information System (GIS), an on-line computer information retrieval system for occupational, two-year college, four-year college, and scholarship and financial aid information, in four detention/correctional facilities in New York. These were the Queens House of Detention for Men (QHDM), Brooklyn…

PPBS for State and Local Officials. Library Notes, Vol. 6, No. 4.

ERIC Educational Resources Information Center

Grossbard, Stephen I.

The planning, programming, budgeting system (PPBS) is an instrument to help policy-makers assign priorities and allocate resources. It does not seek to computerize what is essentially a political process, nor is it intended that the statisticians and cost accountants take over functions that properly belong to the political decision-maker. PPBS is…

Theory and Practice: The Rationale for a Career Guidance Workbook.

ERIC Educational Resources Information Center

Katz, Martin R.

Although theories of career decision making and guidance are usually offered as a basis for practice, the linkage between such theories and the practices of counselors is not always clear. Since treatment in a private dyadic context is difficult to observe and classify, public treatments such as workbooks or computerized systems are more useful…

Planning and Management of Faculty Resources. AIR Forum 1981 Paper.

ERIC Educational Resources Information Center

Montgomery, James R.; And Others

A computerized faculty allocation and reallocation model is presented to aid the decision maker in evaluating the outcomes of various strategies. A unique goal can be computed for each department based on the average index of the institution, the average of the college, the preceding average of the department, and a goal established by management…

EXSPRT: An Expert Systems Approach to Computer-Based Adaptive Testing.

ERIC Educational Resources Information Center

Frick, Theodore W.; And Others

Expert systems can be used to aid decision making. A computerized adaptive test (CAT) is one kind of expert system, although it is not commonly recognized as such. A new approach, termed EXSPRT, was devised that combines expert systems reasoning and sequential probability ratio test stopping rules. EXSPRT-R uses random selection of test items,…

Computerization of the Archivo General de Indias: Strategies and Results.

ERIC Educational Resources Information Center

Gonzalez, Pedro

The project of the Archivo General de Indias (AGI) in Seville, Spain has digitized more than 11 million of its pages of documents relating to Spanish history in the New World. This report illustrates the experience of the AGI, and the range of decisions that managers have faced throughout the project. Following an introduction and background…

A Computer Program You Can Use: Edging and Trimmer Trainer

Treesearch

Philip A. Araman; D. Earl Kline; Matthew F. Winn

1996-01-01

We present a computerized training tool designed to help hardwood sawmill edger and trim saw operators improve their processing performance. It can also be used by managers to understand the affects of processing decisions such as limiting wane beyond standard grading rule restrictions. The program helps users understand the relationships between lumber grade, surface...

User-centered design and usability testing of an innovative health-related quality of life module.

PubMed

Nagykaldi, Z J; Jordan, M; Quitoriano, J; Ciro, C A; Mold, J W

2014-01-01

Various computerized health risk appraisals (HRAs) are available, but few of them assess health-related quality of life (HRQoL) in a goal-directed framework. This study describes the user-centered development and usability testing of an innovative HRQoL module that extends a validated HRA tool in primary care settings. Systematic user-centered design, usability testing, and qualitative methods were used to develop the HRQoL module in primary care practices. Twenty two patients and 5 clinicians participated in two rounds of interactive technology think-out-loud sessions (TOLs) and semi-structured interviews (SSIs) to iteratively develop a four-step, computerized process that collects information on patient goals for meaningful life activities and current level of disability and presents a personalized and prioritized list of preventive recommendations linked to online resources. Analysis of TOLs and SSIs generated 5 categories and 11 sub-categories related to facilitators and barriers to usability and human-technology interaction. The categories included: Understanding the Purpose, Usability, Perceived Value, Literacy, and Participant Motivation. Some categories were inter-connected. The technology was continually and iteratively improved between sessions until saturation of positive feedback was achieved in 4 categories (addressing motivation will require more research). Usability of all screen units of the module was improved substantially. Clinician feedback emphasized the importance of the module's ability to translate the patient-centered HRQoL Report into actionable items for clinicians to facilitate shared decision-making. Complete integration of the HRQoL module into the existing HRA will require further development and testing. Systematic application of user-centered design and human factors principles in technology development and testing may significantly improve the usability and clinical value of health information systems. This more sophisticated approach helped us translate complex clinical concepts, goal-setting steps, and decision-support processes into an accepted and value-added technology.

Primary care guidelines on consultation practices: the effectiveness of computerized versus paper-based versions. A cluster randomized controlled trial among newly qualified primary care physicians.

PubMed

Jousimaa, Jukkapekka; Mäkelä, Marjukka; Kunnamo, Ilkka; MacLennan, Graeme; Grimshaw, Jeremy M

2002-01-01

To compare the effects of computerized and paper-based versions of guidelines on recently qualified physicians' consultation practices. Two arm cluster randomized controlled trial. Physicians were randomized to receive computerized or textbook-based versions of the same guidelines for a 4-week study period. Physicians' compliance with guideline recommendations about laboratory, radiological, physical and other examinations, procedures, nonpharmacologic and pharmacologic treatments, physiotherapy, and referrals were measured by case note review. There were 139 recently qualified physicians working in 96 primary healthcare centers in Finland who participated in the study. Data on 4,633 patient encounters were abstracted, of which 3,484 were suitable for further analysis. Physicians' compliance with guidelines was high (over 80% for use of laboratory, radiology, physical examinations, and referrals). There were no significant differences in physicians' consultation practices in any of the measured outcomes between the computerized and textbook group. Guidelines are a useful source of information for recently qualified physicians working in primary care. However, the method of presentation of the guidelines (electronic or paper) does not have an effect on guideline use or their impact on decisions. Other factors should be considered when choosing the method of presentation of guidelines, such as information-seeking time, ease of use during the consultation, ability to update, production costs, and the physician's own preferences.

Development of a requirements management system for technical decision - making processes in the geological disposal project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hiroyoshi Ueda; Katsuhiko Ishiguro; Kazumi Kitayama

2007-07-01

NUMO (Nuclear Waste Management Organization of Japan) has a responsibility for implementing geological disposal of vitrified HLW (High-Level radioactive Waste) in the Japanese nuclear waste management programme. Its staged siting procedure was initiated in 2002 by an open call for volunteer sites. Careful management strategy and methodology for the technical decision-making at every milestone are required to prepare for the volunteer site application and the site investigation stages after that. The formal Requirement Management System (RMS) is planned to support the computerized implementation of the specific management methodology, termed the NUMO Structured Approach (NSA). This planned RMS will help formore » comprehensive management of the decision-making processes in the geological disposal project, change management towards the anticipated project deviations, efficient project driving such as well programmed R and D etc. and structured record-keeping regarding the past decisions, which leads to soundness of the project in terms of the long-term continuity. The system should have handling/management functions for the database including the decisions/requirements in the project in consideration, their associated information and the structures composed of them in every decision-making process. The information relating to the premises, boundary conditions and time plan of the project should also be prepared in the system. Effective user interface and efficient operation on the in-house network are necessary. As a living system for the long-term formal use, flexibility to updating is indispensable. In advance of the formal system development, two-year activity to develop the preliminary RMS was already started. The purpose of this preliminary system is to template the decision/requirement structure, prototype the decision making management and thus show the feasibility of the innovative RMS. The paper describes the current status of the development, focusing on the initial stage including work analysis/modeling and the system conceptualization. (authors)« less

Improving guideline concordance in multidisciplinary teams: preliminary results of a cluster-randomized trial evaluating the effect of a web-based audit and feedback intervention with outreach visits

PubMed Central

van Engen-Verheul, Mariëtte M.; Gude, Wouter T.; van der Veer, Sabine N.; Kemps, Hareld M.C.; Jaspers, Monique M.W.; de Keizer, Nicolette F.; Peek, Niels

2015-01-01

Despite their widespread use, audit and feedback (A&F) interventions show variable effectiveness on improving professional performance. Based on known facilitators of successful A&F interventions, we developed a web-based A&F intervention with indicator-based performance feedback, benchmark information, action planning and outreach visits. The goal of the intervention was to engage with multidisciplinary teams to overcome barriers to guideline concordance and to improve overall team performance in the field of cardiac rehabilitation (CR). To assess its effectiveness we conducted a cluster-randomized trial in 18 CR clinics (14,847 patients) already working with computerized decision support (CDS). Our preliminary results showed no increase in concordance with guideline recommendations regarding prescription of CR therapies. Future analyses will investigate whether our intervention did improve team performance on other quality indicators. PMID:26958310

Text-interpreter language for flexible generation of patient notes and instructions.

PubMed

Forker, T S

1992-01-01

An interpreted computer language has been developed along with a windowed user interface and multi-printer-support formatter to allow preparation of documentation of patient visits, including progress notes, prescriptions, excuses for work/school, outpatient laboratory requisitions, and patient instructions. Input is by trackball or mouse with little or no keyboard skill required. For clinical problems with specific protocols, the clinician can be prompted with problem-specific items of history, exam, and lab data to be gathered and documented. The language implements a number of text-related commands as well as branching logic and arithmetic commands. In addition to generating text, it is simple to implement arithmetic calculations such as weight-specific drug dosages; multiple branching decision-support protocols for paramedical personnel (or physicians); and calculation of clinical scores (e.g., coma or trauma scores) while simultaneously documenting the status of each component of the score. ASCII text files produced by the interpreter are available for computerized quality audit. Interpreter instructions are contained in text files users can customize with any text editor.

Computerized Design Synthesis (CDS), A database-driven multidisciplinary design tool

NASA Technical Reports Server (NTRS)

Anderson, D. M.; Bolukbasi, A. O.

1989-01-01

The Computerized Design Synthesis (CDS) system under development at McDonnell Douglas Helicopter Company (MDHC) is targeted to make revolutionary improvements in both response time and resource efficiency in the conceptual and preliminary design of rotorcraft systems. It makes the accumulated design database and supporting technology analysis results readily available to designers and analysts of technology, systems, and production, and makes powerful design synthesis software available in a user friendly format.

Development and initial evaluation of a treatment decision dashboard

PubMed Central

2013-01-01

Background For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care. Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Conclusions Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making. PMID:23601912

Measuring outcomes in children's rehabilitation: a decision protocol.

PubMed

Law, M; King, G; Russell, D; MacKinnon, E; Hurley, P; Murphy, C

1999-06-01

To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation. A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge and use of clinical outcome measures. A children's rehabilitation center in a city of 50,000. All service providers in the children's rehabilitation center. Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. Using a conceptual framework based on the International Classification of Impairment, Disability, and Handicap (ICIDH), an outcome measurement decision-making protocol was developed. The decision-making protocol was computerized in an educational software program with an attached database of critically appraised measures. Participants learned about outcome measures through the program and selected outcome measures that met their specifications. The computer software was tested for feasibility in the children's rehabilitation center for 6 months. Knowledge and use of clinical outcome measures were determined before and after the feasibility testing using a survey of all service providers currently at the centre and audits of 30 randomly selected rehabilitation records (at pretest, posttest, and follow-up). Service providers indicated that the outcomes software was easy to follow and believed that the use of the ICIDH framework helped them in making decisions about selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing what measures were available. Use of outcome measures as identified through the audit did not change. The "All About Outcomes" software is clinically useful. Further research should evaluate whether using the software affects the use of outcome measures in clinical practice.

The potential for intelligent decision support systems to improve the quality and consistency of medication reviews.

PubMed

Bindoff, I; Stafford, A; Peterson, G; Kang, B H; Tenni, P

2012-08-01

Drug-related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of a consistently high standard, and there is often room for improvement in the quality of their findings. Our aim was to produce computerized intelligent decision support software that can improve the consistency and quality of medication review reports, by helping to ensure that DRPs relevant to a patient are overlooked less frequently. A system that largely achieved this goal was previously published, but refinements have been made. This paper examines the results of both the earlier and newer systems. Two prototype multiple-classification ripple-down rules medication review systems were built, the second being a refinement of the first. Each of the systems was trained incrementally using a human medication review expert. The resultant knowledge bases were analysed and compared, showing factors such as accuracy, time taken to train, and potential errors avoided. The two systems performed well, achieving accuracies of approximately 80% and 90%, after being trained on only a small number of cases (126 and 244 cases, respectively). Through analysis of the available data, it was estimated that without the system intervening, the expert training the first prototype would have missed approximately 36% of potentially relevant DRPs, and the second 43%. However, the system appeared to prevent the majority of these potential expert errors by correctly identifying the DRPs for them, leaving only an estimated 8% error rate for the first expert and 4% for the second. These intelligent decision support systems have shown a clear potential to substantially improve the quality and consistency of medication reviews, which should in turn translate into improved medication usage if they were implemented into routine use. © 2011 Blackwell Publishing Ltd.

Wind energy Computerized Maintenance Management System (CMMS) : data collection recommendations for reliability analysis.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peters, Valerie A.; Ogilvie, Alistair B.

2012-01-01

This report addresses the general data requirements for reliability analysis of fielded wind turbines and other wind plant equipment. The report provides a rationale for why this data should be collected, a list of the data needed to support reliability and availability analysis, and specific data recommendations for a Computerized Maintenance Management System (CMMS) to support automated analysis. This data collection recommendations report was written by Sandia National Laboratories to address the general data requirements for reliability analysis of operating wind turbines. This report is intended to help develop a basic understanding of the data needed for reliability analysis frommore » a Computerized Maintenance Management System (CMMS) and other data systems. The report provides a rationale for why this data should be collected, a list of the data needed to support reliability and availability analysis, and specific recommendations for a CMMS to support automated analysis. Though written for reliability analysis of wind turbines, much of the information is applicable to a wider variety of equipment and analysis and reporting needs. The 'Motivation' section of this report provides a rationale for collecting and analyzing field data for reliability analysis. The benefits of this type of effort can include increased energy delivered, decreased operating costs, enhanced preventive maintenance schedules, solutions to issues with the largest payback, and identification of early failure indicators.« less

A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia.

PubMed

Gomar, Jesús J; Valls, Elia; Radua, Joaquim; Mareca, Celia; Tristany, Josep; del Olmo, Francisco; Rebolleda-Gil, Carlos; Jañez-Álvarez, María; de Álvaro, Francisco J; Ovejero, María R; Llorente, Ana; Teixidó, Cristina; Donaire, Ana M; García-Laredo, Eduardo; Lazcanoiturburu, Andrea; Granell, Luis; Mozo, Cristina de Pablo; Pérez-Hernández, Mónica; Moreno-Alcázar, Ana; Pomarol-Clotet, Edith; McKenna, Peter J

2015-11-01

The effectiveness of cognitive remediation therapy (CRT) for the neuropsychological deficits seen in schizophrenia is supported by meta-analysis. However, a recent methodologically rigorous trial had negative findings. In this study, 130 chronic schizophrenic patients were randomly assigned to computerized CRT, an active computerized control condition (CC) or treatment as usual (TAU). Primary outcome measures were 2 ecologically valid batteries of executive function and memory, rated under blind conditions; other executive and memory tests and a measure of overall cognitive function were also employed. Carer ratings of executive and memory failures in daily life were obtained before and after treatment. Computerized CRT was found to produce improvement on the training tasks, but this did not transfer to gains on the primary outcome measures and most other neuropsychological tests in comparison to either CC or TAU conditions. Nor did the intervention result in benefits on carer ratings of daily life cognitive failures. According to this study, computerized CRT is not effective in schizophrenia. The use of both active and passive CCs suggests that nature of the control group is not an important factor influencing results. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Szluha, A.T.; Summers, J.R.; Nicholas, W.D.

Current response technologies for floating hazardous chemicals were organized into a response manual. Technologies for spill containment, vapor suppression, and spill removal were included. A decision-making process was developed and work sheets included in an appendix. Physical properties and response information are also included in an appendix for each of the floating CHRIS chemicals. This information has been organized into a computerized data base for easy access.

The Reliability of Classification Decisions for the Furtado-Gallagher Computerized Observational Movement Pattern Assessment System--FG-COMPASS

ERIC Educational Resources Information Center

Furtado, Ovande, Jr.; Gallagher, Jere D.

2012-01-01

Mastery of fundamental movement skills (FMS) is an important factor in preventing weight gain and increasing physical activity. To master FMS, performance evaluation is necessary. In this study, we investigated the reliability of a new observational assessment tool. In Phase I, 110 video clips of children performing five locomotor, and six…

Proceedings of the international conference on cybernetics and societ

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1985-01-01

This book presents the papers given at a conference on artificial intelligence, expert systems and knowledge bases. Topics considered at the conference included automating expert system development, modeling expert systems, causal maps, data covariances, robot vision, image processing, multiprocessors, parallel processing, VLSI structures, man-machine systems, human factors engineering, cognitive decision analysis, natural language, computerized control systems, and cybernetics.

Assessment, evaluation, and testing of technologies for environmental restoration, decontamination, and decommissioning and high level waste management. Progress report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uzochukwu, G.A.

1997-12-31

Nuclear and commercial non-nuclear technologies that have the potential of meeting the environmental restoration, decontamination and decommissioning, and high-level waste management objectives are being assessed and evaluated. A detailed comparison of innovative technologies available will be performed to determine the safest and most economical technology for meeting these objectives. Information derived from this effort will be matched with the multi-objectives of the environmental restoration, decontamination and decommissioning, and high-level waste management effort to ensure that the best, most economical, and the safest technologies are used in decision making at USDOE-SRS. Technology-related variables will be developed and the resulting data formattedmore » and computerized for multimedia systems. The multimedia system will be made available to technology developers and evaluators to ensure that the best, most economical, and the safest technologies are used in decision making at USDOE-SRS. Technology-related variables will be developed and the resulting data formatted and computerized for multimedia systems. The multimedia system will be made available to technology developers and evaluators to ensure that the safest and most economical technologies are developed for use at SRS and other DOE sites.« less

Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making.

PubMed

Jayakumar, Kishore L; Lavenberg, Julia A; Mitchell, Matthew D; Doshi, Jalpa A; Leas, Brian; Goldmann, David R; Williams, Kendal; Brennan, Patrick J; Umscheid, Craig A

2016-03-01

Hospital evidence-based practice centers (EPCs) synthesize and disseminate evidence locally, but their impact on institutional decision making is unclear. To assess the evidence synthesis activities and impact of a hospital EPC serving a large academic healthcare system. Descriptive analysis of the EPC's database of rapid systematic reviews since EPC inception (July 2006-June 2014), and survey of report requestors from the EPC's last 4 fiscal years. Descriptive analyses examined requestor and report characteristics; questionnaire examined report usability, impact, and requestor satisfaction (higher scores on 5-point Likert scales reflected greater agreement). The EPC completed 249 evidence reviews since inception. The most common requestors were clinical departments (29%, n = 72), chief medical officers (19%, n = 47), and purchasing committees (14%, n = 35). The most common technologies reviewed were drugs (24%, n = 60), devices (19%, n = 48), and care processes (12%, n = 31). Mean report completion time was 70 days. Thirty reports (12%) informed computerized decision support interventions. More than half of reports (56%, n = 139) were completed in the last 4 fiscal years for 65 requestors. Of the 64 eligible participants, 46 responded (72%). Requestors were satisfied with the report (mean = 4.4), and agreed it was delivered promptly (mean = 4.4), answered the questions posed (mean = 4.3), and informed their final decision (mean = 4.1). This is the first examination of evidence synthesis activities by a hospital EPC in the United States. Our findings suggest hospital EPCs can efficiently synthesize and disseminate evidence addressing a range of clinical topics for diverse stakeholders, and can influence local decision making. © 2015 Society of Hospital Medicine.

Measuring value for money: a scoping review on economic evaluation of health information systems.

PubMed

Bassi, Jesdeep; Lau, Francis

2013-01-01

To explore how key components of economic evaluations have been included in evaluations of health information systems (HIS), to determine the state of knowledge on value for money for HIS, and provide guidance for future evaluations. We searched databases, previously collected papers, and references for relevant papers published from January 2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system for health information processing, decision support, or management reporting; and include an economic evaluation. Data on study design and economic evaluation methods were extracted and analyzed. Forty-two papers were selected and 33 were deemed high quality (scores ≥ 8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-related outcome analyses. For HIS types, there were seven primary care electronic medical records, six computerized provider order entry systems, five medication management systems, five immunization information systems, four institutional information systems, three disease management systems, two clinical documentation systems, and one health information exchange network. In terms of value for money, 23 papers reported positive findings, eight were inconclusive, and two were negative. We found a wide range of economic evaluation papers that were based on different assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare organizations and HIS types. However, caution is needed when generalizing these findings. Better reporting of economic evaluation studies is needed to compare findings and build on the existing evidence base we identified.

Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review.

PubMed

De Angelis, Gino; Davies, Barbara; King, Judy; McEwan, Jessica; Cavallo, Sabrina; Loew, Laurianne; Wells, George A; Brosseau, Lucie

2016-11-30

The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. The findings suggest that health professionals' perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines. ©Gino De Angelis, Barbara Davies, Judy King, Jessica McEwan, Sabrina Cavallo, Laurianne Loew, George A Wells, Lucie Brosseau. Originally published in JMIR Medical Education (http://mededu.jmir.org), 30.11.2016.

Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients.

PubMed

Vermeulen, K M; van Doormaal, J E; Zaal, R J; Mol, P G M; Lenderink, A W; Haaijer-Ruskamp, F M; Kosterink, J G W; van den Bemt, P M L A

2014-08-01

Prescribing medication is an important aspect of almost all in-hospital treatment regimes. Besides their obviously beneficial effects, medicines can also cause adverse drug events (ADE), which increase morbidity, mortality and health care costs. Partially, these ADEs arise from medication errors, e.g. at the prescribing stage. ADEs caused by medication errors are preventable ADEs. Until now, medication ordering was primarily a paper-based process and consequently, it was error prone. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) is considered to enhance patient safety. Limited information is available on the balance between the health gains and the costs that need to be invested in order to achieve these positive effects. Aim of this study was to study the balance between the effects and costs of CPOE/CDSS compared to the traditional paper-based medication ordering. The economic evaluation was performed alongside a clinical study (interrupted time series design) on the effectiveness of CPOE/CDSS, including a cost minimization and a cost-effectiveness analysis. Data collection took place between 2005 and 2008. Analyses were performed from a hospital perspective. The study was performed in a general teaching hospital and a University Medical Centre on general internal medicine, gastroenterology and geriatric wards. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) was compared to a traditional paper based system. All costs of both medication ordering systems are based on resources used and time invested. Prices were expressed in Euros (price level 2009). Effectiveness outcomes were medication errors and preventable adverse drug events. During the paper-based prescribing period 592 patients were included, and during the CPOE/CDSS period 603. Total costs of the paper-based system and CPOE/CDSS amounted to €12.37 and €14.91 per patient/day respectively. The Incremental Cost-Effectiveness Ratio (ICER) for medication errors was 3.54 and for preventable adverse drug events 322.70, indicating the extra amount (€) that has to be invested in order to prevent one medication error or one pADE. CPOE with basic CDSS contributes to a decreased risk of preventable harm. Overall, the extra costs of CPOE/CDSS needed to prevent one ME or one pADE seem to be acceptable. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Impact of a clinical decision support system for drug dosage in patients with renal failure.

PubMed

Desmedt, Sophie; Spinewine, Anne; Jadoul, Michel; Henrard, Séverine; Wouters, Dominique; Dalleur, Olivia

2018-05-21

Background A clinical decision support system (CDSS) linked to the computerized physician order entry may help improve prescription appropriateness in inpatients with renal insufficiency. Objective To evaluate the impact on prescription appropriateness of a CDSS prescriber alert for 85 drugs in renal failure patients. Setting Before-after study in a 975-bed academic hospital. Method Prescriptions of patients with renal failure were reviewed during two comparable periods of 6 days each, before and after the implementation of the CDSS (September 2009 and 2010). Main outcome measure The proportion of inappropriate dosages of 85 drugs included in the CDSS was compared in the pre- and post-implementation group. Results Six hundred and fifteen patients were included in the study (301 in pre- and 314 in post-implementation periods). In the pre- and post-implementation period, respectively 2882 and 3485 prescriptions were evaluated, of which 14.9 and 16.6% triggered an alert. Among these, the dosage was inappropriate in respectively 25.4 and 24.6% of prescriptions in the pre- and post-implementation periods (OR 0.97; 95% CI 0.72-1.29). The most frequently involved drugs were paracetamol, perindopril, tramadol and allopurinol. Conclusion The implementation of a CDSS did not significantly reduce the proportion of inappropriate drug dosages in patients with renal failure. Further research is required to investigate the reasons why prescribers override alerts. Collaboration with clinical pharmacists might improve compliance with the CDSS recommendations.

Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases.

PubMed

Nair, Bala G; Newman, Shu-Fang; Peterson, Gene N; Wu, Wei-Ying; Schwid, Howard A

2010-11-01

Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized. Starting with the implementation of an anesthesia information management system (AIMS), we designed and implemented several feedback mechanisms to improve compliance of proper antibiotic delivery and documentation. This included generating e-mail feedback of missed documentation, distributing monthly summary reports, and generating real-time electronic alerts with a decision support system. In 20,974 surgical cases for the period, June 2008 to January 2010, the interventions of AIMS install, e-mail feedback, summary reports, and real-time alerts changed antibiotic compliance by -1.5%, 2.3%, 4.9%, and 9.3%, respectively, when compared with the baseline value of 90.0% ± 2.9% when paper anesthesia records were used. Highest antibiotic compliance was achieved when using real-time alerts. With real-time alerts, monthly compliance was >99% for every month between June 2009 and January 2010. Installation of AIMS itself did not improve antibiotic compliance over that achieved with paper anesthesia records. However, real-time guidance and reminders through electronic messages generated by a computerized decision support system (Smart Anesthesia Messenger, or SAM) significantly improved compliance. With such a system a consistent compliance of >99% was achieved.

Comparing the performance of expert user heuristics and an integer linear program in aircraft carrier deck operations.

PubMed

Ryan, Jason C; Banerjee, Ashis Gopal; Cummings, Mary L; Roy, Nicholas

2014-06-01

Planning operations across a number of domains can be considered as resource allocation problems with timing constraints. An unexplored instance of such a problem domain is the aircraft carrier flight deck, where, in current operations, replanning is done without the aid of any computerized decision support. Rather, veteran operators employ a set of experience-based heuristics to quickly generate new operating schedules. These expert user heuristics are neither codified nor evaluated by the United States Navy; they have grown solely from the convergent experiences of supervisory staff. As unmanned aerial vehicles (UAVs) are introduced in the aircraft carrier domain, these heuristics may require alterations due to differing capabilities. The inclusion of UAVs also allows for new opportunities for on-line planning and control, providing an alternative to the current heuristic-based replanning methodology. To investigate these issues formally, we have developed a decision support system for flight deck operations that utilizes a conventional integer linear program-based planning algorithm. In this system, a human operator sets both the goals and constraints for the algorithm, which then returns a proposed schedule for operator approval. As a part of validating this system, the performance of this collaborative human-automation planner was compared with that of the expert user heuristics over a set of test scenarios. The resulting analysis shows that human heuristics often outperform the plans produced by an optimization algorithm, but are also often more conservative.

An extensible six-step methodology to automatically generate fuzzy DSSs for diagnostic applications.

PubMed

d'Acierno, Antonio; Esposito, Massimo; De Pietro, Giuseppe

2013-01-01

The diagnosis of many diseases can be often formulated as a decision problem; uncertainty affects these problems so that many computerized Diagnostic Decision Support Systems (in the following, DDSSs) have been developed to aid the physician in interpreting clinical data and thus to improve the quality of the whole process. Fuzzy logic, a well established attempt at the formalization and mechanization of human capabilities in reasoning and deciding with noisy information, can be profitably used. Recently, we informally proposed a general methodology to automatically build DDSSs on the top of fuzzy knowledge extracted from data. We carefully refine and formalize our methodology that includes six stages, where the first three stages work with crisp rules, whereas the last three ones are employed on fuzzy models. Its strength relies on its generality and modularity since it supports the integration of alternative techniques in each of its stages. The methodology is designed and implemented in the form of a modular and portable software architecture according to a component-based approach. The architecture is deeply described and a summary inspection of the main components in terms of UML diagrams is outlined as well. A first implementation of the architecture has been then realized in Java following the object-oriented paradigm and used to instantiate a DDSS example aimed at accurately diagnosing breast masses as a proof of concept. The results prove the feasibility of the whole methodology implemented in terms of the architecture proposed.

An extensible six-step methodology to automatically generate fuzzy DSSs for diagnostic applications

PubMed Central

2013-01-01

Background The diagnosis of many diseases can be often formulated as a decision problem; uncertainty affects these problems so that many computerized Diagnostic Decision Support Systems (in the following, DDSSs) have been developed to aid the physician in interpreting clinical data and thus to improve the quality of the whole process. Fuzzy logic, a well established attempt at the formalization and mechanization of human capabilities in reasoning and deciding with noisy information, can be profitably used. Recently, we informally proposed a general methodology to automatically build DDSSs on the top of fuzzy knowledge extracted from data. Methods We carefully refine and formalize our methodology that includes six stages, where the first three stages work with crisp rules, whereas the last three ones are employed on fuzzy models. Its strength relies on its generality and modularity since it supports the integration of alternative techniques in each of its stages. Results The methodology is designed and implemented in the form of a modular and portable software architecture according to a component-based approach. The architecture is deeply described and a summary inspection of the main components in terms of UML diagrams is outlined as well. A first implementation of the architecture has been then realized in Java following the object-oriented paradigm and used to instantiate a DDSS example aimed at accurately diagnosing breast masses as a proof of concept. Conclusions The results prove the feasibility of the whole methodology implemented in terms of the architecture proposed. PMID:23368970

Clinical Decision Support Alert Appropriateness: A Review and Proposal for Improvement

PubMed Central

McCoy, Allison B.; Thomas, Eric J.; Krousel-Wood, Marie; Sittig, Dean F.

2014-01-01

Background Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. Methods We present a review of CDS alerts and describe a proposal to develop novel methods for evaluating and improving CDS alerts that builds upon traditional informatics approaches. Our proposal incorporates previously described models for predicting alert overrides that utilize retrospective chart review to determine which alerts are clinically relevant and which overrides are justifiable. Results Despite increasing implementations of CDS alerts, detailed evaluations rarely occur because of the extensive labor involved in manual chart reviews to determine alert and response appropriateness. Further, most studies have solely evaluated alert overrides that are appropriate or justifiable. Our proposal expands the use of web-based monitoring tools with an interactive dashboard for evaluating CDS alert and response appropriateness that incorporates the predictive models. The dashboard provides 2 views, an alert detail view and a patient detail view, to provide a full history of alerts and help put the patient's events in context. Conclusion The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety. PMID:24940129

Separating Business Logic from Medical Knowledge in Digital Clinical Workflows Using Business Process Model and Notation and Arden Syntax.

PubMed

de Bruin, Jeroen S; Adlassnig, Klaus-Peter; Leitich, Harald; Rappelsberger, Andrea

2018-01-01

Evidence-based clinical guidelines have a major positive effect on the physician's decision-making process. Computer-executable clinical guidelines allow for automated guideline marshalling during a clinical diagnostic process, thus improving the decision-making process. Implementation of a digital clinical guideline for the prevention of mother-to-child transmission of hepatitis B as a computerized workflow, thereby separating business logic from medical knowledge and decision-making. We used the Business Process Model and Notation language system Activiti for business logic and workflow modeling. Medical decision-making was performed by an Arden-Syntax-based medical rule engine, which is part of the ARDENSUITE software. We succeeded in creating an electronic clinical workflow for the prevention of mother-to-child transmission of hepatitis B, where institution-specific medical decision-making processes could be adapted without modifying the workflow business logic. Separation of business logic and medical decision-making results in more easily reusable electronic clinical workflows.

The role of computerized diagnostic proposals in the interpretation of the 12-lead electrocardiogram by cardiology and non-cardiology fellows.

PubMed

Novotny, Tomas; Bond, Raymond; Andrsova, Irena; Koc, Lumir; Sisakova, Martina; Finlay, Dewar; Guldenring, Daniel; Spinar, Jindrich; Malik, Marek

2017-05-01

Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties. A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected. Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43). Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of arm support combined with rehabilitation games on upper-extremity function in subacute stroke: a randomized controlled trial.

PubMed

Prange, Gerdienke B; Kottink, Anke I R; Buurke, Jaap H; Eckhardt, Martine M E M; van Keulen-Rouweler, Bianca J; Ribbers, Gerard M; Rietman, Johan S

2015-02-01

Use of rehabilitation technology, such as (electro)mechanical devices or robotics, could partly relieve the increasing strain on stroke rehabilitation caused by an increasing prevalence of stroke. Arm support (AS) training showed improvement of unsupported arm function in chronic stroke. To examine the effect of weight-supported arm training combined with computerized exercises on arm function and capacity, compared with dose-matched conventional reach training in subacute stroke patients. In a single-blind, multicenter, randomized controlled trial, 70 subacute stroke patients received 6 weeks of training with either an AS device combined with computerized exercises or dose-matched conventional training (CON). Arm function was evaluated pretraining and posttraining by Fugl-Meyer assessment (FM), maximal reach distance, Stroke Upper Limb Capacity Scale (SULCS), and arm pain via Visual Analogue Scale, in addition to perceived motivation by Intrinsic Motivation Inventory posttraining. FM and SULCS scores and reach distance improved significantly within both groups. These improvements and experienced pain did not differ between groups. The AS group reported higher interest/enjoyment during training than the CON group. AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation, when applied at the same dose. © The Author(s) 2014.

Patient-specific computer-based decision support in primary healthcare--a randomized trial.

PubMed

Kortteisto, Tiina; Raitanen, Jani; Komulainen, Jorma; Kunnamo, Ilkka; Mäkelä, Marjukka; Rissanen, Pekka; Kaila, Minna

2014-01-20

Computer-based decision support systems are a promising method for incorporating research evidence into clinical practice. However, evidence is still scant on how such information technology solutions work in primary healthcare when support is provided across many health problems. In Finland, we designed a trial where a set of evidence-based, patient-specific reminders was introduced into the local Electronic Patient Record (EPR) system. The aim was to measure the effects of such reminders on patient care. The hypothesis was that the total number of triggered reminders would decrease in the intervention group compared with the control group, indicating an improvement in patient care. From July 2009 to October 2010 all the patients of one health center were randomized to an intervention or a control group. The intervention consisted of patient-specific reminders concerning 59 different health conditions triggered when the healthcare professional (HCP) opened and used the EPR. In the intervention group, the triggered reminders were shown to the HCP; in the control group, the triggered reminders were not shown. The primary outcome measure was the change in the number of reminders triggered over 12 months. We developed a unique data gathering method, the Repeated Study Virtual Health Check (RSVHC), and used Generalized Estimation Equations (GEE) for analysing the incidence rate ratio, which is a measure of the relative difference in percentage change in the numbers of reminders triggered in the intervention group and the control group. In total, 13,588 participants were randomized and included. Contrary to our expectation, the total number of reminders triggered increased in both the intervention and the control groups. The primary outcome measure did not show a significant difference between the groups. However, with the inclusion of patients followed up over only six months, the total number of reminders increased significantly less in the intervention group than in the control group when the confounding factors (age, gender, number of diagnoses and medications) were controlled for. Computerized, tailored reminders in primary care did not decrease during the 12 months of follow-up time after the introduction of a patient-specific decision support system. ClinicalTrial.gov NCT00915304.

Fourth Year Status Report. Computerized Training Systems Project. Project ABACUS.

DTIC Science & Technology

1976-08-01

in 7 9. PERFORMING ORGANIZATION NAME AND ADOMEN ,,, 10. PROGRAM ELEMENT. PROJECT , TASK US Army Tra ining Support Center A R E A S WORK UNIT NUMBERS...transp ired during the fourth year of Project ABACUS, the A rmy ’s program for the development of a Computerized Training System. It inc l udes a...have transpired durlnq the fourth year of Project ABACUS, the Army ’s program for the developmen t o~ aprototype Computer i zed Training System. It

Virtual reality simulation: using three-dimensional technology to teach nursing students.

PubMed

Jenson, Carole E; Forsyth, Diane McNally

2012-06-01

The use of computerized technology is rapidly growing in the classroom and in healthcare. An emerging computer technology strategy for nursing education is the use of virtual reality simulation. This computer-based three-dimensional educational tool simulates real-life patient experiences in a risk-free environment, allows for repeated practice sessions, requires clinical decision making, exposes students to diverse patient conditions, provides immediate feedback, and is portable. The purpose of this article was to review the importance of virtual reality simulation as a computerized teaching strategy. In addition, a project to explore readiness of nursing faculty at one major Midwestern university for the use of virtual reality simulation as a computerized teaching strategy is described where faculty thought virtual reality simulation would increase students' knowledge of an intravenous line insertion procedure. Faculty who practiced intravenous catheter insertion via virtual reality simulation expressed a wide range of learning experiences from using virtual reality simulation that is congruent with the literature regarding the barriers to student learning. Innovative teaching strategies, such as virtual reality simulation, address barriers of increasing patient acuity, high student-to-faculty ratio, patient safety concerns from faculty, and student anxiety and can offer rapid feedback to students.

Symposium on Aviation Psychology, 1st, Ohio State University, Columbus, OH, April 21, 22, 1981, Proceedings

NASA Technical Reports Server (NTRS)

1981-01-01

The impact of modern technology on the role, responsibility, authority, and performance of human operators in modern aircraft and ATC systems was examined in terms of principles defined by Paul Fitts. Research into human factors in aircraft operations and the use of human factors engineering for aircraft safety improvements were discussed, and features of the man-machine interface in computerized cockpit warning systems are examined. The design and operational features of computerized avionics displays and HUDs are described, along with results of investigations into pilot decision-making behavior, aircrew procedural compliance, and aircrew judgment training programs. Experiments in vision and visual perception are detailed, as are behavioral studies of crew workload, coordination, and complement. The effectiveness of pilot selection, screening, and training techniques are assessed, as are methods for evaluating pilot performance.

Exploring Vital Sign Data Quality in Electronic Health Records with Focus on Emergency Care Warning Scores.

PubMed

Skyttberg, Niclas; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2017-08-30

Computerized clinical decision support and automation of warnings have been advocated to assist clinicians in detecting patients at risk of physiological instability. To provide reliable support such systems are dependent on high-quality vital sign data. Data quality depends on how, when and why the data is captured and/or documented. This study aims to describe the effects on data quality of vital signs by three different types of documentation practices in five Swedish emergency hospitals, and to assess data fitness for calculating warning and triage scores. The study also provides reference data on triage vital signs in Swedish emergency care. We extracted a dataset including vital signs, demographic and administrative data from emergency care visits (n=335027) at five Swedish emergency hospitals during 2013 using either completely paper-based, completely electronic or mixed documentation practices. Descriptive statistics were used to assess fitness for use in emergency care decision support systems aiming to calculate warning and triage scores, and data quality was described in three categories: currency, completeness and correctness. To estimate correctness, two further categories - plausibility and concordance - were used. The study showed an acceptable correctness of the registered vital signs irrespectively of the type of documentation practice. Completeness was high in sites where registrations were routinely entered into the Electronic Health Record (EHR). The currency was only acceptable in sites with a completely electronic documentation practice. Although vital signs that were recorded in completely electronic documentation practices showed plausible results regarding correctness, completeness and currency, the study concludes that vital signs documented in Swedish emergency care EHRs cannot generally be considered fit for use for calculation of triage and warning scores. Low completeness and currency were found if the documentation was not completely electronic.

The Relationship Between Computer Experience and Computerized Cognitive Test Performance Among Older Adults

PubMed Central

2013-01-01

Objective. This study compared the relationship between computer experience and performance on computerized cognitive tests and a traditional paper-and-pencil cognitive test in a sample of older adults (N = 634). Method. Participants completed computer experience and computer attitudes questionnaires, three computerized cognitive tests (Useful Field of View (UFOV) Test, Road Sign Test, and Stroop task) and a paper-and-pencil cognitive measure (Trail Making Test). Multivariate analysis of covariance was used to examine differences in cognitive performance across the four measures between those with and without computer experience after adjusting for confounding variables. Results. Although computer experience had a significant main effect across all cognitive measures, the effect sizes were similar. After controlling for computer attitudes, the relationship between computer experience and UFOV was fully attenuated. Discussion. Findings suggest that computer experience is not uniquely related to performance on computerized cognitive measures compared with paper-and-pencil measures. Because the relationship between computer experience and UFOV was fully attenuated by computer attitudes, this may imply that motivational factors are more influential to UFOV performance than computer experience. Our findings support the hypothesis that computer use is related to cognitive performance, and this relationship is not stronger for computerized cognitive measures. Implications and directions for future research are provided. PMID:22929395

Reading Comprehension: A Computerized Intervention with Primary-age Poor Readers.

PubMed

Horne, Joanna Kathryn

2017-05-01

The current study investigates the effectiveness of a computerized reading comprehension programme on the reading accuracy, reading comprehension and reading rate of primary-age poor readers. There is little published literature relating to computerized reading interventions in UK primary schools, and no previous studies have investigated the Comprehension Booster programme. Thirty-eight children (26 boys and 12 girls; aged 6:7 to 11:0) from two schools in East Yorkshire, UK, took part. Half of the participants (the intervention group) undertook the Comprehension Booster programme for a 6-week period, whilst the other half (the control group) continued with their usual teaching. Significant effects of the intervention were found, with increases in reading accuracy and reading comprehension for the intervention group. It is concluded that computerized reading programmes can be effective in improving reading skills, and these are particularly useful for pupils with reading difficulties in disadvantaged areas, where resources are limited and family support in reading is lower. However, such programmes are not a replacement for good teaching, and regular monitoring of children with reading difficulties is required. Further research is necessary to compare the programme used here to other conventional and computerized intervention programmes, using a larger sample. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

The effect of sleep deprivation on vocal expression of emotion in adolescents and adults.

PubMed

McGlinchey, Eleanor L; Talbot, Lisa S; Chang, Keng-Hao; Kaplan, Katherine A; Dahl, Ronald E; Harvey, Allison G

2011-09-01

Investigate the impact of sleep deprivation on vocal expression of emotion. Within-group repeated measures analysis involving sleep deprivation and rested conditions. Experimental laboratory setting. Fifty-five healthy participants (24 females), including 38 adolescents aged 11-15 y and 17 adults aged 30-60 y. A multimethod approach was used to examine vocal expression of emotion in interviews conducted at 22:30 and 06:30. On that night, participants slept a maximum of 2 h. Interviews were analyzed for vocal expression of emotion via computerized text analysis, human rater judgments, and computerized acoustic properties. Computerized text analysis and human rater judgments indicated decreases in positive emotion in all participants at 06:30 relative to 22:30, and adolescents displayed a significantly greater decrease in positive emotion via computerized text analysis relative to adults. Increases in negative emotion were observed among all participants using human rater judgments. Results for the computerized acoustic properties indicated decreases in pitch, bark energy (intensity) in certain high frequency bands, and vocal sharpness (reduction in high frequency bands > 1000 Hz). These findings support the importance of sleep for healthy emotional functioning in adults, and further suggest that adolescents are differentially vulnerable to the emotional consequences of sleep deprivation.

Artificial intelligence: the clinician of the future.

PubMed

Gallagher, S M

2001-09-01

Human beings have long been fascinated with the idea of artificial intelligence. This fascination is fueled by popular films such as Stanley Kubrick's 2001: A Space Odyssey and Stephen Spielberg's recent film, AI. However intriguing artificial intelligence may be, Hubert and Spencer Dreyfus contend that qualities exist that are uniquely human--the qualities thought to be inaccessible to the computer "mind." Patricia Benner further investigated the qualities that guide clinicians in making decisions and assessments that are not entirely evidence-based or grounded in scientific data. Perhaps it is the intuitive nature of the human being that separates us from the machine. The state of artificial intelligence is described herein, along with a discussion of computerized clinical decision-making and the role of the human being in these decisions.

Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice.

PubMed

Riva, Silvia; Monti, Marco; Antonietti, Alessandro

2011-01-01

Over-the-counter (OTC) drugs are widely available and often purchased by consumers without advice from a health care provider. Many people rely on self-management of medications to treat common medical conditions. Although OTC medications are regulated by the National and the International Health and Drug Administration, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions. This study examined how subjects make their decisions to select an OTC drug, evaluating the role of cognitive heuristics which are simple and adaptive rules that help the decision-making process of people in everyday contexts. By analyzing 70 subjects' information-search and decision-making behavior when selecting OTC drugs, we examined the heuristics they applied in order to assess whether simple decision-making processes were also accurate and relevant. Subjects were tested with a sequence of two experimental tests based on a computerized Java system devised to analyze participants' choices in a virtual environment. We found that subjects' information-search behavior reflected the use of fast and frugal heuristics. In addition, although the heuristics which correctly predicted subjects' decisions implied significantly fewer cues on average than the subjects did in the information-search task, they were accurate in describing order of information search. A simple combination of a fast and frugal tree and a tallying rule predicted more than 78% of subjects' decisions. The current emphasis in health care is to shift some responsibility onto the consumer through expansion of self medication. To know which cognitive mechanisms are behind the choice of OTC drugs is becoming a relevant purpose of current medical education. These findings have implications both for the validity of simple heuristics describing information searches in the field of OTC drug choices and for current medical education, which has to prepare competent health specialists to orientate and support the choices of their patients.

Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice

PubMed Central

Riva, Silvia; Monti, Marco; Antonietti, Alessandro

2011-01-01

Introduction Over-the-counter (OTC) drugs are widely available and often purchased by consumers without advice from a health care provider. Many people rely on self-management of medications to treat common medical conditions. Although OTC medications are regulated by the National and the International Health and Drug Administration, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions. Purpose This study examined how subjects make their decisions to select an OTC drug, evaluating the role of cognitive heuristics which are simple and adaptive rules that help the decision-making process of people in everyday contexts. Subjects and methods By analyzing 70 subjects’ information-search and decision-making behavior when selecting OTC drugs, we examined the heuristics they applied in order to assess whether simple decision-making processes were also accurate and relevant. Subjects were tested with a sequence of two experimental tests based on a computerized Java system devised to analyze participants’ choices in a virtual environment. Results We found that subjects’ information-search behavior reflected the use of fast and frugal heuristics. In addition, although the heuristics which correctly predicted subjects’ decisions implied significantly fewer cues on average than the subjects did in the information-search task, they were accurate in describing order of information search. A simple combination of a fast and frugal tree and a tallying rule predicted more than 78% of subjects’ decisions. Conclusion The current emphasis in health care is to shift some responsibility onto the consumer through expansion of self medication. To know which cognitive mechanisms are behind the choice of OTC drugs is becoming a relevant purpose of current medical education. These findings have implications both for the validity of simple heuristics describing information searches in the field of OTC drug choices and for current medical education, which has to prepare competent health specialists to orientate and support the choices of their patients. PMID:23745077

Comparing data collected by computerized and written surveys for adolescence health research.

PubMed

Wu, Ying; Newfield, Susan A

2007-01-01

This study assessed whether data-collection formats, computerized versus paper-and-pencil, affect response patterns and descriptive statistics for adolescent health assessment surveys. Youth were assessed as part of a health risk reduction program. Baseline data from 1131 youth were analyzed. Participants completed the questionnaire either by computer (n = 390) or by paper-and-pencil (n = 741). The rate of returned surveys meeting inclusion requirements was 90.6% and did not differ by methods. However, the computerized method resulted in significantly less incompleteness but more identical responses. Multiple regression indicated that the survey methods did not contribute to problematic responses. The two survey methods yielded similar scale internal reliability and descriptive statistics for behavioral and psychological outcomes, although the computerized method elicited higher reports of some risk items such as carrying a knife, beating up a person, selling drugs, and delivering drugs. Overall, the survey method did not produce a significant difference in outcomes. This provides support for program personnel selecting survey methods based on study goals with confidence that the method of administration will not have a significant impact on the outcome.

DISCOVER: A Computer-Based Career Guidance and Counselor-Administrative Support System. Final Report. July 1974-August 1975.

ERIC Educational Resources Information Center

Harris-Bowlsbey, JoAnn

Based on the Computerized Vocational Information System (CVIS), Project DISCOVER was conceptualized in three parts: Guidance subsystem for direct use by individuals at three age levels (grades 4-6, grades 7-12, and adult) seeking career guidance; the counselor-support subsystem; and the administrator support subsystem. Guidance development and…

Development of medical data information systems

NASA Technical Reports Server (NTRS)

Anderson, J.

1971-01-01

Computerized storage and retrieval of medical information is discussed. Tasks which were performed in support of the project are: (1) flight crew health stabilization computer system, (2) medical data input system, (3) graphic software development, (4) lunar receiving laboratory support, and (5) Statos V printer/plotter software development.

Using Decision Analysis to Select Facility Maintenance Management Information Systems

DTIC Science & Technology

2010-03-01

efficient way possible. Many of today’s maintenance managers thus apply computerized tools that come in the form of information systems that assist in... apply to effectively select a maintenance management information system that enables them to meet the needs of their customers. 3 1.2 Background...recession of the early 1990s. During this time, companies downsized their white-collar workforce performing daily operation and maintenance functions

Does computerizing paper-and-pencil job attitude scales make a difference? New IRT analyses offer insight.

PubMed

Donovan, M A; Drasgow, F; Probst, T M

2000-04-01

The measurement equivalence of 2 scales of the Job Descriptive Index (JDI; P. C. Smith, L. M. Kendall, & C. L. Hulin, 1969), the Supervisor Satisfaction scale and the Coworker Satisfaction scale, was examined across computerized and paper-and-pencil administrations. In this study, employees in 2 organizations (N = 1,777) were administered paper-and-pencil versions of the scales, and employees in a third organization (N = 509) were administered a computerized version. A newly developed item response theory (IRT) technique for examining differential test functioning (N. S. Raju, W. J. van der Linden, & P. F. Fleer, 1995) was used to examine measurement equivalence across media. Results support the measurement equivalence of the JDI Supervisor and Coworker scales across administration media. The implications of these findings for both practitioners and organizational researchers are discussed.

A three-dimensional computerized isometric strength measurement system.

PubMed

Black, Nancy L; Das, Biman

2007-05-01

The three-dimensional Computerized Isometric Strength Measurement System (CISMS) reliably and accurately measures isometric pull and push strengths in work spaces of paraplegic populations while anticipating comparative studies with other populations. The main elements of the system were: an extendable arm, a vertical supporting track, a rotating platform, a force transducer, stability sensors and a computerized data collection interface. The CISMS with minor modification was successfully used to measure isometric push-up and pull-down strengths of paraplegics and isometric push, pull, push-up and pull-down strength in work spaces for seated and standing able-bodied populations. The instrument has satisfied criteria of versatility, safety and comfort, ease of operation, and durability. Results are accurate within 2N for aligned forces. Costing approximately $1,500 (US) including computer, the system is affordable and accurate for aligned isometric strength measurements.

Implementing computerized physician order entry: the importance of special people.

PubMed

Ash, Joan S; Stavri, P Zoë; Dykstra, Richard; Fournier, Lara

2003-03-01

To articulate important lessons learned during a study to identify success factors for implementing computerized physician order entry (CPOE) in inpatient and outpatient settings. Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. The theme we call Special People is explored here in detail. A taxonomy of types of Special People includes administrative leaders, clinical leaders (champions, opinion leaders, and curmudgeons), and bridgers or support staff who interface directly with users. The recognition and nurturing of Special People should be among the highest priorities of those implementing computerized physician order entry. Their education and training must be a goal of teaching programs in health administration and medical informatics.

Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study

PubMed Central

2013-01-01

Background Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. Methods We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Results Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change. Conclusions The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption. PMID:23800211

Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.

PubMed

Simon, Steven R; Keohane, Carol A; Amato, Mary; Coffey, Michael; Cadet, Bismarck; Zimlichman, Eyal; Bates, David W

2013-06-24

Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change. The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.

An empirical evaluation of graphical interfaces to support flight planning

NASA Technical Reports Server (NTRS)

Smith, Philip J.; Mccoy, Elaine; Layton, Chuck; Bihari, Tom

1995-01-01

Whether optimization techniques or expert systems technologies are used, the underlying inference processes and the model or knowledge base for a computerized problem-solving system are likely to be incomplete for any given complex, real-world task. To deal with the resultant brittleness, it has been suggested that 'cooperative' rather than 'automated' problem-solving systems be designed. Such cooperative systems are proposed to explicitly enhance the collaboration of people and the computer system when working in partnership to solve problems. This study evaluates the impact of alternative design concepts on the performance of airline pilots interacting with such a cooperative system designed to support enroute flight planning. Thirty pilots were studied using three different versions of the system. The results clearly demonstrate that different system design concepts can strongly influence the cognitive processes of users. Indeed, one of the designs studied caused four times as many pilots to accept a poor flight amendment. Based on think-aloud protocols, cognitive models are proposed to account for how features of the computer system interacted with specific types of scenarios to influence exploration and decision-making by the pilots. The results are then used to develop recommendations for guiding the design of cooperative systems.

Three Decades of Research on Computer Applications in Health Care

PubMed Central

Michael Fitzmaurice, J.; Adams, Karen; Eisenberg, John M.

2002-01-01

The Agency for Healthcare Research and Quality and its predecessor organizations—collectively referred to here as AHRQ—have a productive history of funding research and development in the field of medical informatics, with grant investments since 1968 totaling $107 million. Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives. This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computer-based medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives. Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review. PMID:11861630

Accuracy of dementia diagnosis: a direct comparison between radiologists and a computerized method.

PubMed

Klöppel, Stefan; Stonnington, Cynthia M; Barnes, Josephine; Chen, Frederick; Chu, Carlton; Good, Catriona D; Mader, Irina; Mitchell, L Anne; Patel, Ameet C; Roberts, Catherine C; Fox, Nick C; Jack, Clifford R; Ashburner, John; Frackowiak, Richard S J

2008-11-01

There has been recent interest in the application of machine learning techniques to neuroimaging-based diagnosis. These methods promise fully automated, standard PC-based clinical decisions, unbiased by variable radiological expertise. We recently used support vector machines (SVMs) to separate sporadic Alzheimer's disease from normal ageing and from fronto-temporal lobar degeneration (FTLD). In this study, we compare the results to those obtained by radiologists. A binary diagnostic classification was made by six radiologists with different levels of experience on the same scans and information that had been previously analysed with SVM. SVMs correctly classified 95% (sensitivity/specificity: 95/95) of sporadic Alzheimer's disease and controls into their respective groups. Radiologists correctly classified 65-95% (median 89%; sensitivity/specificity: 88/90) of scans. SVM correctly classified another set of sporadic Alzheimer's disease in 93% (sensitivity/specificity: 100/86) of cases, whereas radiologists ranged between 80% and 90% (median 83%; sensitivity/specificity: 80/85). SVMs were better at separating patients with sporadic Alzheimer's disease from those with FTLD (SVM 89%; sensitivity/specificity: 83/95; compared to radiological range from 63% to 83%; median 71%; sensitivity/specificity: 64/76). Radiologists were always accurate when they reported a high degree of diagnostic confidence. The results show that well-trained neuroradiologists classify typical Alzheimer's disease-associated scans comparable to SVMs. However, SVMs require no expert knowledge and trained SVMs can readily be exchanged between centres for use in diagnostic classification. These results are encouraging and indicate a role for computerized diagnostic methods in clinical practice.

Accuracy of dementia diagnosis—a direct comparison between radiologists and a computerized method

PubMed Central

Stonnington, Cynthia M.; Barnes, Josephine; Chen, Frederick; Chu, Carlton; Good, Catriona D.; Mader, Irina; Mitchell, L. Anne; Patel, Ameet C.; Roberts, Catherine C.; Fox, Nick C.; Jack, Clifford R.; Ashburner, John; Frackowiak, Richard S. J.

2008-01-01

There has been recent interest in the application of machine learning techniques to neuroimaging-based diagnosis. These methods promise fully automated, standard PC-based clinical decisions, unbiased by variable radiological expertise. We recently used support vector machines (SVMs) to separate sporadic Alzheimer's disease from normal ageing and from fronto-temporal lobar degeneration (FTLD). In this study, we compare the results to those obtained by radiologists. A binary diagnostic classification was made by six radiologists with different levels of experience on the same scans and information that had been previously analysed with SVM. SVMs correctly classified 95% (sensitivity/specificity: 95/95) of sporadic Alzheimer's disease and controls into their respective groups. Radiologists correctly classified 65–95% (median 89%; sensitivity/specificity: 88/90) of scans. SVM correctly classified another set of sporadic Alzheimer's disease in 93% (sensitivity/specificity: 100/86) of cases, whereas radiologists ranged between 80% and 90% (median 83%; sensitivity/specificity: 80/85). SVMs were better at separating patients with sporadic Alzheimer's disease from those with FTLD (SVM 89%; sensitivity/specificity: 83/95; compared to radiological range from 63% to 83%; median 71%; sensitivity/specificity: 64/76). Radiologists were always accurate when they reported a high degree of diagnostic confidence. The results show that well-trained neuroradiologists classify typical Alzheimer's disease-associated scans comparable to SVMs. However, SVMs require no expert knowledge and trained SVMs can readily be exchanged between centres for use in diagnostic classification. These results are encouraging and indicate a role for computerized diagnostic methods in clinical practice. PMID:18835868

Measuring value for money: a scoping review on economic evaluation of health information systems

PubMed Central

Bassi, Jesdeep; Lau, Francis

2013-01-01

Objective To explore how key components of economic evaluations have been included in evaluations of health information systems (HIS), to determine the state of knowledge on value for money for HIS, and provide guidance for future evaluations. Materials and methods We searched databases, previously collected papers, and references for relevant papers published from January 2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system for health information processing, decision support, or management reporting; and include an economic evaluation. Data on study design and economic evaluation methods were extracted and analyzed. Results Forty-two papers were selected and 33 were deemed high quality (scores ≥8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-related outcome analyses. For HIS types, there were seven primary care electronic medical records, six computerized provider order entry systems, five medication management systems, five immunization information systems, four institutional information systems, three disease management systems, two clinical documentation systems, and one health information exchange network. In terms of value for money, 23 papers reported positive findings, eight were inconclusive, and two were negative. Conclusions We found a wide range of economic evaluation papers that were based on different assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare organizations and HIS types. However, caution is needed when generalizing these findings. Better reporting of economic evaluation studies is needed to compare findings and build on the existing evidence base we identified. PMID:23416247

To Trust or Not to Trust: Social Decision Making in Post-institutionalized, Internationally Adopted Youth

PubMed Central

Pitula, Clio E.; Wenner, Jennifer A.; Gunnar, Megan R.; Thomas, Kathleen M.

2015-01-01

Chronic parental maltreatment has been associated with lower levels of interpersonal trust, and depriving environments have been shown to predict shortsighted, risk-averse decision-making. The present study examined whether a circumscribed period of adverse care occurring only early in life was associated with biases in trust behavior. Fifty-three post-institutionalized (PI) youth, adopted internationally on average by one year of age, and 33 never-institutionalized, non-adopted youth (M age = 12.9 years) played a trust game. Participants decided whether or not to share coins with a different anonymous peer in each trial with the potential to receive a larger number of coins in return. Trials were presented in blocks that varied in the degree to which the peers behaved in a trustworthy (reciprocal) or untrustworthy (non-reciprocal) manner. A comparison condition consisted of a computerized lottery with the same choices and probabilistic risk as the peer trials. Non-adopted comparison youth showed a tendency to share more with peers than to invest in the lottery and tended to maintain their level of sharing across trials despite experiencing trials in which peers failed to reciprocate. In contrast, PI children, particularly those who were adopted over a year of age, shared less with peers than they invested in the lottery and quickly adapted their sharing behavior to peers' responses. These results suggest that PI youth were more mistrusting, more sensitive to both defection and reciprocation, and potentially more accurate in their trusting decisions than comparison youth. Results support the presence of a sensitive period for the development of trust in others, whereby conditions early in life may set long-term biases in decision-making. PMID:27089448

To trust or not to trust: social decision-making in post-institutionalized, internationally adopted youth.

PubMed

Pitula, Clio E; Wenner, Jennifer A; Gunnar, Megan R; Thomas, Kathleen M

2017-05-01

Chronic parental maltreatment has been associated with lower levels of interpersonal trust, and depriving environments have been shown to predict short-sighted, risk-averse decision-making. The present study examined whether a circumscribed period of adverse care occurring only early in life was associated with biases in trust behavior. Fifty-three post-institutionalized (PI) youth, adopted internationally on average by 1 year of age, and 33 never-institutionalized, non-adopted youth (M age  = 12.9 years) played a trust game. Participants decided whether or not to share coins with a different anonymous peer in each trial with the potential to receive a larger number of coins in return. Trials were presented in blocks that varied in the degree to which the peers behaved in a trustworthy (reciprocal) or untrustworthy (non-reciprocal) manner. A comparison condition consisted of a computerized lottery with the same choices and probabilistic risk as the peer trials. Non-adopted comparison youth showed a tendency to share more with peers than to invest in the lottery and tended to maintain their level of sharing across trials despite experiencing trials in which peers failed to reciprocate. In contrast, PI children, particularly those who were adopted over 1 year of age, shared less with peers than they invested in the lottery and quickly adapted their sharing behavior to peers' responses. These results suggest that PI youth were more mistrusting, more sensitive to both defection and reciprocation, and potentially more accurate in their trusting decisions than comparison youth. Results support the presence of a sensitive period for the development of trust in others, whereby conditions early in life may set long-term biases in decision-making. © 2016 John Wiley & Sons Ltd.

Discrete event simulation for healthcare organizations: a tool for decision making.

PubMed

Hamrock, Eric; Paige, Kerrie; Parks, Jennifer; Scheulen, James; Levin, Scott

2013-01-01

Healthcare organizations face challenges in efficiently accommodating increased patient demand with limited resources and capacity. The modern reimbursement environment prioritizes the maximization of operational efficiency and the reduction of unnecessary costs (i.e., waste) while maintaining or improving quality. As healthcare organizations adapt, significant pressures are placed on leaders to make difficult operational and budgetary decisions. In lieu of hard data, decision makers often base these decisions on subjective information. Discrete event simulation (DES), a computerized method of imitating the operation of a real-world system (e.g., healthcare delivery facility) over time, can provide decision makers with an evidence-based tool to develop and objectively vet operational solutions prior to implementation. DES in healthcare commonly focuses on (1) improving patient flow, (2) managing bed capacity, (3) scheduling staff, (4) managing patient admission and scheduling procedures, and (5) using ancillary resources (e.g., labs, pharmacies). This article describes applicable scenarios, outlines DES concepts, and describes the steps required for development. An original DES model developed to examine crowding and patient flow for staffing decision making at an urban academic emergency department serves as a practical example.

An Empirical Analysis of Negotiation Teaching Methodologies Using a Negotiation Support System

ERIC Educational Resources Information Center

Jones, Beth H.; Jones, Gary H.; Banerjee, Debasish

2005-01-01

This article describes an experiment that compared different methods of teaching undergraduates the fundamentals of negotiation analysis. Using student subjects, we compared three conditions: reading, lecture-only, and lecture accompanied by student use of a computerized negotiation support system (NSS). The authors examined two facets of…

Development and Evaluation of a Computerized Engagement Intervention for IPS Supported Employment

ERIC Educational Resources Information Center

Haslett, William R.

2013-01-01

Background: Current information technology offers the promise of innovative approaches to engagement for mental health. Specific psychosocial services may also benefit from technology-based engagement interventions. Individual Placement and Support (IPS) is an evidence-based service that helps people who have a severe mental illness to gain…

Social, Organizational, and Contextual Characteristics of Clinical Decision Support Systems for Intensive Insulin Therapy: A Literature Review and Case Study

PubMed Central

Campion, Thomas R.; Waitman, Lemuel R.; May, Addison K.; Ozdas, Asli; Lorenzi, Nancy M.; Gadd, Cynthia S.

2009-01-01

Introduction: Evaluations of computerized clinical decision support systems (CDSS) typically focus on clinical performance changes and do not include social, organizational, and contextual characteristics explaining use and effectiveness. Studies of CDSS for intensive insulin therapy (IIT) are no exception, and the literature lacks an understanding of effective computer-based IIT implementation and operation. Results: This paper presents (1) a literature review of computer-based IIT evaluations through the lens of institutional theory, a discipline from sociology and organization studies, to demonstrate the inconsistent reporting of workflow and care process execution and (2) a single-site case study to illustrate how computer-based IIT requires substantial organizational change and creates additional complexity with unintended consequences including error. Discussion: Computer-based IIT requires organizational commitment and attention to site-specific technology, workflow, and care processes to achieve intensive insulin therapy goals. The complex interaction between clinicians, blood glucose testing devices, and CDSS may contribute to workflow inefficiency and error. Evaluations rarely focus on the perspective of nurses, the primary users of computer-based IIT whose knowledge can potentially lead to process and care improvements. Conclusion: This paper addresses a gap in the literature concerning the social, organizational, and contextual characteristics of CDSS in general and for intensive insulin therapy specifically. Additionally, this paper identifies areas for future research to define optimal computer-based IIT process execution: the frequency and effect of manual data entry error of blood glucose values, the frequency and effect of nurse overrides of CDSS insulin dosing recommendations, and comprehensive ethnographic study of CDSS for IIT. PMID:19815452

Validation of a guideline-based decision support system for the diagnosis of primary headache disorders based on ICHD-3 beta.

PubMed

Dong, Zhao; Yin, Ziming; He, Mianwang; Chen, Xiaoyan; Lv, Xudong; Yu, Shengyuan

2014-06-16

China may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem. We developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China. We found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache. With high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China.

Digital imaging in dentistry.

PubMed

Essen, S Donovan

2011-01-01

Information technology is vital to operations, marketing, accounting, finance and administration. One of the most exciting and quickly evolving technologies in the modern dental office is digital applications. The dentist is often the business manager, information technology officer and strategic planning chief for his small business. The information systems triangle applies directly to this critical manager supported by properly trained ancillary staff and good equipment. With emerging technology driving all medical disciplines and the rapid pace at which it emerges, it is vital for the contemporary practitioner to keep abreast of the newest information technology developments. This article compares the strategic and operational advantages of digital applications, specifically imaging. The focus of this paper will be on digital radiography (DR), 3D computerized tomography, digital photography and digitally-driven CAD/CAM to what are now considered obsolescing modalities and contemplates what may arrive in the future. It is the purpose of this essay to succinctly evaluate the decisions involved in the role, application and implications of employing this tool in the dental environment

Redefining the Practice of Peer Review Through Intelligent Automation-Part 3: Automated Report Analysis and Data Reconciliation.

PubMed

Reiner, Bruce I

2018-02-01

One method for addressing existing peer review limitations is the assignment of peer review cases on a completely blinded basis, in which the peer reviewer would create an independent report which can then be cross-referenced with the primary reader report of record. By leveraging existing computerized data mining techniques, one could in theory automate and objectify the process of report data extraction, classification, and analysis, while reducing time and resource requirements intrinsic to manual peer review report analysis. Once inter-report analysis has been performed, resulting inter-report discrepancies can be presented to the radiologist of record for review, along with the option to directly communicate with the peer reviewer through an electronic data reconciliation tool aimed at collaboratively resolving inter-report discrepancies and improving report accuracy. All associated report and reconciled data could in turn be recorded in a referenceable peer review database, which provides opportunity for context and user-specific education and decision support.

Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

PubMed

Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

2013-01-01

Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline.

Assessing and managing breast cancer risk: clinicians' current practice and future needs.

PubMed

Collins, Ian M; Steel, Emma; Mann, G Bruce; Emery, Jon D; Bickerstaffe, Adrian; Trainer, Alison; Butow, Phyllis; Pirotta, Marie; Antoniou, Antonis C; Cuzick, Jack; Hopper, John; Phillips, Kelly-Anne; Keogh, Louise A

2014-10-01

Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

National Survey of Neonatal Intensive Care Unit Medication Safety Practices.

PubMed

Greenberg, Rachel G; Smith, P Brian; Bose, Carl; Clark, Reese H; Cotten, C Michael; DeRienzo, Chris

2018-06-15

 We conducted a detailed survey to identify medication safety practices among a large network of United States neonatal intensive care units (NICUs).  We created a 53-question survey to assess 300 U.S. NICU's demographics, medication safety practices, adverse drug event (ADE) reporting, and ADE response plans.  Among the 164 (55%) NICUs that responded to the survey, more than 85% adhered to practices including use of electronic health records, computerized physician order entry, and clinical decision support; fewer reported adopting barcoding, formal safety surveys, and formal culture training; 137 of 164 (84%) developed at least one NICU-specific order-set with a median of 10 order-sets.  Among our survey of 164 NICUs, we found that many safety practices remain unused. Understanding safety practice variation is critical to prevent ADEs and other negative infant outcomes. Future efforts should focus on linking safety practices identified from our survey with ADEs and infant outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

76 FR 40844 - Changes to Move Update Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... accuracy standard: a. For computerized lists, Coding Accuracy Support System (CASS)- certified address matching software and current USPS City State Product, within a mailer's computer systems or through an...

Quality Assessment of Process Measures in Antimicrobial Stewardship: Concordance of Valacyclovir Indication and Automatic Prospective Approval in Computerized Provider Order Entry

PubMed Central

Lee, Tiffany; McCoy, Christopher; Mahoney, Monica V

2017-01-01

Abstract Background The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend computerized decision support at the time of prescribing as an antimicrobial stewardship (AST) tool. Providing antimicrobial indications during prescribing can optimize infection-specific therapy through appropriate antimicrobial selection, dosing, and frequency. The Leapfrog group identifies this as a quality measure for their report card system. At Beth Israel Deaconess Medical Center (BIDMC), indication-based dosing has been incorporated in the computerized provider order entry (CPOE) system since 2006. At BIDMC, valacyclovir is only approved for the treatment of varicella zoster (VZV) infection or prophylaxis of solid organ transplant (SOT) patients at low risk for cytomegalovirus. These indications bypass the need for AST approval. Accuracy validation of the selected indications has not been formally performed. Methods A retrospective chart review was performed in patients prescribed valacyclovir during an 8-month period in 2016. Electronic medical records, laboratory reports, and pharmacy records were reviewed to identify the suspected/confirmed infection. The primary outcome was the concordance rate of selected CPOE valacyclovir indication compared with suspected/confirmed infection at the time of ordering. The secondary outcome was the proportion of valacyclovir use per institutional protocol. Results Overall, 117 patients were included, with a median age of 57.9 years, 51 (43.6%) were male, and 4 (3.4%) were located in an intensive care unit. Fifty-nine orders (50.4%) selected VZV as the indication, followed by 21 orders (17.9%) for SOT prophylaxis. Of orders with any CPOE indication, only 59/101 (58.4%) were concordant with suspected/confirmed infection. Of the valacyclovir orders with a VZV indication, 37 (62.7%) were concordant. Of the orders with SOT prophylaxis indications, 5 (23.8%) were concordant. Furthermore, only 46 orders (39.3%) were per BIDMC-protocol. Conclusion Concordance of CPOE indication selection and suspected/confirmed infection for valacyclovir was low. Using CPOE to grant automatic prospective approval must be monitored and audited for accuracy if employed as an AST tool. Disclosures All authors: No reported disclosures.

Views on health information sharing and privacy from primary care practices using electronic medical records.

PubMed

Perera, Gihan; Holbrook, Anne; Thabane, Lehana; Foster, Gary; Willison, Donald J

2011-02-01

To determine how patients and physicians balance the perceived benefits and harms of sharing electronic health data for patient care and for secondary purposes. Before-after survey of patients and providers in practices using electronic medical records (EMRs) enrolled in a clinical trial in Ontario, Canada. Outcomes were measured using the Health Information Privacy Questionnaire (HIPQ) at baseline and end of study. Thirteen questions in 4 general domains investigated attitudes towards the privacy of EMRs, outsider's use of patient's health information, the sharing of patient's information within the health care system, and the overall perception of benefits versus harms of computerization in health care. 511 patients (mean age 60.3 years, 49.6% female) and 46 physicians (mean age 47.2 years, 37.0% female) participated. Most (>90%) supported the computerized sharing of the patient's health records among their health care professionals and to provide clinical advice. Fewer agreed that the patient's de-identified information should be shared outside of the health care circle (<70%). Only a minority of either group supported the notion that computerized records can be keep more private than paper records (38-50%). Overall, a majority (58% patients, 70% physicians) believed that the benefits of computerization were greater than the risks of confidentiality loss. This was especially true for patients who were frequent computer users. While these primary care physicians and their patients valued the clinical features of EMRs, a substantial minority have concerns about the secondary use of de-identified information. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

PubMed Central

2010-01-01

Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. Conclusions The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline. PMID:20082700

Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines.

PubMed

Ongenae, Femke; De Backere, Femke; Steurbaut, Kristof; Colpaert, Kirsten; Kerckhove, Wannes; Decruyenaere, Johan; De Turck, Filip

2010-01-18

Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs.The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.

Exercise Patterns in the U.S. Navy.

DTIC Science & Technology

1988-01-11

decisions are more likely to continue exercise programs in clinical, corporate, and community settings (23,27,28). Environmental factors, including barriors...longitudinal evaluation of the Navy’s Health and Physical Readiness Program . Their average age was 28.3 years (S.D. = 7.0) with a range from 17-59 years...each of the 119 command units. To select individuals within the 119 command units, March 1985 computerized personnel tapes from the Naval military

Progress on Intelligent Guidance and Control for Wind Shear Encounter

NASA Technical Reports Server (NTRS)

Stratton, D. Alexander

1990-01-01

Low altitude wind shear poses a serious threat to air safety. Avoiding severe wind shear challenges the ability of flight crews, as it involves assessing risk from uncertain evidence. A computerized intelligent cockpit aid can increase flight crew awareness of wind shear, improving avoidance decisions. The primary functions of a cockpit advisory expert system for wind shear avoidance are discussed. Also introduced are computational techniques being implemented to enable these primary functions.

Using an Evidence-Based Approach to EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences

PubMed Central

Longhurst, Christopher A.; Palma, Jonathan P.; Grisim, Lisa M.; Widen, Eric; Chan, Melanie; Sharek, Paul J.

2013-01-01

Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites. PMID:24771994

Bladder cancer staging in CT urography: effect of stage labels on statistical modeling of a decision support system

NASA Astrophysics Data System (ADS)

Gandikota, Dhanuj; Hadjiiski, Lubomir; Cha, Kenny H.; Chan, Heang-Ping; Caoili, Elaine M.; Cohan, Richard H.; Weizer, Alon; Alva, Ajjai; Paramagul, Chintana; Wei, Jun; Zhou, Chuan

2018-02-01

In bladder cancer, stage T2 is an important threshold in the decision of administering neoadjuvant chemotherapy. Our long-term goal is to develop a quantitative computerized decision support system (CDSS-S) to aid clinicians in accurate staging. In this study, we examined the effect of stage labels of the training samples on modeling such a system. We used a data set of 84 bladder cancers imaged with CT Urography (CTU). At clinical staging prior to treatment, 43 lesions were staged as below stage T2 and 41 were stage T2 or above. After cystectomy and pathological staging that is considered the gold standard, 10 of the lesions were upstaged to stage T2 or above. After correcting the stage labels, 33 lesions were below stage T2, and 51 were stage T2 or above. For the CDSS-S, the lesions were segmented using our AI-CALS method and radiomic features were extracted. We trained a linear discriminant analysis (LDA) classifier with leave-one-case-out cross validation to distinguish between bladder lesions of stage T2 or above and those below stage T2. The CDSS-S was trained and tested with the corrected post-cystectomy labels, and as a comparison, CDSS-S was also trained with understaged pre-treatment labels and tested on lesions with corrected labels. The test AUC for the CDSS-S trained with corrected labels was 0.89 +/- 0.04. For the CDSS-S trained with understaged pre-treatment labels and tested on the lesions with corrected labels, the test AUC was 0.86 +/- 0.04. The likelihood of stage T2 or above for 9 out of the 10 understaged lesions was correctly increased for the CDSS-S trained with corrected labels. The CDSS-S is sensitive to the accuracy of stage labeling. The CDSS-S trained with correct labels shows promise in prediction of the bladder cancer stage.

An Overview of Integrated Logistic Support in Medical Material Programs.

DTIC Science & Technology

1980-12-01

OF MEDICAL INTEGRATED LOGISTIC SUPPORT ----------------- 7 B. PROBLEM DEFINITION AND OBJECTIVE ------------ 9 C. GENERAL APPROACH AND METHODOLOGY...SYSTEM ---------------------- 61 C. GENERAL CONCLUSIONS ------------------------- 63 D. RECOMMENDATIONS ----------------------------- 73 E. CONCLUSION...21 Technological advancement has caused major changes in medicine and dentistry in the last several decades. Inten- sive care units, computerized axial

Assessment of eHealth capabilities and utilization in residential care settings.

PubMed

Towne, Samuel D; Lee, Shinduk; Li, Yajuan; Smith, Matthew Lee

2016-12-01

The US National Survey of Residential Care Facilities was used to conduct cross-sectional analyses of residential care facilities (n = 2302). Most residential care facilities lacked computerized capabilities for one or more of these capabilities in 2010. Lacking computerized systems supporting electronic health information exchange with pharmacies was associated with non-chain affiliation (p < .05). Lacking electronic health information exchange with physicians was associated with being a small-sized facility (vs large) (p < .05). Lacking computerized capabilities for discharge/transfer summaries was associated with for-profit status (p < .05) and small-sized facilities (p < .05). Lacking computerized capabilities for medical provider information was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), and for-profit status (p < .05). Lack of electronic health record was associated with non-chain affiliation (p < .05), small- or medium-sized facilities (p < .05), for-profit status (p < .05), and location in urban areas (p < .05). eHealth disparities exist across residential care facilities. As the older adult population continues to grow, resources must be in place to provide an integrated system of care across multiple settings. © The Author(s) 2015.

Psychometrics behind Computerized Adaptive Testing.

PubMed

Chang, Hua-Hua

2015-03-01

The paper provides a survey of 18 years' progress that my colleagues, students (both former and current) and I made in a prominent research area in Psychometrics-Computerized Adaptive Testing (CAT). We start with a historical review of the establishment of a large sample foundation for CAT. It is worth noting that the asymptotic results were derived under the framework of Martingale Theory, a very theoretical perspective of Probability Theory, which may seem unrelated to educational and psychological testing. In addition, we address a number of issues that emerged from large scale implementation and show that how theoretical works can be helpful to solve the problems. Finally, we propose that CAT technology can be very useful to support individualized instruction on a mass scale. We show that even paper and pencil based tests can be made adaptive to support classroom teaching.

An Analysis of the Need for a Whole-Body CT Scanner at US Darnall Army Community Hospital

DTIC Science & Technology

1980-05-01

TASK IWORK UNIT ELEMENT NO. I NO.JC NO. rSSION NO. Ij6T’,WAM ’"Aa1W% A WHOLE BODY CT SCANNER AT DARNALL ARMY COMUNITY HOSPITAL 16PTR3OAL tUTHOR(S)* a...computerized axial tomography or CT. Computerized tomography experiments "were conducted by Godfrey Hounsfield at Central Research Laboratories, EMI, Ltd. in...remained the same, with clinical and nursing unit facilities to support a one division post. Presently, Fort Hood is the home of the III US Army Corps, the

The computerized adaptive diagnostic test for major depressive disorder (CAD-MDD): a screening tool for depression.

PubMed

Gibbons, Robert D; Hooker, Giles; Finkelman, Matthew D; Weiss, David J; Pilkonis, Paul A; Frank, Ellen; Moore, Tara; Kupfer, David J

2013-07-01

To develop a computerized adaptive diagnostic screening tool for depression that decreases patient and clinician burden and increases sensitivity and specificity for clinician-based DSM-IV diagnosis of major depressive disorder (MDD). 656 individuals with and without minor and major depression were recruited from a psychiatric clinic and a community mental health center and through public announcements (controls without depression). The focus of the study was the development of the Computerized Adaptive Diagnostic Test for Major Depressive Disorder (CAD-MDD) diagnostic screening tool based on a decision-theoretical approach (random forests and decision trees). The item bank consisted of 88 depression scale items drawn from 73 depression measures. Sensitivity and specificity for predicting clinician-based Structured Clinical Interview for DSM-IV Axis I Disorders diagnoses of MDD were the primary outcomes. Diagnostic screening accuracy was then compared to that of the Patient Health Questionnaire-9 (PHQ-9). An average of 4 items per participant was required (maximum of 6 items). Overall sensitivity and specificity were 0.95 and 0.87, respectively. For the PHQ-9, sensitivity was 0.70 and specificity was 0.91. High sensitivity and reasonable specificity for a clinician-based DSM-IV diagnosis of depression can be obtained using an average of 4 adaptively administered self-report items in less than 1 minute. Relative to the currently used PHQ-9, the CAD-MDD dramatically increased sensitivity while maintaining similar specificity. As such, the CAD-MDD will identify more true positives (lower false-negative rate) than the PHQ-9 using half the number of items. Inexpensive (relative to clinical assessment), efficient, and accurate screening of depression in the settings of primary care, psychiatric epidemiology, molecular genetics, and global health are all direct applications of the current system. © Copyright 2013 Physicians Postgraduate Press, Inc.

Engaging patients in health care decisions in the emergency department through shared decision-making: a systematic review.

PubMed

Flynn, Darren; Knoedler, Meghan A; Hess, Erik P; Murad, M Hassan; Erwin, Patricia J; Montori, Victor M; Thomson, Richard G

2012-08-01

Many decisions in the emergency department (ED) may benefit from patient involvement, even though this setting has been considered least conducive to shared decision-making (SDM). The objective was to conduct a systematic review to evaluate the approaches, methods, and tools used to engage patients or their surrogates in SDM in the ED. Five electronic databases were searched in conjunction with contacting content experts, reviewing selected bibliographies, and conducting citation searches using the Web of Knowledge database. Two reviewers independently selected eligible studies that addressed patient involvement and engagement in decision-making in the ED setting via the use of decision support interventions (DSIs), defined as decision aids or decision support designed to communicate probabilistic information on the risks and benefits of treatment options to patients as part of an SDM process. Eligible studies described and assessed at least one of the following outcomes: patient knowledge, experiences and perspectives on participating in treatment or management decisions, clinician or patient satisfaction, preference for involvement and/or degree of engagement in decision-making and treatment preferences, and clinical outcomes (e.g., rates of hospital admission/readmission, rates of medical or surgical interventions). Two reviewers extracted data on study characteristics, methodologic quality, and outcomes. The authors also assessed the extent to which SDM interventions adhered to good practice for the presentation of information on outcome probabilities (eight probability items from the International Patient Decision Aid Standards Instrument [IPDASi]) and had comprehensive development processes. Five studies met inclusion criteria and were synthesized using a narrative approach. Each study was of satisfactory methodologic quality and used a DSI to engage patients or their surrogates in decision-making in the ED across four domains: 1) management options for children with small lacerations; 2) options for rehydrating children presenting with vomiting or diarrhea or both; 3) risk of bacteremia (and associated complications), tests, and treatment options for febrile children; and 4) short-term risk of acute coronary syndrome (ACS) in adults with low-risk nontraumatic chest pain. Three studies had poor IPDASi probabilities and development process scores and lacked development informed by theory or involvement of clinicians and patients in development and usability testing. Overall, DSIs were associated with improvements in patients' knowledge and satisfaction with the explanation of their care, preferences for involvement, and engagement in decision-making and demonstrated utility for eliciting patients' preferences and values about management and treatment options. Two computerized DSIs (designed to predict risk of ACS in adults presenting to the ED with chest pain) were shown to reduce health care use without evidence of harm. None of the studies reported lack of feasibility of SDM in the ED. Early investigation of SDM in the ED suggests that patients may benefit from involvement in decision-making and offers no empirical evidence to suggest that SDM is not feasible. Future work is needed to develop and test additional SDM interventions in the ED and to identify contextual barriers and facilitators to implementation in practice. © 2012 by the Society for Academic Emergency Medicine.

Effects of Information Visualization on Older Adults' Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study.

PubMed

Price, Margaux M; Crumley-Branyon, Jessica J; Leidheiser, William R; Pak, Richard

2016-06-01

Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults' decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan.

Looking ahead in systems engineering

NASA Technical Reports Server (NTRS)

Feigenbaum, Donald S.

1966-01-01

Five areas that are discussed in this paper are: (1) the technological characteristics of systems engineering; (2) the analytical techniques that are giving modern systems work its capability and power; (3) the management, economics, and effectiveness dimensions that now frame the modern systems field; (4) systems engineering's future impact upon automation, computerization and managerial decision-making in industry - and upon aerospace and weapons systems in government and the military; and (5) modern systems engineering's partnership with modern quality control and reliability.

Empirical Demonstration of Isoperformance Methodology Preparatory of an Interactive Expert Computerized Decision Aid

DTIC Science & Technology

1988-11-01

after modest amounts of 7 practi.ce. Moreover, the advant.ages of display aiding (e.g., Smith & Kennedy, 1976) or artificial intelligence may be largely...team performance in tanks is largely a function of the intelligence of the tank commmander (Wallace, 1932). In summary, individual differences such as...versus small CRT screen), and training on a videogame task which simulated a remotely piloted vehicle. This study was successful as an isoperformance

Lumber Values from Computerized Simulation of Hardwood Log Sawing.

DTIC Science & Technology

1980-01-01

and the which is sawed into boards by parallel centered detective core area . saw cuts (fig. 2). (M 141650) report. Details of how the computer programs...sawing hardwood logs that do will have a somewhat lower production and each market area . It should also be not have an excessive amount of heart rot...species where sapwood and cant, and decision) tended to yield similar Its disadvantages are high initial cost, heartwood are priced differently, live

Girls on the move program to increase physical activity participation.

PubMed

Robbins, Lorraine B; Gretebeck, Kimberlee A; Kazanis, Anamaria S; Pender, Nola J

2006-01-01

Because physical inactivity poses serious health risks, interventions are urgently needed to reverse the increasingly sedentary lifestyles of adolescent girls. The aim of this study was to determine the feasibility of "Girls on the Move," an individually tailored computerized physical activity (PA) program plus nurse counseling intervention, in increasing PA. A pretest-posttest control group design was used with 77 racially diverse sedentary girls in Grades 6, 7, and 8 from two middle schools. Each of the instructional grades was randomly assigned to either an intervention or control condition. After completing computerized questionnaires, each girl in the control group received a handout listing the PA recommendations. To encourage PA, each girl in the intervention group received computerized, individually tailored feedback messages based on her responses to the questionnaires, individual counseling from the school's pediatric nurse practitioner (PNP), and telephone calls and mailings from a trained research assistant. At 12 weeks, girls in both groups responded to the questionnaires. No differences in self-reported PA emerged between the intervention and control groups at Weeks 1 (baseline) and 12 (postintervention). Repeated measures ANOVA showed a significant interaction between group and time for social support for PA, F(1, 69) = 5.73, p = .019, indicating that the intervention group had significantly greater social support across time than did the control group. From baseline to postintervention, social support increased for the intervention group but decreased for the control group. Reasons for the lack of significant differences between the groups on the PA measures were cited. Important information that could inform subsequent studies that test interventions to increase youth PA was acquired from conducting this study. Future efforts to increase PA participation might include this approach for enhancing social support for PA.

Educational Attainment of Workers, March 1981.

ERIC Educational Resources Information Center

Young, Anne McDougall

1982-01-01

According to March 1981 statistics from the Current Population Survey: (1) college graduates had the highest labor force participation rates, and high school dropouts, the lowest, and (2) computerization of the workplace supported this proportion. (CT)

TRANPLAN and GIS support for agencies in Alabama

DOT National Transportation Integrated Search

2001-08-06

Travel demand models are computerized programs intended to forecast future roadway traffic volumes for a community based on selected socioeconomic variables and travel behavior algorithms. Software to operate these travel demand models is currently a...

Computer Mediated Communication: Social Support for Students with and without Learning Disabilities

ERIC Educational Resources Information Center

Eden, Sigal; Heiman, Tali

2011-01-01

The study examined the relationships between the usage mode of four kinds of computerized mediated communication (CMC) by students with and without learning disabilities (LD) and perceived social and emotional support. Little is known about how undergraduate students with LD interpret and perceive CMC. We investigated the impact of the use of CMC…

Effect of the calcaneal medializing osteotomy on soft tissues supporting the plantar arch: A computational study.

PubMed

Larrainzar-Garijo, R; Cifuentes de la Portilla, C; Gutiérrez-Narvarte, B; Díez-Nicolás, E; Bayod, J

2018-06-12

Medializing calcaneal osteotomy forms part of the treatment options for adult acquired flat foot. The structural correction that is achieved is widely known. However, the effect of this procedure on the soft tissues that support the plantar arch has been little studied, since it is not possible to quantify experimentally the tension and deformation variations generated. Therefore, the objective of this study was to evaluate the effect of medializing calcaneal osteotomy on the soft tissue that supports the plantar arch, using a computational model of the human foot designed with a clinical approach. The proposed finite element model was reconstructed from computerized tomography images of a healthy patient. All the bones of the foot, the plantar fascia, cartilages, plantar ligaments and the calcaneus-navicular ligament were included, respecting their anatomical distribution and biomechanical properties. Simulations were performed emulating the monopodal support phase of the human walk of an adult. The effect on each tissue was evaluated according to clinical and biomechanical criteria. The results show that calcaneal osteotomy reduces the tension normally generated on the evaluated tissues, with the effect on the calcaneus-navicular ligament and the plantar fascia being the most notable. The deformation results obtained are consistent with experimental tests and clinical knowledge. The versatility of this model allows the objective assessment of different conditions and supports decision making for the treatment of adult acquired flat foot in middle and advanced stages. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services.

PubMed

Georgiou, Andrew; Westbrook, Johanna; Braithwaite, Jeffrey

2010-07-13

Information and communication technologies (ICT) are contributing to major changes taking place in pathology and within health services more generally. In this article, we draw on our research experience for over 7 years investigating the implementation and diffusion of computerized provider order entry (CPOE) systems to articulate some of the key informatics challenges confronting pathology laboratories. The implementation of these systems, with their improved information management and decision support structures, provides the potential for enhancing the role that pathology services play in patient care pathways. Beyond eliminating legibility problems, CPOE systems can also contribute to the efficiency and safety of healthcare, reducing the duplication of test orders and diminishing the risk of misidentification of patient samples and orders. However, despite the enthusiasm for CPOE systems, their diffusion across healthcare settings remains variable and is often beset by implementation problems. Information systems like CPOE may have the ability to integrate work, departments and organizations, but unfortunately, health professionals, departments and organizations do not always want to be integrated in ways that information systems allow. A persistent theme that emerges from the research evidence is that one size does not fit all, and system success or otherwise is reliant on the conditions and circumstances in which they are located. These conditions and circumstances are part of what is negotiated in the complex, messy and challenging area of ICT implementation. The solution is not likely to be simple and easy, but current evidence suggests that a combination of concerted efforts, better research designs, more sophisticated theories and hypotheses as well as more skilled, multidisciplinary research teams, tackling this area of study will bring substantial benefits, improving the effectiveness of pathology services, and, as a direct corollary, the quality of patient care.

Effectiveness of a real-time clinical decision support system for computerized physician order entry of plasma orders.

PubMed

Yazer, Mark H; Triulzi, Darrell J; Reddy, Vivek; Waters, Jonathan H

2013-12-01

We investigated the effect of implementing adaptive plasma ordering criteria in the computerized physician order entry (CPOE) system, with alerts that were automatically generated if the recipient's antecedent international normalized ratio (INR) did not meet the institutional criteria. In a regional health care system consisting of 11 hospitals using a common CPOE, data on the number of plasma orders and alerts that were generated were collected over a 4-month period before prescribers were required to select an indication for plasma. When adaptive ordering was implemented prescribers had to choose from prepopulated indications for plasma: INR of 1.6 or greater with bleeding, INR of 1.6 or greater before an invasive procedure, therapeutic exchange, massive transfusion, and other. Regardless of the antecedent INR the alert did not trigger if massive transfusion or plasmapheresis was selected. Information on prescribers and recipients was collected during this 5-month period. In the 4-month period before the adaptive alerts were implemented, 42.9% of the plasma orders generated an alert; in the 5-month period thereafter the alert rate was significantly lower at 27.9% (p < 0.0001). The percentage of heeded alerts increased during the adaptive alert period (24.3% vs. 17.1%, respectively, p = 0.004). A significant percentage (45%) of other plasma orders were for periprocedure or bleeding patients whose antecedent INR was less than 1.6. There were significant differences in prescriber specialties among those who ordered plasma using the other indication compared to all plasma orders. Electronic interventions improve compliance with plasma guidelines but as implemented are not sufficient to completely curtail non-evidence-based ordering. © 2013 American Association of Blood Banks.

The effect of a computerized prescribing and calculating system on hypo- and hyperglycemias and on prescribing time efficiency in neonatal intensive care patients.

PubMed

Maat, Barbara; Rademaker, Carin M A; Oostveen, Marloes I; Krediet, Tannette G; Egberts, Toine C G; Bollen, Casper W

2013-01-01

Prescribing glucose requires complex calculations because glucose is present in parenteral and enteral nutrition and drug vehicles, making it error prone and contributing to the burden of prescribing errors. Evaluation of the impact of a computerized physician order entry (CPOE) system with clinical decision support (CDS) for glucose control in neonatal intensive care patients (NICU) focusing on hypo- and hyperglycemic episodes and prescribing time efficiency. An interrupted time-series design to examine the effect of CPOE on hypo- and hyperglycemias and a crossover simulation study to examine the influence of CPOE on prescribing time efficiency. NICU patients at risk for glucose imbalance hospitalized at the University Medical Center Utrecht during 2001-2007 were selected. The risks of hypo- and hyperglycemias were expressed as incidences per 100 patient days in consecutive 3-month intervals during 3 years before and after CPOE implementation. To assess prescribing time efficiency, time needed to calculate glucose intake with and without CPOE was measured. No significant difference was found between pre- and post-CPOE mean incidences of hypo- and hyperglycemias per 100 hospital days of neonates at risk in every 3-month period (hypoglycemias, 4.0 [95% confidence interval, 3.2-4.8] pre-CPOE and 3.1 [2.7-3.5] post-CPOE, P = .88; hyperglycemias, 6.0 [4.3-7.7] pre-CPOE and 5.0 [3.7-6.3] post-CPOE, P = .75). CPOE led to a significant time reduction of 16% (1.3 [0.3-2.3] minutes) for simple and 60% (8.6 [5.1-12.1] minutes) for complex calculations. CPOE including a special CDS tool preserved accuracy for calculation and control of glucose intake and increased prescribing time efficiency.

Indication-Based Ordering: A New Paradigm for Glycemic Control in Hospitalized Inpatients

PubMed Central

Lee, Joshua; Clay, Brian; Zelazny, Ziband; Maynard, Gregory

2008-01-01

Background Inpatient glycemic control is a constant challenge. Institutional insulin management protocols and structured order sets are commonly advocated but poorly studied. Effective and validated methods to integrate algorithmic protocol guidance into the insulin ordering process are needed. Methods We introduced a basic structured set of computerized insulin orders (Version 1), and later introduced a paper insulin management protocol, to assist users with the order set. Metrics were devised to assess the impact of the protocol on insulin use, glycemic control, and hypoglycemia using pharmacy data and point of care glucose tests. When incremental improvement was seen (as described in the results), Version 2 of the insulin orders was created to further streamline the process. Results The percentage of regimens containing basal insulin improved with Version 1. The percentage of patient days with hypoglycemia improved from 3.68% at baseline to 2.59% with Version 1 plus the paper insulin management protocol, representing a relative risk for hypoglycemic day of 0.70 [confidence interval (CI) 0.62, 0.80]. The relative risk of an uncontrolled (mean glucose over 180 mg/dl) patient stay was reduced to 0.84 (CI 0.77, 0.91) with Version 1 and was reduced further to 0.73 (CI 0.66, 0.81) with the paper protocol. Version 2 used clinician-entered patient parameters to guide protocol-based insulin ordering and simultaneously improved the flexibility and ease of ordering over Version 1. Conclusion Patient parameter and protocol-based clinical decision support, added to computerized provider order entry, has a track record of improving glycemic control indices. This justifies the incorporation of these algorithms into online order management. PMID:19885198

Computer Literacy in the Pharmacy Curriculum

PubMed Central

Anderson, R.J.; Young, W. Wayne

1985-01-01

The current generation of pharmacy students must be prepared to make educated decisions on the selection of hardware and software for both business and professional use. Over the next decade, these graduates will be major decision-makers for computerizing over 38,000 community pharmacies and approximately 80% of all hospital pharmacies. A survey of all U.S. colleges of pharmacy was completed to assess the role of microcomputers in the curriculum. The development of a computer applications course at the University of Nebraska utilizing “hands-on” experience in a microcomputer laboratory equipped with IBM and Apple micros is described. The major objective was to attain a degree of computer literacy among undergraduate professional students, and the course structure and organization are applicable to other health care disciplines.

Implementing an ICT-Based Polypharmacy Management Program in Italy.

PubMed

Arcopinto, M; Cataldi, M; De Luca, V; Orlando, V; Simeone, G; D'Assante, R; Postiglione, A; Guida, A; Trama, U; Illario, M; Ferrara, N; Coscioni, E; Iaccarino, G; Cuccaro, P; D'Onofrio, G; Vigorito, C; Cittadini, A; Menditto, E

2017-01-01

Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses on multimorbidity and polytherapy management are encouraged. Furthermore a multidisciplinary approach integrating different health care professionals (physicians, pharmacists, and nurses) may positively impact on reducing the sense of fear related to discontinue or substitute drugs prescribed by others; the fragmentation of therapy among different specialists; reducing costs; and improving adverse drug reaction detection and reporting. Aiming at achieving the individualized pharmacotherapy, a multidisciplinary approach starting with identification of patients and risk for drug-related problems, followed by medication review overtime and use of inappropriateness criteria, supported by computerized systems has been proposed.

Sex differences in strategy and performance on computerized neuropsychological tests as related to gender identity and age at puberty.

PubMed

Meurling, A W; Tonning-Olsson, I; Levander, S

2000-06-01

Neuropsychological sex differences have since long been under debate. Support for the relation between behavioral differences and biological variables like hormone influence is, however, emerging. Sixteen men and sixteen women, all university students, were tested with computerized neuropsychological tests (APT), the Bem Sexual Role Inventory, and asked about pubertal age. The results were in line with earlier findings of sex differences in neuropsychological tests, men being faster and women more cautious. The assumption that women tend to use left-hemispheric, verbal/serial strategies also in spatial tasks was also partly supported. In women, late onset of puberty was related to better spatial performance, and there were also more intercorrelations between verbal and spatial tests in the female than in the male group, indicating that women use less specific strategies (more g-factor intelligence) in problem solving, or that aptitudes are less compartmentalized in women than in men.

Implementations of the HL7 Context-Aware Knowledge Retrieval (“Infobutton”) Standard: Challenges, Strengths, Limitations, and Uptake

PubMed Central

Del Fiol, Guilherme; Huser, Vojtech; Strasberg, Howard R; Maviglia, Saverio M; Curtis, Clayton; Cimino, James J

2012-01-01

To support clinical decision-making,computerized information retrieval tools known as “infobuttons” deliver contextually-relevant knowledge resources intoclinical information systems.The Health Level Seven International(HL7)Context-Aware Knowledge Retrieval (Infobutton) Standard specifies a standard mechanism to enable infobuttons on a large scale. Objective To examine the experience of organizations in the course of implementing the HL7 Infobutton Standard. Method Cross-sectionalonline survey and in-depth phone interviews. Results A total of 17 organizations participated in the study.Analysis of the in-depth interviews revealed 20 recurrent themes.Implementers underscored the benefits, simplicity, and flexibility of the HL7 Infobutton Standard. Yet, participants voiced the need for easier access to standard specifications and improved guidance to beginners. Implementers predicted that the Infobutton Standard will be widely or at least fairly well adopted in the next five years, but uptake will dependlargely on adoption among electronic health record (EHR) vendors. To accelerate EHR adoption of the Infobutton Standard,implementers recommended HL7-compliant infobutton capabilities to be included in the United States Meaningful Use Certification Criteria EHR systems. Limitations Opinions and predictions should be interpreted with caution, since all the participant organizations have successfully implemented the Standard and overhalf of the organizations were actively engaged in the development of the Standard. Conclusion Overall, implementers reported a very positive experience with the HL7 Infobutton Standard.Despite indications of increasing uptake, measures should be taken to stimulate adoption of the Infobutton Standard among EHR vendors. Widespread adoption of the Infobutton standard has the potential to bring contextually relevant clinical decision support content into the healthcare provider workflow. PMID:22226933

Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

PubMed Central

Alagiakrishnan, Kannayiram; Wilson, Patricia; Sadowski, Cheryl A; Rolfson, Darryl; Ballermann, Mark; Ausford, Allen; Vermeer, Karla; Mohindra, Kunal; Romney, Jacques; Hayward, Robert S

2016-01-01

Background Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in ambulatory care EMRs. PMID:26869776

Social, organizational, and contextual characteristics of clinical decision support systems for intensive insulin therapy: a literature review and case study.

PubMed

Campion, Thomas R; Waitman, Lemuel R; May, Addison K; Ozdas, Asli; Lorenzi, Nancy M; Gadd, Cynthia S

2010-01-01

Evaluations of computerized clinical decision support systems (CDSS) typically focus on clinical performance changes and do not include social, organizational, and contextual characteristics explaining use and effectiveness. Studies of CDSS for intensive insulin therapy (IIT) are no exception, and the literature lacks an understanding of effective computer-based IIT implementation and operation. This paper presents (1) a literature review of computer-based IIT evaluations through the lens of institutional theory, a discipline from sociology and organization studies, to demonstrate the inconsistent reporting of workflow and care process execution and (2) a single-site case study to illustrate how computer-based IIT requires substantial organizational change and creates additional complexity with unintended consequences including error. Computer-based IIT requires organizational commitment and attention to site-specific technology, workflow, and care processes to achieve intensive insulin therapy goals. The complex interaction between clinicians, blood glucose testing devices, and CDSS may contribute to workflow inefficiency and error. Evaluations rarely focus on the perspective of nurses, the primary users of computer-based IIT whose knowledge can potentially lead to process and care improvements. This paper addresses a gap in the literature concerning the social, organizational, and contextual characteristics of CDSS in general and for intensive insulin therapy specifically. Additionally, this paper identifies areas for future research to define optimal computer-based IIT process execution: the frequency and effect of manual data entry error of blood glucose values, the frequency and effect of nurse overrides of CDSS insulin dosing recommendations, and comprehensive ethnographic study of CDSS for IIT. Copyright (c) 2009. Published by Elsevier Ireland Ltd.

What Is the Proportion of Studies Reporting Patient and Practitioner Satisfaction with Software Support Tools Used in the Management of Knee Pain and Is This Related to Sample Size, Effect Size, and Journal Impact Factor?

PubMed

Bright, Philip; Hambly, Karen

2017-12-21

E-health software tools have been deployed in managing knee conditions. Reporting of patient and practitioner satisfaction in studies regarding e-health usage is not widely explored. The objective of this review was to identify studies describing patient and practitioner satisfaction with software use concerning knee pain. A computerized search was undertaken: four electronic databases were searched from January 2007 until January 2017. Key words were decision dashboard, clinical decision, Web-based resource, evidence support, and knee. Full texts were scanned for effect of size reporting and satisfaction scales from participants and practitioners. Binary regression was run; impact factor and sample size were predictors with indicators for satisfaction and effect size reporting as dependent variables. Seventy-seven articles were retrieved; 37 studies were included in final analysis. Ten studies reported patient satisfaction ratings (27.8%): a single study reported both patient and practitioner satisfaction (2.8%). Randomized control trials were the most common design (35%) and knee osteoarthritis the most prevalent condition (38%). Electronic patient-reported outcome measures and Web-based training were the most common interventions. No significant dependency was found within the regression models (p > 0.05). The proportion of reporting of patient satisfaction was low; practitioner satisfaction was poorly represented. There may be implications for the suitability of administering e-health, a medium for capturing further meta-evidence needs to be established and used as best practice for implicated studies in future. This is the first review of its kind to address patient and practitioner satisfaction with knee e-health.

An ontology-based approach to patient follow-up assessment for continuous and personalized chronic disease management.

PubMed

Zhang, Yi-Fan; Gou, Ling; Zhou, Tian-Shu; Lin, De-Nan; Zheng, Jing; Li, Ye; Li, Jing-Song

2017-08-01

Chronic diseases are complex and persistent clinical conditions that require close collaboration among patients and health care providers in the implementation of long-term and integrated care programs. However, current solutions focus partially on intensive interventions at hospitals rather than on continuous and personalized chronic disease management. This study aims to fill this gap by providing computerized clinical decision support during follow-up assessments of chronically ill patients at home. We proposed an ontology-based framework to integrate patient data, medical domain knowledge, and patient assessment criteria for chronic disease patient follow-up assessments. A clinical decision support system was developed to implement this framework for automatic selection and adaptation of standard assessment protocols to suit patient personal conditions. We evaluated our method in the case study of type 2 diabetic patient follow-up assessments. The proposed framework was instantiated using real data from 115,477 follow-up assessment records of 36,162 type 2 diabetic patients. Standard evaluation criteria were automatically selected and adapted to the particularities of each patient. Assessment results were generated as a general typing of patient overall condition and detailed scoring for each criterion, providing important indicators to the case manager about possible inappropriate judgments, in addition to raising patient awareness of their disease control outcomes. Using historical data as the gold standard, our system achieved a rate of accuracy of 99.93% and completeness of 95.00%. This study contributes to improving the accessibility, efficiency and quality of current patient follow-up services. It also provides a generic approach to knowledge sharing and reuse for patient-centered chronic disease management. Copyright © 2017 Elsevier Inc. All rights reserved.

Eliminating Health Care Disparities With Mandatory Clinical Decision Support: The Venous Thromboembolism (VTE) Example.

PubMed

Lau, Brandyn D; Haider, Adil H; Streiff, Michael B; Lehmann, Christoph U; Kraus, Peggy S; Hobson, Deborah B; Kraenzlin, Franca S; Zeidan, Amer M; Pronovost, Peter J; Haut, Elliott R

2015-01-01

All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen. The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services. This was a retrospective cohort study of a quality improvement intervention. The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients. In this study, the proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis was evaluated. Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P=0.025) and medicine (69.5% vs. 61.7%, P=0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P=0.99) and medicine (91.8% vs. 88.0%, P=0.082). Similar findings were noted for sex disparities in the trauma cohort. Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.

Validation of a guideline-based decision support system for the diagnosis of primary headache disorders based on ICHD-3 beta

PubMed Central

2014-01-01

Background China may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem. Methods We developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China. Results We found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache. Conclusions With high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China. PMID:24934331

Clinical Decision Support Improves Initial Dosing and Monitoring of Tobramycin and Amikacin

PubMed Central

Cox, Zachary L.; Nelsen, Cori L.; Waitman, Lemuel R.; McCoy, Jacob A.; Peterson, Josh F.

2010-01-01

Purpose Clinical decision support (CDS) systems could be valuable tools in reducing aminoglycoside prescribing errors. We evaluated the impact of CDS on initial dosing, interval, and pharmacokinetic outcomes of amikacin and tobramycin therapy. Methods A complex CDS advisor to provide guidance on initial dosing and monitoring, using both traditional and extended interval dosing strategies, was integrated into computerized provider order entry (CPOE) and compared to a control group which featured close pharmacy monitoring of all aminoglycoside orders. A random sample of 118 patients from an academic, tertiary care medical center prescribed amikacin and tobramycin prior to advisor implementation was compared to 98 patients admitted following advisor implementation. Primary outcome was an initial dose within 10% of a dose calculated to be adherent to published dose guidelines. Secondary outcomes were a guideline-adherent interval, trough and peak concentrations in goal range, and incidence of nephrotoxicity. Results Of 216 patients studied, 97 were prescribed amikacin and 119 were prescribed tobramycin. The primary outcome of initial dosing consistent with guideline-based care increased from 40% in the pre-advisor arm to 80% in the post-advisor arm (p<0.001), with a number needed to treat of 3 patients to prevent one incorrect dose. Correct initial interval based on renal function also increased from 63% to 87% (p<0.001). The changes in initial dosing and interval resulted in an increase of trough concentrations in the goal range from 59% pre-advisor to 89% post-advisor implementation (p=0.0004). There was no significant difference in peak concentrations in goal range or incidence of nephrotoxicity (25% vs. 17%, p=0.2). Conclusion An advisor for aminoglycoside dosing and monitoring integrated into CPOE significantly improves initial dosing, selection of interval, and trough concentrations at goal compared to unassisted physician dosing. PMID:21411805

Computerized Assessment of Competence-Related Abilities in Living Liver Donors: The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL)

PubMed Central

Freeman, Jason; Emond, Jean; Gillespie, Brenda W.; Appelbaum, Paul S.; Weinrieb, Robert; Hill-Callahan, Peg; Gordon, Elisa J.; Terrault, Norah; Trotter, James; Ashworth, April; Dew, Mary Amanda; Pruett, Timothy

2014-01-01

Background Despite its importance, determination of competence to consent to organ donation varies widely based on local standards. We piloted a new tool to aid transplant centers in donor assessment. Methods We assessed competence-related abilities among potential living liver donors (LDs) in the 9-center A2ALL study. Prospective LDs viewed an educational video, and were queried to assess Understanding, Appreciation, Reasoning, and ability to express a Final Choice using the MacArthur Competence Assessment Tool for Clinical Research, adapted for computerized administration in LDs (“MacLiver”). Videotaped responses were scored by a clinical neuropsychologist (JF). Results Ninety-three LDs were assessed. Mean (standard deviation; domain maximum) scores were: Understanding: 18.1 (2.6; max=22), Appreciation: 5.1 (1.0; max=6), Reasoning: 3.1 (0.8; max=4), and Final Choice: 3.8 (0.5; max=4). Scores did not differ by demographics, relationship to the recipient, eligibility to donate, or eventual donation (p>0.4). Higher education was associated with greater Understanding (p=0.004) and Reasoning (p=0.03). Conclusion Standardized, computerized education with independent ratings of responses may (1) alert the clinical staff to potential donors who may not be competent to donate, and (2) highlight areas needing further assessment and education, leading to better informed decision-making. PMID:23859354

The cancer of bureaucracy: how it will destroy science, medicine, education; and eventually everything else.

PubMed

Charlton, Bruce G

2010-06-01

Everyone living in modernizing 'Western' societies will have noticed the long-term, progressive growth and spread of bureaucracy infiltrating all forms of social organization: nobody loves it, many loathe it, yet it keeps expanding. Such unrelenting growth implies that bureaucracy is parasitic and its growth uncontrollable - in other words it is a cancer that eludes the host immune system. Old-fashioned functional, 'rational' bureaucracy that incorporated individual decision-making is now all-but extinct, rendered obsolete by computerization. But modern bureaucracy evolved from it, the key 'parasitic' mutation being the introduction of committees for major decision-making or decision-ratification. Committees are a fundamentally irrational, incoherent, unpredictable decision-making procedure; which has the twin advantages that it cannot be formalized and replaced by computerization, and that it generates random variation or 'noise' which provides the basis for natural selection processes. Modern bureaucracies have simultaneously grown and spread in a positive feedback cycle; such that interlinking bureaucracies now constitute the major environmental feature of human society which affects organizational survival and reproduction. Individual bureaucracies must become useless parasites which ignore the 'real-world' in order to adapt to rapidly-changing 'bureaucratic reality'. Within science, the major manifestation of bureaucracy is peer review, which - cancer-like - has expanded to obliterate individual authority and autonomy. There has been local elaboration of peer review and metastatic spread of peer review to include all major functions such as admissions, appointments, promotions, grant review, project management, research evaluation, journal and book refereeing and the award of prizes. Peer review eludes the immune system of science since it has now been accepted by other bureaucracies as intrinsically valid, such that any residual individual decision-making (no matter how effective in real-world terms) is regarded as intrinsically unreliable (self-interested and corrupt). Thus the endemic failures of peer review merely trigger demands for ever-more elaborate and widespread peer review. Just as peer review is killing science with its inefficiency and ineffectiveness, so parasitic bureaucracy is an un-containable phenomenon; dangerous to the extent that it cannot be allowed to exist unmolested, but must be utterly extirpated. Or else modernizing societies will themselves be destroyed by sclerosis, resource misallocation, incorrigibly-wrong decisions and the distortions of 'bureaucratic reality'. However, unfortunately, social collapse is the more probable outcome, since parasites can evolve more rapidly than host immune systems.

A DSS for sustainable development and environmental protection of agricultural regions.

PubMed

Manos, Basil D; Papathanasiou, Jason; Bournaris, Thomas; Voudouris, Kostas

2010-05-01

This paper presents a decision support system (DSS) for sustainable development and environmental protection of agricultural regions developed in the framework of the Interreg-Archimed project entitled WaterMap (development and utilization of vulnerability maps for the monitoring and management of groundwater resources in the ARCHIMED areas). Its aim is to optimize the production plan of an agricultural region taking in account the available resources, the environmental parameters, and the vulnerability map of the region. The DSS is based on an optimization multicriteria model. The spatial integration of vulnerability maps in the DSS enables regional authorities to design policies for optimal agricultural development and groundwater protection from the agricultural land uses. The DSS can further be used to simulate different scenarios and policies by the local stakeholders due to changes on different social, economic, and environmental parameters. In this way, they can achieve alternative production plans and agricultural land uses as well as to estimate economic, social, and environmental impacts of different policies. The DSS is computerized and supported by a set of relational databases. The corresponding software has been developed in a Microsoft Windows XP platform, using Microsoft Visual Basic, Microsoft Access, and the LINDO library. For demonstration reasons, the paper includes an application of the DSS in a region of Northern Greece.

Technology for the product and process data base

NASA Technical Reports Server (NTRS)

Barnes, R. D.

1984-01-01

The computerized product and process data base is increasingly recognized to be the cornerstone component of an overall system aimed at the integrated automation of the industrial processes of a given company or enterprise. The technology needed to support these more effective computer integrated design and manufacturing methods, especially the concept of 3-D computer-sensible product definitions rather than engineering drawings, is not fully available and rationalized. Progress is being made, however, in bridging this technology gap with concentration on the modeling of sophisticated information and data structures, high-performance interactive user interfaces and comprehensive tools for managing the resulting computerized product definition and process data base.

Evaluation of Learning Associated with Multiple Exposures to Computerized Dynamic Posturography

NASA Technical Reports Server (NTRS)

Dean, S. Lance; Paloski, William H.; Taylor, Laura C.; Vanya, Robert D.; Feiveson, Alan H.; Wood, Scott J.

2009-01-01

Computerized dynamic posturography has been used to quantitatively assess the time course of functional sensorimotor recovery after exposure to spaceflight or to groundbased analogs such as head-down bed rest. An assessment of balance recovery may be confounded as subjects develop new strategies through repeated exposures to test paradigms. The purpose of this control study was to characterize the learning effects of sensory organization and motor control tests across multiple sessions. METHODS: Twenty-eight healthy subjects were tested over four sessions. To examine the effects of between-session interval, subjects were assigned to one of four groups in which the interval between the 1 st and 2nd sessions was 7 (+/- 1) days, 14 (+/-1) days, 28 (+/-2) days, or 56 (+/-3) days. The interval between remaining sessions was 28 (+/-4) days. Peak-to-peak anterior-posterior sway was measured during standard Sensory Organization Tests (SOTs) using either fixed or unstable sway-referenced support with eyes open, eyes closed, or sway-referenced vision. Sway was also measured during modified SOTs using eyes-closed conditions with either static or dynamic head tilts. Postural recovery to unexpected support surface perturbations (translations or rotations) was measured during Motor Control Tests. The test order was block randomized across subjects. RESULTS: The learning effects varied with test condition. There were no measurable differences with a stable support surface. The more challenging conditions (unstable support surface with and without head tilts) led to greater differences and took more trials to stabilize. The effect of time interval between the first two sessions was negligible across conditions. Evidence suggested that learning carried across similar conditions (such as unstable support SOTs). DISCUSSION: Familiarization session and/or trials are recommended to minimize learning effects when characterizing functional recovery after exposure to altered sensory environments. The number of practice trials required depends on task difficulty and similarity across conditions. Learning statement: This presentation will review the learning effects of computerized d

Usability of clinical decision support system as a facilitator for learning the assistive technology adaptation process.

PubMed

Danial-Saad, Alexandra; Kuflik, Tsvi; Weiss, Patrice L Tamar; Schreuer, Naomi

2016-01-01

The aim of this study was to evaluate the usability of Ontology Supported Computerized Assistive Technology Recommender (OSCAR), a Clinical Decision Support System (CDSS) for the assistive technology adaptation process, its impact on learning the matching process, and to determine the relationship between its usability and learnability. Two groups of expert and novice clinicians (total, n = 26) took part in this study. Each group filled out system usability scale (SUS) to evaluate OSCAR's usability. The novice group completed a learning questionnaire to assess OSCAR's effect on their ability to learn the matching process. Both groups rated OSCAR's usability as "very good", (M [SUS] = 80.7, SD = 11.6, median = 83.7) by the novices, and (M [SUS] = 81.2, SD = 6.8, median = 81.2) by the experts. The Mann-Whitney results indicated that no significant differences were found between the expert and novice groups in terms of OSCAR's usability. A significant positive correlation existed between the usability of OSCAR and the ability to learn the adaptation process (rs = 0.46, p = 0.04). Usability is an important factor in the acceptance of a system. The successful application of user-centered design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically in developing other systems. Implications for Rehabilitation Creating a CDSS with a focus on its usability is an important factor for its acceptance by its users. Successful usability outcomes can impact the learning process of the subject matter in general, and the AT prescription process in particular. The successful application of User-Centered Design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically. The study emphasizes the importance of close collaboration between the developers and the end users.

Tele-assistance for semi-autonomous robots

NASA Technical Reports Server (NTRS)

Rogers, Erika; Murphy, Robin R.

1994-01-01

This paper describes a new approach in semi-autonomous mobile robots. In this approach the robot has sufficient computerized intelligence to function autonomously under a certain set of conditions, while the local system is a cooperative decision making unit that combines human and machine intelligence. Communication is then allowed to take place in a common mode and in a common language. A number of exception-handling scenarios that were constructed as a result of experiments with actual sensor data collected from two mobile robots were presented.

Research Priorities in Environmental Risk Assessment. Workshop on Research Needs in Environmental Toxicology and Chemistry Held in Breckenridge, Colorado on August 16-21, 1987

DTIC Science & Technology

1988-06-30

accordance with SETAC’s goal of providing a forum for communication among professionals involved with the use, protection, and management of the...templated action. Risk assessment provides technical input to risk management , the process of making decisions about the acceptability of risks and the need... management and computerized information-processing capabilities needed for risk assessment is also essential. Aquatic Toxicology In order to quantify and

Large Area Crop Inventory Experiment (LACIE). An early estimate of small grains acreage

NASA Technical Reports Server (NTRS)

Lea, R. N.; Kern, D. M. (Principal Investigator)

1979-01-01

The author has identified the following significant results. A major advantage of this scheme is that it needs minimal human intervention. The entire scheme, with the exception of the choice of dates, can be computerized and the results obtained in minutes. The decision to limit the number of acquisitions processed to four was made to facilitate operation on the particular computer being used. Some earlier runs on another computer system were based on as many as seven biophase-1 acquisitions.

A Review of Computerized Team Performance Measures to Identify Military-Relevant, Low-to-Medium Fidelity Tests of Small Group Effectiveness during Shared Information Processing

DTIC Science & Technology

2012-05-01

Alexandria, Virginia 22314. Orders will be expedited if placed through the librarian or other person designated to request documents from DTIC...an official Department of the Army position, policy, or decision, unless so designated by other official documentation. Citation of trade names in...teamwork and evaluate the effectiveness of team training methods (Baker and Salas, 1997). Additionally, good measures of team performance should aid the

[The Internet and shared decision-making between patients and healthcare providers].

PubMed

Silber, Denise

2009-10-01

Insurance companies like Kaiser Permanente in the United States remunerate physicians for their email correspondence with patients, increasing the efficiency of office visits. A survey by the French National Board of Physicians regarding the computerization of medical practices in April 2009, confirms that both physicians and patients in France are very favorable to the development of these tools. When patients can manage and/or access their medical files and determine which providers can access them, they become a true partner.

Computerized Virtual Reality Simulation in Preclinical Dentistry: Can a Computerized Simulator Replace the Conventional Phantom Heads and Human Instruction?

PubMed

Plessas, Anastasios

2017-10-01

In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are paramount. Phantom heads provide an efficient way to teach preclinical students dental procedures safely while increasing their dexterity skills considerably. Modern computerized phantom head training units incorporate features of virtual reality technology and the ability to offer concurrent augmented feedback. The aims of this review were to examine and evaluate the dental literature for evidence supporting their use and to discuss the role of augmented feedback versus the facilitator's instruction. Adjunctive training in these units seems to enhance student's learning and skill acquisition and reduce the required faculty supervision time. However, the virtual augmented feedback cannot be used as the sole method of feedback, and the facilitator's input is still critical. Well-powered longitudinal randomized trials exploring the impact of these units on student's clinical performance and issues of cost-effectiveness are warranted.

A computerized support system to cooperative training in emergency scenarios management and its application to an oil port domain

DOE Office of Scientific and Technical Information (OSTI.GOV)

Balducelli, C.; Bologna, S.; Di Costanzo, G.

1995-12-31

The paper describes part of the results achieved in the framework of the MUSTER project (Multi-Users System for Training and Evaluating Environmental Emergency Response). The aim of this project is to define the detailed specifications of a computer based system supporting collaborative training for emergency management. A system prototype has been implemented to support the refinement and improvement of the system specifications.

Use of Microcomputers and Personal Computers in Pacing

PubMed Central

Sasmor, L.; Tarjan, P.; Mumford, V.; Smith, E.

1983-01-01

This paper describes the evolution from the early discrete circuit pacemaker of the past to the sophisticated microprocessor based pacemakers of today. The necessary computerized supporting instrumentation is also described. Technological and economical reasons for this evolution are discussed.

45 CFR 307.10 - Functional requirements for computerized support enforcement systems in operation by October 1...

Code of Federal Regulations, 2011 CFR

2011-10-01

... information such as social security numbers, names, dates of birth, home addresses and mailing addresses... enable the Office to monitor State operations and assess program performance through the audit conducted...

Exploration of the Factors That Support Learning: Web-Based Activity and Testing Systems in Community College Algebra

ERIC Educational Resources Information Center

Hauk, Shandy; Matlen, Bryan

2016-01-01

A variety of computerized interactive learning platforms exist. Most include instructional supports in the form of problem sets. Feedback to users ranges from a single word like "Correct!" to offers of hints and partially to fully worked examples. Behind-the-scenes design of such systems varies as well --from static dictionaries of…

Exploration of the Factors That Support Learning: Web-Based Activity and Testing Systems in Community College Algebra [Contributed Report

ERIC Educational Resources Information Center

Hauk, Shandy; Matlen, Bryan; Thomas, Larry

2017-01-01

A variety of computerized interactive learning platforms exist. Most include instructional supports in the form of problem sets. Feedback to users ranges from a single word like "Correct!" to offers of hints and partially- to fully-worked examples. Behind-the-scenes design of systems varies as well--from static dictionaries of problems…

Computerized detection of leukocytes in microscopic leukorrhea images.

PubMed

Zhang, Jing; Zhong, Ya; Wang, Xiangzhou; Ni, Guangming; Du, Xiaohui; Liu, Juanxiu; Liu, Lin; Liu, Yong

2017-09-01

Detection of leukocytes is critical for the routine leukorrhea exam, which is widely used in gynecological examinations. An elevated vaginal leukocyte count in women with bacterial vaginosis is a strong predictor of vaginal or cervical infections. In the routine leukorrhea exam, the counting of leukocytes is primarily performed by manual techniques. However, the viewing and counting of leukocytes from multiple high-power viewing fields on a glass slide under a microscope leads to subjectivity, low efficiency, and low accuracy. To date, many biological cells in stool, blood, and breast cancer have been studied to realize computerized detection; however, the detection of leukocytes in microscopic leukorrhea images has not been studied. Thus, there is an increasing need for computerized detection of leukocytes. There are two key processes in the computerized detection of leukocytes in digital image processing. One is segmentation; the other is intelligent classification. In this paper, we propose a combined ensemble to detect leukocytes in the microscopic leukorrhea image. After image segmentation and selecting likely leukocyte subimages, we obtain the leukocyte candidates. Then, for intelligent classification, we adopt two methods: feature extraction and classification by a support vector machine (SVM); applying a modified convolutional neural network (CNN) to the larger subimages. If different methods classify a candidate in the same category, the process is finished. If not, the outputs of the methods are provided to a classifier to further classify the candidate. After acquiring leukocyte candidates, we attempted three methods to perform classification. The first approach using features and SVM achieved 88% sensitivity, 97% specificity, and 92.5% accuracy. The second method using CNN achieved 95% sensitivity, 84% specificity, and 89.5% accuracy. Then, in the combination approach, we achieved 92% sensitivity, 95% specificity, and 93.5% accuracy. Finally, the images with marked and counted leukocytes were obtained. A novel computerized detection system was developed for automated detection of leukocytes in microscopic images. Different methods resulted in comparable overall qualities by enabling computerized detection of leukocytes. The proposed approach further improved the performance. This preliminary study proves the feasibility of computerized detection of leukocytes in clinical use. © 2017 American Association of Physicists in Medicine.

Automated detection of pulmonary nodules in CT images with support vector machines

NASA Astrophysics Data System (ADS)

Liu, Lu; Liu, Wanyu; Sun, Xiaoming

2008-10-01

Many methods have been proposed to avoid radiologists fail to diagnose small pulmonary nodules. Recently, support vector machines (SVMs) had received an increasing attention for pattern recognition. In this paper, we present a computerized system aimed at pulmonary nodules detection; it identifies the lung field, extracts a set of candidate regions with a high sensitivity ratio and then classifies candidates by the use of SVMs. The Computer Aided Diagnosis (CAD) system presented in this paper supports the diagnosis of pulmonary nodules from Computed Tomography (CT) images as inflammation, tuberculoma, granuloma..sclerosing hemangioma, and malignant tumor. Five texture feature sets were extracted for each lesion, while a genetic algorithm based feature selection method was applied to identify the most robust features. The selected feature set was fed into an ensemble of SVMs classifiers. The achieved classification performance was 100%, 92.75% and 90.23% in the training, validation and testing set, respectively. It is concluded that computerized analysis of medical images in combination with artificial intelligence can be used in clinical practice and may contribute to more efficient diagnosis.

Style-based classification of Chinese ink and wash paintings

NASA Astrophysics Data System (ADS)

Sheng, Jiachuan; Jiang, Jianmin

2013-09-01

Following the fact that a large collection of ink and wash paintings (IWP) is being digitized and made available on the Internet, their automated content description, analysis, and management are attracting attention across research communities. While existing research in relevant areas is primarily focused on image processing approaches, a style-based algorithm is proposed to classify IWPs automatically by their authors. As IWPs do not have colors or even tones, the proposed algorithm applies edge detection to locate the local region and detect painting strokes to enable histogram-based feature extraction and capture of important cues to reflect the styles of different artists. Such features are then applied to drive a number of neural networks in parallel to complete the classification, and an information entropy balanced fusion is proposed to make an integrated decision for the multiple neural network classification results in which the entropy is used as a pointer to combine the global and local features. Evaluations via experiments support that the proposed algorithm achieves good performances, providing excellent potential for computerized analysis and management of IWPs.

Power in telephone-advice nursing.

PubMed

Leppänen, Vesa

2010-03-01

Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.

Kidney disease management in UK primary care: guidelines, incentives and information technology.

PubMed

Klebe, Bernhard; Farmer, Chris; Cooley, Roger; de Lusignan, Simon; Middleton, Rachel; O'Donoghue, Donal; New, John; Stevens, Paul

2007-09-01

The last few years have seen new developments to understand and tackle the significant public health issue posed by chronic kidney disease (CKD). Established renal disease currently consumes 2% of the UK National Health Service budget and predictions are that this figure will increase significantly due to the rising number of people requiring renal replacement therapy fuelled by the ageing population and the diabetes mellitus epidemic. This paper reviews the scale of CKD and discusses the new developments such as staging, referral guidelines and new Department of Health incentives brought about to improve awareness. The importance of Information Technology in assisting the management of renal disease is also outlined. We identify various types of intervention which might be used to do this: feedback in an educational context, the establishment of computerized decision support and enhancement of the patient journey. Many principles may be extended to the management of any chronic disease. While new developments are necessary to improve care, wider implementation is required to be able to see if improved outcomes are achieved.

Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity

PubMed Central

Kleinman, Ken; Melly, Steven J.; Sharifi, Mona; Marshall, Richard; Block, Jason; Cheng, Erika R.; Taveras, Elsie M.

2016-01-01

Objectives. To determine whether proximity to a supermarket modified the effects of an obesity intervention. Methods. We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier. Results. Distance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1-mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by −0.04 units relative to controls. Conclusions. Living closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention. PMID:26794159

Mobile medical computing driven by the complexity of neurologic diagnosis.

PubMed

Segal, Michael M

2006-07-01

Medical computing has been split between palm-sized computers optimized for mobility and desktop computers optimized for capability. This split was due to technology too immature to deliver both mobility and capability in the same computer and the lack of medical software that demanded both mobility and capability. Advances in hardware and software are ushering in an era in which fully capable computers will be available ubiquitously. As a result, medical practice, education and publishing will change. Medical practice will be improved by the use of software that not only assists with diagnosis but can do so at the bedside, where the doctor can act immediately upon suggestions such as useful findings to check. Medical education will shift away from a focus on details of unusual diseases and toward a focus on skills of physical examination and using computerized tools. Medical publishing, in contrast, will shift toward greater detail: it will be increasingly important to quantitate the frequency of findings in diseases and their time course since such information can have a major impact clinically when added to decision support software.

Impact of a transfer center on interhospital referrals and transfers to a tertiary care center.

PubMed

Southard, Patricia A; Hedges, Jerris R; Hunter, John G; Ungerleider, Ross M

2005-07-01

The partnership of faculty physicians and senior clinical hospital administrators in the decision to accept interhospital transfers has not been fully studied. Transfers to academic medical centers on the basis of economics have been of particular concern. To evaluate the impact of joint decision making on transfer acceptance, and to evaluate the basis for decisions to transfer patients to an academic medical center. This was a database study of requested adult interhospital transfers, excluding psychiatric transfers, occurring between January 1, 2003, and December 31, 2003, by using data from a computerized patient-tracking system. Where possible, comparisons with the prior calendar year (i.e., prior to implementation of the administrative review process) were made. Incidence of refusal to accept requested transfers and payer mix of transfer patients were the main outcomes of interest. More than 90% of the adult patients were transferred for conditions that required tertiary care or met Emergency Medical Treatment and Labor Act (EMTALA) requirements. The patient conditions that did not meet tertiary care needs included obstetric patients who did not have prenatal care, patients who had hand and facial trauma, and patients who weighed more than 300 pounds. The payer mix of transfer patients remained stable when using the administrator and physician team to determine acceptance of transfers. During the evaluation period, approximately 91,500 patients statewide lost some level of Medicaid coverage. The value of an administrator and physician team as partners in the interhospital transfer process was demonstrated. Active management of interhospital transfers supports transfer of patients who require tertiary care or who meet EMTALA criteria, thus conserving limited bed capacity and ensuring financial equity, while caring for the uninsured and underinsured patients throughout the state.

Utilizing computerized entertainment education in the development of decision aids for lower literate and naïve computer users.

PubMed

Jibaja-Weiss, Maria L; Volk, Robert J

2007-01-01

Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.

Lost in search: (Mal-)adaptation to probabilistic decision environments in children and adults.

PubMed

Betsch, Tilmann; Lehmann, Anne; Lindow, Stefanie; Lang, Anna; Schoemann, Martin

2016-02-01

Adaptive decision making in probabilistic environments requires individuals to use probabilities as weights in predecisional information searches and/or when making subsequent choices. Within a child-friendly computerized environment (Mousekids), we tracked 205 children's (105 children 5-6 years of age and 100 children 9-10 years of age) and 103 adults' (age range: 21-22 years) search behaviors and decisions under different probability dispersions (.17; .33, .83 vs. .50, .67, .83) and constraint conditions (instructions to limit search: yes vs. no). All age groups limited their depth of search when instructed to do so and when probability dispersion was high (range: .17-.83). Unlike adults, children failed to use probabilities as weights for their searches, which were largely not systematic. When examining choices, however, elementary school children (unlike preschoolers) systematically used probabilities as weights in their decisions. This suggests that an intuitive understanding of probabilities and the capacity to use them as weights during integration is not a sufficient condition for applying simple selective search strategies that place one's focus on weight distributions. PsycINFO Database Record (c) 2016 APA, all rights reserved.

Prototyping context-aware nursing support mobile system.

PubMed

Esashi, Misa; Nakano, Tomohiro; Onose, Nao; Sato, Kikue; Hikita, Tomoko; Hoya, Reiko; Okamoto, Kazuya; Ohboshi, Naoki; Kuroda, Tomohiro

2016-08-01

A context aware nursing support system to push right information to the right person at the right moment is the key to increase clinical safety under a computerized hospital. We prototyped a system which obtains context from positions of nurses and list of expected clinical procedures. A WoZ test showed that the proposed approach has potential to decrease incidents caused by information delivery error.

Computerized nursing process in the Intensive Care Unit: ergonomics and usability.

PubMed

Almeida, Sônia Regina Wagner de; Sasso, Grace Teresinha Marcon Dal; Barra, Daniela Couto Carvalho

2016-01-01

Analyzing the ergonomics and usability criteria of the Computerized Nursing Process based on the International Classification for Nursing Practice in the Intensive Care Unit according to International Organization for Standardization(ISO). A quantitative, quasi-experimental, before-and-after study with a sample of 16 participants performed in an Intensive Care Unit. Data collection was performed through the application of five simulated clinical cases and an evaluation instrument. Data analysis was performed by descriptive and inferential statistics. The organization, content and technical criteria were considered "excellent", and the interface criteria were considered "very good", obtaining means of 4.54, 4.60, 4.64 and 4.39, respectively. The analyzed standards obtained means above 4.0, being considered "very good" by the participants. The Computerized Nursing Processmet ergonomic and usability standards according to the standards set by ISO. This technology supports nurses' clinical decision-making by providing complete and up-to-date content for Nursing practice in the Intensive Care Unit. Analisar os critérios de ergonomia e usabilidade do Processo de Enfermagem Informatizado a partir da Classificação Internacional para as Práticas de Enfermagem, em Unidade de Terapia Intensiva, de acordo com os padrões da InternationalOrganization for Standardization (ISO). Pesquisa quantitativa, quase-experimental do tipo antes e depois, com uma amostra de 16 participantes, realizada em uma Unidade de Terapia Intensiva. Coleta de dados realizada por meio da aplicação de cinco casos clínicos simulados e instrumento de avaliação. A análise dos dados foi realizada pela estatística descritiva e inferencial. Os critérios organização, conteúdo e técnico foram considerados "excelentes", e o critério interface "muito bom", obtendo médias 4,54, 4,60, 4,64 e 4,39, respectivamente. Os padrões analisados obtiveram médias acima de 4,0, sendo considerados "muito bons" pelos participantes. O Processo de Enfermagem Informatizado possui padrões ergonômicos e de usabilidade de acordo com os padrões estabelecidos pela ISO. Esta tecnologia apoia a decisão clínica do enfermeiro fornecendo conteúdo completo e atualizado para a prática de Enfermagem em Unidade de Terapia Intensiva.

A review of hospital characteristics associated with improved performance.

PubMed

Brand, Caroline A; Barker, Anna L; Morello, Renata T; Vitale, Michael R; Evans, Sue M; Scott, Ian A; Stoelwinder, Johannes U; Cameron, Peter A

2012-10-01

The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance. The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are indicated.

Impaired cognition and decision-making in bipolar depression but no 'affective bias' evident.

PubMed

Rubinsztein, J S; Michael, A; Underwood, B R; Tempest, M; Sahakian, B J

2006-05-01

Depression is usually the predominant affective state in bipolar disorder. There are few studies, with discrepant views, examining the extent of cognitive impairment in patients with bipolar depression. To our knowledge, there are no previous studies examining decision-making ability or whether there is an affective attentional bias in bipolar depression. We ascertained 24 depressed bipolar I patients from acute psychiatric hospital wards and out-patient clinics and 26 age- and IQ-matched healthy controls. Using computerized tests we evaluated their performance on 'neutral' (non-emotional) cognitive tasks (i.e. memory, attention and executive function) and on novel tasks of emotional cognition (i.e. the decision-making task and the affective go/no-go task). Accuracy measures were significantly impaired on tests of visual and spatial recognition and attentional set-shifting in bipolar depression compared with age- and IQ-matched controls. The quality of decision-making was also significantly impaired in the patients. A mood-congruent attentional bias for 'sad' targets was not evident on the affective go/no-go task. We found widespread evidence of significant cognitive impairment and impaired quality of decision-making in symptomatically severe depressed bipolar patients. This cognitive impairment may contribute to difficulties with daily living, decision-making and the ability to engage and comply with psychological and drug treatments.

Effects of Information Visualization on Older Adults’ Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study

PubMed Central

Price, Margaux M; Crumley-Branyon, Jessica J; Leidheiser, William R

2016-01-01

Background Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults’ decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. Objective The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Methods Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Results Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Conclusions Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan. PMID:27251110

A Newly Designed Mobile-Based Computerized Cognitive Addiction Therapy App for the Improvement of Cognition Impairments and Risk Decision Making in Methamphetamine Use Disorder: Randomized Controlled Trial.

PubMed

Zhu, Youwei; Jiang, Haifeng; Su, Hang; Zhong, Na; Li, Runji; Li, Xiaotong; Chen, Tianzhen; Tan, Haoye; Du, Jiang; Xu, Ding; Yan, Huan; Xu, Dawen; Zhao, Min

2018-06-20

Cognitive rehabilitation therapy has been found to improve cognitive deficits and impulse control problems in methamphetamine use disorder (MUD). However, there is limited research regarding this therapy's feasibility when using mobile-based health technologies in supporting recovery from MUD in China. The main aim of this study was to test whether 4 weeks of a newly designed computerized cognitive addiction therapy (CCAT) app can improve cognitive impairments, eliminate drug-related attention bias, and attenuate risk decision-making behaviors in participants with MUD. Forty MUD participants were assigned randomly to either the CCAT group (n=20), who received 4 weeks of CCAT plus regular detoxification treatment as usual, or the control group (n=20), who only received the regular detoxification treatment as usual, in drug rehabilitation centers in Shanghai. The CCAT was designed by combine methamphetamine use-related picture stimuli with cognitive training with the aim of improving cognitive function and eliminating drug-related attention bias. The CogState Battery, Delay Discounting Task (DDT), Iowa Gambling Task (IGT), and Balloon Analog Risk Task (BART) were administered face-to-face to all participants before and after CCAT interventions. Forty male patients were recruited. The mean age was 32.70 (SD 5.27) years in the CCAT group and mean 35.05 (SD 8.02) years in the control group. Compared to the control group, CCAT improved working memory in the CCAT group (P=.01). Group×time interactions were observed among DDT, IGT, and BART tasks, with rates of discounting delayed rewards, IGT, and BART scores (P<.001) being reduced among those who received CCAT, whereas no changes were found in the control group. The newly designed CCAT can help to improve cognitive impairment and impulsive control in MUD. Further study is needed to understand the underlying brain mechanisms of the cognitive therapy. ClinicalTrials.gov NCT03318081; https://clinicaltrials.gov/ct2/show/NCT03318081 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT03318081). ©Youwei Zhu, Haifeng Jiang, Hang Su, Na Zhong, Runji Li, Xiaotong Li, Tianzhen Chen, Haoye Tan, Jiang Du, Ding Xu, Huan Yan, Dawen Xu, Min Zhao. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.06.2018.

Consumer and provider responses to a computerized version of the Illness Management and Recovery Program.

PubMed

Wright-Berryman, Jennifer L; Salyers, Michelle P; O'Halloran, James P; Kemp, Aaron S; Mueser, Kim T; Diazoni, Amanda J

2013-12-01

To explore mental health consumer and provider responses to a computerized version of the Illness Management and Recovery (IMR) program. Semistructured interviews were conducted to gather data from 6 providers and 12 consumers who participated in a computerized prototype of the IMR program. An inductive-consensus-based approach was used to analyze the interview responses. Qualitative analysis revealed consumers perceived various personal benefits and ease of use afforded by the new technology platform. Consumers also highly valued provider assistance and offered several suggestions to improve the program. The largest perceived barriers to future implementation were lack of computer skills and access to computers. Similarly, IMR providers commented on its ease and convenience, and the reduction of time intensive material preparation. Providers also expressed that the use of technology creates more options for the consumer to access treatment. The technology was acceptable, easy to use, and well-liked by consumers and providers. Clinician assistance with technology was viewed as helpful to get clients started with the program, as lack of computer skills and access to computers was a concern. Access to materials between sessions appears to be desired; however, given perceived barriers of computer skills and computer access, additional supports may be needed for consumers to achieve full benefits of a computerized version of IMR. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients.

PubMed

Tierney, Mary C; Naglie, Gary; Upshur, Ross; Moineddin, Rahim; Charles, Jocelyn; Jaakkimainen, R Liisa

2014-01-01

We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference standard. All eligible patients aged 65 years and older, seen consecutively over 2 months by 1 family practice of 13 primary care physicians, were invited to participate. Patients with a diagnosis or previous work-up for dementia were excluded. Primary care physicians indicated whether they, the patient, or family had concerns about each patient's cognition. A total of 130 patients with cognitive concerns and a matched sample of 133 without cognitive concerns were enrolled. The CAMCI was individually administered after instructions to work independently. Comments were recorded verbatim. A total of 259 (98.5%) completed the entire CAMCI. Two hundred and forty-one (91.6%) completed it without any questions or after simple acknowledgment of their question. Lack of computer experience was the only patient characteristic that decreased the odds of independent CAMCI completion. These results support the feasibility of using self-administered computerized cognitive tests with older primary care patients, given the increasing reliance on computers by people of all ages. The optimal cut-off score had a sensitivity of 80% and specificity of 74%.

The effect of methylphenidate on decision making in patients with borderline personality disorder and attention-deficit/hyperactivity disorder.

PubMed

Gvirts, Hila Z; Lewis, Yael D; Dvora, Shira; Feffer, Kfir; Nitzan, Uriel; Carmel, Ziv; Levkovitz, Yechiel; Maoz, Hagai

2018-07-01

Impaired decision making in patients with borderline personality disorder (BPD) has been reported in several studies. Although methylphenidate (MPH) is known to ameliorate impaired decision making in patients with attention-deficit/hyperactivity disorder (ADHD), it has not yet been examined in patients with BPD. We therefore assessed the efficacy of a single dose of MPH on cognitive functions and decision making in patients with BPD. Twenty-two patients diagnosed with BPD participated in the study. The study was a randomized, double-blind placebo-controlled, random block order cross-over trial. Patients participated in two sessions and performed the Test of Variables of Attention, a digit-span test, and the computerized Iowa Gambling Task, after they had been administered either the MPH or a placebo. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale-18. Lower scores on the inattention symptoms scale were associated with a greater improvement in decision making following the administration of MPH when compared with improvements in patients with higher ADHD scores [F(1,17)=5.63, P=0.030]. We conclude that MPH may improve decision making in patients with BPD, although this effect is mediated by the level of ADHD symptoms. Further studies are needed to assess whether a prolonged beneficial effect of MPH on decision making in patients with BPD might also be present in 'real life'.

Effect of feedback mode and task difficulty on quality of timing decisions in a zero-sum game.

PubMed

Tikuisis, Peter; Vartanian, Oshin; Mandel, David R

2014-09-01

The objective was to investigate the interaction between the mode of performance outcome feedback and task difficulty on timing decisions (i.e., when to act). Feedback is widely acknowledged to affect task performance. However, the extent to which feedback display mode and its impact on timing decisions is moderated by task difficulty remains largely unknown. Participants repeatedly engaged a zero-sum game involving silent duels with a computerized opponent and were given visual performance feedback after each engagement. They were sequentially tested on three different levels of task difficulty (low, intermediate, and high) in counterbalanced order. Half received relatively simple "inside view" binary outcome feedback, and the other half received complex "outside view" hit rate probability feedback. The key dependent variables were response time (i.e., time taken to make a decision) and survival outcome. When task difficulty was low to moderate, participants were more likely to learn and perform better from hit rate probability feedback than binary outcome feedback. However, better performance with hit rate feedback exacted a higher cognitive cost manifested by higher decision response time. The beneficial effect of hit rate probability feedback on timing decisions is partially moderated by task difficulty. Performance feedback mode should be judiciously chosen in relation to task difficulty for optimal performance in tasks involving timing decisions.

45 CFR 307.5 - Mandatory computerized support enforcement systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... hardware, operational system software, and electronic linkages with the separate components of an... plans to use and how they will interface with the base system; (3) Provide documentation that the... and for operating costs including hardware, operational software and applications software of a...

45 CFR 307.5 - Mandatory computerized support enforcement systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... hardware, operational system software, and electronic linkages with the separate components of an... plans to use and how they will interface with the base system; (3) Provide documentation that the... and for operating costs including hardware, operational software and applications software of a...

45 CFR 307.5 - Mandatory computerized support enforcement systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... hardware, operational system software, and electronic linkages with the separate components of an... plans to use and how they will interface with the base system; (3) Provide documentation that the... and for operating costs including hardware, operational software and applications software of a...