Justine E Pang

Publications of Justine E Pang

• Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PHR.

  Authors: Adam Wright, Eric G Poon, Jonathan Wald, Joshua Feblowitz, Justine E Pang, Jeffrey L Schnipper, Richard W Grant, Tejal K Gandhi, Lynn A Volk, Amy Bloom, Deborah H Williams, Kate Gardner, Marianna Epstein, Lisa Nelson, Alex Businger, Qi Li, David W Bates, Blackford Middleton

  Journal of general internal medicine. 09/2011; 27(1):85-92.

  Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied. ToProvider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied. To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations. We conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system. A total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll. Patients in the intervention arm received health maintenance (HM) reminders via a secure PHR "eJournal," which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management. The primary outcome measure was adherence to guideline-based care recommendations. Intention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women's health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal. Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care.

• Governance for clinical decision support: case studies and recommended practices from leading institutions.

  Authors: Adam Wright, Dean F Sittig, Joan S Ash, David W Bates, Joshua Feblowitz, Greg Fraser, Saverio M Maviglia, Carmit McMullen, W Paul Nichol, Justine E Pang, Jack Starmer, Blackford Middleton

  Journal of the American Medical Informatics Association : JAMIA. 01/2011; 18(2):187-94.

  Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technicalClinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support.

• Complementary methods of system usability evaluation: surveys and observations during software design and development cycles.

  Authors: Jan Horsky, Kerry McColgan, Justine E Pang, Andrea J Melnikas, Jeffrey A Linder, Jeffrey L Schnipper, Blackford Middleton

  Journal of biomedical informatics. 10/2010; 43(5):782-90.

  Poor usability of clinical information systems delays their adoption by clinicians and limits potential improvements to the efficiency and safety of care. Recurring usability evaluations arePoor usability of clinical information systems delays their adoption by clinicians and limits potential improvements to the efficiency and safety of care. Recurring usability evaluations are therefore, integral to the system design process. We compared four methods employed during the development of outpatient clinical documentation software: clinician email response, online survey, observations and interviews. Results suggest that no single method identifies all or most problems. Rather, each approach is optimal for evaluations at a different stage of design and characterizes different usability aspect. Email responses elicited from clinicians and surveys report mostly technical, biomedical, terminology and control problems and are most effective when a working prototype has been completed. Observations of clinical work and interviews inform conceptual and workflow-related problems and are best performed early in the cycle. Appropriate use of these methods consistently during development may significantly improve system usability and contribute to higher adoption rates among clinicians and to improved quality of care.

• Order sets in computerized physician order entry systems: an analysis of seven sites.

  Authors: Adam Wright, Dean F Sittig, James D Carpenter, Michael A Krall, Justine E Pang, Blackford Middleton

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:892-6.

  Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets areMost computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. We analyzed order set utilization at seven diverse sites with CPOE. The number of order sets per site ranged from 81 to 535, and the number of order set uses per discharge ranged from 0.48 to 9.89. We also compared the top ten order sets at each site, and found many commonalities, such as generic and condition-specific admission order sets, surgical sets and clinical pathways. We also found that, at each site, utilization of order sets was skewed, with a small number of order sets comprising the bulk of utilization. These findings may be useful for order sets developers, particularly in settings where resources are constrained and the most important order sets must be developed first.

• Clinical Decision Support Capabilities of Commercially-available Clinical Information Systems.

  Authors: Adam Wright, Dean F Sittig, Joan S Ash, Sapna Sharma, Justine E Pang, Blackford Middleton

  Journal of the American Medical Informatics Association : JAMIA. 07/2009;

  Background The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized providerBackground The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems. METHODS We conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features. RESULTS Six of the nine reviewed systems offered all of the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all of the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all of the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen. This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern. CONCLUSION These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.

• Research Paper: Clinical Decision Support Capabilities of Commercially-available Clinical Information Systems.

  Authors: Adam Wright, Dean F. Sittig, Joan S. Ash, Sapna Sharma, Justine E. Pang, Blackford Middleton

  JAMIA. 01/2009; 16:637-644.