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ABSTRACT: The objectives of this paper are to explore issues and perspectives from four regions of the world where health information systems are contributing to patient empowerment and influencing patient safety.
Members of the IMIA Working Group for Health Information Systems Safety came together to explore global issues at the intersection of health information systems safety, patient empowerment and patient safety. The group carried out a review and synthesis of the empirical and grey literature in four different regions/countries of the world that have differing health information system safety priorities.
Regions/countries from differing parts of the world are developing: (1) high quality, safe information for individuals to use in their health related decision making, (2) patient portals and testing them for their safety, (3) methods for identifying unsafe health information system features and functions, and (4) ways of engaging citizens in identifying unsafe features and functions of health information systems.
Internationally, there has been a rise in the number of health information systems and technologies that are being developed to support patient care. The amount of health information available on the World Wide Web (WWW), and the use of mobile phone software to support consumer health behaviours and self-management of chronic illnesses has also grown. The use of some of these health information systems and technologies has helped citizens to improve their health status (e.g. patient portals, mobile phones). However, the safety of these systems and technologies has come into question. As a result, there is a need to refine these systems and ensure their safety when they are used by patients and their families.
Yearbook of medical informatics 01/2012; 7(1):56-64.
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ABSTRACT: The objective of this paper is to examine the extent, range and scope to which frameworks, models and theories dealing with technology-induced error have arisen in the biomedical and life sciences literature as indexed by Medline®.
To better understand the state of work in the area of technology-induced error involving frameworks, models and theories, the authors conducted a search of Medline® using selected key words identified from seminal articles in this research area. Articles were reviewed and those pertaining to frameworks, models or theories dealing with technology-induced error were further reviewed by two researchers.
All articles from Medline® from its inception to April of 2011 were searched using the above outlined strategy. 239 citations were returned. Each of the abstracts for the 239 citations were reviewed by two researchers. Eleven articles met the criteria based on abstract review. These 11 articles were downloaded for further in-depth review. The majority of the articles obtained describe frameworks and models with reference to theories developed in other literatures outside of healthcare. The papers were grouped into several areas. It was found that articles drew mainly from three literatures: 1) the human factors literature (including human-computer interaction and cognition), 2) the organizational behavior/sociotechnical literature, and 3) the software engineering literature.
A variety of frameworks and models were found in the biomedical and life sciences literatures. These frameworks and models drew upon and extended frameworks, models and theoretical perspectives that have emerged in other literatures. These frameworks and models are informing an emerging line of research in health and biomedical informatics involving technology-induced errors in healthcare.
Methods of Information in Medicine 11/2011; 51(2):95-103. · 1.53 Impact Factor
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ABSTRACT: The purpose of this paper is to argue for an integration of cognitive and socio-technical approaches to assessing the impact of health information systems. Historically, health informatics research has examined the cognitive and socio-technical aspects of health information systems separately. In this paper we argue that evaluations of health information systems should consider aspects related to cognition as well as socio-technical aspects including impact on workflow (i.e. an integrated view). Using examples from the study of technology-induced error in healthcare, we argue for the use of simulations to evaluate the cognitive-socio-technical impacts of health information technology [36]. Implications of clinical simulations and analysis of cognitive-social-technical impacts are discussed within the context of the system development life cycle to improve health information system design, implementation and evaluation.
The Open Medical Informatics Journal 01/2010; 4:181-7.
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ABSTRACT: The objective of this research is to assess the suitability of the Apriori association analysis algorithm for the detection of adverse drug reactions (ADR) in health care data. The Apriori algorithm is used to perform association analysis on the characteristics of patients, the drugs they are taking, their primary diagnosis, co-morbid conditions, and the ADRs or adverse events (AE) they experience. This analysis produces association rules that indicate what combinations of medications and patient characteristics lead to ADRs. A simple data set is used to demonstrate the feasibility and effectiveness of the algorithm.
Studies in health technology and informatics 02/2009; 148:95-101.
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ABSTRACT: Health information systems have the ability to reduce medical errors but they can also introduce new types of errors. In the cognitive and human factors literature there is a recognition that many of the high profile accidents that have occurred in other industries outside of healthcare have had their origins in the complexities of organizational work and how work is structured. The authors propose that in order to have a fully robust framework for diagnosing technology-induced errors one must understand the development and implementation of a technology and the influences of policy using a multi-organizational model. The authors propose that technology-induced errors may have their origins in up to four or more organizational structures that make up complex health care systems in addition to the health care provider: governments, model organizations, software development organizations, and local healthcare organizations. In this paper a framework for considering the origins of technology-induced error in healthcare is presented, along with our experiences to date in the application of the framework.
Studies in health technology and informatics 02/2009; 148:181-7.
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ABSTRACT: This paper describes the analysis of the impact of a medication administration system on clinical workflow. The methodological framework employed was based on in-depth analysis of simulated user interactions with a medication administration system. The approach involved the collection of rich data consisting of audio and video recordings of interactions between 16 subjects (5 nurses and 11 physicians) as they interacted with a medication administration system. Methodological considerations and issues in conducting such studies are discussed. The study indicated that use of the system would have a significant impact on nurse and physician workflow and that this impact could be accurately identified using simulation approaches prior to widespread release of such systems in real clinical environments.
Studies in health technology and informatics 02/2008; 136:567-72.
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A W Kushniruk
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ABSTRACT: Decision making by health care professionals is often complicated by the need to integrate ill-structured, uncertain, and potentially conflicting information from various sources. In this paper cognitive approaches to the study of decision making are presented within the context of a variety of complex health care applications. In recent years it has become increasingly accepted that in order to build information systems that can support complex decision making it will be necessary to more fully understand human decision-making processes. Methodological approaches are described that aim to explicate the decision making and reasoning skills of subjects as they perform activities involving the processing of complex information. The paper begins by presenting the theoretical foundations for cognitive analyses of decision making, including discussion of major approaches to the study of decision making in a range of real-world domains, including medicine. Applications of cognitive approaches are then illustrated, including a description of a study in which subjects were asked to "think aloud" in providing treatment decisions for complex medical cases. The resulting protocols were then analyzed for subjects' use of decision strategies and problems in reasoning. Extension of cognitive approaches to the study of group decision-making processes is also described. Recent approaches are discussed which borrow from advances in the study of human-computer interaction and which utilize video analysis of decision-making activities involving information technologies. Using these approaches it has been found that health care information systems, such as computerized patient record systems, may have inadvertent effects on human decision making. Implications of a cognitive approach to improving our understanding of complex decision making are discussed in the context of developing appropriate computer-based decision support for both individuals and groups.
Journal of Biomedical Informatics 11/2001; 34(5):365-76. · 1.79 Impact Factor
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ABSTRACT: The World Wide Web provides an unprecedented opportunity for widespread access to health-care applications by both patients and providers. The development of new methods for assessing the effectiveness and usability of these systems is becoming a critical issue. This paper describes the distance evaluation (i.e. 'televaluation') of emerging Web-based information technologies. In health informatics evaluation, there is a need for application of new ideas and methods from the fields of cognitive science and usability engineering. A framework is presented for conducting evaluations of health-care information technologies that integrates a number of methods, ranging from deployment of on-line questionnaires (and Web-based forms) to remote video-based usability testing of user interactions with clinical information systems. Examples illustrating application of these techniques are presented for the assessment of a patient clinical information system (PatCIS), as well as an evaluation of use of Web-based clinical guidelines. Issues in designing, prototyping and iteratively refining evaluation components are discussed, along with description of a 'virtual' usability laboratory.
International Journal of Medical Informatics 05/2001; 61(1):45-70. · 2.41 Impact Factor
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ABSTRACT: We sought to study the phenomenon of patients having access to their own medical records in order to determine the impact on them and on their relationship with their health care providers. We created the Patient Clinical Information System (PatCIS) to interface with the clinical data repository at New York Presbyterian Hospital to allow patients to add to and review their medical data. We also provided educational resources and automated advice programs. We provided access to the system to thirteen subjects over a nineteen-month period and reviewed their activities in the system's usage log. We also collected data via questionnaire and telephone interview. We found that patients varied in their use of the system, from once a month or less to one or more times per day. All patients primarily used the system to review laboratory results. Both they and their physicians believed that use of the system enhanced the patients' understanding of their conditions and improved their communication with their physicians. There were no adverse events encountered during the study.
Studies in health technology and informatics 02/2001; 84(Pt 2):1440-4.
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ABSTRACT: The advent of Internet-based information systems has provided unprecedented opportunity for the widespread access to medical information. However, issues related to the evaluation of such systems to ensure their usability, effectiveness and to assess their effect on the provider-patient relationship pose a considerable challenge. This paper describes a framework for the distance evaluation of web-based information technologies. The methods are described in the context of an ongoing evaluation of a system known as PatCIS, designed to be accessed by patients from home for obtaining health information, and for management of chronic diseases. We employ a multi-method approach that involves collection of a rich data set, including Web-based questionnaires, automatic logging of user activity and e-mail communication with users. Our work in evaluation design is influenced from research in the areas of cognitive science and the field of usability engineering which aims to characterize the interaction of users with information technologies.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2000;
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ABSTRACT: This paper describes initial experience with the Web-based Patient Clinical Information System (PatCIS). The system was designed to serve as a framework for the integration of applications that help patients access their electronic medical record, add data to their record, review on-line health information, and apply their own clinical data (automatically) to guideline programs that offer health advice. The architecture supports security functions and records user activities, relieving application developers from concerns about safe information practices and the evaluation process. PatCIS is being used to study the social and cognitive impact of allowing patients to have access to their health records via the Web. To date, PatCIS has grown to include 15 clinical functions and 4 dynamic links to literature (called infobuttons). Eleven patients have been enrolled since April, 1999; five have been active users. Experience shows that the PatCIS architecture supports application integration while providing adequate security and evaluation functions. Initial caution with the patient enrollment process has limited recruitment and, consequently, usage. However, experience thus far suggests that PatCIS has good usability and utility. No adverse events, including undesirable impact on doctor-patient interactions, have been reported. There do not appear to be any technical impediments to scaling up the enrollment to continue to observe patient usage.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2000;
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ABSTRACT: This paper reports on a study that examines physicians' understanding of concepts and decision making in problems pertaining to hypercholesterolemia and coronary heart disease (CHD). The study was carried out in two phases: (1) a simulated clinical interview in which two clinical problems were presented and (2) a session in which subjects responded to a series of questions. The questions were related to the analysis of risk factors, diagnostic criteria (DC) for determining elevated lipid values, and differential diagnosis for lipid disorders. The subjects included 12 family practitioners who were randomly selected from a continuing medical education program at McGill University. The results indicate that all subjects exhibited gaps in their understanding of domain concepts. In particular, most physicians demonstrated a lack of knowledge concerning the primary genetic disorders that contribute to CHD, as well as deficiencies in understanding the secondary causes of hypercholesterolemia. The majority of subjects tended to overestimate the lipid value intervals for determining patients at high risk. Physicians had no difficulty diagnosing the first patient problem of familial hypercholesterolemia, but failed to identify the problem of elevated lipids secondary to hypothyroidism. We observed a dissociation between subjects' conceptual understanding and their application of knowledge in solving patient problems. The implications of this work are discussed in terms of the cognitive dimensions of technologies for supporting learning and evidence-based decision making.
International Journal of Medical Informatics 11/1999; 55(3):159-77. · 2.41 Impact Factor
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ABSTRACT: This paper presents a psychological perspective on key issues related to medical vocabularies. There have been rapid advances in the development of computer technology underlying medical information systems. However, in keeping with technological progress, we must also take into account advances in our understanding of human behaviour and learn from failures in human performance. A central issue examined in this paper is the extent to which we can develop generic vocabularies that are also flexible and adaptable to specific situations. Empirical research indicates that variability in human performance is much greater than what current medical classifications take into account. A related challenge is that of how to best develop vocabularies that meet the needs of users. Based on theoretical perspectives and research emerging from the domain of cognitive psychology, we suggest that an understanding of the cognitive mechanisms underlying the comprehension and application of terminology is required. It is argued that rather than beginning with highly specified terminologies, i.e. the normative approach, we might instead begin by examining the natural context of how health care workers acquire, understand and negotiate knowledge in practice.
Methods of Information in Medicine 12/1998; 37(4-5):460-70. · 1.53 Impact Factor
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ABSTRACT: This paper proposes and defends the small worlds hypothesis, which states that expert physicians organize diagnostic knowledge on the basis of similarities between disease categories, forming 'small worlds' consisting of small subsets of diseases and their distinguishing features. Examining existing data from several previous studies, the authors provide support for the small worlds hypothesis and for a characterization of the process of expert medical diagnostic reasoning as a succession of limited comparisons involving related diagnostic hypotheses. In one study, subjects were presented clinical endocrine cases one statement at a time and were prompted to think aloud after presentation of each statement. A combination of discourse and protocol analysis techniques were used to investigate hypothesis generation and evaluation. In another study, dialogues from doctor-patient interviews were examined. It was found that expert subjects rapidly select relatively small sets of plausible diagnostic hypotheses (small worlds) and focus on the most relevant medical findings that distinguish among the diseases in such small worlds. Results from both studies indicate that expert physicians use efficient strategies for discriminating among these alternative hypotheses in a stepwise process. In contrast, non-experts often generate large numbers of possible diagnostic hypotheses, belonging to widely differing disease categories. The results provide empirical support for the theoretical basis of small worlds. The implications of these results for the study of medical expertise and knowledge engineering are discussed, as well as considerations for the development of decision support systems.
International Journal of Medical Informatics 06/1998; 49(3):255-71. · 2.41 Impact Factor
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ABSTRACT: An important challenge in the development of computer-based health care environments is the design of effective user interfaces. In this paper we consider a number of aspects of interface design related to the study of human-computer interaction from a cognitive perspective. It is argued that user interfaces must be designed with consideration of the information requirements, cognitive capabilities and limitations of the end users. Greater concern for fundamental research in design of user interfaces is also needed to complement short-term goals and approaches to improving user interfaces. Towards these objectives, several emerging trends are beginning to have an important impact in the design of health care interfaces. This includes the recognition of the need for iterative design and evaluation of user interfaces, applying theoretical frameworks and methods from cognitive science. An understanding of distributed as well as individual cognition will also become critical in the development of effective user interfaces as access to health care systems becomes increasingly widespread.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/1998;
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ABSTRACT: 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.
Proceedings: a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium 02/1997;
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ABSTRACT: Medical informatics has experienced dramatic growth, both as an applied and as a research discipline in recent years. In this paper, we argue that there is a need to expand the research base to characterize the cognitive dimension of informatics. Theories and methods from cognitive science can provide an effective counterpart to traditional medical informatics in addressing issues of usability of the systems, the processing of information, and the training of physicians. In the first part of the paper, we address the problems inherent in applying basic theories to practice and suggest some potential solutions. The second section deals with epistemological issues that are fundamental to cognitive science research and medical informatics. We then discuss two areas of application of cognitive scientific theories and methods to medical informatics: cognitive evaluation of human computer interface and intelligent medical decision support systems. The paper addresses the progress that has been made thus far and discusses how future cognitive research can facilitate further growth in the development of these applications.
Medinfo. MEDINFO. 02/1995; 8 Pt 2:1278-82.
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ABSTRACT: This paper describes a methodology, based on cognitive research, for assessing the usability of medical computing systems. The issue of developing appropriate evaluation tools, both for use in the design process and for analysis of end products, is beginning to be recognized as being of great importance. In this paper, the use of video recording for collecting empirical data on system usability is detailed. The techniques described allow for the collection of an integrated data set consisting of the transcripts of physicians as they "think aloud" in interacting with a medical system, along with video records of user-computer interaction. The use of coding methodologies and a computer-based annotation system for the analysis of video data are described. Our preliminary experience indicates that this methodology offers a powerful way for assessing physicians' informational needs. Implications for the development and evaluation of medical information systems are discussed.
Medinfo. MEDINFO. 02/1995; 8 Pt 2:1566-9.
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ABSTRACT: This paper describes cognitive methods for analyzing medical decision making and evaluating medical information systems. The overall approach focuses on understanding the processes involved in the decision making and reasoning of health care workers, both with and without the use of information technologies. The issue of developing appropriate evaluation tools, for use in the design and analysis of medical information systems is considered to be of great importance. However, conventional methods are limited in their ability to identify and characterize the effects of information technology on the cognitive processes involved in decision making and reasoning. In this paper a range of methods are described involving video recording for collecting data on the use of information systems. The techniques described allow for the collection of an integrated data set consisting of transcripts of health care workers as they 'think aloud' in interacting with a medical system, along with complete video records of user-computer interaction. In addition, the methods can be extended to allow for the collection of process data from video recording of systems in actual clinical and emergency situations. The use of a variety of approaches, borrowing from research in cognitive science, is discussed. The development and application of these evaluation methods within the Canadian Centres of Excellence network HEALNet is subsequently described. Finally, implications for the development and evaluation of medical information systems are considered.
International Journal of Medical Informatics 51(2-3):83-90. · 2.41 Impact Factor
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ABSTRACT: Numerous research and development projects have been aimed at implementing computerized patient record (CPR) systems. Yet little emphasis has been placed on physicians' ability to learn and use these systems or on their effects on physicians' reasoning. This article describes an innovative approach to assessing these aspects of a CPR system. The method involves observing physicians' use of a CPR under various clinical conditions and analyzing the CPR system with a technique called the cognitive walkthrough. We will show how learning to use a CPR system can change a physician's performance, with accompanying effects on information gathering and reasoning.
M.D. computing: computers in medical practice 13(5):406-15.
