Bengisu Tulu

Worcester Polytechnic Institute | WPI · School of Business

italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Goal: To accurately detect infections in Diabetic Foot Ulcers (DFUs) using photographs taken at the Point of Care (POC). Achieving high performance is critical for preventing complications and amputations, as well as minimizing unnecessary emergency de...

Eye tracking has become the gold standard in measuring human attention and information-processing behavior. As such, eye tracking in mixed-methods user experience (UX) research serves as an invaluable tool to learn about user needs and to create actionable insights for improving product and service design during the development cycle. Here, we disc...

Personas are fictional but realistic representations of user groups of a product or service that focus on their goals, needs, behavior, and other characteristics that may impact the design of the product. Using personas in the early phases of the design process can help identify product features, and demonstrate how these features address user need...

BACKGROUND Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in...

Background Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in...

italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Goal: Augment a small, imbalanced, wound dataset by using semi-supervised learning with a secondary dataset. Then utilize the augmented wound dataset for deep learning-based wound assessment. Methods: The clinically-validated Photographic Wound Asses...

Background: Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk...

Technology-Assisted Systems Change for Suicide Prevention (TASCS) is a study to develop a technology-facilitated version of the ED-SAFE intervention, to address suicidal ideation and behavior in ED patients. We applied a user persona development process to explore the needs and characteristics of patients presenting to the ED with suicide risk, cre...

Research studies investigating the acceptance of information systems mostly focused on systems designed for long-term use without considering systems designed for one-time or short-term use. However, systems designed for short-term use are part of the health information technology portfolio. We propose a theoretical model inspired by the D&M IS suc...

Affordance theory posits that users' engagement with technology can form affordances that facilitate goal-oriented actions. Studies investigating affordances of fitness apps employed diverse definitions of affordances. Relying on the affordance theory, we developed principles to help identify fitness apps' affordances: (1) affordances require users...

While fitness apps show promise to improve people's health and well-being, studies have indicated a high dropout rate among their users. This study uses the expectation confirmation model (ECM) to examine post-adoption factors affecting continued use or dropout among users of fitness apps, with a specific focus on the impact of users' personality t...

User engagement (UE), a priority for product and service design in various contexts, has been a topic of discussion in information technology literature for the past two decades. A critical challenge has been to increase, evaluate, measure, and understand factors that affect engagement. We conducted an umbrella review of published literature review...

More than 2.3 million people are held in incarceration in the US with a high recidivism rate, high substance use disorders (SUD) percentage, and 3 times higher HIV infection than normal Americans. Unfortunately, this group receives inadequate preparation opportunities and assistance during their reentry into their communities. Smartphones and other...

A major goal of decision support tools (decision aids [DAs]) is to help people make informed decisions; hence, they often provide users with important information. This is particularly true for medical shared decision-making tools (decision aids [DAs]) for surrogate-decision-makers. These tools are designed to help individuals make crucial life-or-...

Periodic assessment is necessary to evaluate the healing prog-ress of chronic wounds. Image analyses using computer vision algorithms have recently emerged as a viable alternative that has been demonstrated by prior work. However, the performance of such image analysis methods degrade on captured in adverse illumination, which is common in many ind...

Wellness mHealth apps are applications that guide and motivate users to form healthy habits, such as walking, to improve their health and well-being. However, such improvements require long-term engagement, which is found to be rare as many users discontinue these activities after a short period. This creates an opportunity for research to investig...

Goal: Chronic wounds affect 6.5 million Americans. Wound assessment via algorithmic analysis of smartphone images has emerged as a viable option for remote assessment. Methods: We comprehensively score wounds based on the clinically-validated Photographic Wound Assessment Tool (PWAT), which comprehensively assesses clinically important ranges of...

Research indicates that suicidal behavior, which is one of the leading causes of death in the United States, can be effectively prevented through technology. The popularity and prevalence of mobile technologies provides many opportunities for suicide prevention through smartphone interventions. For example, smartphone applications facilitate a ubiq...

Research indicates that suicidal behavior, which is one of the leading causes of death in the United States, can be effectively prevented through technology. The popularity and prevalence of mobile technologies provides many opportunities for suicide prevention through smartphone interventions. For example, smartphone applications facilitate a ubiq...

Background Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. Objective This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. Methods We conducted a randomized pilo...

Previous research on the effectiveness of wellness mHealth apps focused on the design and features of such apps and paid insufficient attention to how the whole relationship between the apps and users impact use. Using affordance theory, we investigated what wellness mHealth apps afford to users and why these affordances are not actualized by all u...

Chronic wounds affect 6.5 million Americans, are complex conditions to manage and cost $28–$32 billion annually. Although digital solutions exist for non-expert clinicians to accurately segment tissues, analyze affected tissues or efficiently document their wound assessment results, there exists a lack of decision support for non-expert clinicians...

Abstract: Lower extremity chronic wounds affect 4.5 million Americans annually. Due to inadequate access to wound experts in underserved areas, many patients receive non-uniform, non-standard wound care, resulting in increased costs and lower quality of life. We explored machine learning classifiers to generate actionable wound care decisions about...

BACKGROUND Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. OBJECTIVE This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. METHODS We conducted a randomized pilo...

Unlabelled: This research employs design ethnography to study the design process of a design science research (DSR) project conducted over eight years. The DSR project focuses on chronic wounds and how Information Technology (IT) might support the management of those wounds. Since this is a new and complex problem not previously addressed by IT, i...

Smartphone wound image analysis has recently emerged as a viable way to assess healing progress and provide actionable feedback to patients and caregivers between hospital appointments. Segmentation is a key image analysis step, after which attributes of the wound segment (e.g. wound area and tissue composition) can be analyzed. The Associated Hier...

A key requirement for the successful adoption of clinical decision support systems (CDSS) is their ability to provide users with reliable explanations for any given recommendation which can be challenging for some tasks such as wound management decisions. Despite the abundance of decision guidelines, wound non-expert (novice hereafter) clinicians w...

Rare diseases, affecting approximately 30 million Americans, are often poorly understood by clinicians due to lack of familiarity with the disease and proper research. Patients with rare diseases are often unfavorably treated, especially those with extremely painful chronic orofacial rare disorders. In the absence of structured knowledge, such pati...

Healthcare organizations and stakeholders are profoundly challenged in transiting a telemedicine project into a sustainable telehealth service line. While project management best practices have added values across multiple domains, a knowledge gap exists on informed execution of telehealth best practices. Project definition, or initiation, sets the...

Diabetes mellitus is a serious chronic disease that affects millions of people worldwide. In patients with diabetes, ulcers occur frequently and heal slowly. Grading and staging of diabetic ulcers is the first step of effective treatment and wound depth and granulation tissue amount are two important indicators of wound healing progress. However, w...

Osteoarthritis is a common chronic disease that can be better treated with the help of self-management interventions. Mobile health (mHealth) technologies are becoming a popular means to deliver such interventions. We reviewed the current state of research and development of mHealth technologies for osteoarthritis self-management to determine gaps...

Making a life-or-death decision about the best course of action for a loved one is emotionally taxing and cognitively complex. Decision aids can help reduced the burden by providing relevant important information that facilitates decision making while allowing the decision maker to process the information at their own pace. Given the intense cognit...

As traditional visual-examination-based methods provide neither reliable nor consistent wound assessment, several computer-based approaches for quantitative wound image analysis have been proposed in recent years. However, these methods require either some level of human interaction for proper image processing or that images be captured under contr...

Background: Mobile health (mHealth) applications that support individuals in various health related issues such as weight management, stress management, smoking cessation, and self-management of chronic conditions have been on the rise. Despite their potential benefits, the use of these tools has been limited since most users drop them, just after...

This book constitutes the thoroughly refereed proceedings of the 14th International Conference on Designing for a Digital and Globalized World, DESRIST 2019, held Worcester, MA, USA, June 2019. The 20 revised full papers included in the volume were carefully reviewed and selected from 54 submissions. They are organized in the following topical sec...

BACKGROUND Mobile health (mHealth) applications that support individuals in various health related issues such as weight management, stress management, smoking cessation, and self-management of chronic conditions have been on the rise. Despite their potential benefits, the use of these tools has been limited since most users drop them, just after a...

Background: Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss...

Healthcare organizations and stakeholders are profoundly challenged in transiting a telemedicine project into a sustainable telehealth service line. While project management best practices have added values across multiple domains, a knowledge gap exists on informed execution of telehealth best practices. Project definition, or initiation, sets the...

Introduction: Mobile health (mHealth) technology can be used to integrate into medical decision making for patients with advanced knee arthritis. We explored patient preferences on content and design of a mobile health app to facilitate daily symptom capture and summary feedback reporting, in order to inform treatment decisions, including use of to...

Introduction: Mobile health (mHealth) technology can be used to integrate into medical decisionmaking for patients with advanced knee arthritis. We explored patient preferences on content and design of a mobile health app to facilitate daily symptom capture and summary feedback reporting, in order to inform treatment decisions, including use of to...

Objective: We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. Methods: We coded 1000 threads of SM communication sampled from 40 primary care teams. Results: Most threads (94.5%) were initiate...

Obesity is one of the top health issues around the globe. Rapid adoption of smartphones presents an opportunity for delivering technology-based interventions that are designed to tackle behaviors that contribute to weight gain. Research shows that the vast majority of weight loss apps in the market place do not go beyond deploying tracking based st...

The standard chronic wound assessment method based on visual examination is potentially inaccurate and also represents a significant clinical workload. Hence, computer-based systems providing quantitative wound assessment may be valuable for accurately monitoring wound healing status, with the wound area the best suited for automated analysis. Here...

This study investigates project initiation for telemedicine, a technology innovation in healthcare organizations that manifests both intra- and inter-organizational collaboration. Moving from a telemedicine project to a sustainable telemedicine service line can be a challenge for many organizations (LeRouge, Tulu, & Forducey, 2010). Project definit...

This paper presents a study of online patient portal utilization through the analysis of system logs. We analyze click data generated between August 2009 and July 2011 by 1886 users of an online patient portal. We investigate variations in utilization for Login and the top five system features (Appointment Review, Lab Tests, Medical Advice Request,...

Over the past decade, the healthcare industry has adopted games as a powerful tool for promoting personal health and wellness. Utilizing principles of gamification to engage patients with positive reinforcement, these games promote stronger attention to clinical and self-care guidelines, and offer exciting possibilities for primary prevention. Tar...

For individuals with type 2 diabetes, foot ulcers represent a significant health issue. The aim of this study is to design and evaluate a wound assessment system to help wound clinics assess patients with foot ulcers in a way that complements their current visual examination and manual measurements of their foot ulcers. The physical components of t...

The potential of patient portals to improve patient engagement and health outcomes has been discussed for over a decade. The slow growth in patient portal adoption rates among patients and providers in the United States, despite external incentives, indicates this is a complex issue. In this paper, we examine evidence of patient portal use with a f...

Purpose: The needs of complex patients with chronic conditions can be unpredictable and can strain resources. Exploring how tasks vary for different patients, particularly those with complex needs, can yield insights about designing better processes in healthcare. The purpose of this paper is to explore the tasks required to manage complex patient...

While exergames are becoming mainstream with increasing sales, fewer exergame units are still sold annually than non-exergame video games. For instance, in 2013 there was only one exergame (Just Dance 4) in the list of top 10 games sold. In this chapter, the authors attempt to determine (1) if a gap exists in appeal between exergames and non-exerga...

The demand for healthcare services continues to grow as our population ages and is ridden with illness. However, the supply of affordable and accessible care cannot possibly keep up with this growth in demand for services. The rapidly advancing field of robotics is seen as a source of new personal health management service opportunities for the agi...

Secure messaging (SM) allows patients to communicate with their providers for non-urgent health issues. Like other health information technologies, the design and implementation of SM should account for workflow to avoid suboptimal outcomes. SM may present unique workflow challenges because patients add a layer of complexity, as they are also direc...

Many people are bored with their current physical activities and would like individualized recommendations of alternatives. Even users who have favorite exercises may seek recommendations if their context (e.g., bad weather, location) changes. Prior work has focused on tracking user activities and goal-setting, but not on recommendations. In this p...

In this paper we endeavor to develop a theory to explain the dynamics of an Electronic Health Record (EHR) implementation. We base our theory on a well-established system dynamics model of improvement evolution—the model by Repenning and Sterman (RS)—with modifications that incorporate aspects of the more detailed Affordance Actualization (AA) th...

Diabetic foot ulcers represent a significant health issue, for both patients’ quality of life and healthcare system costs. Currently, wound care is mainly based on visual assessment of wound size, which suffers from lack of accuracy and consistency. Hence, a more quantitative and computer-based method is needed. Supervised machine learning based ob...

This study investigates project initiation for telemedicine, a technology innovation in healthcare organizations that manifests both intra- and inter-organizational collaboration. Moving from a telemedicine project to a sustainable telemedicine service line can be a challenge for many organizations (LeRouge, Tulu, & Forducey, 2010). Project definit...

While organizations implement information technology (IT) to effect change, current theories of IT-associated organizational change pay insufficient attention to the change goals, the role of IT in organizational change, and the multilevel nature of change processes. We take a fresh look at IT-associated organizational change using grounded theory...

Chronic disease management is a serious problem, both for patients with such a disease and for the healthcare delivery system. Technology, in particular smartphones, could be a key part of the solution because it is available when needed to help patients with daily monitoring and care of their chronic conditions. We are designing and developing a s...

Running is a popular physical activity that improves physical and mental well being. Unfortunately, up-to-date information about runners' performance and psychological well being is limited. Many questions remain unanswered, such as how far and how fast runners typically run, their preferred running times and frequencies, how long new runners persi...

Over one billion smartphones have now been shipped worldwide. These mobile devices feature multi-core CPUs and GPUs, megapixel cameras and an array of sensors. Smartphone sensors can now be processed to diagnose a wide variety of medical conditions including cough detection, irregular heartbeat detection, and lung function analysis. The ability to...

Over one billion smartphones have now been shipped worldwide. These mobile devices feature multi-core CPUs and GPUs, megapixel cameras and an array of sensors. Smartphone sensors can now be processed to diagnose a wide variety of medical conditions including cough detection, irregular heartbeat detection, and lung function analysis. The ability to...

Clinical pathways are evidence-based recommendations for treating a diagnosis. Although implementations of clinical pathways have reduced medical errors, lowered costs, and improved patient outcomes, monitoring whether a patient is following the intended pathway is problematic. Implementing a variance reporting program is impeded by the lack of a r...

Diabetic foot ulcers represent a significant health issue, and daily wound care is necessary for wound healing to occur. The goal of this research is to create a smart phone based wound image analysis system for people with diabetes to track the healing process of chronic ulcers and wounds. This system has been implemented on an Android smart phone...

This study investigates telemedicine as a collaborative technology innovation in healthcare organizations. We use the collaborative ontology [17] inspiring this mini-track to describe our instantiation of telemedicine, namely telestroke services. We discuss how the telestroke project initiation process is managed and how this process impacts the ov...

Case studies are useful for studying complex work systems when direct data collection about rare and challenging situations is not practical using in situ field methodologies, such as observations or archival studies, such as review of medical records. In healthcare organizations, careful examination of challenging situations can guide appropriate...

This paper evaluates existing taxonomies aimed at characterizing the interaction between robots and their users and modifies them for health care applications. The modifications are based on existing robot technologies and user acceptance of robotics. Characterization of the user, or in this case the patient, is a primary focus of the paper, as the...

Personal Health Records (PHRs) and patient portals are becoming more popular as health systems continue to emphasize patient centered health care delivery. Our study investigates the factors that influence adoption and utilization of PHR systems using a mixed method approach. Our data include PHR system utilization data collected about registered u...

Generation Y (Gen Y) forms a sizeable workforce in today’s economy. Because this generation is tech savvy, it is likely that virtual worlds would serve as an ideal medium for recruiting such employees. Our research, however, showed that the participants in our study, who were part of the Generation Y population, had very little prior knowledge abou...