Yalini SenathirajahState University of New York Downstate Medical Center | SUNY · Program in Medical Informatics
Yalini Senathirajah
PhD in Biomedical Informatics
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Publications
Publications (49)
Hospitals faced extraordinary challenges during the pandemic. Some of these were directly related to patient care-expanding capacities, adjusting services, and using new knowledge to save lives in a dynamically changing situation. Other challenges were regulatory. The COVID-19 pandemic significantly disrupted routine hospital infection control prac...
Introduction: Public health agencies’ ability to monitor outbreaks requires government mandated reporting from healthcare institutions, with consequences for noncompliance. This study aims to characterize the burden on acute care hospitals from government reporting requirements during COVID-19 pandemic.
Method: A retrospective study over a 14-mont...
Introduction: Management of outbreaks rely on hospitals’ health information technology (IT) to electronically share data to public health systems. Studies show that half of non-federal hospitals reported a lack of capacity to exchange information with public health agencies, placing a variable burden on institutions to meet the government mandated...
The impact of Covid-19 on hospitals was profound, with many lower-resourced hospitals' information technology resources inadequate to efficiently meet the new needs. We interviewed 52 personnel at all levels in two New York City hospitals to understand their issues in emergency response. The large differences in IT resources show the need for a sch...
COVID-19 remains an important focus of study in the field of public health informatics. COVID-19 designated hospitals have played an important role in the management of patients affected by the disease. In this paper we describe our modelling of the needs and sources of information for infectious disease practitioners and hospital administrators us...
We interviewed six clinicians to learn about their lived experience using electronic health records (EHR, Allscripts users) using a semi-structured interview guide in an academic medical center in New York City from October to November 2016. Each participant interview lasted approximately one to two hours. We applied a clustering algorithm to the i...
Objectives: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patien...
BACKGROUND
Navigational complexity can present formidable challenges for electronic health record (EHR) users. The fragmented design of conventional EHRs can contribute to increased cognitive load for clinician users and poor fit-to-task. First, the ‘keyhole effect’ describes the phenomenon in which due to the large volume of information and limite...
BACKGROUND
The complexity of healthcare data and workflows presents challenges to the study of usability in electronic health records (EHR). Display fragmentation refers to the distribution of relevant data across different screens, requiring complex navigation for the user’s workflow. Task and data source fragmentation also contributes to cognitiv...
Background
The complexity of health care data and workflow presents challenges to the study of usability in electronic health records (EHRs). Display fragmentation refers to the distribution of relevant data across different screens or otherwise far apart, requiring complex navigation for the user’s workflow. Task and information fragmentation also...
BACKGROUND
Participation in clinical trials among people of color remains low, compared with whites. This protocol describes the development of Act NOW! (Advancing People of Color in Clinical Trials NOW!), a culturally tailored website designed to influence clinical trial decision making among people of color.
OBJECTIVE
This cluster randomized stu...
Background:
Participation in clinical trials among people of color remains low, compared with white subjects. This protocol describes the development of "Advancing People of Color in Clinical Trials Now!" (ACT Now!), a culturally tailored website designed to influence clinical trial decision making among people of color.
Objective:
This cluster...
Eye-tracking has long been used to assess usability for the public web. Recently, it is used to assess user behavior with electronic health records (EHRs). We conducted a scoping review of studies involving eye-tracking for usability of EHRs to determine the current state. Three main themes emerged: studies of usual use of systems, development of n...
Introduction
Sleep apnea is characterized by repeated breathing pauses during sleep. Black/African Americans are at greater risk for sleep apnea than other racial/ethnic groups. The current study utilized a comprehensive approach with multiple key stakeholders to tailor health messages to black/African American individuals about sleep apnea.
Metho...
Introduction
Blacks are at higher risk of developing obstructive sleep apnea (OSA), relative to other racial/ethnic groups. Yet, they are less likely to seek evaluation and treatment than their counterparts. In an NHLBI-funded study to promote awareness of OSA among blacks, we designed and evaluated the effect of a tailored, web-based educational i...
Blacks are at greater risk for lower sleep quality and higher risk for obstructive sleep apnea (OSA) than other racial groups. In this study, we summarize the development of a tailored website including visuals, key messages, and video narratives, to promote awareness about sleep apnea among community-dwelling blacks. We utilized mixed methods, inc...
Objective
Inefficient navigation in electronic health records has been shown to increase users’ cognitive load, which may increase potential for errors, reduce efficiency, and increase fatigue. However, navigation has received insufficient recognition and attention in the electronic health record (EHR) literature as an independent construct and con...
Electronic health records have often been criticized for poor interaction design. One major problem is the 'display fragmentation problem' i.e. the fact that conventional EHRs require the user to view many screens and retain information in memory or external tools rather than being able to view all relevant information together, increasing cognitiv...
Persistent problems with healthcare IT that is unusable and unsafe have been reported worldwide. In this paper we present our vision for deploying usability engineering in healthcare in a more substantive way in order to improve the current situation. The argument will be made that stronger and more substantial efforts need to be made to bring mult...
The usability and safety of health information systems have become major issues in the design and implementation of useful healthcare IT. In this paper we describe a multi-phased multi-method approach to integrating usability engineering methods into system testing to ensure both usability and safety of healthcare IT upon widespread deployment. The...
In this paper, the authors outline a vision for the future of mobile usability, workflow and safety testing. The authors argue for the use of glasses that can audio and video record usability, workflow and safety data. Here, citizens, patients and health professionals would become collectors of study data as they use mobile devices and software to...
Summary
Objectives: The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. Methods: The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associa...
Background/purpose:
Adolescents from urban, socioeconomically disadvantaged communities of color encounter high rates of adverse childhood experiences. To address the resulting multidimensional problems, we developed an innovative approach, Experiential Participatory and Interactive Knowledge Elicitation (EPIKE), using remote experiential needs el...
Background:
Challenges in the design of electronic health records (EHRs) include designing usable systems that must meet the complex, rapidly changing, and high-stakes information needs of clinicians. The ability to move and assemble elements together on the same page has significant human-computer interaction (HCI) and efficiency advantages, and...
Delivering safe patient centered care remains an important yet elusive goal across healthcare systems worldwide. The complexity of healthcare delivery and the unique contexts where it is delivered necessitates patient safety solutions that go beyond individual perspectives. This paper articulates the current state of patient safety research and HIT...
As the deployment of health information technology progresses, issues of usability and safety, including the possibility of technology-induced errors have come to the fore. Increased complexity of care delivery models and emergent conditions such as the Ebola scare in the US point to the difficulty of design that allows for human cognitive limits w...
User-composable approaches provide clinicians with the control to design and assemble information elements on screen via drag/drop. They hold considerable promise for enhancing the electronic-health-records (EHRs) user experience. We previously described this novel approach to EHR design and our illustrative system, MedWISE. The purpose of this pap...
Creating electronic health records that support the uniquely complex and varied needs of healthcare presents formidable challenges. To address some of these challenges we created a new model for healthcare information systems, embodied in MedWISE(3), a widget-based highly configurable electronic health record (EHR) platform. Founded on the idea tha...
Clinicians need historical information that does not change over time, as well as other information from the notes of others to inform their documentation - to save time, they cut and paste since that is a feature in many conventional EHRs. Copy and paste is a solution to clinicians' needs that has associated downsides including errors. As part of...
In previous work we have described the creation and user testing of a drag/drop user-composable electronic health record, MedWISE. Any new design poses new potential problems; here we discuss the accuracy, potential for new types of errors, and user reactions to the approach, including their perceptions of ease of use and usefulness. Our results co...
Among the expected benefits of electronic health records (EHRs) is increased reporting of public health information, such as immunization status. State and local immunization registries aid control of vaccine-preventable diseases and help offset fragmentation in healthcare, but reporting is often slow and incomplete. The Primary Care Information Pr...
In this paper, we describe a new method for the study of clinical information system (CIS) logfiles joined with information in the clinical data warehouse. This method uses heatmap representations and clustering techniques to examine clinicians' viewing patterns of laboratory test results. The context of our application of these techniques is to in...
We have proposed that widget-based systems, which allow the user to select, arrange, modify, share, and create clinical and other health information, can have several advantages over conventional systems[1, 2] including better fit with user domain knowledge, integration of clinical and external information, better collaboration and communication, a...
Keywords Clinician information needs, widget-based in-terface, clinical information system interface, web2.0 Summary Background: In this paper, we describe a new method for the study of clinical information system (CIS) logfiles joined with information in the clinical data warehouse. This method uses heatmap representations and clustering technique...
Healthcare information systems frequently do not truly meet clinician needs, due to the complexity, variability, and rapid change in medical contexts. Recently the internet world has been transformed by approaches commonly termed 'Web 2.0'. This paper proposes a Web 2.0 model for a healthcare adaptive architecture. The vision includes creating modu...
We summarize findings of one case from initial in-lab usability and cognitive tests of 13 clinicians using MedWISE, a widget-based electronic health record (EHR) interface, to familiarize themselves with real patient cases and verbalize their assessment and plan. Multiple methods were used to examine patterns of use, time taken, use of new function...
Health information systems have extremely complex, variable and changeable information requirements and vendor-controlled development has resulted in systems that frequently neither reflect clinical users' domain knowledge nor meet their needs. 'Web 2.0' approaches have transformed the commercial/public internet world. Consequently we created MedWI...
In our previous work, we described an electronic health record (EHR) architecture based on Web 2.0 principles. With this architecture, users in healthcare and public health can select, configure, share and control the information and interfaces they use by means of simple techniques such as "drag-and-drop" without the intervention of programmers. W...
Significant advances in the treatment of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) place a premium on early detection and linkage to care. Recognizing the need to efficiently yet comprehensively provide HIV counseling, we assessed the feasibility of using audio computer-assisted self-inventory (A-CASI) in a commun...
Information technology is playing an increasing role in managing the challenges of global public health issues. The emergence of Web 2.0 technologies provides a tremendous avenue to foster connections among diverse health professionals engaged in the development and implementation of informatics-based solutions for global health. Our website, www.g...
ACASI (Audio Computer-Assisted Self-Interview) has been demonstrated to be more effective than face to face interviews in eliciting truthful responses on sensitive subjects such as substance abuse and sexual behavior (1, 2). Thus, ACASI has the potential to streamline and standardize HIV counseling and testing by providing a comprehensive overview...
We describe the creation and evaluation of an online system which allows users to configure information delivery as filtered feeds, extracts from medical text information, and other resources in user-configurable layouts. The need for such a resource, expected advantages and evaluation with respect to speed of access, effectiveness of alerting, use...
This review describes recent experimental and focus group research on graphics as a method of communication about quantitative health risks. Some of the studies discussed in this review assessed effect of graphs on quantitative reasoning, others assessed effects on behavior or behavioral intentions, and still others assessed viewers' likes and disl...
Risks can be explained to patients in narratives, numbers, or graphs. All these methods depend upon description. However, decisions from description differ systematically from decisions about risks that are experienced through activities such as drawing cards from a deck. We have developed a dynamic graphic interface that provides a virtual experie...
Health information systems have extremely complex, variable and changeable information requirements. Current development practices have sometimes resulted in systems that frequently neither reflect clinical users' domain knowledge nor meet their needs. 'Web 2.0' participatory approaches have transformed the commercial/public internet world. Consequ...