Brandon M. Welch

Lessons learned from the usability assessment of home-based telemedicine systems.

At-home telemedicine visits are quickly becoming an acceptable alternative for in-person patient visits. However, little work has been done to understand the usability of these home-based telemedicine solutions. It is critical for user acceptance and real-world applicability to evaluate available telemedicine solutions within the context-specific needs of the users of this technology. To address this need, this study evaluated the usability of four home-based telemedicine software platforms: Doxy.me, Vidyo, VSee, and Polycom. Using a within-subjects experimental design, twenty participants were asked to complete a telemedicine session involving several tasks using the four platforms. Upon completion of these tasks for each platform, participants completed the IBM computer system usability questionnaire (CSUQ) and the NASA Task Load Index test. Upon completing the tasks on all four platforms, the participants completed a final post-test subjective questionnaire ranking the platforms based on their preference. Of the twenty participants, 19 completed the study. Statistically significant differences among the telemedicine software platforms were found for task completion time, total workload, mental demand, effort, frustration, preference ranking and computer system usability scores. Usability problems with installation and account creation led to high mental demand and task completion time, suggesting the participants preferred a system without such requirements. Majority of the usability issues were identified at the telemedicine initiation phase. The findings from this study can be used by software developers to develop user-friendly telemedicine systems.

Family Health History: The Case for Better Tools

Every medical student remembers the clinical lesson to collect a family health history. In fact, the family history remains one of the most important resources available to help clinicians identify potential health risks and personalize care of their patients. Empowered with information from the family history, clini-cians can guide their patients to take preventive steps and initiate mitigating strategies to reduce disease risk. For example, if a physician knows that a patient has a history of familial hypercholesterolemia, the physician can encourage the patient to make lifestyle changes or, if appropriate, take medication to reduce his or her risk for heart disease. Information from the family history also plays an important role in the interpretation of genetic test results. For example, if a healthy 35-year-old woman with no documented family history of breast cancer receives a BRCA1 test result showing a variant of unknown significance, the clinician might recommend watchful waiting ; however, if the same woman has a known family history that includes a mother with bilateral breast cancer at age 42 years and a maternal aunt with ovarian cancer at 53 years, the clinician can now recommend a substantially different course of action, from active surveillance to consideration of preemptive bilateral mastectomy and salpingo-oophorectomy. Despite the increasing complexity of genomics and genetic testing, the family health history continues to be a simple and powerful way to assess an individual patients risk for disease. Despite its importance in health care and person-alized medicine, the family health history remains un-derutilized in clinical practice constrained by time, accuracy , and physician bias. Physicians, other clinicians, and even trainees often lack time to collect, interpret, and discuss the family history during a busy clinical visit. As a result, family history information is often incompletely collected during a clinical encounter, is gathered from only a minority of patients, and lacks the necessary detail for accurate risk assessment. 1 Even if sufficient time could be created to record a detailed family history, a patients self-reported family history is often suboptimal. The accuracy and consistency of self-reported family history range widely from 30% to 90%, depending on the degree of family relat-edness and the reported disease. 1 Health history of first-degree relatives (eg, parents, siblings, and children) tends to be more accurately reported than that of more distant relatives (eg, aunts, uncles, cousins, grandparents). Also, certain major physical diseases, such as cancer and …

10 years later: Assessing the impact of public health efforts on the collection of family health history

In 2004, a nationwide survey found that the majority (96.3%) of Americans believed their family health history (FHx) was important for their own health; however, only a third (29.8%) of respondents had ever actively collected this information. Over the past decade, government agencies, advocacy groups, professional societies, and healthcare provider organizations have aimed to improve the collection rates and utilization of FHx. This study assesses the current attitudes, knowledge, and practices of Americans regarding their FHx and whether the interventions over the past 10 years have led to any FHx‐related changes. We conducted a nationwide survey of 5,258 respondents using the same measures used in the 2004 survey. Overall, there was little change in Americans knowledge and use of FHx information. While there was a statistically significant increase in respondents who have actively collected their FHx (36.9%), respondents know roughly the same or less about his or her FHx today. Furthermore, only a small fraction (2.6%) had ever collected their FHx using a web‐based FHx tool. Several factors were identified which influence whether an individual actively collects his or her FHx. New FHx tools and approaches may be necessary to promote clinically meaningful improvement in FHx collection among patients.

An Investigation of the Usability Issues of Home-based Video Telemedicine Systems with Geriatric Patients:

Telemedicine is the use of technology to provide and support healthcare when distance separates the clinical service and the patient. This system is rapidly replacing the conventional method of in-person clinical visits. More than seventy percent of the geriatric population is predicted to need long-term healthcare; telemedicine could potentially support their increased healthcare needs. However, for increased user acceptance, it is important to investigate the usability of telemedicine systems. This study aims to investigate the usability issues associated with geriatric patients using home-based video telemedicine systems. Four home-based video telemedicine systems were chosen for this study: (1) Doxy.me, (2) Polycom, (3) Vidyo and (4) VSee. Using a between-subjects experimental design, 20 participants were randomly assigned to one of these four conditions. They were asked to complete a demographic questionnaire, followed by the completion of representative tasks on the telemedicine platform. This is followed by a retrospective think-aloud session at the end of which, the participants completed a NASA-TLX workload survey, an IBM Computer System Usability Questionnaire (IBM-CSUQ), and a post-test subjective questionnaire. Issues faced by the participants include downloading application plug-ins, locating icons and the size of the icons.

Teleconsent: A Novel Approach to Obtain Informed Consent for Research.

Lack of recruitment of qualified research participants continues to be a significant bottleneck in clinical trials, often resulting in costly time extensions, underpowered results, and in some cases early termination. Some of the reasons for suboptimal recruitment include laborious consent processes and access to participants at remote locations. While new electronic consents technologies (eConsent) help overcome challenges related to readability and consent management, they do not adequately address challenges related to remote access. To address this, we have developed an innovative solution called “teleconsent”, which embeds the informed consent process into a telemedicine session. Teleconsent allows a researcher to remotely video conference with a prospective research participant, display and interactively guide participants in real-time through a consent form. When finished, the researcher and participant can electronically sign the consent form and print or download the signed document for archiving. This process can eliminate challenges related to travel and management of personnel at remote sites. Teleconsent has been successfully implemented in several clinical trials. Teleconsent can improve research recruitment by reducing the barriers related to informed consent, while preserving human interaction.

Social determinants of family health history collection

Family health history (FHH) is the most basic form of genomic information. Although public health efforts have been made to promote FHH collection, empirical data on the extent to which community residents in rural areas actively collect FHH is limited. Therefore, we examined rates of FHH collection in a community-based sample of South Carolina residents. We conducted a structured telephone survey in a random sample of black and white South Carolina residents. Respondents were asked if they had ever actively collected FHH from relatives using an item developed by the Centers for Disease Control and Prevention. Overall, 42xa0% of respondents reported that they had actively collected their FHH. Blacks were significantly more likely than whites to have collected their FHH in bivariate analysis, but race did not have a significant association with FHH collection in the multivariate model (ORu2009=u20091.36, 95xa0% CIu2009=u20090.79, 2.35, pu2009=u20090.26). The likelihood of collecting FHH was increased among respondents whose last medical visit occurred in the past year compared to those whose last medical visit was more than 1xa0year ago (ORu2009=u20092.00, 95xa0% CIu2009=u20091.12, 3.56, pu2009=u20090.02). In addition, older respondents had a reduced likelihood of collecting their FHH (ORu2009=u20090.69, 95xa0% CIu2009=u20090.53, 0.90, pu2009=u2009.01). Lastly, women were about twice as likely as men to have collected their FHH (ORu2009=u20091.83, 95xa0% CIu2009=u20091.12, 2.99, pu2009=u20090.02). Greater efforts are needed to increase the collection of FHH information; these efforts may need to target men, the elderly, and individuals who have not had a recent medical visit.

The genomic CDS sandbox

Genomics is a promising tool that is becoming more widely available to improve the care and treatment of individuals. While there is much assertion, genomics will most certainly require the use of clinical decision support (CDS) to be fully realized in the routine clinical setting. The National Human Genome Research Institute (NHGRI) of the National Institutes of Health recently convened an in-person, multi-day meeting on this topic. It was widely recognized that there is a need to promote the innovation and development of resources for genomic CDS such as a CDS sandbox. The purpose of this study was to evaluate a proposed approach for such a genomic CDS sandbox among domain experts and potential users. Survey results indicate a significant interest and desire for a genomic CDS sandbox environment among domain experts. These results will be used to guide the development of a genomic CDS sandbox.

Review and Comparison of Electronic Patient-Facing Family Health History Tools

Family health history (FHx) is one of the most important pieces of information available to help genetic counselors and other clinicians identify risk and prevent disease. Unfortunately, the collection of FHx from patients is often too time consuming to be done during a clinical visit. Fortunately, there are many electronic FHx tools designed to help patients gather and organize their own FHx information prior to a clinic visit. We conducted a review and analysis of electronic FHx tools to better understand what tools are available, to compare and contrast to each other, to highlight features of various tools, and to provide a foundation for future evaluation and comparisons across FHx tools. Through our analysis, we included and abstracted 17 patient-facing electronic FHx tools and explored these tools around four axes: organization information, family history collection and display, clinical data collected, and clinical workflow integration. We found a large number of differences among FHx tools, with no two the same. This paper provides a useful review for health care providers, researchers, and patient advocates interested in understanding the differences among the available patient-facing electronic FHx tools.

Patient preferences for direct-to-consumer telemedicine services: a nationwide survey

BackgroundDirect-to-consumer (DTC) telemedicine providers has the potential to change the traditional patient-physician relationship. Professional medical organizations recommend that telemedicine exist within the medical home. This study aims to understand patients’ preferences and desires for DTC telemedicine.MethodsWe conducted a nationwide survey of 4345 survey respondents demographically balanced to represent the United States adult population. The survey consisted of questions assessing the respondents’ attributes and their willingness and comfortability using telemedicine as well as the importance and desired attributes of a provider providing care via telemedicine.ResultsRelatively few respondents (3.5%) had ever had an online video visit with their care provider. Respondents were more willing to see their own provider via telemedicine than unwilling (52% vs. 25%). Additionally, respondents were less willing to use telemedicine to see a different provider from the same healthcare organization (35%) and were least willing to see a different provider from a different organization (19%). Forty-one percent of respondents felt it was unimportant that their current provider offer telemedicine, and only 15% would consider leaving their current provider to a new provider who offers telemedicine as an option. More than half (56%) of respondents felt it was important to have an established relationship with a provider they’re having a telemedicine visit with. Nearly two-thirds of respondents (60%) felt it was important for a telemedicine provider to have access to their health records.ConclusionsPatients prefer to use telemedicine with their own doctor with whom they have an established relationship.

Assessing the Satisfaction of Citizens Using Teleconsent in Clinical Research.

Researchers tested the functionality, and evaluated the feasibility of a telemedicine software, Doxy.me, to complete informed teleconsent sessions remotely with prospective research participants. Twenty healthy volunteers completed a teleconsent session, and web survey assessing overall experience and satisfaction with the Doxy.me software. There was a statistically significant correlation found between age and mean response for the overall reaction category (r = 0.398, p = 0.091) and the systems capabilities category (r = 0.380, p = 0.099). Results suggested that younger users are more satisfied than older users with using teleconsent as a modality for informed consenting. This information will be used to improve the software design and functionality of the Doxy.me software to make the teleconsent experience as simple and intuitive as possible.