Seth M. Powsner

Novel user interface design for medication reconciliation: an evaluation of Twinlist.

OBJECTIVE The primary objective was to evaluate time, number of interface actions, and accuracy on medication reconciliation tasks using a novel user interface (Twinlist, which lays out the medications in five columns based on similarity and uses animation to introduce the grouping - www.cs.umd.edu/hcil/sharp/twinlist) compared to a Control interface (where medications are presented side by side in two columns). A secondary objective was to assess participant agreement with statements regarding clarity and utility and to elicit comparisons. MATERIAL AND METHODS A 1 × 2 within-subjects experimental design was used with interface (Twinlist or Control) as an independent variable; time, number of clicks, scrolls, and errors were used as dependent variables. Participants were practicing medical providers with experience performing medication reconciliation but no experience with Twinlist. They reconciled two cases in each interface (in a counterbalanced order), then provided feedback on the design of the interface. RESULTS Twenty medical providers participated in the study for a total of 80 trials. The trials using Twinlist were statistically significantly faster (18%), with fewer clicks (40%) and scrolls (60%). Serious errors were noted 12 and 31 times in Twinlist and Control trials, respectively. DISCUSSION Trials using Twinlist were faster and more accurate. Subjectively, participants rated Twinlist more favorably than Control. They valued the novel layout of the drugs, but indicated that the included animation would be valuable for novices, but not necessarily for advanced users. Additional feedback from participants provides guidance for further development and clinical implementations. CONCLUSIONS Cognitive support of medication reconciliation through interface design can significantly improve performance and safety.

Teaching Consultation Psychiatry Through Computerized Case Simulation

The PsyConsult Adventure Simulation program presents a case simulation of consultation in a general hospital. Exploring this computerized case helps trainees prepare for the complexities of consultation that they will face on the hospital wards. The simulation provides a distinctive approach, modeling the process of an actual consultation and allowing trainees to explore on their own initiative. It presents general techniques of psychiatric consultation as well as specifics of diagnosis and treatment. The program demonstrates the feasibility of using case simulation with a personal computer system as a supplement to bedside teaching of consultation psychiatry.

Exploring New Frontiers: Recovery-Oriented Peer Support Programming in a Psychiatric ED

Enhancing the diversity of roles for paid peer-support specialists is a topic of increasing interest throughout the country. Peer specialist positions promote a renewed sense of hope for the possibility of recovery, while also offering unique and valuable competitive employment options for mental health consumers. As we strive toward local and national recovery-oriented systems of care, we must continue to explore practical program applications and their associated benefits and challenges. The authors describe the development and implementation of a recovery-oriented peer support team within the psychiatric service of an emergency department (psychiatric ED) located at an academic medical center in a northeastern state.

Lessons Learned from a Pilot Implementation of the UMLS Information Sources Map

OBJECTIVE To explore the software design issues involved in implementing an operational information sources map (ISM) knowledge base (KB) and system of navigational tools that can help medical users access network-based information sources relevant to a biomedical question. DESIGN A pilot biomedical ISM KB and associated client-server software (ISM/Explorer) have been developed to help students, clinicians, researchers, and staff access network-based information sources, as part of the National Library of Medicines (NLM) multi-institutional Unified Medical Language System (UMLS) project. The system allows the user to specify and constrain a search for a biomedical question of interest. The system then returns a list of sources matching the search. At this point the user may request 1) further information about a source, 2) that the list of sources be regrouped by different criteria to allow the user to get a better overall appreciation of the set of retrieved sources as a whole, or 3) automatic connection to a source. RESULTS The pilot system operates in client-server mode and currently contains coded information for 121 sources. It is in routine use from approximately 40 workstations at the Yale School of Medicine. The lessons that have been learned are that: 1) it is important to make access to different versions of a source as seamless as possible, 2) achieving seamless, cross-platform access to heterogeneous sources is difficult, 3) significant differences exist between coding the subject content of an electronic information resource versus that of an article or a book, 4) customizing the ISM to multiple institutions entails significant complexities, and 5) there are many design trade-offs between specifying searches and viewing sets of retrieved sources that must be taken into consideration. CONCLUSION An ISM KB and navigational tools have been constructed. In the process, much has been learned about the complexities of development and evaluation in this new environment, which are different from those for Gopher, wide area information servers (WAIS), World-Wide-Web (WWW), and MOSAIC resources.

Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department

Background The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions. Objective Our objective is to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients’ specific concerns. Methods User-centered design with practice-based and participatory decision aid development was used to design, develop, and evaluate patient-centered decision support regarding CT use in minor head injury in the emergency department. User experience and user interface (UX/UI) development involved successive iterations with incremental refinement in 4 phases: (1) initial prototype development, (2) usability assessment, (3) field testing, and (4) beta testing. This qualitative approach involved input from patients, emergency care clinicians, health services researchers, designers, and clinical informaticists at every stage. Results The Concussion or Brain Bleed app is the product of 16 successive iterative revisions in accordance with UX/UI industry design standards. This useful and usable final product integrates clinical decision support with a patient decision aid. It promotes shared use by emergency clinicians and patients at the point of care within the emergency department context. This tablet computer app facilitates evidence-based conversations regarding CT in minor head injury. It is adaptable to individual clinician practice styles. The resultant tool includes a patient injury evaluator based on the Canadian CT Head Rule and provides patient specific risks using pictographs with natural frequencies and cues for discussion about patient concerns. Conclusions This tool was designed to align evidence-based practices about CT in minor head injury patients. It establishes trust, empowers active participation, and addresses patient concerns and uncertainty about their condition. We hypothesize that, when implemented, the Concussion or Brain Bleed app will support—not hinder—the clinician-patient relationship, safely reduce CT use, and improve the patient experience of care.

Semantic relationships and medical bibliographic retrieval: a preliminary assessment

This paper describes a project exploring whether semantic relationships between bibliographic terms may effectively partition the clinical literature. To address this question, a set of semantic relationships was identified between pairs of bibliographic terms taken from four categories: (1) diseases, (2) treatments, (3) tests, and (4) patient characteristics. The MEDLINE system of the National Library of Medicine was used to generate lists of abstracts relating to pairs of clinical terms. Each list of abstracts was examined to identify the semantic relationships, if any, which applied to the two terms in each paper. The study suggests that semantic relationships may play a potentially valuable role in assisting computer-based medical bibliographic retrieval. The degree to which relationships partition the literature is strongly dependent on the underlying semantics of the particular bibliographic terms involved.

Implementing a computer system for psychiatric training : the electric resident.

The Electric Resident System is an experimental arrangement of software for the personal computer. It is designed to help residents in the educational cycle of patient interview, literature review, write-up, attending review, and patient treatment. The authors emphasize the system’s immediate utility and ease of operation, using a graphical interface. Within a year of operation this system was in daily use on a consultation service with minimal formal instruction. Usage data show a positive correlation between the number of patients seen per month and the number of computer-assisted MEDLINE literature searches performed. Residents’ comments indicate not only acceptance of the system but increased interest in computer applications in medical care. The Electric Resident System is meant to be the first step toward a computer-aided residency.

Capturing the semantic relationship between clinical terms with current MeSH bibliographic coding

This paper compares bibliographic retrieval using current MeSH (Medical Subject Headings) to bibliographic retrieval using explicitly coded semantic relationships between index terms. In a previous study, ten lists of abstracts, each list containing 20-40 papers discussing a specific pair of terms, were analyzed to identify the specific relationship(s) between those terms discussed in each paper. In the present study, we analyze how well current MeSH coding using topical subheadings and check tags, can selectively retrieve those papers discussing each semantic relationship.

Immediate and delayed learning

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Psychiatric Consultation in the Emergency Setting

Consultants may be called to an emergency department for a variety of reasons. Most requests are like those from a general hospital ward. However, two issues are notable: a broader definition of psychiatric emergencies and greater concern about patient rights. These issues stem from an emergency department’s lack of a buffer from its surrounding community: patients come as they are, whether pushed, or just so inclined, whether in crisis, or just avoiding clinic appointment delays. There is little or no time for patients and emergency department staff to come to any understanding. In this absence of a traditional physician–patient relationship, consultants may be forced to change their usual approach.