Soudabeh Khodambashi

Lean Analysis of an Intra-operating Management Process-identifying Opportunities for Improvement in Health Information Systems☆

Abstract The application of information systems in clinical processes needs to be evaluated to maximize alignment between the new applied information systems and the process. This study focuses on the evaluation of a health information system (HIS) adoption to intra-operating management of the anesthesia process in heart operation. We conducted a case study and applied the Lean method to the intra-operating management process. We applied the Value Stream Map and the A3 method as the common tools of the Lean method to evaluate the anesthesia process. Using the value stream mapping and A3 problem solving tool assist us to map the process and remove the “non-value” added steps and actions in the process, enhance data integration and process integration. This paper and the related results can guide clinicians and practitioners in the application of the Lean method to HIS to reduce waste in the clinical workflows.

The development and feasibility of a personal health-optimization system for people with bipolar disorder

BackgroundPeople with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies.MethodsBased on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed.ResultsSeventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient’s preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines.ConclusionWe have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient’s health on a shared platform. User tests indicate that the feasibility of the system is acceptable.

Usability Evaluation of Published Clinical Guidelines on the Web: A Case Study

Publishing clinical guidelines (GLs) on the web improves their accessibility. Although such publication is common, usability evaluation of GLs and their web presentation has been neglected. In this study we have carried out such an evaluation. Four of the most commonly used GL websites in Norway were selected for evaluation. In addition, we included UpToDate, which is widely used under a national licence in Norway. A total of 14 volunteer GL users participated in our case study. A pretest survey, scenario-based task completion, system usability scale (SUS) questionnaire, observation, and semi-structured interview were methods we employed. A step-by-step thematic synthesis method was used on the interview transcripts to identify themes. Analysis of the SUS results show that except for UpToDate, there was no correlation between user familiarity with the studied website and higher SUS score. Users were mostly concerned about the amount of text and scrolling, font size, no more than one navigation bar and no redirection to other websites. Keeping the same format and structure for presentation in all web pages and presenting numerical information in tabular format were the other suggestions for improvement. The results of this paper can be used by GL publishers to improve their websites usability.

Comparing User Experiences on the Search-based and Content-based Recommendation Ranking on Stroke Clinical Guidelines- A Case Study☆

Abstract Researchers have proposed methods and tools in order to translate the guidelines to a computer interpretable format in order to generate patient-specific recommendations and highlight the most relevant recommendation to clinicians, known as a clinical decision support system (CDSS). Although there are many evaluation aspects that have been considered to assess the impact of CDSS, however investigating the users’ feedback with respect to recommendation ranking has been neglected. Hence, in this study we compared the search-based and content-based recommendation rankings for the guideline users. We first developed two prototypes and then conducted a case study. A survey, usability test and questionnaire were administered in order to achieve more accurate results. Our results showed that users were more successful in finding the right recommendation for treatment using a content-based prototype. 75% of participants preferred the content-based prototype. Furthermore, we concluded that the less experienced user preferred the content-based prototype. Although usability test scores in the searched-based prototype were higher compared to content-based module, our interview results revealed the opposite outcome regarding user satisfaction. Our results indicated that users are mostly concerned with credibility of recommendations; hence providing additional information with the graded recommendation would increase their confidence in choosing recommendations. In addition, participants stated that understanding the recommendation ranking increased their confidence when choosing recommendations. Regarding the search-based prototype, users mostly searched for an acronym rather than the full length term. Participants suggested a combination of search-based and content-based approaches when finding the guidelines and relevant treatments.

Reality Versus user's Perception in Finding Answer to Clinical Questions in Published National Guidelines on the Web: An Empirical Study

Abstract Advances in information systems have enabled guideline developer organisations to disseminate the guidelines on the web with accompanied search functionality. The aim of searching functions is enabling guideline users to find the most relevant guideline for their clinical questions. Hence evaluating the user experiences in finding answers to their clinical questions in the published guidelines on the web with search functionality is important in order to understand the factors that affect users’ satisfaction and performance. Thus, in this study we studied how users interact with clinical guidelines during the decision making process, and examined how the structure of the clinical guidelines accompanied with search function impacted finding the right answer. We conducted an empirical study with a total of 19 medical students, divided into two groups. The first group accessed the list of all available national stroke guidelines while the second group accessed the most relevant guidelines. First a scenario was given to the participants. Second, the participants were asked to follow a set of tasks and then fill out a questionnaire. Analysis of the answers revealed that the more relevant the presented guideline was to the patient scenario, the more the user was successful in finding the right answer, the easier it was for the user to find the answer and the more satisfied the user was with the guideline structure. Although the objective measure of finding the answer in the second group was higher, their perception of finding the right answer was lower than the first group. Hence, a more detailed study is required to investigate what factors impacted the participants perception score. Our findings highlight that conducting a usability test on the national guidelines user interface and investigating the best position of the search box for capturing the users’ attention are necessary.

Alignment of an intra-operating management process to a health information system: a Lean analysis approach

Abstract Health information systems (HISs) are widely used in the healthcare domain for different purposes. To assess the integration between the newly applied HIS and the clinical process, an evaluation of both is necessary. This study focuses on the evaluation of a HIS adoption in the field of intra-operating management in the anesthesia process in heart operation. The HIS which is known as “IntelliVue Clinical Information Portfolio” (ICIP) was designed to assist anesthetists in the pre-operating and intra-operating management process. According to the anesthetist’s feedback, some incidents were identified: The patient’s vital signs recorded in the system, during the intra-operating process, have not been recorded from the beginning of the operation. To investigate the root of the problems and delays, we conducted a case study and applied the Lean method to the intra-operating management process. This paper represents the case study and the application of the Lean method in intra-operating management process after ICIP implementation. We applied the value stream map and the A3 method as the common tools of the Lean method to evaluate how the ICIP and clinical process fit are integrated. Application of Lean concept increased process integration which resulted in higher “value-added” activities to the patients. In addition, analysis of the process by Lean method identified the areas for improvement which reduced the “non-value-added” activities. Based on the findings, in order to increase integration and alignment of implemented HISs to clinical workflow, we recommend evaluating the implemented HISs and clinical process in unison.

Female Leadership in Software Projects—A Preliminary Result on Leadership Style and Project Context Factors

Women have been shown to be effective leaders in many team-based situations. However, it is also well-recognized that women are underrepresented in engineering and technology areas, which leads to wasted efforts and a lack of diversity in professional organizations. Although studies about gender and leadership are rich, research focusing on engineering-specific activities, are scarce. To react on this gap, we explored the experience of female leaders of software development projects and possible context factors that influence leadership effectiveness. The study was conducted as a longitudinal multiple case study. Data was collected from survey, interviews, observation and project reports. In this work, we reported some preliminary findings related to leadership style, team perception on leadership and team-task context factors. We found a strong correlation between perceived team leadership and task management. We also observed a potential association between human-oriented leading approach in low customer involvement scenarios and task-oriented leading approach in high customer involvement situations.

Usability Methods and Evaluation Criteria for Published Clinical Guidelines on the Web: A Systematic Literature Review

The usability evaluation of published clinical guidelines (GL) on the web is an important analytical tool. This evaluation helps to determine how presentation affects GL use; it identifies the user’s needs and assesses whether the user’s perceived success rate in finding an answer is reliable or not. Such information is of great value since an inaccurate perceived success rate could lead to potentially critical consequences. This paper explores literature focusing on the usability evaluation of GL web-sites. We examine the evaluation goal, criteria and methods that researchers considered in GL website evaluation. We found that although many researchers have concentrated on the evaluation of clinical decision support systems and their usability; a problem subsists. Evaluation of the usability of published GLs on the Web and the understanding of the users’ interaction is in its infancy. Building GL websites is not substantially different than building a highly functional website with high usability in general. However, there are particular factors such as clinicians’ time constraints and information overload that need to be considered in the design of a GL website and its evaluation.

Reviewing Clinical Guideline Development Tools: Features and Characteristics

BackgroundTo improve consistency and streamline development and publication of clinical guidelines (GL), there is a need for appropriate software support. We have found few specific tools for the actual authoring and maintaining of GLs, and correspondingly few analyses or reviews of GL development tool functionality. In order to assist GL developers in selecting and evaluating tools, this study tries to address the perceived gap by pursuing four goals: 1) identifying available tools, 2) reviewing a representative group of tools and their supported functionalities, 3) uncovering themes of features that the studied tools support, and 4) compare the selected tools with respect to the themes.MethodsWe conducted a literature search using PubMed and Google Scholar in order to find GL development tools (GDT). We also explored tools and Content Management Systems (CMS) used in representative organisations and international communities that develop and maintain GLs. By reading a selected representative group of five GL tool manuals, exploring tools hands-on, we uncovered 8 themes of features. All found tools were compared according to these themes in order to identify the level of functionality they offer to support the GL development and publishing process. In order to limit the scope, tools for designing computer-interpretable/executable GL are excluded.ResultsAfter finding 1552 published papers, contacting 7 organizations and international communities, we identified a total of 19 unique tools, of which 5 tools were selected as representative in this paper. We uncovered a total of 8 themes of features according to the identified functionalities that each tool provides. Four features were common among tools: Collaborative authoring process support, user access control, GL repository management, electronic publishing. We found that the GRADE methodology was supported by three of the reviewed tools, while only two tools support annotating GL with MeSH terms. We also identified that monitoring progress, reference management, Managing versions (version control), and Change control (tracking) were often the missing features.ConclusionThe results can promote sector discussion and eventual agreement on important tool functionality. It may aid tool and GL developers towards more efficient, and effective, GL authoring.