Improving Situation Awareness to Advance Patient Outcomes: A Systematic Literature Review.

Improving nurses' situation awareness skills would likely improve patient status recognition and prevent adverse events. Technologies such as electronic health record dashboards can be a promising approach to support nurses' situation awareness. However, the effect of these dashboards on this skill is unknown. This systematic literature review explores the evidence around interventions to improve nurses' situation awareness at the point of care. Current research on this subject is limited. Studies that examined the use of electronic health record dashboards as an intervention had weak evidence to support their effectiveness. Other interventions, including communication interventions and structured nursing assessments, may also improve situation awareness, but more research is needed to confirm this. It is important to carefully consider the design and content of situation awareness interventions, as well as the specific outcomes being measured, when designing situation awareness interventions. Overall, there is a need for higher-quality research in this area to determine the most effective interventions for improving nurse situation awareness. Future studies should focus on developing dashboards that follow a theoretical situation awareness model information and represent all situation awareness levels.

Challenges in data quality assurance for electronic health records.

Data quality is an integral part of EHR systems. Quality assurance for these systems not only identifies the current defects in the data but also aims for minimizing the risk of their future occurrence. Previous studies for secondary use of data in research projects presented several dimensions for such defects and proposed few methods for identifying them. Although those methods were successful in small scale research studies, their application to large scale day-to-day flow of information in EHR systems involves many challenges. In this paper, we highlighted those challenges for each method and each dimension and proposed a framework for using existing technologies to address those challenges.

TeMaD system: telecare for managing diabetes in Saudi Arabia.

This paper briefly describes the main characteristics of the TeMaD system, developed for the Saudi National Guard Hospital in Riyadh. TeMaD attempts to improve current healthcare services for diabetic patients, and assists healthcare givers in disease management. It strengthens communication channels between patients and their healthcare givers, possibly leading to better health.

Lexical patterns, features and knowledge resources for coreference resolution in clinical notes.

Generation of entity coreference chains provides a means to extract linked narrative events from clinical notes, but despite being a well-researched topic in natural language processing, general-purpose coreference tools perform poorly on clinical texts. This paper presents a knowledge-centric and pattern-based approach to resolving coreference across a wide variety of clinical records from two corpora (Ontology Development and Information Extraction (ODIE) and i2b2/VA), and describes a method for generating coreference chains using progressively pruned linked lists that reduces the search space and facilitates evaluation by a number of metrics. Independent evaluation results give an F-measure for each corpus of 79.2% and 87.5%, respectively. A baseline of blind coreference of mentions of the same class gives F-measures of 65.3% and 51.9% respectively. For the ODIE corpus, recall is significantly improved over the baseline (p<0.05) but overall there was no statistically significant improvement in F-measure (p>0.05). For the i2b2/VA corpus, recall, precision, and F-measure are significantly improved over the baseline (p<0.05). Overall, our approach offers performance at least as good as human annotators and greatly increased performance over general-purpose tools. The system uses a number of open-source components that are available to download.

Automated recognition and post-coordination of complex clinical terms.

One of the key tasks in integrating guideline-based decision support systems with the electronic patient record is the mapping of clinical terms contained in both guidelines and patient notes to a common, controlled terminology. However, a vocabulary of pre-coordinated terms cannot cover every possible variation - clinical terms are often highly compositional and complex. We present a rule-based approach for automated recognition and post-coordination of clinical terms using minimal, morpheme-based thesauri, neoclassical combining forms and part-of-speech analysis. The process integrates MetaMap with the open-source GATE framework.

Study of the effects of Clinical Decision Support System's incorrect advice and clinical case difficulty on users' decision making accuracy.

Different Clinical Decision Support Systems (CDSS) are reported to have different effects on clinicians' performance and various factors have been shown to be responsible for that (e.g. system's advice correctness, case difficulty, users' expertise...). The aim of this study is to determine how "advice correctness" and "case difficulty" affect users accepting/rejecting the comments of the system and consequently making a right or wrong decision. It was shown that in difficult cases, users level of making mistakes in clinical decision making was significantly higher when the comments were wrong. But there was no statistically significant difference between easy and difficult cases in how users accepted/rejected correct advice.

Use of ontologies for monitoring electronic health records for compliance with clinical practice guidelines.

Ontologies can assist with translating information from an electronic health record to a clinical practice guideline and reformatting it into a compliance report. A 2009 literature search reviews publications on the use of ontologies to support automated reporting of compliance with clinical practice guidelines via electronic health records. Research stage, data-pulling capabilities, ontologies used, and issues raised are some of the comparative data pulled from 13 articles from the literature review results. Suggestions for further research are given.

Applying a methodological approach for a telecare solution in Saudi Arabia.

This paper briefly examines some major cultural/social factors influencing the quality of healthcare services in Saudi Arabia, then offers a telecare model used to provide the National Guard diabetic patients at King Abdulaziz Medical City in Riyadh with an alternative method of receiving healthcare services, to improve services and cope with healthcare, social, and cultural obstacles.

A requirements engineering approach for improving the quality of diabetes education websites.

Diabetes Mellitus is a major chronic disease with multi-organ involvement and high-cost complications. Although it has been proved that structured education can control the risk of developing these complications, there is big room for improvement in the educational services for these patients. e-learning can be a good solution to fill this gap. Most of the current e-learning solutions for diabetes were designed by computer experts and healthcare professionals but the patients, as end-users of these systems, haven't been deeply involved in the design process. Considering the expectations of the patients, this article investigates a requirement engineering process comparing the level of importance given to different attributes of the e-learning by patients and healthcare professionals. The results of this comparison can be used for improving the currently developed online diabetes education systems.

Decision support and automation bias: methodology and preliminary results of a systematic review.

Automation bias - or a tendency to over-rely on automation - is a subject which has been studied in a variety of academic fields. Clinical Decision Support Systems (CDSS) aim to benefit the clinical decision making process. Although most research shows overall improved performance with use, there is often a failure to recognize the new errors that CDSS can introduce, and as such the healthcare field has a gap in this research. This paper summarizes the methodology and preliminary results of a systematic review over a broad range of fields into the effects of over-reliance on automation. Results indicate that though automation bias is a significant phenomenon, it is not well defined, and there is a gap in the research which must be addressed to optimize the use of decision support.

Automation bias - a hidden issue for clinical decision support system use.

Automation bias - the tendency to over-rely on automation - has been studied in a variety of academic fields. Clinical Decision Support Systems aim to benefit the clinical decision making process. Although most research shows overall improved performance with use, there is often a failure to recognize the new errors that CDSS can introduce, and the healthcare field has a gap in this research. This paper outlines some of the most compelling theoretical factors in the literature involved in automation bias, and builds a simple model to be tested empirically. Ultimately, this will uncover the mechanisms by which this bias operates and help CDSS producers and healthcare practitioners optimize the medical decision making process.

Usability evaluation of a pilot implementation of the electronic clinical transfusion management system IT specification for blood tracking.

Safe working practices and patient safety are of critical importance in the administration of blood transfusion. While the use of information technology has been proposed to ensure the safety of this process, the usability of such systems has not previously been studied. We present the results of a usability evaluation of an electronic clinical transfusion management system being piloted by the National Health Service in England. A number of major usability problems were recorded, largely relating to unnecessary action, limiting user control and recovery from user error. Such problems can, however, be resolved by relatively minor changes to system functionality and design.

National patient flow framework: an ontological patient-oriented redesign.

This study introduces the necessary ontological redesign regarding patient-oriented frameworks. Different national healthcare frameworks around the world as well as semantic gaps have been discovered and demonstrate the need for a new healthcare management framework. This study's Patient-Oriented Management and Reporting framework (POMR framework) will introduce and measure the concept of value-added, patient-oriented flow. The ontological introduction of leading patient-oriented measures is also considered as a novel approach to solving problems. These measures are included in this POMR framework which introduces a unique ontological model redesign (POMR model) and its patient-oriented supporting information system (POMRS) adding value to the concept's implementation in CLIPS technology.

Functional safety in telecare: a proposal for implementation and joint validation.

The introduction of telecare systems represents an inherent risk which can potentially result in patient harm. Given the importance of patient safety, in this paper, we address safety from the functional safety point of view.

Evaluation of alert-based monitoring in a computerised blood transfusion management system.

Blood transfusion is a critical and multi-step process that can be lifesaving. At the same time, any mistakes can be life threatening. An electronic blood transfusion system has been designed to ensure the correctness and safety of the blood transfusion process. The standards for the system include notification mechanisms to inform system managers of any errors in the process. Analysis of system alerts has been used to evaluate the performance of the system. The majority of alerts were classified as 'moderate' in terms of risk (i.e. operational rather than affecting clinical safety) and tended to result from user error. The process of alert acknowledgement and resolution by the system administrator acted as a bottleneck whenever the alerts increased above 100 items per month. Although there was no statistically significant correlation between the number of alerts and the number of transfusions or number of the new users of the system, relatively similar patterns were observable in their charts. A major benefit is that the alerts automatically provided information that would not be captured in a manual transfusion process.

Formatively evaluating the importance of different aspects of an electronic blood transfusion system from the end users' point of view: a questionnaire study.

Blood transfusion is a process in which potential errors may result in serious adverse events to patients. To help improve the safety and efficiency of the blood transfusion process an electronic clinical transfusion management system is being piloted by NHS Connecting for Health. Evaluation of the implementation is being carried out in parallel. One component of the evaluation project aims to assess the importance placed in the various potential benefits of this new system by patients and healthcare workers. A questionnaire was generated and completed by healthcare workers and patients. Results indicate respondents viewing all factors as at least "important". "System" factors were deemed most important. Overall, clinical workers expressed the lowest importance to new process factors. Ultimately these results will be measured against final satisfaction with the system to assess 'fit' between perceived importance and satisfaction to guide areas for attention and resource allocation.

Potential Return on Investment (RoI) on web-based diabetes education in UK.

The incidence of diabetes mellitus is growing in the UK. As most diabetes care is performed by the patients themselves, structured education is one way to encourage their responsible participation in delivering effective care. Continuous e-learning by Internet has proven to be a useful method of diabetes education. "Return on Investment" (RoI) can be used as an indicator of the cost-benefit of web-based education. RoI is the ratio of money gained or lost on an investment relative to the amount of money invested. This report uses system dynamics modeling to predict the flow of patients in the educational system and the cost of their care. The analysis compared traditional and web-based education. Separate models were developed for each educational method and simulated until 2020 in one year intervals. The population of diabetic patients was adjusted at each cycle according to anticipated incidence and mortality rates. The population of educated diabetic patients was based on the educational capacity and literacy limits of each method. A report by the National Health Service (NHS) was used to calculate the cost of care by considering the cost difference between uneducated and educated patients. By 2020 with an annual rate of inflation of 3%, the annual cost of care is projected to increase to pound 3.67 billion for the traditional model as compared to pound 3.39 billion for the web-based model. RoI is estimated to be a ratio of 32.33. Investment in web-based diabetes education is not only a health benefit but also a reduction in care cost.

Axe the Fax: What Users Think of Electronic Referral.

Long wait times for elective services are seen as one of the major challenges for Canadian healthcare. Canadians report that they wait longer for specialists than citizens in other countries. The main reason for this is that the referral process is poorly coordinated and leads to delays in care. Electronic referral (eReferral) is seen as a potential means of improving the referral process and enabling faster access to care. There is the potential for national implementation of eReferral in Canada to help achieve this aim. However, existing initiatives have encountered challenges with user adoption and users have continued to use fax. A validated tool was used to survey both users of fax as well as users of eReferral. These two groups of users were then compared. Most family physicians using fax were satisfied overall with the process. This highlighted how challenging any change of this engrained technology will be. There were, however, some significant areas were eReferral was superior to fax. This included response time, the overall quality of referral information, completeness of the information, the timeliness of the information, and the format and layout. There is an opportunity to leverage these findings to support the adoption of eReferral and help reduce wait times.

System Dynamics in Remote Monitoring Service for Cardiovascular Implantable Electronic Devices.

This methodological paper describes how system dynamics was applied in evaluating the effect of remote monitoring (RM) of cardiovascular implantable electronic device (CIED) workload on clinical resource utilization. The development of a causal loop diagram and a stock and flow diagram and the construction of the simulation model for comparison of an in-person clinic group and RM clinic group are described.

Volumetric Curved Planar Reformation for virtual endoscopy.

Curved Planar Reformation (CPR) has proved to be a practical and widely used tool for the visualization of curved tubular structures within the human body. It has been useful in medical procedures involving the examination of blood vessels and the spine. However, it is more difficult to use it for large, tubular, structures such as the trachea and the colon because abnormalities may be smaller relative to the size of the structure and may not have such distinct density and shape characteristics. Our new approach improves on this situation by using volume rendering for hollow regions and standard CPR for the surrounding tissue. This effectively combines gray scale contextual information with detailed color information from the area of interest. The approach is successfully used with each of the standard CPR types and the resulting images are promising as an alternative to virtual endoscopy. Because the CPR and the volume rendering are tightly coupled, the projection method used has a significant effect on properties of the volume renderer, such as distortion and isometry. We describe and compare the different CPR projection methods and how they affect the volume rendering process. A version of the algorithm is also presented which makes use of importance driven techniques; this ensures the users attention is always focused on the area of interest and also improves the speed of the algorithm.