Motorcycle ABS Testing Related to Draft GTR Phase II Results June, 2006
RESULTS: PHASE II
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RESULTS: PHASE II INFOBUTTONS IN USE: Examples of Context Specific Links to Web-based Materials METHODS: PHASE I Study Design • Ethnographic evaluation of the clinical work environment Participants • One nurse in the Coronary Care Unit (CCU) Procedures • Data collection was limited to note-taking and asking basic questions regarding CCU workflow and the use of technologies • Data were coded to characterize general clinical information system (CIS) related activities and communication between RN and team BACKGROUND • Studies of clinician’s information needs while treating patients have shown that the resolution of these needs is often deferred or fails, which may lead to medical errors • The Infobutton Manager (IM) was developed to help improve the resolution of information needs by providing users with links to on-line health information resources • The aim of this study was to determine the usability of the Infobutton interface to resolve clinicians’ information needs RESULTS: PHASE I Phase I: Ethnographic Observation •Information needs were observed to occur at two time points when the nurse was using the CIS during the workday: 1. At the beginning of shift when reviewing the electronic chart 2. During documentation of nursing activities throughout the day (e.g., after each patient assessment) Infobuttons: A Study of Usability Lily Gutnik 1 , Sarah Collins RN, BSN 2 , Leanne M. Currie RN, DNSc 1,2 James J. Cimino MD 1 , & Vimla L. Patel, PhD, DSc 1 Columbia University, New York, NY, 1 Department of Biomedical Informatics, 2 School of Nursing, METHODS: PHASE II Study Design • Laboratory study examining IM use by nurses and physicians • Survey of satisfaction with the infobutton manager Participants • 2 nurses (RN), 1 physician (MD), and 1 physician’s assistant (PA) Procedures: • Participants were given a script with 3 scenarios with a set of tasks • Participants were asked to "think aloud" as they used the IM and the resources • Morae™ software was used to capture the computer screen and the audio recording of the user ACKNOWLEDGMENTS: This project was supported by US National Library of Medicine 1R01LM07593. Question Types From Ely’s Taxonomy: 1. What is the drug of choice for condition x? 2. What is the cause of symptom x? 3. What test is indicated in situation x? 4. What is the dose of drug x? 5. How should I treat condition x (not limited to drug treatment)? 6. How should I manage condition x (not specifying diagnostic or therapeutic)? 7. What is the cause of physical finding x? 8. What is the cause of test finding x? 9. Can drug x cause (adverse) finding y? From Infobutton Project: 1. Could this patient have condition x? 2. What are my patient's data? 3. How do we do this here? 4. What is this institution-specific data? 5. What is this? Expression of Need: Implicit/Explicit Basis of Need: Foreground/Background Context in CIS: e.g., Lab, Pharmacy, CPOE Resource Type: Human/Computer/Paper Success Rate: Success/Deferred/Failed PURPOSE • To determine the usability of the Infobutton interface to resolve clinicians’ information needs Information Needs Coding Framework Domain Subject Institution S-I D-I S-D- I S-D Type of Need RESULTS: PHASE II Information Needs Taxonomy Items MD 1 PA RN3 RN4 Tota l Success 12 16 15 5 48 Deferred 1 2 2 10 15 Failure 3 7 6 0 16 Subject 0 0 2 0 2 Domain 0 6 7 3 16 Institution 0 0 2 3 5 Subject-Institution 0 0 0 0 0 Subject-Domain 10 9 6 8 33 Institution-Domain 6 10 4 1 21 Subject-Domain-Institution 0 0 2 0 2 Information Retrieval- Internal Source 3 10 6 7 26 Information Retrieval- External Source 12 14 17 8 51 Calculation 1 1 0 0 2 Natural Language Processing 0 0 0 0 0 Question Types MD1 PA RN1 RN2 Tota l What is the drug of choice for condition x? 0 0 0 0 0 What is the cause of symptom x? 0 0 1 0 1 What test is indicated in situation x? 0 0 0 0 0 What is the dose of drug x? 2 5 1 1 9 How should I treat condition x? 0 0 0 0 0 How should I manage condition x? 2 5 3 0 10 What is the cause of physical finding x? 0 0 0 0 0 What is the cause of test finding x? 0 0 0 0 0 Can drug x cause (adverse) finding y? 5 3 5 1 14 Could this patient have condition x? 1 0 0 0 1 What are my patient's data? 0 3 5 7 15 How do we do this here? 3 4 0 0 7 What are this institution- specific data? 2 2 3 3 10 What is this? 1 3 4 3 11 What is the expected outcome? 0 0 1 0 1 Total 16 25 23 15 79 CONCLUSIONS • Clinicians commonly have information needs as they treat their patients • Nurses have information needs throughout their day • During laboratory sessions with 4 clinicians, 79 information needs events were observed • The most commonly occurring question types were: • “What are my patient's data?” and “Can drug x cause (adverse) finding y?” • Most information needs events were successful, and domain-related • Frequent documentation by nurses in the CCU suggests that the IM may provide a useful and accessible link for clinicians seeking information resources at the point of care • This study accentuated the need to be mindful of information overload Web-based Medical Reference Web-based Patient Education Materials Web-based Calculator
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Type of Need. Infobuttons: A Study of Usability Lily Gutnik 1 , Sarah Collins RN, BSN 2 , Leanne M. Currie RN, DNSc 1,2 James J. Cimino MD 1 , & Vimla L. Patel, PhD, DSc 1 Columbia University, New York, NY, 1 Department of Biomedical Informatics, 2 School of Nursing,. METHODS: PHASE II - PowerPoint PPT Presentation
Transcript of RESULTS: PHASE II
RESULTS: PHASE II
INFOBUTTONS IN USE: Examples of Context Specific Links to Web-based Materials
METHODS: PHASE IStudy Design• Ethnographic evaluation of the clinical work environment Participants• One nurse in the Coronary Care Unit (CCU)Procedures• Data collection was limited to note-taking and asking basic questions
regarding CCU workflow and the use of technologies• Data were coded to characterize general clinical information system
(CIS) related activities and communication between RN and team
BACKGROUND• Studies of clinician’s information needs while treating patients have
shown that the resolution of these needs is often deferred or fails, which may lead to medical errors
• The Infobutton Manager (IM) was developed to help improve the resolution of information needs by providing users with links to on-line health information resources
• The aim of this study was to determine the usability of the Infobutton interface to resolve clinicians’ information needs
RESULTS: PHASE IPhase I: Ethnographic Observation• Information needs were observed to occur at two time points when the
nurse was using the CIS during the workday:1. At the beginning of shift when reviewing the electronic chart2. During documentation of nursing activities throughout the day (e.g.,
after each patient assessment)
Infobuttons: A Study of Usability Lily Gutnik1, Sarah Collins RN, BSN2, Leanne M. Currie RN, DNSc1,2
James J. Cimino MD1, & Vimla L. Patel, PhD, DSc1
Columbia University, New York, NY, 1Department of Biomedical Informatics, 2School of Nursing,
METHODS: PHASE IIStudy Design• Laboratory study examining IM use by nurses and physicians• Survey of satisfaction with the infobutton managerParticipants• 2 nurses (RN), 1 physician (MD), and 1 physician’s assistant (PA)Procedures:• Participants were given a script with 3 scenarios with a set of
tasks • Participants were asked to "think aloud" as they used the IM and
the resources• Morae™ software was used to capture the computer screen and
the audio recording of the user
ACKNOWLEDGMENTS: This project was supported by US National Library of Medicine 1R01LM07593.
Question Types From Ely’s Taxonomy:1. What is the drug of choice for condition x?2. What is the cause of symptom x?3. What test is indicated in situation x?4. What is the dose of drug x?5. How should I treat condition x (not limited to drug
treatment)?6. How should I manage condition x (not specifying
diagnostic or therapeutic)?7. What is the cause of physical finding x?8. What is the cause of test finding x?9. Can drug x cause (adverse) finding y?From Infobutton Project:1. Could this patient have condition x?2. What are my patient's data?3. How do we do this here?4. What is this institution-specific data?5. What is this?
Expression of Need: Implicit/ExplicitBasis of Need: Foreground/BackgroundContext in CIS: e.g., Lab, Pharmacy, CPOEResource Type: Human/Computer/PaperSuccess Rate: Success/Deferred/Failed
PURPOSE• To determine the usability of the Infobutton interface to resolve
clinicians’ information needs
Information Needs Coding Framework
Domain
SubjectInstitution S-I
D-I
S-D-I
S-D
Type of Need
RESULTS: PHASE II
Information Needs Taxonomy Items MD 1 PA RN3 RN4 Total
Success 12 16 15 5 48
Deferred 1 2 2 10 15
Failure 3 7 6 0 16
Subject 0 0 2 0 2
Domain 0 6 7 3 16
Institution 0 0 2 3 5
Subject-Institution 0 0 0 0 0
Subject-Domain 10 9 6 8 33
Institution-Domain 6 10 4 1 21
Subject-Domain-Institution 0 0 2 0 2
Information Retrieval-Internal Source 3 10 6 7 26
Information Retrieval-External Source 12 14 17 8 51
Calculation 1 1 0 0 2
Natural Language Processing 0 0 0 0 0
Question Types MD1 PA RN1 RN2 Total
What is the drug of choice for condition x? 0 0 0 0 0
What is the cause of symptom x? 0 0 1 0 1
What test is indicated in situation x? 0 0 0 0 0
What is the dose of drug x? 2 5 1 1 9
How should I treat condition x? 0 0 0 0 0
How should I manage condition x? 2 5 3 0 10
What is the cause of physical finding x? 0 0 0 0 0
What is the cause of test finding x? 0 0 0 0 0
Can drug x cause (adverse) finding y? 5 3 5 1 14
Could this patient have condition x? 1 0 0 0 1
What are my patient's data? 0 3 5 7 15
How do we do this here? 3 4 0 0 7
What are this institution-specific data? 2 2 3 3 10
What is this? 1 3 4 3 11
What is the expected outcome? 0 0 1 0 1
Total 16 25 23 15 79
CONCLUSIONS• Clinicians commonly have information needs as they treat their patients
• Nurses have information needs throughout their day• During laboratory sessions with 4 clinicians, 79 information needs
events were observed • The most commonly occurring question types were:
• “What are my patient's data?” and “Can drug x cause (adverse) finding y?”
• Most information needs events were successful, and domain-related• Frequent documentation by nurses in the CCU suggests that the IM may
provide a useful and accessible link for clinicians seeking information resources at the point of care
• This study accentuated the need to be mindful of information overload
Web-based Medical Reference Web-based Patient Education MaterialsWeb-based Calculator
