Biomedical subjects

Andre Kushniruk

Publications and source records attributed to Andre Kushniruk.

7 recordsLinked to original sources

PubMed2006

The usability axiom of medical information systems.

INTRODUCTION: In this article we begin by connecting the concept of simplicity of user interfaces of information systems with that of usability, and the concept of complexity of the problem-solving in information systems with the concept of usefulness. We continue by stating "the usability axiom" of medical information technology: information systems must be, at the same time, usable and useful. We then try to show why, given existing technology, the axiom is a paradox and we continue with analysing and reformulating it several times, from more fundamental information processing perspectives. DISCUSSION: We underline the importance of the concept of representation and demonstrate the need for context-dependent representations. By means of thought experiments and examples, we advocate the need for context-dependent information processing and argue for the relevance of algorithmic information theory and case-based reasoning in this context. Further, we introduce the notion of concept spaces and offer a pragmatic perspective on context-dependent representations. We conclude that the efficient management of concept spaces may help with the solution to the medical information technology paradox. Finally, we propose a view of informatics centred on the concepts of context-dependent information processing and management of concept spaces that aligns well with existing knowledge centric definitions of informatics in general and medical informatics in particular. In effect, our view extends M. Musen's proposal and proposes a definition of Medical Informatics as context-dependent medical information processing. SUMMARY: The axiom that medical information systems must be, at the same time, useful and usable, is a paradox and its investigation by means of examples and thought experiments leads to the recognition of the crucial importance of context-dependent information processing. On the premise that context-dependent information processing equates to knowledge processing, this view defines Medical Informatics as a context-dependent medical information processing which aligns well with existing knowledge centric definitions of our field.

Algorithms↗

PubMed2006

Predicting changes in workflow resulting from healthcare information systems: ensuring the safety of healthcare.

This paper describes an approach to studying medical error and workflow that can be applied to help ensure the safety of new healthcare information systems. The approach focuses on identification of usability problems resulting from implementation of new information technology, as well as identification of problems related to changes in workflow. The paper illustrates how the approach can be applied in the simulation-based analyses of emerging healthcare information systems. The paper includes discussion of the application of an approach to identifying inadvertent changes in healthcare workflow that may result from design issues in a range of information technologies including medication order entry systems. General implications for the design, development and evaluation of safer healthcare information systems are discussed. It is argued that there is a need for thorough simulation-based testing of systems under a variety of conditions before they are released in order to ensure the safety of healthcare.

Efficiency, Organizational↗

PubMed2005

A framework for capturing the interactions between laypersons' understanding of disease, information gathering behaviors, and actions taken during an epidemic.

This paper provides a description of a methodological framework designed to capture the inter-relationships between the lay publics' understanding of health-related processes, information gathering behaviors, and actions taken during an outbreak. We developed and refined our methods during a study involving eight participants living in severe acute respiratory syndrome (SARS)-affected areas (Hong Kong, Taiwan, and Toronto). The framework is an adaptation of narrative analysis, a qualitative method that is used to investigate a phenomenon through interpretation of the stories people tell about their experiences. From our work, several hypotheses emerged that will contribute to future research. For example, our findings showed that many decisions in an epidemic are carefully considered and involve use of significant information gathering. Having a good model of lay actions based on information received and beliefs held will contribute to the development of more effective information support systems in the event of a future epidemic.

Decision Support Systems, Clinical↗

PubMed2005

Identifying and preventing technology-induced error using simulations: application of usability engineering techniques.

In this paper, we describe a framework for the analysis of technology-induced errors, extending approaches from the emerging area of usability engineering. The approach involves collection of a rich set of data consisting of audio and video recordings of interactions of healthcare workers with health information systems under simulated conditions. The application of the approach is discussed, along with methodological considerations and issues in conducting such studies. The steps involved in carrying out such studies are described along with a discussion of our current work. It is argued that health care information systems will need to undergo more rigorous evaluation under simulated conditions in order to detect and prevent technology-induced errors before they are deployed in real healthcare settings.

Canada↗

PubMed2004

The relationship of usability to medical error: an evaluation of errors associated with usability problems in the use of a handheld application for prescribing medications.

This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to "think aloud" while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to issues of ease of use. In addition, other problems were identified which were related to limitations of the content of the program. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for the improvement of safety of health care information systems are discussed.

Computers, Handheld↗

PubMed2003

From prototype to production system: lessons learned from the evolution of the SignOut System at Mount Sinai Medical Center.

Approaches to the development of information systems in large health care institutions range from prototyping to conventional development of large scale production systems. This paper discusses the development of the SignOut System at Mount Sinai Medical Center, which was designed in 1997 to capture vital resident information. Local need quickly outstripped proposed delays for building a production system and a prototype system quickly became a production system. By the end of 2002 the New SignOut System was built to create an integrated application that was a true production system. In this paper we discuss the design and implementation issues in moving from a prototype to a production system. The production system had a number of advantages, including increased organizational visibility, integration into enterprise resource planning and full time staff for support. However, the prototype allowed for more rapid design and subsequent changes, less training, and equal to or superior help desk support. It is argued that healthcare IT systems may need characteristics of both prototype and production system development to rapidly meet the changing and different needs of healthcare user populations.

Academic Medical Centers↗

PubMed2002

Evaluation in the design of health information systems: application of approaches emerging from usability engineering.

This paper examines the role of evaluation in the design of health care information systems. A framework is presented for considering evaluation in the context of software development processes, in particular, the systems development life cycle (SDLC). Variations on standard design methodologies are then discussed, including methods based on rapid development and continual evaluation of prototype systems. Usability testing is presented as a key method for conducting evaluations during iterative system development. The emergence of design methodologies, where evaluation is viewed as a central part of the development cycle is also discussed. Evaluation methodologies are then considered along a continuum, ranging from studies involving a high degree of experimental control to observational approaches. A full cycle approach to evaluation of health care systems is argued for, involving deployment of new methods across the SDLC. Implications for future work exploring the integration of design and evaluation processes in health informatics are discussed.

Biomedical Engineering↗