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Biomedical subjects

Douglas S Bell

Publications and source records attributed to Douglas S Bell.

11 recordsLinked to original sources
PubMed2006

A test of knowledge about prostate cancer screening. Online pilot evaluation among Southern California Physicians.

BACKGROUND: Although the benefits of prostate cancer screening are uncertain and guidelines recommend that physicians share the screening decision with their patients, most U.S. men over age 50 are routinely screened, often without counseling. OBJECTIVE: To develop an instrument for assessing physicians' knowledge related to the U.S. Preventive Services Task Force recommendations on prostate cancer screening. PARTICIPANTS: Seventy internists, family physicians, and general practitioners in the Los Angeles area who deliver primary care to adult men. MEASUREMENTS: We assessed knowledge related to prostate cancer screening (natural history, test characteristics, treatment effects, and guideline recommendations), beliefs about the net benefits of screening, and prostate cancer screening practices for men in different age groups, using an online survey. We constructed a knowledge scale having 15 multiple-choice items. RESULTS: Participants' mean knowledge score was 7.4 (range 3 to 12) of 15 (Cronbach's alpha=0.71). Higher knowledge scores were associated with less belief in a mortality benefit from prostate-specific antigen (PSA) testing (r=-.49, P<.001). Participants could be categorized as low, age-selective, and high users of routine PSA screening. High users had lower knowledge scores than age-selective or low users, and they believed much more in mortality benefits from PSA screening. CONCLUSIONS: Based on its internal consistency and its correlations with measures of physicians' net beliefs and self-reported practices, the knowledge scale developed in this study holds promise for measuring the effects of professional education on prostate cancer screening. The scale deserves further evaluation in broader populations.

Adult↗
PubMed2006

A Web-based telemedicine system for diabetic retinopathy screening using digital fundus photography.

The purpose was to design and implement a Web-based telemedicine system for diabetic retinopathy screening using digital fundus cameras and to make the software publicly available through Open Source release. The process of retinal imaging and case reviewing was modeled to optimize workflow and implement use of computer system. The Web-based system was built on Java Servlet and Java Server Pages (JSP) technologies. Apache Tomcat was chosen as the JSP engine, while MySQL was used as the main database and Laboratory of Neuro Imaging (LONI) Image Storage Architecture, from the LONI-UCLA, as the platform for image storage. For security, all data transmissions were carried over encrypted Internet connections such as Secure Socket Layer (SSL) and HyperText Transfer Protocol over SSL (HTTPS). User logins were required and access to patient data was logged for auditing. The system was deployed at Hubert H. Humphrey Comprehensive Health Center and Martin Luther King/Drew Medical Center of Los Angeles County Department of Health Services. Within 4 months, 1500 images of more than 650 patients were taken at Humphrey's Eye Clinic and successfully transferred to King/Drew's Department of Ophthalmology. This study demonstrates an effective architecture for remote diabetic retinopathy screening.

Diabetic Retinopathy↗
PubMed2005

Functional characteristics of commercial ambulatory electronic prescribing systems: a field study.

OBJECTIVE: To compare the functional capabilities being offered by commercial ambulatory electronic prescribing systems with a set of expert panel recommendations. DESIGN: A descriptive field study of ten commercially available ambulatory electronic prescribing systems, each of which had established a significant market presence. Data were collected from vendors by telephone interview and at sites where the systems were functioning through direct observation of the systems and through personal interviews with prescribers and technical staff. MEASUREMENTS: The capabilities of electronic prescribing systems were compared with 60 expert panel recommendations for capabilities that would improve patient safety, health outcomes, or patients' costs. Each recommended capability was judged as having been implemented fully, partially, or not at all by each system to which the recommendation applied. Vendors' claims about capabilities were compared with the capabilities found in the site visits. RESULTS: On average, the systems fully implemented 50% of the recommended capabilities, with individual systems ranging from 26% to 64% implementation. Only 15% of the recommended capabilities were not implemented by any system. Prescribing systems that were part of electronic health records (EHRs) tended to implement more recommendations. Vendors' claims about their systems' capabilities had a 96% sensitivity and a 72% specificity when site visit findings were considered the gold standard. CONCLUSIONS: The commercial electronic prescribing marketplace may not be selecting for capabilities that would most benefit patients. Electronic prescribing standards should include minimal functional capabilities, and certification of adherence to standards may need to take place where systems are installed and operating.

Ambulatory Care Information Systems↗
PubMed2005

The stadium diagram, a web-based tool for visualizing the expected outcomes of alternative clinical management strategies.

OBJECTIVE: To explore the use of graphical animation for helping clinicians to understand the evidence about expected risks and benefits associated with multi-step clinical management strategies. METHODS: We used Flash and XML to create a tool capable of displaying the sequence of health state changes that may result from a specific management strategy, as applied to a simulated population. We evaluated this tool in 6 focus groups involving a total of 44 community internists and family physicians. We successively revised the tool based on grounded theory analysis of the focus group transcripts. RESULTS: The process of responding to design issues raised in focus groups resulted in a final tool that presents a group of person icons arranged in rows to give the illusion of people in a stadium or theater. Each action in the management strategy causes persons to change color and move among rows to reflect changes in health state. The tool can play audio narration to explain each step and links are provided to the supporting evidence. Most physicians found these visualizations to be attractive and clear. Some were interested in using the tool with patients. Others rejected the specific decision model used to demonstrate the tool and a few rejected the notion of applying quantitative risks to individual patients. CONCLUSIONS: A visual approach to demonstrating the possible benefits and harms of a given management strategy holds interest for many clinicians. However, visualizations may fail to influence clinicians who do not believe the available evidence.

Computer Graphics↗
PubMed2003

A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities.

OBJECTIVE: Electronic prescribing (e-prescribing) may substantially improve health care quality and efficiency, but the available systems are complex and their heterogeneity makes comparing and evaluating them a challenge. The authors aimed to develop a conceptual framework for anticipating the effects of alternative designs for outpatient e-prescribing systems. DESIGN: Based on a literature review and on telephone interviews with e-prescribing vendors, the authors identified distinct e-prescribing functional capabilities and developed a conceptual framework for evaluating e-prescribing systems' potential effects based on their capabilities. Analyses of two commercial e-prescribing systems are presented as examples of applying the conceptual framework. MEASUREMENTS: Major e-prescribing functional capabilities identified and the availability of evidence to support their specific effects. RESULTS: The proposed framework for evaluating e-prescribing systems is organized using a process model of medication management. Fourteen e-prescribing functional capabilities are identified within the model. Evidence is identified to support eight specific effects for six of the functional capabilities. The evidence also shows that a functional capability with generally positive effects can be implemented in a way that creates unintended hazards. Applying the framework involves identifying an e-prescribing system's functional capabilities within the process model and then assessing the effects that could be expected from each capability in the proposed clinical environment. CONCLUSION: The proposed conceptual framework supports the integration of available evidence in considering the full range of effects from e-prescribing design alternatives. More research is needed into the effects of specific e-prescribing functional alternatives. Until more is known, e-prescribing initiatives should include provisions to monitor for unintended hazards.

Ambulatory Care↗
PubMed2003

Is there a digital divide among physicians? A geographic analysis of information technology in Southern California physician offices.

OBJECTIVE: The aim of this study was to determine whether physician offices located in high-minority and low-income neighborhoods have different levels of access to information technology than offices located in lower-minority and higher-income areas. DESIGN: A cross-sectional survey was conducted of pediatrics, family medicine, and general practice offices in Orange County, California. Survey data were linked with community demographic data from the 2000 Census using a geographical information system. RESULTS: Of 307 offices surveyed, 141 responded (46%). Offices located in high-minority and high-poverty areas were as likely to respond as other offices. Among responding offices, 94% had a computer, 77% had Web access, 29% had broadband Internet access, and 53% used computerized scheduling and billing systems. Offices located in minority and low-income communities had equivalent access to each technology. Offices in communities with larger proportions of Hispanics were less likely to have practice Web pages, but other uses of the Internet were not associated with practice location. Offices reported high levels of interest in online clinical systems but also high levels of concern about these systems' usability and confidentiality. Offices with Web access and those with practice management systems expressed greater interest in online clinical systems but also greater levels of concern about usability and confidentiality. These attitudes were equivalent among offices in different communities. CONCLUSION: Primary care offices located in poor and minority communities in a large, suburban county had high levels of access to and interest in Web-based systems. Physicians' offices may therefore provide a venue for online services aimed at improving health outcomes for poor and minority communities. Research is needed in other geographic regions to determine the generalizability of these findings.

Attitude to Computers↗
PubMedDate not supplied

E-prescribing and the medicare modernization act of 2003.

Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 are intended to foster electronic prescribing by requiring standards for interoperability and by permitting third parties to offset implementation costs. Although physicians have been slow to embrace e-prescribing, adoption may increase in 2006, when a new tide of pharmacy messages will arrive from patients entering multi-tier drug coverage under Medicare. However, the e-prescribing systems selected may lack the advanced features needed to improve patient safety and chronic disease control. To optimize the return on Medicare drug spending, the government should consider additional incentives to spur the uptake of more advanced systems.

Drug Prescriptions↗
PubMedDate not supplied

Recommendations for comparing electronic prescribing systems: results of an expert consensus process.

Commercially available electronic prescribing systems may differ in their effects on patients' health outcomes and on patients' ability to manage costs. An expert panel convened to recommend specific features that would enable electronic prescribing systems to advance these goals. The panel authored sixty recommendations and rated each using a modified Delphi process. Ratings identified fifty-two recommendations as clearly positive for patient safety and health outcomes and forty-three recommendations as achievable in the average clinician's office within three years. Overall, these recommendations offer a synthesis of evidence and expert opinion that can help guide the development of electronic prescribing policy.

Delphi Technique↗
PubMedDate not supplied

Electronic prescribing and HIPAA privacy regulation.

Electronic prescribing offers the prospect of safer medication management, but fulfillment of that promise depends on ready access to personal health information from many sources, thus raising new concerns about information privacy and security. Federal privacy regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) limit the sharing of health information by providers, and particularly may discourage information sharing over distributed computer networks. This analysis finds that although HIPAA has only a limited effect on current e-prescribing practices, future electronic prescribing systems will likely fall short of their potential benefits, absent policy refinements designed to encourage clinically appropriate, networked sharing of patient health information.

Clinical Pharmacy Information Systems↗