Biomedical subjects

Eta S Berner

Publications and source records attributed to Eta S Berner.

At least 19 recordsLinked to original sources

PubMed2006

Development and testing of a scale to assess physician attitudes about handheld computers with decision support.

OBJECTIVE: The authors developed and evaluated a rating scale, the Attitudes toward Handheld Decision Support Software Scale (H-DSS), to assess physician attitudes about handheld decision support systems. DESIGN: The authors conducted a prospective assessment of psychometric characteristics of the H-DSS including reliability, validity, and responsiveness. Participants were 82 Internal Medicine residents. A higher score on each of the 14 five-point Likert scale items reflected a more positive attitude about handheld DSS. The H-DSS score is the mean across the fourteen items. Attitudes toward the use of the handheld DSS were assessed prior to and six months after receiving the handheld device. STATISTICS: Cronbach's Alpha was used to assess internal consistency reliability. Pearson correlations were used to estimate and detect significant associations between scale scores and other measures (validity). Paired sample t-tests were used to test for changes in the mean attitude scale score (responsiveness) and for differences between groups. RESULTS: Internal consistency reliability for the scale was alpha = 0.73. In testing validity, moderate correlations were noted between the attitude scale scores and self-reported Personal Digital Assistant (PDA) usage in the hospital (correlation coefficient = 0.55) and clinic (0.48), p < 0.05 for both. The scale was responsive, in that it detected the expected increase in scores between the two administrations (3.99 (s.d. = 0.35) vs. 4.08, (s.d. = 0.34), p < 0.005). CONCLUSION: The authors' evaluation showed that the H-DSS scale was reliable, valid, and responsive. The scale can be used to guide future handheld DSS development and implementation.

Analysis of Variance↗

PubMed2005

Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting. DESIGN: The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status. MEASUREMENTS: Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group. RESULTS: At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs. CONCLUSION: PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.

Ambulatory Care Information Systems↗

PubMed2005

Informatics challenges for the impending patient information explosion.

As we move toward an era when health information is more readily accessible and transferable, there are several issues that will arise. This article addresses the challenges of information filtering, context-sensitive decision support, legal and ethical guidelines regarding obligations to obtain and use the information, aligning patient and health professionals' expectations in regard to the use and usefulness of the information, and enhancing data reliability. The authors discuss the issues and offer suggestions for addressing them.

Confidentiality↗

PubMed2005

Data quality in the outpatient setting: impact on clinical decision support systems.

Clinical decision support system (CDSS) performance may vary with the quality of the input data. We assessed the impact of medical record completeness and accuracy on a CDSS that provides risk assessment for gastrointestinal bleeding and recommends therapy when prescribing NSAIDs. We examined the documentation of six data elements in the medical record and the impact on the performance of the CDSS. We reviewed 178 transcribed clinical encounters from standardized patients with predefined clinical histories. Results showed that the mean completeness score across all encounters was .34. The mean correctness score for those elements present was .94. When the available data was input into the CDSS, the missing data elements resulted in inappropriate and unsafe recommendations in almost 77% of the encounters. The results show that important gaps in the medical record can affect the accuracy of a CDSS designed to improve safe prescribing.

Adult↗

PubMed2004

Will the wave finally break? A brief view of the adoption of electronic medical records in the United States.

For over thirty years, there have been predictions that the widespread clinical use of computers was imminent. Yet the "wave" has never broken. In this article, two broad time periods are examined: the 1960's to the 1980's and the 1980's to the present. Technology immaturity, health administrator focus on financial systems, application "unfriendliness," and physician resistance were all barriers to acceptance during the early time period. Although these factors persist, changes in clinicians' economics, more computer literacy in the general population, and, most importantly, changes in government policies and increased support for clinical computing suggest that the wave may break in the next decade.

Computers↗

PubMed2004

Added value of video compared to audio lectures for distance learning.

Asynchronous distance learning programs in health informatics are becoming more prevalent, but there is little research on the best practices of asynchronous learning technologies. There are virtually no data on the value of video of the instructor compared to an audio slide presentation. We conducted a randomized controlled trial in which we showed the same slide presentation to two groups of students. One group saw a video of the instructor giving the lecture and the other group saw the same presentation with audio only. Our results show that adding video to an audio presentation does not lead to greater satisfaction or greater learning. Students may think they want the video, but those who have it are not uniformly pleased with it. These results demonstrate that despite the intuitive appeal of streaming video, the addition of a video to an audio presentation may not be worth the extra expense and effort.

Alabama↗

PubMed2004

Assessing graduate programs for healthcare information management/technology (HIM/T) executives.

This paper describes a methodology to assess health/medical informatics graduate-level education curricula. The authors used the Certified Professional in Healthcare Information Management Systems (CPHIMS) exam objectives published by the Healthcare Information and Management Systems Society (HIMSS) as the basis for their assessment. The authors compared the 69 CPHIMS exam objectives against four health/medical informatics program course objectives as stated in the selected program's online graduate catalog. Results showed that the two programs with management as a focus addressed the majority (67 and 59%) of the CPHIMS objectives within core and elective courses combined. Overall, the other two programs addressed closer to a third of the CPHIMS objectives (36 and 32%). This methodology could prove to be useful in assisting students interested in graduate-level training programs with a tool by which to measure the congruence of the curricula of different programs with the mission of the programs and with their own professional interests.

Curriculum↗

PubMed2004

Proposed curricular objectives to teach physicians competence in using the World Wide Web.

As the World Wide Web becomes more ubiquitous, physicians are increasingly using the information it provides as part of medical practice. The Web can be a valuable information resource for patient education and decision support or it can be a troubling source of misinformation for providers and patients alike. Attempts have been made to apply quality standards to Web sites, but these have been only moderately successful. Medical schools are designing curricula to confront the content of the medical information explosion, but they also have an obligation to teach students how to quality filter and critically analyze the sources of this information, particularly when it is delivered over the Web. The authors suggest some of the concepts that need to be considered when educating the next generation of what they have termed "information-astute physicians."

Computer User Training↗

PubMed2004

Comparing health/medical informatics graduate program curricula against two sets of professional criteria.

Students often have a difficult time determining the differences among training programs and deciding which best meets their needs, especially in the area of health and medical informatics, where training programs often have similar names but very different content. This manuscript describes a methodology for systematically analyzing the content of graduate programs in health and medical informatics. This methodology attempts to determine if the systematic analysis of published competencies can be used to identify differences among the ever-increasing number of informatics graduate programs. The authors use the methodology to compare four graduate informatics programs to two sets of professional criteria: the Certified Professional in Healthcare Information Management Systems (CPHIMS) exam objectives published by HIMSS and the recommendations of the International Medical Informatics Association (IMIA) Working Group for Education (WG1) for competencies in medical informatics. This article discusses similarities and differences among the programs. Criteria and the implications of the differences are described.

Curriculum↗

PubMed2004

Impact of patient feedback on residents' handheld computer use: a multi-site study.

Handheld computers are being proposed as a resource for ambulatory care, yet physician reluctance to use the devices in the presence of patients is reported to be a barrier to optimal use. This study examined patient attitudes toward the use of handheld computers and the impact of those attitudes on the physicians' use of the handheld computers in the patient care setting. Most patients hold favorable attitudes toward physician use of handheld computers. Providing these data to physicians, however, did not uniformly lead to significant increases in handheld use in the presence of the patient. More understanding of the factors that influence behavior change and methods that will decrease barriers to the use of handhelds is needed

Adult↗

PubMed2004

Beating the system--pitfalls of bar code medication administration.

Beating the system to maximize efficiency will yield no positive return on a bar code investment, in terms of reducing medical errors. The critical success factor in the bar coding scenario is that of operational effectiveness. By shifting the nurses' focus from that of efficiency to that of operational effectiveness, the use of bar coding medication technology will reduce medication errors. CIOs looking for a quick fix to reducing medication errors through the use of bar coding technology need to understand that the technology alone won't solve their problem. Rather, it's the balance between operational efficiency and effectiveness among multiple departments working together, both vertically and horizontally, which will yield the greatest ROI.

Electronic Data Processing↗

PubMed2003

Do local opinion leaders augment hospital quality improvement efforts? A randomized trial to promote adherence to unstable angina guidelines.

BACKGROUND: The influence of an opinion leader intervention on adherence to Unstable Angina (UA) guidelines compared with a traditional quality improvement model was investigated. RESEARCH DESIGN: A group-randomized controlled trial with 2210 patients from 21 hospitals was designed. There were three intervention arms: (1) no intervention (NI); (2) a traditional Health Care Quality Improvement Program (HCQIP); and (3) a physician opinion leader in addition to the HCQIP model (OL). Quality indicators included: electrocardiogram within 20 minutes, antiplatelet therapy within 24 hours and at discharge, and heparin and beta-blockers during hospitalization. Hospitals could determine the specific indicators they wished to target. Potential cases of UA were identified from Medicare claims data. UA confirmation was determined by a clinical algorithm based on data abstracted from medical records. Data analyses included both hospital level analysis (analysis of variance) and patient level analysis (generalized linear models). RESULTS: The only statistically significant postintervention difference in percentage compliant was greater improvement for the OL group in the use of antiplatelet therapy at 24 hours in both hospital level (P = 0.01) and patient level analyses (P <0.05) compared with the HCQIP and NI groups. When analyses were confined to hospitals that targeted specific indicators, compared with the HCQIP hospitals, the OL hospitals showed significantly greater change in percentage compliant postintervention in both antiplatelet therapy during the first 24 hours (20.2% vs. -3.9%, P = 0.02) and heparin (31.0% vs.9.1%, P = 0.05). CONCLUSIONS: The influence of physician opinion leaders was unequivocally positive for only one of five quality indicators. To maximize adherence to best practices through physician opinion leaders, more research on how these physicians influence health care delivery in their organizations will be required.

Aged↗

PubMed2003

Clinician performance and prominence of diagnoses displayed by a clinical diagnostic decision support system.

Clinical decision support systems (CDSS) can impact both diagnostic and therapeutic decision-making, but physicians sometimes fail to heed the appropriate CDSS advice, or become influenced in a negative way by the CDSS. This study examined the relationships among clinicians' prior diagnostic accuracy, the performance of a diagnostic CDSS, and how the CDSS influenced the accuracy of the clinician's subsequent diagnoses. Results showed that (1) clinicians who already were considering the correct diagnosis prior to using the CDSS were more likely to get the CDSS to produce the correct diagnosis in a prominent position than those not considering it initially; (2) physicians are strongly anchored by their initial diagnoses prior to using the CDSS; and (3) changes in the clinicians' diagnoses after using the CDSS are related to presence or absence of the correct diagnosis in the top 10 diagnoses displayed by the CDSS.

Clinical Competence↗

PubMed2003

Patient perceptions of physician use of handheld computers.

BACKGROUND: Handheld computers have advantages for healthcare providers including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration. OBJECTIVE: To survey patients' perceptions of handheld use, and compare those with their providers' perceptions. METHODS: A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed. RESULTS: Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld computer with patients. CONCLUSIONS: Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.

Adult↗

PubMed2003

Comparison of health/medical informatics curricula against multiple sets of professional criteria.

This poster expands on a methodology presented at the 2003 International Medical Informatics Association (IMIA) Conference on Education by analyzing the match between four graduate informatics programs to both the IMIA Working Group for Education (WG1) recommendations and the Certified Professional in Healthcare Information Management Systems (CPHIMS) exam objectives published by the Healthcare Information and Management Systems Society (HIMSS). Similarities and differences among the programs and criteria are described.

Curriculum↗

PubMed2002

Developing an action plan for integrating sleep topics into the medical school curriculum.

Sleep disorders are prevalent although they go unrecognized by clinicians, partially because of limited exposure to sleep medicine topics during medical school. Sleep topics can be integrated during both the preclinical and clinical years of the medical school curriculum by developing an integration strategy and action plan. Components of the action plan include examining the current medical school curriculum and the teaching infrastructure. Understanding curricular governance issues and how curriculum time is allocated will allow development of an effective integrative strategy. Sleep topics can be integrated into neuroscience, neuroanatomy, physiology, and behavioral science courses during the preclinical years. The sleep history and physical can be integrated into the physical diagnosis course. Sleep disorders can be introduced in clinical correlation courses. Integration strategies during the clinical years may include computer-based simulations. Careful assessment of the existing curriculum, curricular governance processes, and available educational resources will optimize the probability of successfully integrating sleep topics into the medical school curriculum.

Curriculum↗

PubMed2002

A model for assessing information retrieval and application skills of medical students.

PURPOSE: To develop and evaluate a model for assessing information retrieval and application skills, and to compare the performances on the assessment exercises of students who were and were not instructed in these skills. METHOD: The authors developed a set of four examination stations, each with multiple subtasks, and administered the exams to students at two medical schools. Students at one school had intensive instruction in literature searching and filtering skills for information quality (instructed group), and those at the other school had minimal instruction in these areas (uninstructed group). The stations addressed pediatrics content and the skills of searching Medline and the World Wide Web, evaluating research articles, evaluating the accuracy of information from the Web, and using the information to make recommendations to patients. The authors determined the psychometric characteristics of the stations and compared the performances of the two groups of students. RESULTS: Students in the instructed group performed significantly better and with less variability than the uninstructed group on four tasks and no differently on seven tasks. There was no task on which the uninstructed group performed significantly better than the instructed group. CONCLUSION: The prototype stations showed predictable differences across curricula, indicating that they have promise as assessment tools for the essential skills of information retrieval and application.

Alabama↗

PubMed2002

Ethical and legal issues in the use of clinical decision support systems.

The clinician must be able to make informed decisions on when to seek out, follow, or ignore the clinical decision support system's advice. In addition, knowledge bases must be properly maintained, and vendors should inform the client about how the systems were developed and tested, the source of the rules in the system, expectations of the user, and type of user training required.

Computer User Training↗