Biomedical subjects

James P Turley

Publications and source records attributed to James P Turley.

7 recordsLinked to original sources

PubMed2006

Operating manual-based usability evaluation of medical devices: an effective patient safety screening method.

BACKGROUND: Use of medical devices often directly contributes to medical errors. Because it is difficult or impossible to change the design of existing devices, the best opportunity for improving medical device safety is during the purchasing process. However, most hospital personnel are not familiar with the usability evaluation methods designed to identify aspects of a user interface that do not support intuitive and safe use. A review of medical device operating manuals is proposed as a more practical method of usability evaluation. METHOD: Operating manuals for five volumetric infusion pumps from three manufacturers were selected for this study (January-April 2003). Each manual's safety message content was evaluated to determine whether the message indicated a device design characteristic that violated known usability principles (heuristics) or indicated a violation of an affordance of the device. RESULTS: "Minimize memory load," with 65 violations, was the heuristic violated most frequently across pumps. Variations between pumps, including the frequency and severity of violations for each, were noted. DISCUSSION: Results suggest that manual review can provide a proxy for heuristic evaluation of the actual medical device. This method, intended to be a component of prepurchasing evaluation, can complement more formal usability evaluation methods and be used to select a subset of devices for more extensive and formal testing.

Equipment and Supplies↗

PubMed2005

The significance of cognitive modeling in building healthcare interfaces.

BACKGROUND: Although there are many reasons that widespread adoption of healthcare information systems has not transpired, one reason is a failure to take into account the cognitive needs of the users. AIM: To understand the cognitive needs of nurses and physicians and determine how these needs should influence the design of healthcare interfaces. DESIGN OF STUDY: A qualitative and quantitative study that compares how nurses and physicians comprehend patient information. SETTING: Twenty-four registered nurses and twenty-four physicians working in the specialties of gastrointestinal or internal medicine. METHODS: Each clinician reviewed two mock electronic medical records and summarized the cases using a think-aloud protocol. All verbalizations were coded for medical and conceptual information. RESULTS: The nurses included a larger mean proportion (p<0.001) of recalls than did the physicians. As compared to the nurses, the physicians included a statistically significant (p<0.001) larger mean proportion of inferences, conditional statements, and interventions. The nurses concentrated on functional problems, whereas the physicians focused on diagnosis, treatment, and management. CONCLUSION: The main cognitive differences between the physicians and the nurses are explained through the differences in their practice models. Therefore, healthcare IT must develop separate interfaces for each discipline to address their unique needs.

Adult↗

PubMed2005

Human-centered design of a distributed knowledge management system.

Many healthcare technology projects fail due to the lack of consideration of human issues, such as workflow, organizational change, and usability, during the design and implementation stages of a project's development process. Even when human issues are considered, the consideration is typically on designing better user interfaces. We argue that human-centered computing goes beyond a better user interface: it should include considerations of users, functions and tasks that are fundamental to human-centered computing. From this perspective, we integrated a previously developed human-centered methodology with a Project Design Lifecycle, and we applied this integration in the design of a complex distributed knowledge management system for the Biomedical Engineer (BME) domain in the Mission Control Center at NASA Johnson Space Center. We analyzed this complex system, identified its problems, generated systems requirements, and provided specifications of a replacement prototype for effective organizational memory and knowledge management. We demonstrated the value provided by our human-centered approach and described the unique properties, structures, and processes discovered using this methodology and how they contributed in the design of the prototype.

Artificial Intelligence↗

PubMed2005

Interruptions in workflow for RNs in a Level One Trauma Center.

An understanding of interruptions in healthcare is important for the design, implementation, and evaluation of health information systems and for the management of clinical workflow and medical errors. The purpose of this study is to identify and classify the types of interruptions experienced by ED nurses working in a Level One Trauma Center. This was an observational field study of Registered Nurses employed in a Level One Trauma Center using the shadowing method. Results of the study indicate that nurses were both recipients and initiators of interruptions. Telephone, pagers, and face-to-face conversations were the most common sources of interruptions. Unlike other industries, the outcomes caused by interruptions resulting in medical errors, decreased efficiency and increased cost have not been systematically studied in healthcare. Our study presented here is an initial step to understand the nature, causes, and effects of interruptions, and to develop interventions to manage interruptions to improve healthcare quality and patient safety. We developed an ethnographic data collection technique and a data coding method for the capturing and analysis of interruptions. The interruption data we collected are systematic, comprehensive, and close to exhaustive. They confirmed the findings from early studies by other researchers that interruptions are frequent events in critical care and other healthcare settings. We are currently using these data to analyze the workflow dynamics of ED clinicians, identify the bottlenecks of information flow, and develop interventions to improve the efficiency of emergency care through the management of interruptions.

Communication↗

PubMed2004

Assessing informatics students' satisfaction with a web-based courseware system.

This study assessed health informatics student satisfaction with two subsequent versions of Prometheus, a web-based courseware system. Prometheus versions 4 and 5 were assessed to gauge the effect of modifications to improve the usability of the system. The Questionnaire for User Interaction Satisfaction (QUIS, version 7.0) was administered at the end of fall semester 2001 (in which Prometheus version 4 was used) and again at the end of Spring 2002 (in which Prometheus version 5 was used). QUIS contains measures of user satisfaction of the overall system and 11 specific dimensions, including screen, terminology and system information, learning, system capabilities, manuals and online help, multimedia, and teleconferencing. In general, students had favorable judgments of Prometheus, and their satisfaction level remained relatively stable across the two versions. However, usability enhancements incorporated into version 5 produced no significant differences in student satisfaction ratings. The results of this study provide a benchmark for comparing the relative usability of alternative courseware systems and demonstrate the utility of user satisfaction surveys for assessing and improving courseware systems. With increases in the need for compliance education and the education of clinicians with 'just in time knowledge', courseware systems will become an integral part of the clinical information systems, increasing the importance of usability studies such as this one.

Adult↗

PubMed2003

Outcomes and methods in telemedicine evaluation.

One hundred and four articles, published from 1966 to 2000, were reviewed to investigate telemedicine evaluation studies in terms of methods and outcomes. A total of 112 evaluations were reported in these 104 articles. Two types of evaluations were evaluated: clinical and nonclinical. Within the clinical evaluations, three were on clinical effectiveness, 26 on patient satisfaction, 49 on diagnostic accuracy, and nine on cost. In the non-clinical evaluations, 15 articles discussed technical issues relating to digital images, such as bandwidth, resolution, and color, and 10 articles assessed management issues concerning efficiency of care, such as avoiding unnecessary patient transfer, or saving time. Of the 112 evaluations, 72 were descriptive in nature. The main methods used in the remaining 40 articles used quantitative methods. Nineteen articles employed statistical techniques, such as receiver operating characteristics curve (three evaluations) and kappa values (seven evaluations). Only one article utilized a qualitative approach to describe a telemedicine system. Currently, there are a number of good reports on diagnostic accuracy, satisfaction, and technological evaluation. However, clinical effectiveness and cost-effectiveness are important parameters, and they have received limited attention. Since telemedicine evaluations tend to explore various outcomes, it may be appropriate to evaluate from a multidisciplinary perspective, and to utilize various methodologies.

Humans↗

PubMedDate not supplied

Taking it to the streets: recording medical outreach data on personal digital assistants.

Carrying hundreds of patient files in a suitcase makes medical street outreach to the homeless clumsy and difficult. Healthcare for the Homeless--Houston (HHH) began a case study under the assumption that tracking patient information with a personal digital assistant (PDA) would greatly simplify the process. Equipping clinicians with custom-designed software loaded onto Palm V Handheld Computers (palmOne, Inc, Milpitas, CA), Healthcare for the Homeless--Houston assessed how this type of technology augmented medical care during street outreach to the homeless in a major metropolitan area. Preliminary evidence suggests that personal digital assistants free clinicians to focus on building relationships instead of recreating documentation during patient encounters. However, the limits of the PDA for storing and retrieving data made it impractical long-term. This outcome precipitated a new study to test the feasibility of tablet personal computers loaded with a custom-designed software application specific to the needs of homeless street patients.

Community-Institutional Relations↗