Biomedical subjects

Richard S Marken

Publications and source records attributed to Richard S Marken.

6 recordsLinked to original sources

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

Optical trajectories and the informational basis of fly ball catching.

D. M. Shaffer and M. K. McBeath (see record 2002-02027-006) plotted the optical trajectories of uncatchable fly balls and concluded that linear optical trajectory is the informational basis of the actions taken to catch these balls. P. McLeod, N. Reed, and Z. Dienes (see record 2002-11140-016) replotted these trajectories in terms of changes in the tangent of optical angle over time and concluded that optical acceleration is the informational basis of fielder actions. Neither of these conclusions is warranted, however, because the optical trajectories of even uncatchable balls confound the information that is the basis of fielder action with the effects of those same actions on these trajectories. To determine the informational basis of fielder action, it is necessary to do the control-theory-based Test for the Controlled Variable, in which the informational basis of catching is found by looking for features of optical trajectories that are protected from experimentally or naturally applied disturbances.

Baseball↗

PubMed2003

Error in skilled performance: a control model of prescribing.

A control model of skilled performance is proposed as a framework for understanding why prescribing errors occur at a particular rate. Model error rate depends on skill level, system design characteristics, the range of different types of prescriptions that are produced and the time available to complete each prescription. The parameters of the model can be adjusted so it produces error rates that are quantitatively equal to those found in studies of the incidence of different types of prescribing error. The model will also produce error rates that are qualitatively consistent with the results of studies that show increases in prescribing error rates as a result of increases in distractions and workload. The model is used to determine the likely effectiveness of different prescribing error prevention interventions.

Attention↗

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↗

PubMed1986

Perceptual organization of behavior: a hierarchical control model of coordinated action.

The behavior of individual subjects is compared with a hierarchical control system model of behavioral organization. Subjects varied the position of two control handles simultaneously to keep the distance constant between two pairs of lines. Three variations on this basic experiment that illustrate some fundamental properties of coordinated action are shown: first, how independent actions, compensating for unpredictable and undetectable disturbances, can produce a single behavioral result; second, how the ability to produce a particular result is maintained when the connection between action and result is changed; and third, how two independent outputs can appear to be related as coordinative structures when one output disturbs a result being controlled by the other. The correlation between the behavior of subjects and model in all experiments is typically on the order of .99. A detailed examination of the operation of the model shows that actions are structured by perception, not by central commands or equations of constraint.

Goals↗

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↗