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Biomedical subjects

Vimla L Patel

Publications and source records attributed to Vimla L Patel.

At least 19 recordsLinked to original sources
PubMed2006

Towards a hybrid method to categorize interruptions and activities in healthcare.

OBJECTIVE: Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper, a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular as well as improving healthcare quality and patient safety in general. METHOD: The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory. RESULTS: The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case. CONCLUSIONS: Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Communication↗
PubMed2006

The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care.

Several studies have shown that there is information loss during interruptions, and that multitasking creates higher memory load, both of which contribute to medical error. Nowhere is this more critical than in the emergency department (ED), where the emphasis of clinical decision is on the timely evaluation and stabilization of patients. This paper reports on the nature of multitasking and shift change and its implications for patient safety in an adult ED, using the methods of ethnographic observation and interviews. Data were analyzed using grounded theory to study cognition in the context of the work environment. Analysis revealed that interruptions within the ED were prevalent and diverse in nature. On average, there was an interruption every 9 and 14 min for the attending physicians and the residents, respectively. In addition, the workflow analysis showed gaps in information flow due to multitasking and shift changes. Transfer of information began at the point of hand-offs/shift changes and continued through various other activities, such as documentation, consultation, teaching activities and utilization of computer resources. The results show that the nature of the communication process in the ED is complex and cognitively taxing for the clinicians, which can compromise patient safety. The need to tailor existing generic electronic tools to support adaptive processes like multitasking and handoffs in a time-constrained environment is discussed.

Continuity of Patient Care↗
PubMed2006

Workflow modeling in critical care: piecing together your own puzzle.

The intensive care unit (ICU) is an instance of a very dynamic health care setting where critically ill patients are being managed. To provide good care, an extensive and coordinated communication amongst the role players, use of numerous information systems and operation of devices for monitoring and treatment purposes are required. The purpose of this research is to study error evolution and management within this environment. The focus is on representing the workflow of critical care environment, which emphasizes the importance such a representation may play in strategizing the management of medical errors. We used ethnographic observation and interview data to build individual pieces of the workflow, dependent on the individual and the activity concerned. Key personnel were intensively followed during their respective patient care activities and the related actions. All interactions were recorded for analysis. These clinicians and nurses were interviewed to complement the observation data and to delineate their individual workflows. These pieces of the ICU workflow were used to develop a generalize-able cognitive model to represent the intricate workflow applicable to other health care settings. The proposed model can be used to identify and characterize medical errors and for error prediction in practice.

Critical Care↗
PubMed2006

The role of emotion in decision-making: a cognitive neuroeconomic approach towards understanding sexual risk behavior.

Models of decision-making usually focus on cognitive, situational, and socio-cultural variables in accounting for human performance. However, the emotional component is rarely addressed within these models. This paper reviews evidence for the emotional aspect of decision-making and its role within a new framework of investigation, called neuroeconomics. The new approach aims to build a comprehensive theory of decision-making, through the unification of theories and methods from economics, psychology, and neuroscience. In this paper, we review these integrative research methods and their applications to issues of public health, with illustrative examples from our research on young adults' safe sex practices. This approach promises to be valuable as a comprehensively descriptive and possibly, better predictive model for construction and customization of decision support tools for health professionals and consumers.

Adolescent↗
PubMed2006

Shaping understanding of HIV through negotiation and conflict resolution during peer group discussion.

High-risk behavior in youths related to HIV transmission continues to occur despite large-scale efforts to disseminate information about safe sexual practices through education. Our study examined the relationships among knowledge, decision-making strategies, and risk assessment about HIV by youths during peer group focused discussions. Two focus groups with first-year college students were conducted, with a series of questions about risk for HIV transmission as prompts. All group interactions were recorded, transcribed and analyzed using methods of discourse analysis to characterize a detailed description of the interactions. The results indicated that youths negotiated their perspectives with the use of justification and elaboration to support alternative opinions and positions. They used concrete experiential examples to further explain and illustrate their positions, Opposing views or arguments met with requests for clarification and further negotiation. This cycle of clarification-negotiation shaped their understanding of HIV-related concepts. The use of strategies, such as justification of alternative positions and the use of examples as support for arguments to clarify and negotiate various perspectives, could be used as a tool for designing educational programs to improve understanding of health related issues, such as HIV transmission and prevention.

Adult↗
PubMed2006

Clinical cognition and biomedical informatics: Issues of patient safety.

Recent developments in biomedical informatics research have afforded possibilities for great advances in health care delivery. As in most domains, there is a gulf between technologic artifacts and end users, which compromises the culture of safety in the workplace. This necessitates a broadening of disciplinary boundaries to consider cognitive and social factors related to the design and use of technology. The authors argue for a place of prominence for cognitive science in understanding nursing factors associated with patient safety. Cognitive science provides a framework for the analysis and modeling of complex human performance. Studies of clinical cognition can meaningfully inform and shape design, development, and assessment of information systems. Furthermore, they have a decisive impact on whether information technology has a positive influence on human performance and are especially important in understanding and promoting safe practices. These issues are discussed in the context of clinical informatics with a focus on nursing practice.

Cognitive Science↗
PubMed2006

An automated approach to studying health resource and infobutton use.

Many studies have found that clinicians require access to medical knowledge sources while viewing data in their patients' health records. To address this need, we have been developing links to various on-line health information resources from our Web-based clinical information system (WebCIS). Clinicians can access these resources through a "Health Resources" Web page or use context-sensitive "infobuttons" that automatically link to specific resources. To assist in understanding how clinicians interact with these two mechanisms, we have been exploring the use of an automated approach to answer questions about usage for guiding the further development of links to resources. In this paper, we discuss the use of a knowledge discovery technique (CIS Usage Mining) to obtain usage statistics from log files that record interactions with health resources and infobuttons in WebCIS, describe a Web-based interface developed to present the results, and summarize how the results could be applied. The availability of effective links to on-line medical knowledge sources from the patient health record can assist in resolving information needs, potentially improving patient care and decision-making.

Access to Information↗
PubMed2006

Knowledge content of advance practice nurse and physician experts: A cognitive evaluation of clinical practice guideline comprehension.

Clinical practice guidelines (CPGs) are intended to provide evidence based knowledge for decision making for patient care. However, these guidelines have been poorly adopted by healthcare providers. One reason for this may be the static paper-based formats, isolated from the point of care. Biomedical informatics has provided a solution to this limitation through Computer Interpretable Guidelines (CIGs). An essential component of this process is CPG translation to a computer interpretable model. From the guideline modeling literature, the translators of CPGs typically are physicians. It is not known if other healthcare providers (i.e., Advance Practice Nurses [APNs]) comprehend CPGs similarly. This descriptive study utilized novice and expert APN and physician participants (varied by level of expertise) in a CPG comprehension task. Demographic data, verbal protocols, and recall model drawings were obtained and analyzed by description, protocol analysis, discourse analysis, and content analysis. The findings of this study indicate similar comprehension by the expert APNs and physicians suggesting that either type of expert may be utilized for modeling CPGs.

Comprehension↗
PubMed2005

Heuristic evaluation of paper-based Web pages: a simplified inspection usability methodology.

Online medical information, when presented to clinicians, must be well-organized and intuitive to use, so that the clinicians can conduct their daily work efficiently and without error. It is essential to actively seek to produce good user interfaces that are acceptable to the user. This paper describes the methodology used to develop a simplified heuristic evaluation (HE) suitable for the evaluation of screen shots of Web pages, the development of an HE instrument used to conduct the evaluation, and the results of the evaluation of the aforementioned screen shots. In addition, this paper presents examples of the process of categorizing problems identified by the HE and the technological solutions identified to resolve these problems. Four usability experts reviewed 18 paper-based screen shots and made a total of 108 comments. Each expert completed the task in about an hour. We were able to implement solutions to approximately 70% of the violations. Our study found that a heuristic evaluation using paper-based screen shots of a user interface was expeditious, inexpensive, and straightforward to implement.

Computer Graphics↗
PubMed2005

Clinical cognition and biomedical informatics: issues of patient safety.

Recent developments in biomedical informatics research have afforded possibilities for great advances in health care delivery. These exciting opportunities also present a number of challenges to the implementation and integration of technologies in the workplace. As in most domains, there is a gulf between technologic artifacts and end users, which compromises the culture of safety in the workplace. Because clinical practice is a human endeavor, there is a need for bridging disciplines to enable clinicians to benefit from rapid technologic advances. This, in turn, necessitates a broadening of disciplinary boundaries to consider cognitive and social factors related to the design and use of technology. The authors argue for a place of prominence for cognitive science in understanding nursing factors associated with patient safety. Cognitive science provides a framework for the analysis and modeling of complex human performance. Studies of clinical cognition can meaningfully inform and shape design, development and assessment of information systems. Furthermore, they have a decisive impact on whether information technology has a positive influence on human performance and are especially important in understanding and promoting safe practices. These issues are discussed in the context of clinical informatics with a focus on nursing practice.

Biomedical Engineering↗
PubMed2005

Interpreting procedures from descriptive guidelines.

Errors in clinical practice guidelines may translate into errors in real-world clinical practice. The best way to eliminate these errors is to understand how they are generated, thus enabling the future development of methods to catch errors made in creating the guideline before publication. We examined the process by which a medical expert from the American College of Physicians (ACP) created clinical algorithms from narrative guidelines, as a case study. We studied this process by looking at intermediate versions produced during the algorithm creation. We identified and analyzed errors that were generated at each stage, categorized them using Knuth's classification scheme, and studied patterns of errors that were made over the set of algorithm versions that were created. We then assessed possible explanations for the sources of these errors and provided recommendations for reducing the number of errors, based on cognitive theory and on experience drawn from software engineering methodologies.

Artificial Intelligence↗
PubMed2005

Comprehensive analysis of a medication dosing error related to CPOE.

This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological reconstruction of events and their interdependencies from provider order entry usage logs, semistructured interviews with involved clinicians, and interface usability inspection of the ordering system. Information collected from all sources was compared and evaluated to understand how the error evolved and propagated through the system. In this case, the error was the product of faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. The authors characterized errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of the authors' analysis were used to formulate specific recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps of the KCl ordering process to reduce the risk of future medication dosing errors.

Aged↗
PubMed2005

Participant perceptions of the influences of the NLM-sponsored Woods Hole medical informatics course.

This report provides an evaluation of the National Library of Medicine-sponsored Woods Hole Medical Informatics (WHMI) course and the extent to which the objectives of the program are achieved. Two studies were conducted to examine the participants' perceptions of both the short-term (spring 2002) and the long-term influences (1993 through 2002) on knowledge, skills, and behavior. Data were collected through the use of questionnaires, semistructured telephone interviews, and participant observation methods to provide both quantitative and qualitative assessment. The participants of the spring 2002 course considered the course to be an excellent opportunity to increase their knowledge and understanding of the field of medical informatics as well as to meet and interact with other professionals in the field to establish future collaborations. Past participants remained highly satisfied with their experience at Woods Hole and its influence on their professional careers and their involvement in a broad range of activities related to medical informatics. This group considered their knowledge and understanding of medical informatics to be of greater quality, had increased their networking with other professionals, and were more confident and motivated to work in the field. Many of the participants feel and show evidence of becoming effective agents of change in their institutions in the area of medical informatics, which is one of the objectives of the program.

Fellowships and Scholarships↗
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

Designing the design phase of critical care devices: a cognitive approach.

In this study, we show how medical devices used for patient care can be made safer if various cognitive factors involved in patient management are taken into consideration during the design phase. The objective of this paper is to describe a methodology for obtaining insights into patient safety features--derived from investigations of institutional decision making--that could be incorporated into medical devices by their designers. The design cycle of a product, be it a medical device, software, or any kind of equipment, is similar in concept, and course. Through a series of steps we obtained information related to medical errors and patient safety. These were then utilized to customize the generic device design cycle in ways that would improve the production of critical care devices. First, we provided individuals with different levels of expertise in the clinical, administrative, and engineering domains of a large hospital setting with hypothetical clinical scenarios, each of which described a medical error event involving health professionals and medical devices. Then, we asked our subjects to "think-aloud" as they read through each scenario. Using a set of questions as probes, we then asked our subjects to identify key errors and attribute them to various players. We recorded and transcribed the responses and conducted a cognitive task analysis of each scenario to identify different entities as "constant," "partially modifiable," or "modifiable." We compared our subjects' responses to the results of the task analysis and then mapped them to the modifiable entities. Lastly, we coded the relationships of these entities to the errors in medical devices. We propose that the incorporation of these modifiable entities into the device design cycle could improve the device end product for better patient safety management.

Cognitive Science↗
PubMed2005

Identifying reasoning strategies in medical decision making: a methodological guide.

Reasoning strategies are a key component in many medical tasks, including decision making, clinical problem solving, and understanding of medical texts. Identification of reasoning strategies used by clinicians may prove critical to the optimal design of decision support systems. This paper presents a formal method of cognitive-semantic analysis for the identification and characterization of reasoning strategies deployed in medical tasks and demonstrates its use through specific examples. Although semantic analysis was originally developed in the investigation of knowledge structures, it can also be applied to identify the reasoning and decision processes used by physicians and medical trainees in clinical tasks. Assumptions underlying the methods, as well as illustrations of their use in diagnostic explanation tasks, are presented. We discuss semantic analysis in the context of the current interests in developing medical ontologies and argue that a frame-based propositional analytic methodology can provide a systematic way of addressing the construction of such ontologies. Although the application of propositional analysis methods has some limitations, we show how such limitations are being addressed and present some examples of information tools that have been developed to ease, and make more systematic, the process of analysis.

Artificial Intelligence↗
PubMed2005

Toward a framework for understanding lay public's comprehension of disaster and bioterrorism information.

In the last decade, we have witnessed a significant increase in disaster preparedness and crisis communication efforts. This stands in sharp contrast with paucity of research that deals with the public's comprehension of disaster information and related decision-making. The objective of this paper is to outline a theoretical and methodological framework for research on lay comprehension of crisis information. The proposed framework integrates two bodies of research: (1) cognitive science literature on comprehension and decision-making and (2) studies of the effects of anxiety on performance. The paper reviews selected works and methods from both fields, discussing how cognitive perspective could be extended to include emotional factors. We also discuss how further research integrating the proposed framework with public health communication perspective could: (1) provide insights for developing effective disaster communication and (2) inform the development of technological support for disaster communication and for education of lay people and health professionals.

Bioterrorism↗