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PubMed1991

Cognitive representations, control, and understanding of complex systems: a field study focusing on components of users' mental models and expert/novice differences.

Users' mental models of systems are frequently asserted to be important in their interactions with those systems. Although there are few explicit definitions of mental models in the literature, mental models are assumed to be important and researchers have seemed to accept and understand the concept intuitively. In our research, we have extracted three themes from the definitions of mental models including: (1) the relations among features or components of a system; (2) the capability of the mental model to aid in the control of the system; and (3) the capability of the mental model to enhance the user's understanding of the system. The relationships among the components of users' mental models, including procedural and declarative knowledge, perceptions of the use of system features, and the relations among the similarity of use of system features, were investigated in a field study. Trained and untrained novice users of a new business phone system rated the similarity of use of nine standard features on the phone. These ratings were used to derive cognitive representations of the relations among the system features. Users' ratings of features on univariate scales about the use of the features and scores obtained on a test of procedural knowledge were related to these representations. The two novice groups' mental models were similar except for the perception of one feature; it was more accurately depicted in the trained users' representation than those who did not attend a training programme. Two types of experts' similarity of use ratings were evaluated to determine an 'appropriate' representation of the use of the system features; this was then compared to the novices'. This comparison suggested that there were deficiencies in the mental models of novices. Designing training programmes and instructional aids for systems using the discrepancies between novices' and experts' mental models are discussed.

Adult↗
PubMed1999

Evidence-based practice. Data day.

A project assessing the feasibility of using research data in routine clinical practice showed that most clinicians found it too time-consuming. Obtaining relevant research articles took an average of three days with an on-site library, and a week without one. The most serious barrier was the poor state of the information itself. Investment should focus on developing the information, followed by effective and easy-to-use search methods.

Attitude of Health Personnel↗
PubMed2000

A move to electronic patient records in the community: a qualitative case study of a clinical data collection system, problems caused by inattention to users and human error.

With the move toward electronic patient records, many U.K. National Health Service (NHS) Trusts are using computers to make their workforces more clinically effective. This article examines one such system where clinicians are using hand-held computers to maintain up-to-date records on their clients. The effectiveness of the system is measured using standard human computer interaction concepts. The results are considered, leading us to the conclusion that for the effective use of information technology, industry and the NHS must ensure that the whole lifecycle of a project is considered together with its impact on users and its integration with the rest of the information systems.

Computer User Training↗
PubMed2005

Developing computer skills and competencies in seniors.

We developed a training protocol for elderly participants of a home telemedicine study, grounded in prior usability research. The training aimed to reduce barriers in developing system mastery. Our findings are indicative of both the promises and challenges involved in bridging the digital divide. Sixteen participants of a diabetes study were trained to use the computer applications.

Aged↗
PubMed2005

Use of libraries and electronic information resources by primary care staff: outcomes from a survey.

OBJECTIVES: To assess the use of existing libraries; usage of the Internet and biomedical databases; and need for training on use of the Internet and biomedical databases for primary care staff. METHODS: A postal survey of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Nottingham and Rotherham, UK. RESULTS: Overall, 243 questionnaires were used. The response rate in Nottingham was 24%, in Rotherham it was 34%. Reported use of libraries was low (30%), with PNs reporting significantly higher usage (65%) than others (P < 0.01). Most respondents reported using the Internet (81%), but fewer (44%) reported using databases. GPs and PNs were significantly more likely to report using databases than PMs (P < 0.01). Lack of training was the most reported barrier to using the Internet (67%) and databases (52%). Overall, 52% of respondents reported wanting Internet training, 64% wanted database training. The percentages requesting training on databases were high among GPs and PNs, but significantly lower for PMs (P = 0.02). CONCLUSIONS: There are differences in the usage of libraries and electronic resources among the primary care team, and in reported training needs. While the reported levels of usage of the Internet and biomedical databases are encouraging, our study identified a training need. If met, this could increase usage further.

Adult↗
PubMed1992

The CD-ROM experience at Loma Linda: the issues of training, logistics, and creative financing.

Since the end of 1987, the Medical Center and University libraries at Loma Linda have progressed from stand-alone CD-ROM-based workstations for access to MEDLINE to networked CD-ROM access to a variety of databases. T.O.M.M.I. (Total Online Medical Material Integration) is a CD-ROM-based wide area network linking the Loma Linda University Medical Center, Loma Linda University, and other entities in Loma Linda, California. T.O.M.M.I., a microcomputer-based system, represents the implementation of IAIMS at Loma Linda. In addition to discussing the issue of "downsizing" campus-wide information networks, this article focuses on the issues of training, handling of logistical problems, and the use of creative financing.

CD-ROM↗
PubMed2004

Identifying barriers to the effective use of clinical reminders: bootstrapping multiple methods.

Advances in electronic medical record capabilities enable clinical reminders to inform providers when recommended actions are "due" for a patient. Despite evidence that they improve adherence to guidelines, the Veteran's Health Administration (VHA) has experienced challenges in having providers consistently use clinical reminders as intended. In this paper, we describe how multiple methods were used to opportunistically triangulate, or "bootstrap," an understanding of barriers to the effective use of clinical reminders in the VHA. In an initial study using ethnographic observations and semi-structured interviews of HIV clinical reminders, we identified six barriers to effective use: workload, time to remove inapplicable reminders, false alarms, training, reduced eye contact, and the use of paper forms rather than software. In a second study, we collected open-ended and closed-ended data regarding barriers and facilitators to the use of clinical reminders in general in the VHA through a survey of 261 participants at a national informatics meeting, where 104 of 142 VHA health care facilities were represented. The findings from the second study extended our understanding of the previously identified barriers. In addition, four new barriers were identified: ease of use issues, accessibility of workstations, resident physicians and trainees, and administration benefiting more than providers from clinical reminder use. We discuss potential implications regarding the similarities and differences in study findings for factors to consider in planning interventions to improve clinical reminder use.

Appointments and Schedules↗
PubMed1989

Management of microsystems at Forbes Health System.

Support for purchase and operation of microsystems hardware and software at Forbes Health System in Pittsburgh, Pennsylvania is provided by Management Engineering, part of the Management Systems Division. Five key areas of support are described in this paper: Purchase Control, Installation Management, Operational Support, Development Services and Training Management. Discussion of multiple training options, centralized hardware support and specialized levels of end user operational support are included. Some future directions in software and hardware utilization are also presented.

Computer User Training↗
PubMed1996

Preparing physicians for practice in managed care environments.

The author first describes the evolution and characteristics of managed care and its emphasis on the care of populations as well as individuals. She then reviews managed care's implications for medical education; for example, managed care physicians must know non-office-based approaches to keeping their patients healthy. She identifies and defines eight domains of knowledge in which physicians must be competent for practice in environments dominated by managed care. These are epidemiologic thinking, human behavior, organizational behavior, information systems, quality measurement and improvement, health system financing and delivery, ethics, and systems based care. Teaching students to practice in managed care environments is a challenge partly because there are few role models of the new breed of physician among medical school faculties. The author suggests strategies and attitudes to remedy this situation (for example, faculty must understand that managed care is not homogeneous and that it is not all bad; medical schools should develop "master teachers" for the rest of the faculty; and interactive CD-ROM-driven problem-based learning sets could be used). Focusing on training faculty for the new era and on emphasizing the eight knowledge better physicians, whether they practice inside or outside managed care.

Behavior↗
PubMed2005

Factors affecting people with intellectual disabilities in learning to use computer technology.

Using information technology (IT) in work and leisure has become an essential part of life. However, people with intellectual disabilities (ID) may have difficulties in learning the complex skills involved in IT. The aim of this study was to explore (1) level of competency in IT, (2) requirements to learn IT and (3) factors related to IT competency for people with ID. Three-hundred-and-fifty-three adults (age 16 years or above, mean age=28.77 years) with ID were assessed on basic IT skills using a self-developed skill-based checklist including the use of the keyboard and mouse and getting onto the Internet. A short questionnaire was sent out to the parents and caregivers to explore the various factors affecting the learning-teaching process. Results indicated that only 6.2% (22) of the participants knew how to operate the keyboard and mouse and 9.1% (32) were able to get onto the Internet; 33.1% of participants could not operate the computer system at all. Younger people with ID and with mild-grade ID have better IT skills. Three-hundred-and-twenty-seven (92.6%) caregivers reported that although they had a computer in their home or at their work place, people with ID were not given any opportunity to use it. They also reported difficulties in training people with ID to use IT due to insufficient knowledge on training techniques and a lack of software that is suitable for training. As modern society relies more and more on IT in daily activities, the poor computer competency of people with ID may lower their level of participation in leisure, functional and vocational aspects of life. Their general perception was that with sufficient training and support, people with ID could also join the world of IT.

Adolescent↗
PubMed2006

Systematic evaluation of current control devices used by people with intellectual disabilities in non-immersive virtual environments.

Virtual environments have a role to play in facilitating the acquisition of living skills in people with intellectual disabilities, improving their cognitive skills and providing them with entertainment. However, the currently recommended devices to allow navigation in and interaction with the environments are difficult to use. Using a methodology established in an earlier study, the study aims to systematically document the performance of users with the currently recommended devices in order to (i) inform the design of a usable control device or devices and (ii) act as a baseline against which they can be evaluated. 40 people with severe intellectual disabilities aged 21-67 years used four environments with an equal number of sessions with the different devices being evaluated. Results indicate that when forward movement is provided by the software using the mouse for both navigation and interaction allows better performance both initially and after exposure than using the fire button on the joystick. When the user had to initiate forward movement with the navigation device, the joystick allowed better performance than the arrows on the keyboard. Preventing slippage of the joystick base would make its use much easier and it is suggested that separate devices are retained for navigation and interaction.

Adult↗
PubMed1999

A feasibility study of two methods for end-user configuration of a clinical event monitor.

We developed and evaluated a feature that allows users to control what types of clinical information are delivered to them. Using a paper or web-based configuration form, users turn individual alerts and sets of results on or off, and set how they are delivered. We used usage rates to evaluate this feature. Of 16 residents who had received clinical information from our clinical event monitor, 4 (25%) made at least one change (range 10-25). Of 41 interns, 5 (12.2%) made at least one change (range 5-91). The difference was borderline significant (p < 0.1). 5/7 web users changed preferences through a dial-up connection from home. More users used the web-based preference form than the paper form. This difference may be due to the better accessibility of the web-based form. A survey established that this feature was not as highly utilized as anticipated partly because the initial (default) preference setting was acceptable and partly because the users were too busy to customize their alert settings. We conclude that user configuration of a system that delivers information using a web-based preference form is feasible and may become important as the volume of information and number of available communication channels increase.

Attitude to Computers↗
PubMed1991

End-user participation in the needs assessment for a clinical information system.

The successful introduction of a new information system requires technological and behavioral changes. Intended users of the new system should participate in defining goals for the system, examining alternatives for achieving these goals, and selecting from these alternatives. Broad-based end-user involvement is especially useful during the needs assessment (goal definition) phase, both to identify the diverse expectations of the end-user community and to develop a sense of system ownership by these users. System planners can stimulate active end-user involvement by inviting each constituent user group (for example, each hospital department) to assume responsibility for specifying its objectives for the new system. The collection of all groups' objectives defines the organization's expectations of a new system, provides a means for comparing systems, and aids in predicting the overall acceptance of any proposed system. Each constituent group's list of objectives likewise provides a measure of anticipated acceptance for that group.

Computer User Training↗