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PubMed2004

Protecting the patient by promoting end-user competence in health informatics systems-moves towards a generic health computer user "driving license".

The effectiveness and quality of health informatics systems' support to healthcare delivery are largely determined by two factors-the suitability of the system installed, and the competence of the users. However, the profile of users of large-scale clinical health systems is significantly different from the profile of end-users in other enterprises such as the finance sector, insurance, travel or retail sales. Work with a mental health provider in Ireland, who was introducing a customized electronic patient record (EPR) system, identified the strong legal and ethical importance of adequately skills for the health professionals and others, who would be the system users. The experience identified the need for a clear and comprehensive generic user qualification at a basic but robust level. The European computer driving license (ECDL) has gained wide recognition as a basic generic qualification for users of computer systems. However, health systems and data have a series of characteristics that differentiate them from other data systems. The logical conclusion was the recognition of a need for an additional domain-specific qualification-an "ECDL Health Supplement". Development of this is now being progressed.

Computer Literacy↗
PubMed1994

Do general practice computer systems assist in medical audit?

This study was designed to assess the capabilities of current general practice computer software to perform medical audit. A total of 43 general practice clinical software suppliers were asked to complete a questionnaire consisting of general questions concerning their systems' responses to 85 audit questions that a practice might wish to ask in the areas of quality of care and contractual compliance. It was assumed that all systems had full patient data. Fourteen installations representing 14 systems that had been randomly selected from the responders were visited to validate the suppliers' responses. Thirty-two (74%) suppliers responded to the questionnaire and they represented 7696 installations. One supplier marketed two distinct systems giving 33 systems for analysis. The majority (52%) of responding suppliers had between 0 and 50 installations. Many shortfalls in auditing capability were demonstrated, e.g. 24% of systems were unable to audit the clinical content of a patient review, 48% were unable to audit the numbers of acute and repeat prescriptions, 51% were unable to audit emergency admissions, 70% were unable to audit the length of time a drug had been prescribed for and 85% were unable to audit the continuity of patient care. Limitations in the ability to perform even basic medical audits were demonstrated among current general practice computer systems. These have implications for the development of medical audit. Seven (21%) of the systems had no facilities for statistical analysis including percentages and 8 (24%) had no graphical abilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Technological changes in the healthcare sector. A method to assess change readiness.

This paper describes the theory, method and recent results of a study developing methods for assessment of change readiness. The empirical focus is on development and implementation of clinical IT systems in the Danish healthcare sector. To assess change readiness, a questionnaire has been developed. The questionnaire has been tested in a hospital department as a part of a pre analysis related to development and implementation of an IT quality assurance system. The study shows a general positive attitude to the IT system and the organisational changes, related to the implementation and use of the system. It also supplies the project organisation with specific information, useful to the project organisation to continue the essential dialogue with the healthcare professionals during the change process. Furthermore it provides a useful tool for planning the ongoing developing processes. Several other healthcare organisations are at the moment entering the study.

Attitude to Computers↗
PubMedDate not supplied

Computer use in an urban university hospital: technology ahead of literacy.

The linkage of patient safety and care quality to the implementation of computerized information systems assumes that clinical staff are skilled with computers. Nurses and nursing support staff increasingly require computers to carry out their work. Minimum computer competencies for nurses have been identified. The determination of whether the current nursing workforce has acquired these competencies remains uncertain. We administered a self-assessment survey to nurses and nursing support staff to determine proficiency with computer skills they might perform at work. Respondents reported inadequacies in basic and work-related computer skills. More than 28% scored themselves as having fair or poor proficiency on all skills, and more than 50% as fair or poor on five of 11 skills. Respondents over age 50 and those graduating before 1984 tended to score proficiency lower. Our study suggests that many nurses and nursing support staff may not have the minimum computer competencies to effectively and efficiently perform their work.

Adult↗
PubMed1994

Measurement of user performance and attitudes assists the initial design of a computer user display and orientation method.

OBJECTIVE: The objective of our study was to assess the acceptability of a proposed user interface to visually interfaced computer-assisted anesthesia record (VISI-CAARE), before the application was begun. The user interface was defined as the user display and its user orientation methods. METHODS: We designed methods to measure user performance and attitude toward two different anesthesia record procedures: (1) the traditional pen and paper anesthetic record procedure of our hospital, and (2) VISI-CAARE. Performance measurements included the reaction speed (identifying the type and time of an event) and completion speed (describing the event). Performance also included accuracy of the recorded time of the event and accuracy of the description. User attitude was measured by (1) the physician's rating on a scale of 0 to 9 of the potential usefulness of computers in anesthesia care; (2) willingness to use the future application in the clinical environment; and (3) user suggestions for change. These measurements were used in a randomized trial of 21 physicians, of which data from 20 were available. RESULTS: After exposure to VISI-CAARE, the experimental subjects' ranking of computer usefulness in anesthesia care improved significantly (4.2 +/- 1.1 to 7.6 +/- 1.5, p = 0.0001), as did controls' (5.2 +/- 2.6 to 8 +/- 1.5, p = 0.0019). All the volunteers were willing to try the proposed prototype clinically, when it was ready. VISI-CAARE exposure was associated with faster and more accurate reaction to events over the traditional pen and paper machine, and slower and more accurate description of events in an artificial mock setting. VISI-CAARE 1.1 demonstrated significant improvements in both reaction speed and completion speed over VISI-CAARE 1.0, after changes were made to the user display and orientation methods. CONCLUSION: With graphic user interface prototyping environments, one can obtain preliminary user attitude and performance data, even before application programming is begun. This may be helpful in revising initial display and orientation methods, while obtaining user interest and commitment before actual programming and clinical testing.

Anesthesia↗
PubMed1987

A device for spike train sampling with built-in memory.

The described interface to a digital computer measures interspike interval durations with a resolution of 10 microseconds. A built-in first-in first-out (FIFO) memory relieves the host computer from frequent I/O intensive tasks. The internal FIFO buffer can store up to 512 data words (wordlength is 16 bit) and works on the dual-port principle. This way the acquisition of a neuronal spike train is completely independent of the computer's simultaneously ongoing data access. A simple handshake protocol between the interface and the computer prevents any overhead communication. The buffer architecture of the instrument releases the host computer from high speed I/O handling schemes like real-time, clock-controlled, polling or interrupt procedures, that would request assembly language support. The body of two software, driver routines in the BASIC and the PASCAL language is presented. A complete and detailed schematic diagram of the circuitry is included.

Computer Literacy↗
PubMedDate not supplied

Utilization of a paediatric link collection by health professionals and laypersons.

The Internet is an evolving resource for health-care information. However little information exists on providers' and other web patrons' usage of the 'medical' Internet. This study aims to characterize the users of a large paediatric link collection, describe their objectives and track their use of the information provided by the site. We utilized a paediatric link collection called the Pediatric Points of Interest (POI) and a combination of a questionnaire, unique user identifier and link-tracking system to collect data about POI patrons' demographics and Internet resource utilization. During a five week period, 5216 individuals visited the POI and requested 36,187 links. The majority of users had less than one year of Internet experience and were first-time visitors to the POI. More than 83% of users were from North America. Medical professionals were more likely to return to the POI during the study period and reported visiting the POI mainly for 'medical education', 'research', 'resource identification', and 'disease specific information'; they proceeded primarily to the resource categories 'Medical Institutions and Agencies' (32%) and 'Professional Education and Resources' (28%). Laypersons expressed the greatest interest in 'disease specific information' and 'patient education' and most frequently visited the category. 'Patient Education' (42%). On average, users were able to identify resources related to their stated goals within one level of searching. Health care providers and other web patrons are actively utilizing Internet sites to seek medical information and are able to identify resources with a minimum of searching.

Adolescent↗
PubMed1999

Information literacy in an undergraduate nursing curriculum: development, implementation, and evaluation.

With the increasing complexity of nursing practice and health care delivery, developing information literacy in students for lifelong learning is a vital element of nursing education. The San Francisco State University School of Nursing has developed, implemented, and evaluated an integrated program of information literacy in its undergraduate curriculum. The curriculum strand includes a variety of instructional strategies woven through all semesters of the nursing program. To evaluate the information literacy program, an exploratory descriptive approach was taken using two different cohorts of students. Baseline testing prior to implementation of the information literacy program and posttesting after implementation of the program revealed selected positive occurrences in students' use of bibliographic databases and journal literature. However, students did not perceive they were more successful in accessing information, and faculty assessment of students' ability to evaluate information did not change from 1992 to 1996. These and other evaluation findings have implications for the development of an information literacy curriculum and its integration with other facets of student learning.

Computer Literacy↗
PubMed1997

Challenges for medical informatics in the 21st century.

This paper introduces the topic of this special issue: challenges for medical informatics in the 21st century. This paper discusses the nature of medical informatics. Some descriptions and definitions of medical informatics are reviewed. Then the research aspects of medical informatics are discussed. It is argued that the more mundane aspects of medical informatics like system development and implementation are important and need further consideration, especially concerning social aspects and correctness.

Computer Literacy↗
PubMed1997

Caught in the Web. Combating work stress in the information age.

The computer, the fax, the cell phone, the pager--all the trappings of the information age--cause much stress in the workplace. Mastering these gadgets--knowing how and when to use them and dealing with the barrage of messages generated by them--is essential to maintaining workplace sanity.

Clinical Laboratory Information Systems↗
PubMed1997

Preparing the next generation of clinicians to manage information.

Curriculum development in informatics must be underpinned by knowledge of the information environment new recruits encounter after qualification. A pilot study was carried out to identify the type of information handling tasks newly qualified healthcare professionals are expected to undertake. This data was related to the skills junior staff possess at the point of entry to hospital posts. Data was collected on the opportunities these recently qualified individuals had to acquire IT skills and generic competence in information handling in their prequalification courses. Self-report data was supplemented by direct observation of junior staff on the wards. In addition to investigating the perspective of the junior staff, the study also explored the attitudes and expectations of senior clinicians, educationalists and NHS trust staff. The purpose of the study was to provide guidance to those involved in developing informatics curricula for clinical students at the prequalification stage. This paper reports some of our preliminary findings.

Adult↗
PubMed1998

Understanding, navigating and communicating knowledge: issues and challenges.

This paper presents a psychological perspective on key issues related to medical vocabularies. There have been rapid advances in the development of computer technology underlying medical information systems. However, in keeping with technological progress, we must also take into account advances in our understanding of human behaviour and learn from failures in human performance. A central issue examined in this paper is the extent to which we can develop generic vocabularies that are also flexible and adaptable to specific situations. Empirical research indicates that variability in human performance is much greater than what current medical classifications take into account. A related challenge is that of how to best develop vocabularies that meet the needs of users. Based on theoretical perspectives and research emerging from the domain of cognitive psychology, we suggest that an understanding of the cognitive mechanisms underlying the comprehension and application of terminology is required. It is argued that rather than beginning with highly specified terminologies, i.e. the normative approach, we might instead begin by examining the natural context of how health care workers acquire, understand and negotiate knowledge in practice.

Artificial Intelligence↗
PubMed2002

Health literacy: a review.

Illiteracy has become an increasingly important problem, especially as it relates to health care. A national survey found that almost half of the adult population has deficiencies in reading or computation skills. Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English-speaking patients do not have adequate functional health literacy. The consequences of inadequate health literacy include poorer health status, lack of knowledge about medical care and medical conditions, decreased comprehension of medical information, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates, increased hospitalizations, and increased health care costs. The medical community must acknowledge this issue and develop strategies to ensure that patients receive assistance in overcoming the barriers that limit their ability to function adequately in the health care environment.

Educational Status↗
PubMed2005

Goal orientation and its relationship to academic success in a laptop-based BScN program.

This longitudinal study, conducted within a laptop-based BScN program examines the relationship of goal orientation profiles to comfort with technology and academic success. In phase 1 of this study, 101 first year nursing students completed an on line survey. The measurement tools used were Goal Orientation Assessment, Multiple Intelligences Learning Inventory and a locally developed Technology Comfort survey. Results showed that students were predominantly high in the mastery goal orientation profile. Males had a higher comfort level with technology. Age was inversely related to comfort with technology. An unexpected finding was that grade point average was inversely related to comfort with use of technology. The data did not support the commonly held belief that today's students are uniformly well-skilled and comfortable with new technologies. This study will continue over the next three years and will allow comparison of variables over time. Specific teaching interventions may be developed to accommodate varying learning and motivational styles in relation to comfort with technology.

Adult↗
PubMed2006

A user-centred deployment process for ICT in health care teams--experiences from the OLD@HOME project.

OBJECTIVE: To present a user-centred method for introducing ICT in health care organisations, taking factors that influence acceptance into account. METHODS: User centred methods are used in combination with previous research regarding factors that affect user acceptance, in order to facilitate users' acceptance of new ICT tools. RESULTS: A method is presented that supports the introduction of ICT in team work. The method consists of three major steps; (1) the start-up seminar, (2) end user education and (3) continuous follow-up during the deployment phase. Important results of the start-up seminar are documentation of the users' expectations, and an agreement of ground rules that supports both the social norm factor and the users' perceived behavioural control. Education and follow-up also improve perceived behavioural control, and by involving super users perceived usefulness and ease of use can be improved through subjective norm. CONCLUSION: Key factors in the deployment process are; user participation, end user experience and education, and continuous follow-up of the process.

Computer Literacy↗
PubMed1994

Navigating the Internet.

Navigating any complex set of information resources requires tools for both browsing and searching. A number of tools are available today for using Internet resources, and more are being developed. This article reviews existing navigational tools, including two developed at the Yale University School of Medicine, and points out their strengths and weaknesses. A major shortcoming of the present Internet navigation methods is the lack of controlled descriptions of the available resources. As a result, navigating the Internet is very difficult.

Computer Communication Networks↗