Multicenter, multidisciplinary user-centered design of a clinical decision-support and simulation system for massive transfusion.

Background: Managing critical bleeding with massive transfusion (MT) requires a multidisciplinary team, often physically separated, to perform several simultaneous tasks at short notice. This places a significant cognitive load on team members, who must maintain situational awareness in rapidly changing scenarios. Similar resuscitation scenarios have benefited from the use of clinical decision support (CDS) tools.

Massive transfusion experience, current practice and decision support: A survey of Australian and New Zealand anaesthetists.

Massive transfusions guided by massive transfusion protocols are commonly used to manage critical bleeding, when the patient is at significant risk of morbidity and mortality, and multiple timely decisions must be made by clinicians. Clinical decision support systems are increasingly used to provide patient-specific recommendations by comparing patient information to a knowledge base, and have been shown to improve patient outcomes. To investigate current massive transfusion practice and the experiences and attitudes of anaesthetists towards massive transfusion and clinical decision support systems, we anonymously surveyed 1000 anaesthetists and anaesthesia trainees across Australia and New Zealand.

CareTrack: assessing the appropriateness of health care delivery in Australia.

Objective: To determine the percentage of health care encounters at which a sample of adult Australians received appropriate care (ie, care in line with evidence-based or consensus-based guidelines).

Design, Setting And Participants: Computer-assisted telephone interviews and retrospective review of the medical records (for 2009-2010) of a sample of at least 1000 Australian adults to measure compliance with 522 expert consensus indicators representing appropriate care for 22 common conditions. Participants were selected from households in areas of South Australia and New South Wales chosen to be representative of the socioeconomic profile of Australians.

A PubMed-wide associational study of infectious diseases.

Background: Computational discovery is playing an ever-greater role in supporting the processes of knowledge synthesis. A significant proportion of the more than 18 million manuscripts indexed in the PubMed database describe infectious disease syndromes and various infectious agents. This study is the first attempt to integrate online repositories of text-based publications and microbial genome databases in order to explore the dynamics of relationships between pathogens and infectious diseases.

Computational reasoning across multiple models.

Computational support of clinical decisions frequently requires the integration of data in a variety of formats and from multiple sources and domains. Some impressive multiscale computational models of biological phenomena have been developed as part of the study of disease and healthcare systems. One can now contemplate harnessing these models arising from computational biology and using highly interconnected clinical data to support clinical decision-making.

Can cognitive biases during consumer health information searches be reduced to improve decision making?

Objective: To test whether the anchoring and order cognitive biases experienced during search by consumers using information retrieval systems can be corrected to improve the accuracy of, and confidence in, answers to health-related questions.

Design: A prospective study was conducted on 227 undergraduate students who used an online search engine developed by the authors to find health information and then answer six randomly assigned consumer health questions. The search engine was fitted with a baseline user interface and two modified interfaces specifically designed to debias anchoring or order effect.

Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians' work.

Objectives: To evaluate whether introduction of an emergency department (ED) telemedicine system changed patient management and outcome indicators and to investigate clinicians' perceptions of the impact of the system on care provided and on their work.

Design: Before-and-after study of use of the Virtual Critical Care Unit (ViCCU), which uses an ultrabroadband connection allowing real-time audiovisual communication between clinicians at distant sites. Semi-structured interviews were conducted with medical and nursing staff at the end of the study.

Is relevance relevant? User relevance ratings may not predict the impact of Internet search on decision outcomes.

Objective: A common measure of Internet search engine effectiveness is its ability to find documents that a user perceives as 'relevant'. This study sought to test whether user provided relevance ratings for documents retrieved by an Internet search engine correlate with the decision outcome after use of a search engine.

Design: 227 university students were asked to answer four randomly assigned consumer health questions, then to conduct an Internet search on one of two randomly assigned search engines of different performance, and to again answer the question.

Impact of web searching and social feedback on consumer decision making: a prospective online experiment.

Background: The World Wide Web has increasingly become an important source of information in health care consumer decision making. However, little is known about whether searching online resources actually improves consumers' understanding of health issues.

Objectives: The aim was to study whether searching on the World Wide Web improves consumers' accuracy in answering health questions and whether consumers' understanding of health issues is subject to further change under social feedback.

Do people experience cognitive biases while searching for information?

Objective: To test whether individuals experience cognitive biases whilst searching using information retrieval systems. Biases investigated are anchoring, order, exposure and reinforcement.

Design: A retrospective analysis and a prospective experiment were conducted to investigate whether cognitive biases affect the way that documentary evidence is interpreted while searching online.

What factors are associated with the integration of evidence retrieval technology into routine general practice settings?

Background: Information retrieval systems have the potential to improve patient care but little is known about the variables which influence clinicians' uptake and use of systems in routine work.

Aim: To determine which factors influenced use of an online evidence retrieval system.

Design Of Study: Computer logs and pre- and post-system survey analysis of a 4-week clinical trial of the Quick Clinical online evidence system involving 227 general practitioners across Australia.

Critical incidents and journey mapping as techniques to evaluate the impact of online evidence retrieval systems on health care delivery and patient outcomes.

Background: Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited.

Purpose And Methods: In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care.

Measuring the Impact of Online Evidence Retrieval Systems using Critical Incidents & Journey Mapping.

Online evidence retrieval systems are one potential tool in supporting evidence-based practice. We have undertaken a program of research to investigate how hospital-based clinicians (doctors, nurses and allied health professionals) use these systems, factors influencing use and their impact on decision-making and health care delivery. A central component of this work has been the development and testing of a broad range of evaluation techniques.

The impact of an online evidence system on confidence in decision making in a controlled setting.

Objective: To examine the impact of online evidence retrieval on clinicians' decision-making confidence and to determine if this differs for experienced doctors and nurses.

Methods: A sample of 44 doctors and 31 clinical nurse consultants (CNCs) answered 8 clinical scenarios (600 scenario answers) before and after the use of online evidence resources. Clinicians rated their confidence in scenario answers and in the evidence they found using the information system.

Do online information retrieval systems help experienced clinicians answer clinical questions?

Objective: To assess the impact of clinicians' use of an online information retrieval system on their performance in answering clinical questions.

Design: Pre-/post-intervention experimental design.

Measurements: In a computer laboratory, 75 clinicians (26 hospital-based doctors, 18 family practitioners, and 31 clinical nurse consultants) provided 600 answers to eight clinical scenarios before and after the use of an online information retrieval system.