A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.

To determine whether a clinical decision support system can favorably impact the delivery of emergency department and hospital services. Randomized clinical trial of three clinical decision support delivery modalities: email messages to care managers (email), printed reports to clinic administrators (report) and letters to patients (letter) conducted among 20,180 Medicaid beneficiaries in Durham County, North Carolina with follow-up through 9 months. Patients in the email group had fewer low-severity emergency department encounters vs.

Clinical and economic results from a randomized trial of clinical decision support in a rural health network.

Background: Replication studies evaluate technologies in usual use settings.

Methods: We conducted a clinical trial to determine whether reductions in clinical and economic results observed in a previous study could be replicated in a larger setting. Subjects were randomized to receive intervention (email notifications for sentinel health events sent to their care managers) or control.

A randomized clinical trial of clinical decision support in a rural community health network serving lower income individuals: study design and baseline characteristics.

Lower income individuals in the US frequently experience difficulties in obtaining access to needed health care services. We describe a randomized clinical trial that seeks to improve the quality of, and access to healthcare services for medically underserved populations in five rural counties of North Carolina. We propose to achieve these improvements by implementing system-to-system integration via a telehealth network with an asynchronous clinical decision support system for health care providers.

Facilitating consumer clinical information seeking by maintaining referential context: evaluation of a prototypic approach.

Millions of consumers seek health information on the Internet. Unfortunately, this searching often falls short because of design limitations of many consumer-oriented Web sites. In this paper, we describe an approach that addresses several known barriers to consumer health information seeking.

Coupling direct collection of health risk information from patients through kiosks with decision support for proactive care management.

Data collection from patients for use in clinical decision making is foundational for medical practice. Increasingly, kiosks are being used to facilitate direct data collection from patients. However, kiosk-collected data are generally not integrated into the care process.

Deployment of health information kiosks in diverse community settings: experience and lessons learned.

The use of kiosks in healthcare by patients to collect and deliver health information is growing rapidly. When planning kiosk deployment many factors such as proper location, presentation, access, and support need to be considered to foster usage. This poster describes how these factors were addressed, presents actual experiences with kiosk deployment, and provides lessons learned from the field.

Providing contextually relevant health literature for at-risk patients using free-standing touchscreen computer kiosks in community settings.

In this project we describe the successful implementation of a computer kiosk system that collects health risk information directly from patients and provides both contextually relevant and patient-tailored health information. We include usage statistics for kiosks located in community settings and demonstrate that patients will readily utilize these kiosks to access health information.

Determining user preferences between touch and pen data entry methods in the Tablet PC computing environment.

Tablet personal computers (PCs) are becoming common in the clinical environment. In a recent survey comparing mobile devices, the Tablet PC was perceived to have made the most significant difference in the delivery of healthcare. As the use of Tablet PC technology increases, understanding which features are most usable for data entry becomes important.

Proactive population health management in the context of a regional health information exchange using standards-based decision support.

The clinic-based healthcare model does not deliver high quality, cost-effective care to populations of patients. Despite public perception that aggressive investment in information technology will lead to improvements in the safety and quality of healthcare delivery, there is little evidence that health information technology can be used to promote population-based health management. This paper describes the use of a standards-based clinical decision support system to facilitate proactive population health management using data from a regional health information exchange (HIE) network.

Development and evaluation of an improved methodology for assessing adherence to evidence-based drug therapy guidelines using claims data.

Non-adherence to evidence-based pharmacotherapy is associated with increased morbidity and mortality. Claims data can be used to detect and intervene on such non-adherence, but existing claims-based approaches for measuring adherence to pharmacotherapy guidelines have significant limitations. In this manuscript, we describe a methodology for assessing adherence to pharmacotherapy guidelines that overcomes many of these limitations.

User interface considerations for collecting data at the point of care in the tablet PC computing environment.

Collecting clinical data directly from clinicians is a challenge. Many standard development environments designed to expedite the creation of user interfaces for electronic healthcare applications do not provide acceptable components for satisfying the requirements for collecting and displaying clinical data at the point of care on the tablet computer. Through an iterative design and testing approach using think-aloud sessions in the eye care setting, we were able to identify and resolve several user interface issues.

Overcoming obstacles to collecting narrative data from eye care professionals at the point-of-care.

Capturing the nuances of clinical observations in an electronic format has been a major challenge in implementing electronic health records. In a formative evaluation study using three different methodologies, we identified that the greatest obstacle to point-of-care data entry for eye care was supporting free text annotation of clinical observations. To overcome this obstacle, we developed an approach that captures an image of a free text entry and associates this image with related data elements in an encounter note.

Creation and use of a survey instrument for comparing mobile computing devices.

Both personal digital assistants (PDAs) and tablet computers have emerged to facilitate data collection at the point of care. However, little research has been reported comparing these mobile computing devices in specific care settings. In this study we present an approach for comparing functionally identical applications on a Palm operating system-based PDA and a Windows-based tablet computer for point-of-care documentation of clinical observations by eye care professionals when caring for patients with diabetes.

Direct comparison of a tablet computer and a personal digital assistant for point-of-care documentation in eye care.

New mobile computing devices including personal digital assistants (PDAs) and tablet computers have emerged to facilitate data collection at the point of care. Unfortunately, little research has been reported regarding which device is optimal for a given care setting. In this study we created and compared functionally identical applications on a Palm operating system-based PDA and a Windows-based tablet computer for point-of-care documentation of clinical observations by eye care professionals when caring for patients with diabetes.

Identifying and overcoming obstacles to point-of-care data collection for eye care professionals.

Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to point-of-care data entry for eye care and then used the formative process to develop and test solutions to overcome these obstacles. The greatest obstacles were supporting free text annotation of clinical observations and accommodating the creation of detailed diagrams in multiple colors.