Understanding Barriers and Facilitators to Living Kidney Donation Within a Sociotechnical Systems Framework.

The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system.

Automated Text Messaging During COVID-19: Patient Feedback to Increase Adoption.

Automated text messaging interventions can effectively improve self-care and were used to support the U.S. Veterans Health Administration's (VHA) public health outreach during the COVID pandemic.

Veteran and Staff Experience from a Pilot Program of Health Care System-Distributed Wearable Devices and Data Sharing.

Objective: The growing trend to use wearable devices to track activity and health data has the potential to positively impact the patient experience with their health care at home and with their care team. As part of a pilot program, the U.S.

Development and cross-sectional evaluation of a text message protocol to support mental health well-being.

Coping with stressors related to the coronavirus disease (COVID) pandemic has caused major mental health challenges. Text message interventions are identified as helpful for promoting health behavior self-management. Drawing from cognitive-behavioral theory (CBT), U.

Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists: Workflow Analysis Based on Semistructured Interviews.

Background: The hospitalist workday is cognitively demanding and dominated by activities away from patients' bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use.

Objective: The purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists' workflows.

Veterans' response to an automated text messaging protocol during the COVID-19 pandemic.

The US Department of Veterans Affairs (VA) is using an automated short message service application named "Annie" as part of its coronavirus disease 2019 (COVID-19) response with a protocol for coronavirus precautions, which can help the veteran monitor symptoms and can advise the veteran when to contact his or her VA care team or a nurse triage line. We surveyed 1134 veterans on their use of the Annie application and coronavirus precautions protocol. Survey results support what is likely a substantial resource savings for the VA, as well as non-VA community healthcare.

Provider Preference in Exam Room Layout Design and Computing.

Background: The introduction of the electronic health record (EHR) has had a significant impact on provider-patient interactions, particularly revolving around patient-centeredness. More research is needed to understand the provider perspective of this interaction.

Objectives: Our objective was to obtain provider feedback on a new exam room design compared with the one already in use with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning.

Field Investigation of Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Pilot Study.

The Department of Veterans Affairs (VA) has developed a new exam room design standard that is intended to facilitate a greater degree of patient centeredness. This new design includes a wall-mounted monitor on an armature system and a moveable table workspace. To date, however, this design has not been formally evaluated in a field setting.

Performance, workload, and usability in a multiscreen, multi-device, information-rich environment.

Potential benefits of multiscreen and multiple device environments were assessed using three different computing environments. A single factor, within-subject study was conducted with 18 engineering students in a laboratory experiment. Three levels for the computing environment factor included one with a desktop computer with a single monitor (control, condition A); one with a desktop with dual monitors, as well as a single tablet computer (condition B); and one with a desktop with a single monitor, as well as two tablet computers (condition C).

The effect of role assignment in high fidelity patient simulation on nursing students: An experimental research study.

Background: Previous studies have evaluated the effectiveness of high fidelity patient simulators (HFPS) on nursing training; however, a gap exists on the effects of role assignment on critical thinking, self-efficacy, and situation awareness skills in team-based simulation scenarios.

Objectives: This study aims to determine if role assignment and the involvement level related to the roles yields significant effects and differences in critical thinking, situation awareness and self-efficacy scores in team-based high-fidelity simulation scenarios.

Design: A single factorial design with five levels and random assignment was utilized.

Investigating the need for clinicians to use tablet computers with a newly envisioned electronic health record.

Objective: The Veterans Health Administration (VHA) has deployed a large number of tablet computers in the last several years. However, little is known about how clinicians may use these devices with a newly planned Web-based electronic health record (EHR), as well as other clinical tools. The objective of this study was to understand the types of use that can be expected of tablet computers versus desktops.

Ten factors to consider when developing usability scenarios and tasks for health information technology.

The quality of usability testing is highly dependent upon the associated usability scenarios. To promote usability testing as part of electronic health record (EHR) certification, the Office of the National Coordinator (ONC) for Health Information Technology requires that vendors test specific capabilities of EHRs with clinical end-users and report their usability testing process - including the test scenarios used - along with the results. The ONC outlines basic expectations for usability testing, but there is little guidance in usability texts or scientific literature on how to develop usability scenarios for healthcare applications.

Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study.

Background: Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care.

Purpose: Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning.

Methods: In a lab-based experiment, 28 providers used prototypes of the new and older "legacy" outpatient exam room layouts in a within-subject comparison using simulated patient encounters.

Evaluating a Modular Decision Support Application For Colorectal Cancer Screening.

Background: There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework.

Objective: To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing.

Pilot evaluation of a method to assess prescribers' information processing of medication alerts.

Background: Prescribers commonly receive alerts during medication ordering. Prescribers work in a complex, time-pressured environment; to enhance the effectiveness of safety alerts, the effort needed to cognitively process these alerts should be minimized. Methods to evaluate the extent to which computerized alerts support prescribers' information processing are lacking.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening.

Design and Evaluation of an Electronic Override Mechanism for Medication Alerts to Facilitate Communication Between Prescribers and Pharmacists.

Background: Computerized medication alerts can often be bypassed by entering an override rationale, but prescribers' override reasons are frequently ambiguous to pharmacists who review orders.

Objective: To develop and evaluate a new override mechanism for adverse reaction and drug-drug interaction alerts. We hypothesized that the new mechanism would improve usability for prescribers and increase the clinical appropriateness of override reasons.

Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography.

Objective: This study evaluated the current use of commercial-off-the-shelf Clinical Information Systems (CIS) for intensive care units (ICUs) and Anesthesia Record Keeping (ARK) for operating rooms and post-anesthesia care recovery settings at three Veterans Affairs Medical Centers (VAMCs). Clinicians and administrative staff use these applications at bedside workstations, in operating rooms, at nursing stations, in physician's rooms, and in other various settings. The intention of a CIS or an ARK system is to facilitate creation of electronic records of data, assessments, and procedures from multiple medical devices.

Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation.

Objective: To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors.

Materials And Methods: We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts.

Accessibility, usability, and usefulness of a Web-based clinical decision support tool to enhance provider-patient communication around Self-management TO Prevent (STOP) Stroke.

This article reports redesign strategies identified to create a Web-based user-interface for the Self-management TO Prevent (STOP) Stroke Tool. Members of a Stroke Quality Improvement Network (N = 12) viewed a visualization video of a proposed prototype and provided feedback on implementation barriers/facilitators. Stroke-care providers (N = 10) tested the Web-based prototype in think-aloud sessions of simulated clinic visits.

Sources of variation in primary care clinical workflow: implications for the design of cognitive support.

This article identifies sources of variation in clinical workflow and implications for the design and implementation of electronic clinical decision support. Sources of variation in workflow were identified via rapid ethnographic observation, focus groups, and interviews across a total of eight medical centers in both the Veterans Health Administration and academic medical centers nationally regarded as leaders in developing and using clinical decision support. Data were reviewed for types of variability within the social and technical subsystems and the external environment as described in the sociotechnical systems theory.

"Attention on the flight deck": what ambulatory care providers can learn from pilots about complex coordinated actions.

Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room.

Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation.

You and me and the computer makes three: variations in exam room use of the electronic health record.

Challenges persist on how to effectively integrate the electronic health record (EHR) into patient visits and clinical workflow, while maintaining patient-centered care. Our goal was to identify variations in, barriers to, and facilitators of the use of the US Department of Veterans Affairs (VA) EHR in ambulatory care workflow in order better to understand how to integrate the EHR into clinical work. We observed and interviewed 20 ambulatory care providers across three geographically distinct VA medical centers.