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.

Assessment of relative importance of tablet computer features in supporting direct electronic documentation of encounters by eye care professionals.

Extensive utilization of mobile devices at the point of care will depend on device acceptance by the providers. We conducted focus groups involving nine eye care professionals to evaluate and elucidate the most important features of a tablet Personal Computer (PC) for data entry at the point of care. Ease of use, and quality and size of display were considered to be the most critical features of such a mobile device by the majority of the participants.

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.

Design, implementation, use, and preliminary evaluation of SEBASTIAN, a standards-based Web service for clinical decision support.

Despite their demonstrated ability to improve care quality, clinical decision support systems are not widely used. In part, this limited use is due to the difficulty of sharing medical knowledge in a machine-executable format. To address this problem, we developed a decision support Web service known as SEBASTIAN.

Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital.

The experience of Mount Sinai Hospital is representative of the challenges and problems facing large academic medical centers in selecting an ambulatory EMR. The facility successfully revived a stalled process in a challenging financial climate, using a framework of science and rigorous investigation. The process incorporated several innovations: 1) There was a thorough review of medical informatics literature to develop a mission statement, determine practical objectives and guide the demonstration process; 2) The process involved rigorous investigation of vendor statements, industry statements and other institution's views of vendors; 3) The initiative focused on user-centric selection, and the survey instrument was scientifically and specifically designed to assess user feedback; 4) There was scientific analysis of validated findings and survey results at all steering meetings; 5) The process included an assessment of vendors' ability to support research by identifying funded and published research; 6) Selection involved meticulous total cost of ownership analysis to assess and compare real costs of implementing a vendor solution; and finally, 7) There were iterative meetings with stakeholders, executives and users to understand needs, address concerns and communicate the vision.

A simple, flexible and scalable approach for generating tailored questionnaires and health education messages.

Tailored health information is important for generating patient-specific recommendations in clinical decision support systems and for crafting health education materials that are specifically customized to a patient. Many previous attempts to generate tailored information require complex representations, lack general applicability, and are inflexible to content alterations. In this article, we describe a simple, yet flexible approach for tailoring health communication.

Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success.

Objective: To identify features of clinical decision support systems critical for improving clinical practice.

Design: Systematic review of randomised controlled trials.

Data Sources: Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews.

Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients.

Clinical information collected directly from patients is critical to the practice of medicine. Past efforts to collect this information using computers have had limited utility because these efforts required users to be facile with the computerized information collecting system. In this paper we describe the design, development, and function of a computer system that uses recent technology to overcome the limitations of previous computer-based data collection tools by adapting the human-computer interface to the native language, reading literacy, and computer skills of the user.

Lightening the burden of the heavy regulatory hand an incentive for outpatient computer patient record.

However many benefits may be achieved for the organization, it is difficult to introduce a computer patient record (CPR) into an outpatient setting until the clinical practitioners themselves see direct benefit from the time invested. The ever increasing burden of regulation on health care in the outpatient setting includes (but is not limited to) guidelines for evaluation and management (E&M) coding, Local Medical Review Policy (LMRP) rules for diagnostic justification of tests and procedures and associated requirements for Advance Beneficiary Notification (ABN), and the rules for teaching physicians in academic settings. Achieving compliance with just the LMRP rules requires immediate access to an eight-inch-thick stack of manuals (ICD9, CPT, HCPCS, and LMRP), 4 inches of which is subject to update on a monthly basis.