This chapter focuses on one particular innovation—clinical reminders—intended to act as a decision aid to primary care providers. Computerized clinical reminders are intended to highlight aspects of ...preventative care and disease management that might be overlooked in the context of a busy exam. The chapter describes three methods, including a taxonomy development exercise, a survey, and ethnographic observations. Data from these three sources were used to triangulate on a set of findings framed around barriers to the use of computerized clinical reminders. Barriers to reminder use identified via ethnographic observation were sorted into five categories including workflow, coordination, workload, lack of flexibility, and usability. The goal of the reminders software is to support and aid the healthcare team, leaving issues of clinical judgment to the provider. This software-based tool addresses support of key macrocognitive functions; supporting planning activities for an individual exam, as well as real-time decision making and replanning that occur during the patient exam.
A study of logged interventions at an electronic intensive care unit (e-ICU) was conducted to examine how functions changed over a two-year period. In total, 2301 log entries of e-ICU interventions ...from 2005 and 2007 were uniquely coded as to function. A Chi square goodness of fit analysis revealed that 7 out of 11 functions (64%) significantly changed over the two years that were measured. There were increases seen by the log data in the e-ICU nurses calling ICU nurses to supply missing information, recommend the use of best practices, and providing education to ICU nurses. Additionally, increases were seen for e-ICU physicians receiving requests for ordering actions to be taken on patients. Decreases were seen in e-ICU nurses communicating critical lab results and vital sign changes to ICU nurses. We discuss how these shifts relate to several of our predicted archetypical patterns for how new technologies change over time, both in terms of their primary functions as well as changes to positive and negative “unintended” consequences on secondary functions.
Towards a Functional Model of Quality Improvement Collaboratives Patterson, Emily S.; Schweikhart, Sharon; Anders, Shilo ...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting,
10/2007, Volume:
51, Issue:
11
Book Review, Journal Article
Peer reviewed
Quality improvement collaboratives (QIC) are widely used for seeking improvements in healthcare quality and safety. Nevertheless, the effectiveness of QICs is variable. In order to support research ...that identifies critical elements in running a successful collaborative, we fill a conceptual gap by moving towards a functional model of QICs. Specifically, we define how QICs are distinct from traditional quality improvement teams, conceptualize how primary and secondary functions are accomplished in a means-ends framework, and illustrate how the functions are dynamically accomplished in a series of meetings by nested teams within a collaborative. Finally, we discuss distinctions among QICs.
In this paper, we describe the use of an animated prototyping technique to elicit feedback on the usefulness of a set of modular design concepts for dealing with information dynamics in inferential ...analysis under data overload conditions. The design concepts were comprised of innovative solutions that utilized technology to assist in inferential analysis. The findings generally support the “promisingness” of the design directions for addressing information dynamics challenges in inferential analysis under data overload. Elicited feedback provides insight on how the concepts might prove useful to intelligence analysts in the field. Analysts recommended significant modifications that would be difficult to change post-implementation of software, suggesting that the animock technique was useful for exploring how design concepts could address challenging issues where no current software support exists.
Clinical Reminders: Why Don't they use them? Militello, Laura; Patterson, Emily S.; Tripp-Reimer, Toni ...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting,
09/2004, Volume:
48, Issue:
15
Book Review, Journal Article
Peer reviewed
There are many potential benefits associated with the use of computerized clinical reminders for both health care providers and patients. Clinical reminders are designed to reduce the likelihood that ...an aspect of care will “fall though the cracks” during a busy exam, ensure that care is well-documented so that the range of health care providers interacting with each patient will have full access to the patient history, and increase standardization across patient exams. While most agree that the concept of clinical reminders is good, recent research indicates that some providers do not use clinical reminders when available (Demakis et al, 2000). This paper describes the qualitative portion of a survey study aimed at exploring the perceived facilitators and barriers to clinical reminder use within Veterans Administration health care facilities.
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