Usability of Computerized Lung Auscultation–Sound Software (CLASS) for learning pulmonary auscultation

The mastering of pulmonary auscultation requires complex acoustic skills. Computer-assisted learning tools (CALTs) have potential to enhance the learning of these skills; however, few have been developed for this purpose and do not integrate all the required features. Thus, this study aimed to assess the usability of a new CALT for learning pulmonary auscultation. Computerized Lung Auscultation-Sound Software (CLASS) usability was assessed by eight physiotherapy students using computer screen recordings, think-aloud reports, and facial expressions. Time spent in each task, frequency of messages and facial expressions, number of clicks and problems reported were counted. The timelines of the three methods used were matched/synchronized and analyzed. The tasks exercises and annotation of respiratory sounds were the ones requiring more clicks (median 132, interquartile range [23-157]; 93 [53-155]; 91 [65-104], respectively) and where most errors (19; 37; 15%, respectively) and problems (n = 7; 6; 3, respectively) were reported. Each participant reported a median of 6 problems, with a total of 14 different problems found, mainly related with CLASS functionalities (50%). Smile was the only facial expression presented in all tasks (n = 54). CLASS is the only CALT available that meets all the required features for learning pulmonary auscultation. The combination of the three usability methods identified advantages/disadvantages of CLASS and offered guidance for future developments, namely in annotations and exercises. This will allow the improvement of CLASS and enhance students' activities for learning pulmonary auscultation skills

Evaluation, Validation & Implementation of a Computerized Diagnostic Decision Support System in Primary Practice

Background: Medical diagnosis may be the most complex task attempted by humans. Studies estimate that 95% of diagnoses in outpatient care are accurate, implying that the annual rate of inaccurate diagnoses is 12 million in the US alone, with the potential for patient harm in about half. A well-researched differential might reduce inaccurate diagnoses by offering alternatives matching the patient’s symptoms. This study searched the literature for articles evaluating the diagnostic performance of commercially available computerized diagnostic decision support systems. This search led to selecting Isabel Pro, developed by Isabel Healthcare, Ltd. of Haslemere, UK. Evaluation and Validation: A computerized diagnostic decision support system should respond adequately to four questions: What is the “diagnostic retrieval accuracy”? Does it perform as well as clinicians? When provided with the differential, do clinicians improve diagnostic accuracy? Is it easily incorporated into routine practice? The project validated the diagnostic retrieval accuracy of Isabel Pro using 46 cases with a previously confirmed diagnosis. The confirmed diagnosis appeared in Isabel Pro’s differential in 24 cases (52.2%), outperforming even internal medicine faculty (47%). Using those 24 cases and the differentials produced, the author conducted a diagnostic challenge that involved 120 McGovern Medical School residents. The residents produced 406 diagnoses, of which 105 (25.9%) were correct without the differentials, and 37 were correct post-consultation, a 9.1% absolute improvement. In responses, 75.1% of the participants agreed the differentials would be helpful in routine practice, and 64.1% agreed they would consult the differentials if available. Implementation: The project successfully proposed Isabel Pro as a solution to UT practice leadership on September 16, 2021, and incorporated the system into the Epic EHR as a menu line link on November 30, 2021. This system-wide integration also included a QR code for downloading Isabel Pro to a mobile device. Usage of Isabel Pro in the practices of UTPhysicians began on December 8, 2021. Results: The project concluded data collection after 86 days on March 4, 2022, with usage showing a steady increase in the final three weeks. The project produced 73 unique users (37 faculty and 36 residents). The user survey responses showed 83.3% agreeing they would consult the differential generated by Isabel Pro if available at every patient encounter (+19.2% compared to the challenge survey) and 77.8% agreeing that the suggestions would be helpful in routine practice (+2.7% compared to the challenge survey). More than one-third (36.8%) responded that they changed their diagnosis in response to the differential. Limitations: Only usage statistics were analyzed; the system records no reason for the clinician discontinuing a diagnostic session. Only 20 participants responded out of 73 (27.4%), so even though the respondents represented a spread of experience levels, the results may not represent the total number of potential users. The project covered a limited period of 86 days. Conclusions: Diagnostic inaccuracy is a significant patient safety concern. Studies show that computerized diagnostic decision support systems improve diagnostic accuracy, but they are not wide implementation lags despite these findings. This project demonstrated the feasibility of implementing such a well-known system in academic medical practice. The responses to the surveys demonstrate favorable opinions about the system’s perceived usefulness. Active communication and dissemination programs may be essential to improve and sustain use

A Sustainable Future In The Implementation Of Clinical Pharmacogenomics

Purpose: The sustainability of clinical pharmacogenomics requires further study of clinical education on the topic, its effects on clinical workflow, and the responsibilities of different providers for its delivery. Tools from the discipline of implementation science were utilized herein to help achieve the purposes of the three studies. The broad purpose of this dissertation is to advance the work of clinical pharmacogenomic implementation through a more rigorous convergence with implementation science. Methods: Three studies constitute the whole of this dissertation. The first is a scoping review that provides a broad characterization of the methods utilized in available peer-revieliterature focusing on provider use of and experience with using pharmacogenomics in practice or the study setting. The second study used semi-structured in-depth interviews to elicit strategies and perspectives from leadership in current implementation programs using the Consolidated Framework for Implementation Science (CFIR) Process Domain. The third used a cross-sectional quantitative survey with experimental vignettes to explore the potential for pharmacist-physician collaboration using newly developed implementation science outcomes. Results: The scoping review included 25 studies, with many focused on the interactions of providers with clinical decision support systems and adherence to therapeutic recommendations represented. Results from the interviews were extensive but several highlights included a focus on understanding pharmacogenomic use prior to implementation, high-touch informal communication with providers, and the power of the patient case. The survey analysis revealed that the primary care physicians believe that it is more appropriate to deliver clinical pharmacogenomics when a pharmacist is physically located in a clinic and is responsible for managing and modifying a drug therapy based on these results. Conclusion: These three studies further the convergence of implementation science and genomic medicine, with particular focus on pharmacogenomics and the foundational concept of implementation science, sustainability. The scoping review should provide future researchers with a landscape of available and previously used methodologies for interventional pharmacogenomic studies. The interview results will help new implementers of pharmacogenomics steer around avoidable hurdles or make them easier to address. The survey results showcase the potential for pharmacist-physician collaboration in clinical pharmacogenomics

Current Management Issues in Health Information Technology

Health information technology can improve quality care delivery, thereby boosting the healthcare business reputation. However, it can negatively affect quality care delivery and lead to a negative business reputation if not efficiently managed. This single qualitative study aimed to explore the causes of the inefficiencies in managing health information technology and strategies that healthcare organizations use to ensure its efficiencies. In a purposive sample, the researcher conducted telephone interviews with twenty-one participants from Lancaster General Hospital. The participants comprised medical doctors, Doctor of Nursing practitioners, managers of health informatics, and informatics specialists working in various divisions and E-health operations. Other participants included the director of quality improvement within Epic Solutions and clinical applications, the director of health information management, the entity and privacy officer, the risk department manager, the executive director of ACO inter-community care, the pharmacist, and the director of operations. Data collected and analyzed yielded four themes: Users face various management challenges leading to HIT management efficiencies, primarily due to a need for adequate training. Strategies used to ensure the efficient management of health information technology comprised the use of robust policies and procedures, Management issues leading to the disruption of health information technology due to the issues with the design of tools of HIT, and Users reported more potential than actual impact on business reputation as judged through external organization ratings. This study could positively impact social change by fostering efficiencies in its adoption, implementation, and use, which could enhance better care delivery

Use of primary care data for identifying individuals at risk of cardiovascular disease

The aim of this research was to explore the potential of routinely collected primary care data to support the identification of individuals for cardiovascular risk reduction. The work involved a systematic literature review of reminder interventions operating at the point of care; a randomised controlled trial of a novel software tool to facilitate the targeting of individuals at risk of cardiovascular disease; and an exploration of qualitative issues relevant to the challenge of cardiovascular risk reduction in current practice. The Systematic review resulted in a narrative synthesis and a meta-analysis. It concluded that reminder interventions are generally effective at changing practitioner behaviour, but the effect is inconsistent, probably dependent on organisational context, and difficult to predict. The e-Nudge trial involved 19 practices in Coventry and Warwickshire, who used the e-Nudge software tool for two years. This tool was programmed for the project by the clinical software company EMIS. Whilst the primary outcome (cardiovascular event rate) was not significantly reduced in this timescale, a beneficial effect was demonstrated on the adequacy of data to support risk estimation and on the visibility of the at risk population. A new means of addressing the problem of undiagnosed and late-diagnosed diabetes was also discovered. Qualitative aspects of this area of care are presented through a discussion of ethical issues, a limited series of interviews with members of the public included in the appendix, and extensive field notes taken throughout the research. These provide some context in support of the e-Nudge trial. Routinely collected data of UK general practice provide a potentially rich resource to support primary cardiovascular disease prevention, but practical, ethical and conceptual issues must all be addressed to optimise their impact. This conclusion forms the thesis to be explored and justified through this dissertation