The Building Blocks for Enhanced Technological Literacy

Many students have experience with smart phones, internet browsing, and social networking. Although exposure to these types of technologies are pure indicators of society’s evolution towards a more integrated and pervasive computing environment, they do not serve as accurate indicators of technological literacy. With the advent and rapid expansion of knowledge and technology intensive industries, these skills do not provide a sufficient core/foundational literacy to the development of characteristics possessed by technologically literate students. Gonzales and Renshaw (2005) identified six computing competency skill areas for pre-engineering majors – 1) Computer use and file management, 2) Word processing, 3) Spreadsheets, 4)Databases, 5) Presentations, and 6) Information and Communications. These competencies, previously the focus of engineers, have now transferred to society at large with 38% of all the value created in the U.S. requiring the skills of a technologically literate workforce (National Science Board, 2010). The widespread use of technology in society and everyday life has forced the need of technological literacy amongst non-Science, Technology, Engineering and Mathematics (STEM) majors, hence the need for a comprehensive course that provides the building blocks for technological literacy. However, there is still skepticism on the value of classes that focus on the introduction of computers. These classes lay the foundation that is crucial for non-STEM majors to become technologically literate. The goal of this paper is to show that there is still a need for these types of classes and also that they provide a gateway for these students to become technologically literate before their graduation. By reviewing the performance of 130 students in an introductory level computing course at Indiana State University the need for such a class will be evidenced

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. Methods: Semi-structured interviews were conducted with 24 clinicians at a Veterans Health Administration (VHA) Medical Center. Results: An inductive qualitative analysis resulted in findings organized around recurrent themes of: (1) Barriers, (2) Facilitators, (3) Current Use, (4) Anticipated Use, (5) Patient Interaction, and (6) Connection. Conclusions: Our study generated several recommendations for the use of tablet computers with new health information technology tools being developed. Continuous connectivity for the mobile device is essential to avoid interruptions and clinician frustration. Also, making a physical keyboard available as an option for the tablet was a clear desire from the clinicians. Larger tablets (e.g., regular size iPad as compared to an iPad mini) were preferred. Being able to use secure messaging tools with the tablet computer was another consistent finding. Finally, more simplicity is needed for accessing patient data on mobile devices, while balancing the important need for adequate security

Clinical thinking via electronic note templates: Who benefits?

This work was supported by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416. Dr. Weiner is Chief of Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN. Dr. Savoy is supported in part by grants KL2TR002530 (A Carroll, PI) and UL1TR002529 (A. Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award

Systematic Heuristic Evaluation of Computerized Consultation Order Templates: Clinicians’ and Human Factors Engineers’ Perspectives

We assessed the usability of consultation order templates and identified problems to prioritize in design efforts for improving referral communication. With a sample of 26 consultation order templates, three evaluators performed a usability heuristic evaluation. The evaluation used 14 domain-independent heuristics and the following three supplemental references: 1 new domain-specific heuristic, 6 usability goals, and coded clinicians’ statements regarding ease of use for 10 sampled templates. Evaluators found 201 violations, a mean of 7.7 violations per template. Minor violations outnumbered major violations almost twofold, 115 (57%) to 62 (31%). Approximately 68% of violations were linked to 5 heuristics: aesthetic and minimalist design (17%), error prevention (16%), consistency and standards (14%), recognition rather than recall (11%), and meet referrers’ information needs (10%). Severe violations were attributed mostly to meet referrers’ information needs and recognition rather than recall. Recorded violations yielded potential negative consequences for efficiency, effectiveness, safety, learnability, and utility. Evaluators and clinicians demonstrated 80% agreement in usability assessment. Based on frequency and severity of usability heuristic violations, the consultation order templates reviewed may impede clinical efficiency and risk patient safety. Results support the following design considerations: communicate consultants’ requirements, facilitate information seeking, and support communication. While the most frequent heuristic violations involved interaction design and presentation, the most severe violations lacked information desired by referring clinicians. Violations related to templates’ inability to support referring clinicians’ information needs had the greatest potential negative impact on efficiency and safety usability goals. Heuristics should be prioritized in future design efforts

Gains, losses, and uncertainties from computerizing referrals and consultations

Consultations entail transitions in care between referrers and consultants, as patients visit different clinicians and care sites. This complex process has been consistently prone to communication breakdowns. Despite expectations and benefits of electronic health records (EHRs), incomplete, vague, or inappropriate referrals continue to hinder consultations; referrals can be sent to the wrong specialty service; and consultation findings frequently fail to reach referrers. Due to the inadequate support of interpersonal communication afforded by EHRs, these issues persist. Important aspects of ergonomics and human factors engineering frequently appear overlooked during the design and implementation of EHRs. Usability issues have contributed to delays in medical diagnosis, treatment, and follow-up. Some of these delays contribute to patient harms. Our multidisciplinary team of clinicians and ergonomics professionals reflects on referral and consultation. We describe how computerization in healthcare should benefit from approaches informed and developed through applied ergonomics and human factors

Cognitive requirements for primary care providers during the referral process: Information needed from and interactions with an electronic health record system

Objectives This study sought to identify and describe the cognitive requirements and associated information needs of referring primary care providers (PCPs) during the referral process as well as characterize referring PCPs’ experiences with current health information technology. Materials and methods We interviewed 62 referring PCPs. Our four-member analysis team used hierarchical task analysis to construct a goal-directed hierarchy. We utilized extensions of the task analysis to describe PCPs’ common experiences with health information technologies throughout the referral process. Results The resultant goal hierarchy includes one main goal (Referral for Additional Care), two sub-goals (Assess Patient’s Condition and Manage Referrals), and four major tasks with respective decisions (What consultation is warranted; What information should I provide; What additional action is needed; and How to integrate specialists’ findings). Approximately 22 information needs were commonly identified and PCPs described their use of various sources - other PCPs, electronic health records, chat software, and paper- to satisfy those information needs. Conclusion Cognitive demand for referring PCPs is high throughout the referral process. They have to search, identify, compose, track, and integrate information across multiple screens, systems, and people. Existing interfaces do not adequately support the communication, information exchange, or care coordination related to the referral process. Results from this study provide an important foundation for developing patient-centered displays that support PCPs’ decision-making process and reduce cognitive challenges

iPhone in NASA Ground Operations

A comprehensive review of the literature and historical background of NASA established a need for an easy-to-implement technological improvement to displaying procedures which is cost effective and risk reducing. Previous unsuccessful attempts have led this team to explore the practicality of using a mobile handheld device. The major products, inputs, resources, constraints, planning and effort required for consideration of this type of solution were outlined. After analyzing the physical, environmental, life-cycle, functional, and socio-technical requirements, a Functional Analysis was performed to describe the top-level, second-level, and third-level functions of the system requirements. In addition, the risk/value proposition of conversion to a new technology was considered and gave a blueprint for transitioning along with the tasks necessary to implement the device into the Vehicle Assembly Building's (VAB) current infrastructure. A Work Breakdown Structure (WBS) described the elemental work items of the implementation. Once the viability of this system was confirmed, a device was selected through use of technical design comparison methods including the Pugh Matrix and House of Quality. Comparison and evaluation of the Apple iPhone, Motorola Q, Blackberry, PC Notebook, and PDA revealed that the iPhone is the most suitable device for this task. This paper outlines the device design/ architecture, as well as some of the required infrastructure

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. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists’ perspectives on mobile technology and apps. Methods: We conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas. Results: Over 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized. Conclusions: Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists’workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists’ memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine.This work was supported by a pilot grant (PPO 15-401; AS) and a Center of Innovation grant (CIN 13-416, M Weiner), both from the United States Department of Veterans Affairs Health Services Research and Development. AS is supported in part by the following grants: KL2TR002530 (A Carroll, PI), and UL1TR002529 (A Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award

Dashboards for visual display of patient safety data: A systematic review

Background Methods to visualise patient safety data can support effective monitoring of safety events and discovery of trends. While quality dashboards are common, use and impact of dashboards to visualise patient safety event data remains poorly understood. Objectives To understand development, use and direct or indirect impacts of patient safety dashboards. Methods We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE and CINAHL for publications between 1 January 1950 and 30 August 2018 involving use of dashboards to display data related to safety targets defined by the Agency for Healthcare Research and Quality’s Patient Safety Net. Two reviewers independently reviewed search results for inclusion in analysis and resolved disagreements by consensus. We collected data on development, use and impact via standardised data collection forms and analysed data using descriptive statistics. Results Literature search identified 4624 results which were narrowed to 33 publications after applying inclusion and exclusion criteria and consensus across reviewers. Publications included only time series and case study designs and were inpatient focused and emergency department focused. Information on direct impact of dashboards was limited, and only four studies included informatics or human factors principles in development or postimplementation evaluation. Discussion Use of patient-safety dashboards has grown over the past 15 years, but impact remains poorly understood. Dashboard design processes rarely use informatics or human factors principles to ensure that the available content and navigation assists task completion, communication or decision making. Conclusion Design and usability evaluation of patient safety dashboards should incorporate informatics and human factors principles. Future assessments should also rigorously explore their potential to support patient safety monitoring including direct or indirect impact on patient safety