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Research
Projects Industry-Academia
Partnership Clinical
Guidelines (Funded by MDLogix,Inc.,
Columbia University PI: Vimla L. Patel)
The PathBuilder system
was developed as a software tool to implement the major depression guideline
published by the American Psychiatric Association (APA). We performed a study
to observe/interview three psychiatrist subjects on their use of the system.
For each subject, we used the think-aloud protocols to ask him/her to review
each part of the system, to give his/her opinion on the existing functions,
and to provide comments on additional features that would help to enhance the
system. Our analyses of the data are summarized in the following aspects. First, we found that the organization of guideline
knowledge in the system appeared to be clear. This has been shown in the
following aspects: (1) presenting a high level structure of the guideline
knowledge was helpful to the users, as it provided a reference when the
system was used, and (2) presenting a list of medications and a dose range
table was helpful to the users, as it provided a concise summary of guideline
knowledge that was easy to search. We found the following potential areas
that could be improved: (1) providing a chronological view of care process as
recommended by the guideline, and (2) tailoring the guideline to individual
cases and providing patient-specific and context-sensitive recommendations. Second, we found that the organization and
presentation of medical data in the system was helpful to the users.
Specifically, we found that it was very useful (1) to provide an overview of
a patient's demographic data, (2) to present a list of clinical findings, and
(3) to support a configurable longitudinal view of patient data. We found the
following potential areas that could be improved: (1) the organization and
presentation of history data, which should be around the current problem, and
(2) the appropriate use of CESDR, such as its mapping to DSM-based diagnostic
scoring and its modification to include additional dimensions of scoring (intensity,
etc.). We found that one aspect of the system, i.e., which categories of data
need a longitudinal view, required further investigation. Third, we found that the functions provided by the
system could fit with clinical workflow. Specifically, we found that it was
easy to do patient management. This has been shown in the following two
aspects: (1) presenting a list of previous sessions of patient was useful,
and (2) presenting a brief summary on the last session was helpful. We found
the following potential areas that could be improved: (1) providing a better
approach to session management, and (2) providing a brief summary on each of
the previous sessions. We found that the system appeared to be able to help
some of the clinical tasks. Specifically, we found it was helpful (1) to
assist selecting specific antidepressant by presenting the medication list
and the dose range table, (2) to improve the completeness of patient
assessment by presenting a list of such assessment items, and (3) to review the
assessment data by presenting them right after their input. We found the
following potential areas that could be improved: (1) providing templates to
facilitate capturing of assessment data, (2) integration with other clinical
systems, such as a CPOE system, and (3) generation of reminders/alerts to
prevent potential errors, such as drug-drug interactions. Fourth, We found that the system was able to assist
clinical decision making by providing a list of possible options. We found
the following potential areas that could be improved: (1) presentation of
data relevant to decisions, (2) presentation of arguments on specific
options, (3) providing an algorithm that could be used to choose a specific
option of treatment, and (4) availability of information about costs and
insurance. The general impression to the system is positive.
These include: (1) it is easy to learn the system, (2) the tutorial of the
system is helpful, and (3) the functions provided by the system in general
are useful.( Research Team: Dongwen Wang, Vimla
Patel, Alan Tien) Utilization and Evaluation of Electronic Resources for Dental Health
(Funded By
NYSTAR and AETNA) Evaluation of Aetna Smoking
Cessation Project Through a collaboration of
Aetna Dental and Columbia University, Dental School, a project was taken up
to increase the awareness of dentists about the effects of smoking on oral
and dental health. A group of nearly two hundred doctors and dental staff
from twenty nine states were approached for this phase of the study and were
given an instructional CD-ROM followed by a series of six emails. Both the CD
and the emails conveyed the same information about the effect of tobacco use
and the appropriate methods of intervention. In the second part of this study
our primary aim is to assess the current information technology based
education/dissemination initiatives including; 1) CD-ROMs, 2)
electronic-detailing, and 3) web-based education. This assessment will
conducted through a telephone survey, in which we will ask the dentists about
their use the CD-ROM, electronic detailing and web-based educational and
administrative tools. We hope that this will provide insight into the
efficacy of our information technology initiatives. Subsequently, we will use
this information to evaluate the Information Technology Transfer in the Aetna
Dental Network. Ultimately, we will report our findings and recommendations
for Technology Transfer within Aetna Dental to dental providers.
Electronic Detailing and Cessation of Smoking
Electronic detailing is becoming increasingly common and, in many cases, a high yield tool for dissemination of consumer information and even changing behavior.
In this project we are trying to examine the impact of electronic detailing with regard to cessation of smoking among internet users, in particular those who
are seek and/or receive health information from the web. As part of a collaborative project with Aetna Dental, we hope use electronic detailing for two
purposes, namely, to increase the knowledge base of the consumers of electronic health information and secondly to try to change the behavior of this population
with regard to smoking. Cognitive Evaluation of User Interface for
Phase I Clinical trials (Funded by
Merck& co. PI: Bhanu
Bahl (Masters Research Project) )
This was a collaboration project between Department of Biomedical
Informatics, Columbia University and Clinical Pharmacology, Worldwide Clinical
Data Management Operations (WCDMO), Merck & Co, Inc. We assessed the
functionality and usability of the remote data capture interface – CPC2000
deployed in Phase I and IIA Clinical trials. The objective of the usability
testing was to evaluate the tool on cognitive standards and characterize
interactive behavior of users to account for patterns of errors with emphasis
on how well the interface supports "exploratory learning". We made
recommendations to revise/enhance CPC 2000 or design future interfaces, making
them less prone to data entry errors directly attributable to specific
representations of displayed data and the relative configuration of screen
artifacts.
In the Pharmaceutical industry, there is a growing emphasis on applying cognitive techniques and methods to improve and validate clinical trial data capture
interfaces like data entry tools and paper Case Report Forms (CRFs), to ensure compliance, ease of use and minimal errors by investigator sites when recording
the data. Earlier error detection typically results in lower final error rates, lower error detection/error correction costs, and also improves site
satisfaction. The objective of the usability testing is to evaluate the tool on cognitive standards and make recommendations to revise/enhance the interface or
future interfaces, making them more user-friendly, logical and thus less prone to data entry errors. For the study purposes, usability of Merck & Co, Inc.'s
Clinical Pharmacology data entry system, CPC 2000, is evaluated for first-time or infrequent users with special attention to how well the interface supports
"exploratory learning", i.e., first-time use without formal training. The cognitive method used is Cognitive Walkthrough (CW). Sessions were video-taped and
analyzed for reactions, responses, errors and for the cues generated by the interface. The findings were sorted into 20 key areas to allow for semantic
groupings. Cognitive Walkthrough helped us identify the trouble spots and how the users thought through the decisions they made. The importance of designing
Data Entry (DE) system to ease the tedium of reporting on patients and treatments cannot be overemphasized. This will, increase compliance, improve turn-around
time, facilitate quick error check and resolution, and in the end, provide cost effective and clean data.
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