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Biomedical subjects

D F Sittig

Publications and source records attributed to D F Sittig.

At least 19 recordsLinked to original sources
PubMed2003

Grand challenges in dental informatics.

When truly significant scientific challenges are overcome, it profoundly changes the daily activities, as well as the future research activities, of everyone involved in the related field. By identifying and describing the grand challenges facing a scientific field, we can help funding agencies identify and prioritize projects for support, stimulate and encourage new investigators to work on these intellectual and technological challenges, and help define the field itself. In this article, we present an informatics-oriented, future-patient-care scenario, then describe a series of applications and the related informatics grand challenges facing the dental field today. New techniques and technologies to help us overcome these challenges would facilitate the development of truly monumental applications, such as a comprehensive electronic oral health record, an automated dental treatment planning system for all diagnoses, or a system to profile patient risk for chronic oral diseases.

Databases, Factual↗
PubMed2001

A survey of patient-provider e-mail communication: what do patients think?

Communication between patients and providers forms the backbone of the patient-provider relationship. Often such communication is strained due to time and space limitations on the part of both patients and providers. Many healthcare organizations are developing secure e-mail communication facilities to allow patients to exchange e-mail messages with their providers. Providers are worried that opening such lines of communication will inundate them with vast quantities of e-mail from their patients. Patients are worried that their messages will be intercepted and read by unauthorized people. In an attempt to determine how a group of internet-active, e-mail-ready patients currently use, or potentially view, the ability to exchange e-mail messages with their health care providers, we distributed a survey via e-mail to over 9500 patients. After determining each patient's e-mail activity level (based on the number of messages sent each day), we asked questions such as: "Have you ever sent e-mail to your provider?" "What issues or concerns have prevented you from sending e-mail messages to your provider?" "If your provider were to tell you that someone in his/her office may screen, read or perhaps reply to your message before he/she sees it, to what extent would you be concerned about this?" and "How would you rate your overall satisfaction with the use of e-mail to communicate with your provider?" Results from the survey indicate that nearly 85% of the patients surveyed send at least one e-mail message per day, but that very few (i.e. 6%) of the patients have actually sent an e-mail message to their provider. Interestingly, over half of the patients indicated that they would like to send their providers e-mail, but that they do not know their provider's e-mail address.

Chi-Square Distribution↗
PubMed2001

The emerging science of very early detection of disease outbreaks.

A surge of development of new public health surveillance systems designed to provide more timely detection of outbreaks suggests that public health has a new requirement: extreme timeliness of detection. The authors review previous work relevant to measuring timeliness and to defining timeliness requirements. Using signal detection theory and decision theory, the authors identify strategies to improve timeliness of detection and position ongoing system development within that framework.

Bioterrorism↗
PubMed2001

Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use".

Ambulatory Care Facilities↗
PubMed2000

Communication breakdown in the outpatient referral process.

OBJECTIVE: To evaluate primary care and specialist physicians' satisfaction with interphysician communication and to identify the major problems in the current referral process. DESIGN: Surveys were mailed to providers to determine satisfaction with the referral process; then patient-specific surveys were e-mailed to this group to obtain real-time referral information. SETTING: Academic tertiary care medical center. PARTICIPANTS: Attending-level primary care physicians (PCPs) and specialists. MEASUREMENTS AND MAIN RESULTS: The response rate for mail surveys for PCPs was 57% and for specialists was 51%. In the mail survey, 63% of PCPs and 35% of specialists were dissatisfied with the current referral process. Respondents felt that major problems with the current referral system were lack of timeliness of information and inadequate referral letter content. Information considered important by recipient groups was often not included in letters that were sent. The response rate for the referral specific e-mail surveys was 56% for PCPs and 53% for specialists. In this e-mail survey, 68% of specialists reported that they received no information from the PCP prior to specific referral visits, and 38% of these said that this information would have been helpful. In addition, four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists. CONCLUSIONS: Substantial problems were present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inadequate content of interphysician communication. Information obtained from the general survey and referral-specific survey was congruent. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care.

Ambulatory Care↗
PubMed2000

Techniques for identifying the applicability of new information management technologies in the clinical setting: an example focusing on handheld computers.

This article describes techniques and strategies used to judge the potential applicability of new information management technologies in the clinical setting and to develop specific design recommendations for new features and services. We focus on a project carried out to identify the potential uses of handheld computers (i.e., the Palm Pilot or a small WinCE-based device) in the ambulatory practice setting. We found that the potential for a robust handheld computing device to positively affect the outpatient ambulatory clinical setting is enormous, and that the information derived from the exploratory research project is useful in creating specific design recommendations for further development.

Ambulatory Care Facilities↗
PubMed1999

A computer-based outpatient clinical referral system.

The process of generating a clinical referral for a patient, and the resulting transfer of information from the primary care physician to the specialist and back again, are key components in the struggle to deliver less costly and more effective clinical care. We have created a computer-based, outpatient clinical referral application that facilitates: (1) identifying an appropriate specialist; (2) collecting the clinical, demographic, and financial data required to generate a referral; and (3) transferring the information between the specialist and the primary care physician (PCP). This article describes the development of the application itself and several of the knowledge bases that were created to facilitate this process. Preliminary results indicate that the new computer-based referral process is faster to use than conventional methods.

Ambulatory Care↗
PubMed1999

Evaluating physician satisfaction regarding user interactions with an electronic medical record system.

A limiting factor in realizing the full potential of electronic medical records (EMR) is physician reluctance to use these applications. There have been very few formal usability studies of experienced physician users of EMRs in routine clinical use. We distributed the Questionnaire for User Interaction Satisfaction (QUIS) to 75 primary care physicians who routinely use the Brigham and Women's Integrated Computing System (BICS). BICS scored highest in the area of screen design and lowest in the area of system capability. Overall user satisfaction was most highly correlated with screen design and layout, and surprisingly not with system response time. Human-computer interaction studies can help focus our design efforts as we strive to increase clinician usage of information technology.

Attitude of Health Personnel↗
PubMed1999

Use of fuzzy set theory to extend Dhawan's journal selection model: ranking the biomedical informatics serials.

OBJECTIVE: Experts disagree on the parameters to use to identify the "best" serials within a scientific field. The author set out to develop an extension to Dhawan's journal selection model for ranking serials in any scientific field. METHODS: Comparison of three different instantiations of Dhawan's model were used to rank thirty-four biomedical informatics serials. RESULTS: The first instantiation of Dhawan's model identified seven serials and divided them into two groups. The second instantiation of Dhawan's model identified twelve serials and separated them into two groups. Using fuzzy set theory the new extended model produced a rank ordered list of the top twelve biomedical informatics serials. CONCLUSIONS: Use of fuzzy set theory to assign set membership and combine data in Dhawan's journal selection model allows one to: (1) eliminate the need to determine arbitrary cutoff points for inclusion of serials within each of Dhawan's evaluation criteria categories, (2) combine data from disparate sources, and (3) obtain a rank-ordered list of the biomedical informatics serials rather than simply identifying a set of the "top" serials. Such a ranked list provides librarians and researchers alike with the information necessary to help them make their biomedical informatics serial selection decisions based on objective, quantifiable data.

Abstracting and Indexing↗
PubMed1998

Design and development of a computer-based clinical referral system for use within a physician hospital organization.

The process of creating a clinical referral for a patient and the transfer of information from the primary care physician to the specialist and back again is a key component in the struggle to deliver less costly and more effective clinical care. We have created a computer-based clinical referral application which facilitates 1) identifying an appropriate specialist; 2) collecting the clinical, demographic, and financial data required to generate a referral; and 3) transferring the information between the specialist and the primary care physician. Preliminary results indicate that the new computer-based process is faster.

Ambulatory Care Information Systems↗
PubMed1998

Components of the optimal ambulatory care computing environment.

We present here a framework of core components of an ambulatory care computing environment, based on clinical and functional needs and workflow scenarios. We have established this framework through the use of two study devices: a vision of the clinical office of the future, and a survey of possible computer applications, both designed to help clinicians and practice directors communicate their information needs to systems designers. Clinicians prioritize applications based on strategic and practice goals: support for clinical users' workflow, improved quality of care, reduced cost of care, and the ability to measure performance and status. By reorganizing the needed functionality from a clinical viewpoint into a technical viewpoint, we are able to identify core information components for systems design. Based on this analysis, information needs in the ambulatory environment can be divided into five primary functions: patient data retrieval, documentation, communication, knowledge resources, and aggregate reporting. Three other fundamental processes--knowledge-based interventions, information integration, and confidentiality--run through all of these front-line functions. Component applications and data structures built with this framework in mind will afford a maximum combination of functionality and flexibility to handle future changes in the clinical environment.

Ambulatory Care↗
PubMed1998

Using web technology and Java mobile software agents to manage outside referrals.

A prototype, web-based referral application was created with the objective of providing outside primary care providers (PCP's) the means to refer patients to the Massachusetts General Hospital and the Brigham and Women's Hospital. The application was designed to achieve the two primary objectives of providing the consultant with enough data to make decisions even at the initial visit, and providing the PCP with a prompt response from the consultant. The system uses a web browser/server to initiate the referral and Java mobile software agents to support the workflow of the referral. This combination provides a light client implementation that can run on a wide variety of hardware and software platforms found in the office of the PCP. The implementation can guarantee a high degree of security for the computer of the PCP. Agents can be adapted to support the wide variety of data types that may be used in referral transactions, including reports with complex presentation needs and scanned (faxed) images Agents can be delivered to the PCP as running applications that can perform ongoing queries and alerts at the office of the PCP. Finally, the agent architecture is designed to scale in a natural and seamless manner for unforeseen future needs.

Computer Communication Networks↗
PubMed1998

A software architecture to support a large-scale, multi-tier clinical information system.

A robust software architecture is necessary to support a large-scale multi-tier clinical information system. This paper describes our mechanism for enterprise distribution of applications and support files, the consolidation of data-access functions and system utilities stored on the data access tier, and an application framework which implements a coherent clinical computing environment. The software architecture and systems described in this paper have been robust through pilot testing of our applications at Massachusetts General Hospital.

Computer Security↗
PubMed1998

Modifiable templates facilitate customization of physician order entry.

Physician order entry is a key factor in improving the quality of healthcare, while simultaneously reducing its cost. This paper describes an editor, a database, and a run-time system for creating and executing highly customized, user modifiable, order entry templates. The system allows non-programmers to create new order entry templates rapidly. Over the past 18 months, the templates have been used on over 2500 patients to enter over 40,000 separate orders.

Database Management Systems↗
PubMed1998

A graphical user interaction model for integrating complex clinical applications: a pilot study.

We have developed and implemented a multi-faceted, graphical user interaction model for an advanced clinical information system. This paper describes a classification scheme for applications used by clinicians in their daily work, discusses the way clinicians interact with these applications, and the issues that arise during these user interactions. Through its emphasis on support for application interoperation, the graphical user interface that implements the model presents a single, consistent, context to the user, and thereby helps maintain patient safety and ensure ease of use.

Computer Graphics↗
PubMed1997

Preserving context in a multi-tasking clinical environment: a pilot implementation.

The Partners Clinical Application Suite (CAS) is a multi-tasking software architecture that facilitates the development, deployment, and use of advanced clinical information management applications. This paper describes 1) a software shell in which clinical applications run; 2) an application programming interface (API); and 3) development of a set of "Look & Feel" guidelines. Through its emphasis on support for multi-tasking and application interoperability, CAS facilitates preservation of the user's context.

Hospital Information Systems↗
PubMed1996

Re-engineering healthcare: computer tools support the definition and analysis of work at the Vanderbilt University Hospital and Clinic.

In November 1993 The Vanderbilt University Hospital and Clinic (VUH/TVC) convened a 10-member Collaborative Organization Design (COD) team comprised of a multi-disciplinary team representing a diagonal slice through the organization. This team, lead by Gelinas * James, Inc. a consulting firm specializing in restructuring, was charged to develop, recommend, and implement a new organizational design that would promote stronger patient focus, increased efficiency, and lower cost. The COD process is structured to inspire and enable employees to rebuild their organization to respond to the challenges and opportunities that exist within their environment, to customer needs, and their own aspirations. This manuscript presents an overview of (1) the computer tools developed and/or employed to support the re-engineering process, and (2) the findings obtained as the work of patient care was defined and analyzed at VUH/TVC.

Computer-Assisted Instruction↗