Search PubMed⌕ Search

Biomedical subjects

E Coiera

Publications and source records attributed to E Coiera.

At least 19 recordsLinked to original sources
PubMed2006

The safety and quality of decision support systems.

OBJECTIVES: The use of clinical decision support systems (CDSS) can improve the overall safety and quality of health care delivery, but may also introduce machine-related errors. Recent concerns about the potential for CDSS to harm patients have generated much debate, but there is little research available to identify the nature of such errors, or quantify their frequency or clinical impact. METHODS: A review of recent literature into electronic prescribing systems, as well as related literature in decision support. RESULTS: There seems to be some evidence for variation in the outcomes of using CDSS, most likely reflecting variations in clinical setting, culture, training and organizational process, independent of technical variables. There is also preliminary evidence that poorly implemented CDSS can lead to increased mortality in some settings. Studies in the US, UK and Australia have found commercial prescribing systems often fail to uniformly detect significant drug interactions, probably because of errors in their knowledge base. Electronic medication management systems may generate new types of error because of user-interface design, but also because of events in the workplace such as distraction affecting the actions of system users. Another potential source of CDSS influenced errors are automation biases, including errors of omission where individuals miss important data because the system does not prompt them to notice them, and errors of commission where individuals do what the decision aid tells to do, even when this contradicts their training and other available data. Errors of dismissal occur when relevant alerts are ignored. On-line decision support systems may also result in errors where clinicians come to an incorrect assessment of the evidence, possibly shaped in part by cognitive decision biases. CONCLUSIONS: The effectiveness of decision support systems, like all other health IT, cannot be assessed purely by evaluating the usability and performance of the software, but is the outcome of a complex set of cognitive and socio-technical interactions. A deeper understanding of these issues can result in the design of systems which are not just intrinsically 'safe' but which also result in safe outcomes in the hands of busy or poorly resourced clinicians.

Decision Support Systems, Clinical↗
PubMed2002

Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results.

BACKGROUND: neuraminidase (NA) inhibitors have recently become available for treatment of influenza. Rapid antigen detection assays at 'point-of-care' may improve the accuracy of clinical diagnosis, but the value of these techniques in assisting with the appropriate use of antivirals remains controversial. OBJECTIVE: to compare the diagnostic utilities of two management strategies for influenza, empirical antiviral therapy versus therapy based on a positive rapid test result in pre-epidemic and epidemic periods. STUDY DESIGN: a threshold decision analytic model was designed to compare these competing strategies and sensitivity analysis performed to examine the impact of diagnostic variables on the expected utility of the decision with a range of prior probabilities of infection between 1 and 50%. RESULTS: on the basis of the calculated sensitivity (77%) and specificity (95%) of a point-of-care test for influenza, pre-treatment testing was preferred and cost-effective in non-epidemic stage of the influenza cycle. The alternative strategy of empirical treatment produces a higher utility value during epidemics, but may result in overuse of antivirals for low-risk populations. The two strategies had equivalent efficacy when the probability of influenza was 42%. CONCLUSIONS: Patients with flu-like illness, who present outside the influenza outbreak and are considered to be at low risk for influenza-related complications, should be tested to confirm the diagnosis before starting antiviral treatment with a NA inhibitor. The most important variables in the model were the accuracy of the clinical diagnosis and the pre-test probability of influenza. A threshold probability of influenza of 42% would dictate changing from the rapid testing strategy to a 'treat regardless' strategy.

Antiviral Agents↗
PubMed2001

Maximising the uptake of evidence into clinical practice: an information economics approach.

Evidence such as systematic reviews or clinical practice guidelines are information products, and clinicians are consumers of those products; their current proliferation but low uptake by consumers indicates an information oversupply. The costs and benefits of accessing and applying information are at least as important as are the costs and benefits of the treatments the information describes. In the same way that a citation index is a measure of the impact of a scientific paper, an evidence uptake index could measure effectiveness of evidence products in a clinical population. The uptake of evidence-based medicine may be hampered by the perceived high cost of changing to it. At present, most costs are borne by individual clinicians, but individual benefits for clinicians are downplayed in favour of population benefits. Specific strategies to increase evidence uptake into practice include decreasing the "cost of ownership"; increasing the direct or perceived value of evidence resources in routine practice; and customising evidence to suit different users, tasks and clinical contexts.

Cost-Benefit Analysis↗
PubMed2001

What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners.

BACKGROUND: The analysis of factors that influence prescribing decisions is increasingly important. Antibiotic use is often based on limited evidence and lack of information about clinical decision-making processes is an important obstacle to improving antibiotic utilization. AIMS: To compare the attitudes of intensive care unit practitioners (ICUP) and infectious disease practitioners (IDP) to antibiotic use and to the evidence-based information support. METHOD: A postal survey conducted between March and July 2000 of ICUP and IDP representing all States and Territories in Australia. RESULTS: One hundred and fifty-three of 224 clinicians returned the questionnaire (68.3% response rate). In choosing an antibiotic, IDP placed significantly more weight than ICUP on the in vitro susceptibility of the pathogen (P = 0.001), antibiotic cost (P = 0.05) and possible development of antibiotic resistance (P = 0.007). More than 95% of both groups believed that unit-specific antibiotic susceptibility of endemic pathogens was an essential factor in rational prescribing, but only 68.5% of IDP and 38.7% of ICUP use microbiology laboratory databases. When in doubt about appropriate antibiotic use, 63.8% of ICUP seek and 76.3% usually follow the advice of IDP. Both groups agree that published antibiotic guidelines are useful, but IDP were more likely to consult them. ICUP were more likely to believe that guidelines are used to control clinicians rather than to improve quality of care (P = 0.001). A greater proportion of IDP (71.2%) than ICUP (52.5%) believed that antibiotic prescribing in their intensive care unit (ICU) was evidence based but most (91.8% and 86.9%, respectively) agreed that it should be. CONCLUSIONS: Australian clinicians have positive views about evidence-based prescribing and antibiotic guidelines. However, there are clinically significant differences in prescribing behaviour between ICUP and IDP. These may be explained by different disease spectra managed by each group or different cultures, training and/or cognitive styles. Improvements in the understanding of physicians' information and decision support needs are required to strengthen evidence-based prescribing.

Anti-Bacterial Agents↗
PubMed1999

Ten essential clinical informatics skills.

Information skills are basic to good medical practice. Every clinician needs to understand the principles of data interpretation, the logical foundations of the diagnostic process, and the management of uncertainty in clinical knowledge. Understanding the implications of using one medium rather than another is central to developing effective communication skills as these communication options become commonplace in the community.

Communication↗
PubMed1998

Communication behaviours in a hospital setting: an observational study.

OBJECTIVE: An exploratory study to identify patterns of communication behaviour among hospital based healthcare workers. DESIGN: Non-participatory, qualitative observational study. SETTING: British district general hospital. SUBJECTS: Eight doctors and two nurses. RESULTS: Communication behaviours resulted in an interruptive workplace, which seemed to contribute to inefficiency in work practice. Medical staff generated twice as many interruptions via telephone and paging systems as they received. Hypothesised causes for this level of interruption include a bias by staff to interruptive communication methods, a tendency to seek information from colleagues in preference to printed materials, and poor provision of information in support of contacting individuals in specific roles. Staff were observed to infer the intention of messages based on insufficient information, and clinical teams demonstrated complex communication patterns, which could lead to inefficiency. CONCLUSION: The results suggest a number of improvements to processes or technologies. Staff may need instruction in appropriate use of communication facilities. Further, excessive emphasis on information technology may be misguided since much may be gained by supporting information exchange through communication technology. Voicemail and email with acknowledgment, mobile communication, improved support for role based contact, and message screening may be beneficial in the hospital environment.

Attitude of Health Personnel↗
PubMed1996

Clinical communication: a new informatics paradigm.

Observational studies of clinical workers in a hospital setting suggest that communication problems are a significant source of inefficiency. The need to reduce interruptions, improve contactability, and the sharing of informal information suggests that a mobile communication system capable of supporting asynchronous messaging, role-based contact, and communication policies would be beneficial. A prototype of such a system is described.

Communication↗
PubMed1995

Medical informatics.

Explore the source record for details and available documents.

Computer Communication Networks↗
PubMedDate not supplied

Information economics and the Internet.

Information economics offers insights into the dynamics of information across networked systems like the Internet. An information marketplace is different from other marketplaces because an information good is not actually consumed and can be reproduced and distributed at almost no cost. For information producers to remain profitable, they will need to minimize their exposure to competition. For example, information can be sold by charging site access rather than information access fees, or it can be bundled with other information or "versioned." For information consumers, a variation of Malthus' law predicts that the exponential growth in information will mean that specific information will become increasingly expensive to find, because search costs will grow but human attention will remain limited. Furthermore, the low cost of creating poor-quality information on the Web means that the low-quality information may eventually swamp high-quality resources. The use of reputable information portals on the Web, or smart search technologies, may help in the short run, but it is unclear whether an "information famine" is avoidable in the longer term.

Information Services↗
PubMedDate not supplied

When conversation is better than computation.

While largely ignored in informatics thinking, the clinical communication space accounts for the major part of the information flow in health care. Growing evidence indicates that errors in communication give rise to substantial clinical morbidity and mortality. This paper explores the implications of acknowledging the primacy of the communication space in informatics and explores some solutions to communication difficulties. It also examines whether understanding the dynamics of communication between human beings can also improve the way we design information systems in health care. Using the concept of common ground in conversation, proposals are suggested for modeling the common ground between a system and human users. Such models provide insights into when communication or computational systems are better suited to solving information problems.

Communication↗