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Biomedical subjects

Jiajie Zhang

Publications and source records attributed to Jiajie Zhang.

At least 19 recordsLinked to original sources
PubMed2006

Towards a hybrid method to categorize interruptions and activities in healthcare.

OBJECTIVE: Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper, a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular as well as improving healthcare quality and patient safety in general. METHOD: The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory. RESULTS: The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case. CONCLUSIONS: Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Communication↗
PubMed2006

Influenza Virus Database (IVDB): an integrated information resource and analysis platform for influenza virus research.

Frequent outbreaks of highly pathogenic avian influenza and the increasing data available for comparative analysis require a central database specialized in influenza viruses (IVs). We have established the Influenza Virus Database (IVDB) to integrate information and create an analysis platform for genetic, genomic, and phylogenetic studies of the virus. IVDB hosts complete genome sequences of influenza A virus generated by Beijing Institute of Genomics (BIG) and curates all other published IV sequences after expert annotation. Our Q-Filter system classifies and ranks all nucleotide sequences into seven categories according to sequence content and integrity. IVDB provides a series of tools and viewers for comparative analysis of the viral genomes, genes, genetic polymorphisms and phylogenetic relationships. A search system has been developed for users to retrieve a combination of different data types by setting search options. To facilitate analysis of global viral transmission and evolution, the IV Sequence Distribution Tool (IVDT) has been developed to display the worldwide geographic distribution of chosen viral genotypes and to couple genomic data with epidemiological data. The BLAST, multiple sequence alignment and phylogenetic analysis tools were integrated for online data analysis. Furthermore, IVDB offers instant access to pre-computed alignments and polymorphisms of IV genes and proteins, and presents the results as SNP distribution plots and minor allele distributions. IVDB is publicly available at http://influenza.genomics.org.cn.

Databases, Genetic↗
PubMed2006

The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care.

Several studies have shown that there is information loss during interruptions, and that multitasking creates higher memory load, both of which contribute to medical error. Nowhere is this more critical than in the emergency department (ED), where the emphasis of clinical decision is on the timely evaluation and stabilization of patients. This paper reports on the nature of multitasking and shift change and its implications for patient safety in an adult ED, using the methods of ethnographic observation and interviews. Data were analyzed using grounded theory to study cognition in the context of the work environment. Analysis revealed that interruptions within the ED were prevalent and diverse in nature. On average, there was an interruption every 9 and 14 min for the attending physicians and the residents, respectively. In addition, the workflow analysis showed gaps in information flow due to multitasking and shift changes. Transfer of information began at the point of hand-offs/shift changes and continued through various other activities, such as documentation, consultation, teaching activities and utilization of computer resources. The results show that the nature of the communication process in the ED is complex and cognitively taxing for the clinicians, which can compromise patient safety. The need to tailor existing generic electronic tools to support adaptive processes like multitasking and handoffs in a time-constrained environment is discussed.

Continuity of Patient Care↗
PubMed2006

Applying heuristic evaluation to improve the usability of a telemedicine system.

The development of a telemedicine system should not only take advantage of technological advances but also pay close attention to users and the human issues involved. In this paper we examine the utility of heuristic evaluation in improving the usability of a digital emergency medical services (EMS) system equipped on an ambulance. The digital EMS system used advanced communication technologies to help remotely located trauma specialists gain access to patient data in real-time and direct life-saving measures in a timely fashion. To improve its usability, three experts inspected prototypes of the system according to 14 software usability heuristics. The analyses revealed information on the prevalence, severity, and nature of heuristic violations in the user interface design. The results were subsequently utilized to guide the iterative software design process. A comparison between two consecutive prototypes showed that the second design had only half as many usability violations as the first prototype and had considerable improvement in a number of usability heuristic categories. The validity of heuristic evaluation was examined in an ethnographic study of paramedics using a prototype of the system in their work environment. Users' task performances partially verified heuristic evaluation results. However, they also revealed problems that were not identified in heuristic evaluation but only became prominent during field observation. In conclusion, we argue that usability should be given high priority in the development of a telemedicine system, and that heuristic evaluation can be an effective and efficient way to identify usability problems in the early stage of software development.

Ambulances↗
PubMed2006

The involvement of the inferior parietal cortex in the numerical Stroop effect and the distance effect in a two-digit number comparison task.

The neural mechanism of number representation and processing is currently under extensive investigation. In this functional magnetic resonance imaging study, we designed a number comparison task to examine how people represent and compare two-digit numbers in the brain, and whether they process the decade and unit digits in parallel. We manipulated the decade-unit-digit congruency and numerical distance between the pairs of numbers. We observed both Stroop-like interference and the distance effect in the participants' performance. People responded more slowly to incongruent pairs of numbers and pairs of a smaller distance. The inferior parietal cortex showed common and distinct patterns of activation for both attentional selection and number comparison processes, and its activity was modulated by the Stroop-like interference effect and the distance effect. Taken together, these results support both parallel and holistic comparison of two-digit numbers in the brain.

Adolescent↗
PubMed2005

Designing the design phase of critical care devices: a cognitive approach.

In this study, we show how medical devices used for patient care can be made safer if various cognitive factors involved in patient management are taken into consideration during the design phase. The objective of this paper is to describe a methodology for obtaining insights into patient safety features--derived from investigations of institutional decision making--that could be incorporated into medical devices by their designers. The design cycle of a product, be it a medical device, software, or any kind of equipment, is similar in concept, and course. Through a series of steps we obtained information related to medical errors and patient safety. These were then utilized to customize the generic device design cycle in ways that would improve the production of critical care devices. First, we provided individuals with different levels of expertise in the clinical, administrative, and engineering domains of a large hospital setting with hypothetical clinical scenarios, each of which described a medical error event involving health professionals and medical devices. Then, we asked our subjects to "think-aloud" as they read through each scenario. Using a set of questions as probes, we then asked our subjects to identify key errors and attribute them to various players. We recorded and transcribed the responses and conducted a cognitive task analysis of each scenario to identify different entities as "constant," "partially modifiable," or "modifiable." We compared our subjects' responses to the results of the task analysis and then mapped them to the modifiable entities. Lastly, we coded the relationships of these entities to the errors in medical devices. We propose that the incorporation of these modifiable entities into the device design cycle could improve the device end product for better patient safety management.

Cognitive Science↗
PubMed2005

A user-centered framework for redesigning health care interfaces.

Numerous health care systems are designed without consideration of user-centered design guidelines. Consequently, systems are created ad hoc, users are dissatisfied and often systems are abandoned. This is not only a waste of human resources, but economic resources as well. In order to salvage such systems, we have combined different methods from the area of computer science, cognitive science, psychology, and human-computer interaction to formulate a framework for guiding the redesign process. The paper provides a review of the different methods involved in this process and presents a life cycle of our redesign approach. Following the description of the methods, we present a case study, which shows a successfully applied example of the use of this framework. A comparison between the original and redesigned interfaces showed improvements in system usefulness, information quality, and interface quality.

Artificial Intelligence↗
PubMed2005

Human-centered design of a distributed knowledge management system.

Many healthcare technology projects fail due to the lack of consideration of human issues, such as workflow, organizational change, and usability, during the design and implementation stages of a project's development process. Even when human issues are considered, the consideration is typically on designing better user interfaces. We argue that human-centered computing goes beyond a better user interface: it should include considerations of users, functions and tasks that are fundamental to human-centered computing. From this perspective, we integrated a previously developed human-centered methodology with a Project Design Lifecycle, and we applied this integration in the design of a complex distributed knowledge management system for the Biomedical Engineer (BME) domain in the Mission Control Center at NASA Johnson Space Center. We analyzed this complex system, identified its problems, generated systems requirements, and provided specifications of a replacement prototype for effective organizational memory and knowledge management. We demonstrated the value provided by our human-centered approach and described the unique properties, structures, and processes discovered using this methodology and how they contributed in the design of the prototype.

Artificial Intelligence↗
PubMed2005

The effect of external representations on numeric tasks.

This article explores the effect of external representations on numeric tasks. Through several minor modifications on the previously reported two-digit number comparison task, we obtained different results. Rather than holistic comparison, we found parallel comparison. We argue that this difference was a reflection of different representational forms: The comparison was based on internal representations in previous studies but on external representations in our present study. This representational effect is discussed under a framework of distributed number representations. We propose that in numerical tasks involving external representations, numbers should be considered as distributed representations, and the behaviour in these tasks should be considered as the interactive processing of internal and external information through the interplay of perceptual and cognitive processes. We suggest that theories of number representations and process models of numerical cognition should consider external representations as an essential component.

Cognition↗
PubMed2005

Object location memory: the interplay of multiple representations.

This article reports three experiments in which the representational nature of human object location memory was studied. The results show that multiple frames of reference can be used to encode the spatial relationships among objects. Depending on their dominancy, availability, and validity, these multiple representations interact to determine memory performance. Specifically, representations that are automatically encoded and extensively practiced are more dominant, and their availability improves performance when they are valid. On the other hand, when the dominant representations are available but invalid, people may have to resort to the less dominant representations. As a result, the availability of these dominant but invalid representations can actually hurt performance, due to interference. If these interfering representations are eliminated, the performance is again improved. The implications of these findings for general human spatial cognition are discussed.

Adult↗
PubMed2005

Interruptions in workflow for RNs in a Level One Trauma Center.

An understanding of interruptions in healthcare is important for the design, implementation, and evaluation of health information systems and for the management of clinical workflow and medical errors. The purpose of this study is to identify and classify the types of interruptions experienced by ED nurses working in a Level One Trauma Center. This was an observational field study of Registered Nurses employed in a Level One Trauma Center using the shadowing method. Results of the study indicate that nurses were both recipients and initiators of interruptions. Telephone, pagers, and face-to-face conversations were the most common sources of interruptions. Unlike other industries, the outcomes caused by interruptions resulting in medical errors, decreased efficiency and increased cost have not been systematically studied in healthcare. Our study presented here is an initial step to understand the nature, causes, and effects of interruptions, and to develop interventions to manage interruptions to improve healthcare quality and patient safety. We developed an ethnographic data collection technique and a data coding method for the capturing and analysis of interruptions. The interruption data we collected are systematic, comprehensive, and close to exhaustive. They confirmed the findings from early studies by other researchers that interruptions are frequent events in critical care and other healthcare settings. We are currently using these data to analyze the workflow dynamics of ED clinicians, identify the bottlenecks of information flow, and develop interventions to improve the efficiency of emergency care through the management of interruptions.

Communication↗
PubMed2005

A human-centered design and evaluation framework for information search.

Information search in a distributed environment is an interactive process between the user and the artifact. How the information is distributed across the user and the artifact determines the efficacy of information search. Using a human-centered method, UFuRT, we developed an information search model and a taxonomy of search tasks. Further, we developed prototypes to investigate the relationship between search tasks and interface types. Preliminary results of analysis reveal the requirement of distributed information for search tasks and help understand the complexity of the tasks in different types of interfaces.

Humans↗
PubMed2005

A distributed information analysis for information search tasks.

Information search in a distributed environment is an interactive process that involves both retrieval and the processing of information across users and artifacts. How the information is distributed across internal representations and external representations affects the efficacy of information search. Using a human-centered method called UFuRT, we developed an information search model and a taxonomy of search tasks. We further developed several prototypes of information search interfaces with different patterns of distributed information and investigated the relations between search tasks and interface types. The results from the analyses show that UFuRT is a useful process that not only provides design guidelines but also generates estimates of representational efficiencies, task complexities and user behavioral outcomes.

Computer Communication Networks↗
PubMed2005

Information visualization for quality control in health data exchange platforms.

Policy Makers, System Administrators and Designers in health care are often deluged by the complexity of maintaining a reliable information exchange platform involving multiple systems. Often two factors are taken for granted in such health data exchange settings: that the communication between systems is reliable and that the messages transmitted between systems contain quality data. We are presenting an approach to meaningfully analyzing and visualizing information exchange to provide situational awareness in data exchange platforms.

Bioterrorism↗