Biomedical subjects

Suzanne Bakken

Publications and source records attributed to Suzanne Bakken.

At least 19 recordsLinked to original sources

PubMed2006

Description of a method to support public health information management: organizational network analysis.

In this case study, we describe a method that has potential to provide systematic support for public health information management. Public health agencies depend on specialized information that travels throughout an organization via communication networks among employees. Interactions that occur within these networks are poorly understood and are generally unmanaged. We applied organizational network analysis, a method for studying communication networks, to assess the method's utility to support decision making for public health managers, and to determine what links existed between information use and agency processes. Data on communication links among a health department's staff was obtained via survey with a 93% response rate, and analyzed using Organizational Risk Analyzer (ORA) software. The findings described the structure of information flow in the department's communication networks. The analysis succeeded in providing insights into organizational processes which informed public health managers' strategies to address problems and to take advantage of network strengths.

Database Management Systems↗

PubMed2006

Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire.

OBJECTIVES: To describe the development and validation of low literacy English and Spanish versions of the 26-item Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), report telemedicine satisfaction and usefulness ratings of urban and rural participants in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, and explore relationships between utilization and perceptions of satisfaction and usefulness. METHODS: Data sources included TSUQ, utilization data from IDEATel log files, and sociodemographic data from the annual IDEATel interview. Psychometric analyses were conducted to examine the reliability and validity of TSUQ. Data were analyzed using descriptive, correlational techniques. RESULTS: The principal components factor analysis extracted two factors (Video Visits, alpha=.96, and Use and Impact, alpha=.92) that explained 63.6% of the variance in TSUQ satisfaction scores. All satisfaction and usefulness items had mean scores of greater than 4 on a 5-point scale. Those from urban areas reported significantly higher ratings on both factors than rural participants as did those who did not know how to use a computer at baseline. Mean frequency of utilization of IDEATel components was highest for blood sugar testing followed by web site for reviewing results, blood pressure testing, video visits, and ADA educational Web pages. Associations between utilization and perceptions of satisfaction and usefulness varied among IDEATel components. CONCLUSION: Psychometric analyses support the construct validity and internal consistency reliability of TSUQ, which is available in both English and Spanish at a readability level of 8th grade. Both rural and urban participants reported high levels of satisfaction and found all IDEATel components useful. Further work is needed to examine the relationships between utilization and perceptions of satisfaction and usefulness and to explore the effects of location (urban versus rural) and ethnicity on satisfaction with telemedicine services.

Diabetes Mellitus↗

PubMed2006

Informatics for patient safety: a nursing research perspective.

In Crossing the Quality Chasm, the Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing a health system that produces care that is "safe, effective, patient-centered, timely, efficient, and equitable" (Committee on Quality of Health Care in America, 2001, p. 164). A subsequent IOM report contends that improved information systems are essential to a new health care delivery system that "both prevents errors and learns from them when they occur" (Committee on Data Standards for Patient Safety, 2004, p. 1). This review specifically highlights the role of informatics processes and information technology in promoting patient safety and summarizes relevant nursing research. First, the components of an informatics infrastructure for patient safety are described within the context of the national framework for delivering consumer-centric and information-rich health care and using the National Health Information Infrastructure (NHII) (Thompson & Brailer, 2004). Second, relevant nursing research is summarized; this includes research studies that contributed to the development of selected infrastructure components as well as studies specifically focused on patient safety. Third, knowledge gaps and opportunities for nursing research are identified for each main topic. The health information technologies deployed as part of the national framework must support nursing practice in a manner that enables prevention of medical errors and promotion of patient safety and contributes to the development of practice-based nursing knowledge as well as best practices for patient safety. The seminal work that has been completed to date is necessary, but not sufficient, to achieve this objective.

Accidental Falls↗

PubMed2006

Caseworkers' perceptions of the mental health information needs of persons living with HIV/AIDS.

This qualitative study was the first phase in designing a computer system that provides interactive tailored interventions for management of depressive symptoms in HIV-infected individuals (HIV TIDES). The purposes of the study were to explore caseworkers' perceptions of the mental health information needs of persons living with HIV/AIDS (PLWHA), barriers of accessing mental health information, and possible solutions to fulfilling PLWHA's mental health information needs. A focus group methodology was used to gather perceptions from six experienced community-based workers who provided direct case management services for PLWHA in East Harlem, New York. Data were classified into four main categories: mental health information needs, information sources for mental health concerns, barriers to accessing mental health information, and need for mental health interventions. The results of this study were used to inform the design of HIV TIDES.

Allied Health Personnel↗

PubMed2006

Creation of a gold standard for validation of a computer-interpretable depression screening guideline.

Clinical practice guidelines (CPGs) are common tools for clinicians in daily practice. In order to use CPGs effectively at the point of care, representing CPGs into computer-interpretable format is essential. Since computer-interpretable guidelines (CIGs) have been reported to increase clinicians' usage of guidelines and improve patient's outcomes, it is critical to validate health care knowledge translated from CPGs into CIGs. A comprehensive method of developing and evaluating a gold standard for a depression screening CIG was performed and analyzed in this study. GLIF encoding was conducted for a depression screening CPG and 21 clinical scenarios were created based on the encoded depression screening CIG. Two nurse practitioners were recruited to generate initial management for each scenario. Proficiency and efficiency scores were calculated for each scenario. In 13 of 21 scenarios, both experts had proficiency scores of 100%. Proficiency scores were lowest for scenarios that included bipolar disease. Implications of our findings for development of a gold standard are discussed.

Depression↗

PubMed2006

Preliminary analysis for the development of a PDA-based decision support system for the screening and management of obesity.

This preliminary study toward the development of a Mobile Decision Support System for Advanced Practice Nursing (MODS-APN) for the management of obesity compared APN students' current electronic clinical log (CL-APN) documentation to an obesity clinical practice guideline (CPG) and examined the extent to which concepts related to the screening and management of obesity could be represented with standardized terminologies. The data that were documented by APN students with the CL-APN were retrieved using the Structured Query Language (SQL) and were compared to the CPG using a scoring tool developed for this study. Only 1.4 % of the encounters had obesity as an assessment diagnosis and about 40 % of those encounters did not have any plans of care related to the CPG's main treatment recommendations. Fifty-six concepts related to the screening and management of obesity were extracted from the CPG and were mapped to 36 terms using standardized terminologies.

Computers, Handheld↗

PubMed2006

Requirements specification for automated fall and injury risk assessment.

Fall and injury prevention continues to be a challenge in the acute care environment. Identification of patients at risk can guide preventive care for these individuals. The following study employed usability engineering methods via a series of focus groups, to specify functional and design requirements for an automated Fall-Injury Risk Assessment Instrument. Focus groups were held with interdisciplinary decision makers and end-users to identify functional and design specifications for the automated instrument. The results were mapped to usability heuristics, which were used to guide design decisions. The main elements identified were data completeness, workflow processes, resource access, and cognitive burden. The main usability factors identified were efficiency of user, match with real world, error prevention, recognition not recall and minimalist design. Focus groups are a useful methodology to specify requirements for healthcare applications. Outcomes evaluation of the automated instrument is in process.

Academic Medical Centers↗

PubMed2006

Heuristic evaluation of a Web-based Educational Resource for low literacy NICU parents.

"Web-based Educational Resources for the NICU Parent," an educational website for low literacy families, was developed and implemented as prototype web pages using Macromedia Dreamweaver MX. Research has shown that evaluating a website before its implementation can reduce usability errors and improve the overall interface design. As an initial assessment of the website's interface, a heuristic evaluation was conducted with a sample of three usability experts. The usability experts reviewed the website with typical case scenario and completed an evaluation form covering ten usability heuristics. The task was completed in approximately one and a half hours; 82 heuristic violations were reported. The heuristic violations noted on the evaluation forms and the experts' verbalizations captured by a usability testing tool (Morae) were content analyzed and categorized based on the potential design solutions to be implemented: function, design and layout, content, and navigation. Approximately 88% of the violations were resolved by implementing these solutions. The study findings suggest that the heuristic evaluation was an efficient and inexpensive method for evaluating the low literacy interface of the "Web-based Educational Resources for the NICU Parent."

Comprehension↗

PubMed2006

An automated approach to studying health resource and infobutton use.

Many studies have found that clinicians require access to medical knowledge sources while viewing data in their patients' health records. To address this need, we have been developing links to various on-line health information resources from our Web-based clinical information system (WebCIS). Clinicians can access these resources through a "Health Resources" Web page or use context-sensitive "infobuttons" that automatically link to specific resources. To assist in understanding how clinicians interact with these two mechanisms, we have been exploring the use of an automated approach to answer questions about usage for guiding the further development of links to resources. In this paper, we discuss the use of a knowledge discovery technique (CIS Usage Mining) to obtain usage statistics from log files that record interactions with health resources and infobuttons in WebCIS, describe a Web-based interface developed to present the results, and summarize how the results could be applied. The availability of effective links to on-line medical knowledge sources from the patient health record can assist in resolving information needs, potentially improving patient care and decision-making.

Access to Information↗

PubMed2006

Knowledge content of advance practice nurse and physician experts: A cognitive evaluation of clinical practice guideline comprehension.

Clinical practice guidelines (CPGs) are intended to provide evidence based knowledge for decision making for patient care. However, these guidelines have been poorly adopted by healthcare providers. One reason for this may be the static paper-based formats, isolated from the point of care. Biomedical informatics has provided a solution to this limitation through Computer Interpretable Guidelines (CIGs). An essential component of this process is CPG translation to a computer interpretable model. From the guideline modeling literature, the translators of CPGs typically are physicians. It is not known if other healthcare providers (i.e., Advance Practice Nurses [APNs]) comprehend CPGs similarly. This descriptive study utilized novice and expert APN and physician participants (varied by level of expertise) in a CPG comprehension task. Demographic data, verbal protocols, and recall model drawings were obtained and analyzed by description, protocol analysis, discourse analysis, and content analysis. The findings of this study indicate similar comprehension by the expert APNs and physicians suggesting that either type of expert may be utilized for modeling CPGs.

Comprehension↗

PubMed2006

Is the Health Level 7/LOINC document ontology adequate for representing nursing documents?

The use of nursing documents from different electronic health record (EHR) systems is challenging due to inconsistency in document naming across systems and institutions. Mapping each local document name to standard document ontology may enable health care professionals to navigate and retrieve documents efficiently for multiple purposes such as quality assurance, outcomes research or public health reporting. The purpose of this study was to evaluate the sufficiency of the Health Level 7 (HL7)/Logical Observation Identifiers, Names, and Codes (LOINC) document ontology for representing nursing document names. We collected 94 nursing document types from the Eclipsys Clinical Information System (CIS) and the Columbia Medical Entities Dictionary (MED) and mapped them to the components of the HL7/LOINC document ontology. Seventy-five (79.8%) nursing document names were completely represented and 19 (20.2%) document names were partially represented. In order for the HL7/LOINC document ontology to be of more use in implementing EHRs that support nursing documentation, Subject Matter Domain and Type of Service axes require extension and clarification.

Humans↗

PubMed2006

Usefulness of a personal digital assistant-based advanced practice nursing student clinical log: Faculty stakeholder exemplars.

The number of health sciences educational programs that are integrating personal digital assistants (PDAs) into their curricula is on the rise. In this paper, we report an evaluation of the usefulness of a PDA-based advanced practice nursing (APN) student clinical log through faculty stakeholder exemplars in three areas: pediatric asthma care; procedures of Acute Care Nurse Practitioner (NP) students; and diagnostic and screening procedures of Women's Health NP students. We generated descriptive data through routine queries and through custom SQL queries at the request of a specific faculty member who wished to examine a particular aspect of an educational program. In addition, we discussed the potential implications of the data with the respective faculty members. The exemplars provide evidence that faculty stakeholders found the APN student clinical log to be useful for a variety of purposes including monitoring of student performance, benchmarking, and quality of care assessments.

Computers, Handheld↗

PubMed2006

Encoding a depression screening guideline using GLIF.

Computer-interpretable guidelines (CIGs) have been reported to increase clinicians' usage of guidelines and to improve patient outcomes. The Guideline Interchange Format (GLIF) represents a guideline as a flowchart of clinical decision and action steps. We encoded a depression screening guideline using GLIF to transform it into a CIG. After identifying all guideline steps from the text format guideline, a flowchart was drawn using the encoded steps in GLIF. The flowchart was validated by an experienced psychiatric nurse clinician.

Decision Making, Computer-Assisted↗

PubMed2006

Markup of temporal information in electronic health records.

Temporal information plays a critical role in the understanding of clinical narrative (i.e., free text). We developed a representation for marking up temporal information in a narrative, consisting of five elements: 1) reference point, 2) direction, 3) number, 4) time unit, and 5) pattern. We identified 254 temporal expressions from 50 discharge summaries and represented them using our scheme. The overall inter-rater reliability among raters applying the representation model was 75 percent agreement. The model can contribute to temporal reasoning in computer systems for decision support, data mining, and process and outcomes analyses by providing structured temporal information.

Hospitals, Religious↗

PubMed2006

Demonstration of HIV TIDES--Tailored interventions for the management of depressive symptoms in HIV-infected individuals.

Depression has been reported as one of the biggest health problems experienced by persons living with HIV/AIDS (PLWHA). HIV TIDES is an interactive program designed specifically for the management of depressive symptoms in this population. The main functions of this system include (1) assessing current level of depressive symptoms, (2) providing reinforcement messages for positive thoughts and health behaviors, (3) suggesting tailored strategies for depression prevention, and (4) presenting information for depression treatment. HIV TIDES is expected to be operated by individuals with minimum computer experience.

Depression↗

PubMed2006

Mobile decision support for advanced practice nurses.

Mobile Decision Support for Advanced Practice Nurses (MODS-APN) is a PDA-based decision support tool designed to assist APNs in the diagnosis and management of smoking cessation, obesity, and depression. It is currently being tested in a randomized, controlled trial (RCT) in a sample of APN students to determine the effect on adherence to clinical practice guideline (CPG) recommendations. Tools such as MODS-APN have the potential to increase CPG adherence, enhance evidence-based practice, promote patient safety, and in the long term improve patient outcomes.

Computers, Handheld↗

PubMed2005

Heuristic evaluation of paper-based Web pages: a simplified inspection usability methodology.

Online medical information, when presented to clinicians, must be well-organized and intuitive to use, so that the clinicians can conduct their daily work efficiently and without error. It is essential to actively seek to produce good user interfaces that are acceptable to the user. This paper describes the methodology used to develop a simplified heuristic evaluation (HE) suitable for the evaluation of screen shots of Web pages, the development of an HE instrument used to conduct the evaluation, and the results of the evaluation of the aforementioned screen shots. In addition, this paper presents examples of the process of categorizing problems identified by the HE and the technological solutions identified to resolve these problems. Four usability experts reviewed 18 paper-based screen shots and made a total of 108 comments. Each expert completed the task in about an hour. We were able to implement solutions to approximately 70% of the violations. Our study found that a heuristic evaluation using paper-based screen shots of a user interface was expeditious, inexpensive, and straightforward to implement.

Computer Graphics↗

PubMed2005

Effect of an informatics for evidence-based practice curriculum on nursing informatics competencies.

Effective and appropriate use of information and communication technologies is an essential competency for all health care professionals. The purpose of this paper is to describe the effect of an evolving informatics for evidence-based practice (IEBP) curriculum on nursing informatics competencies in three student cohorts in the combined BS/MS program for non-nurses at the Columbia University School of Nursing. A repeated-measures, non-equivalent comparison group design was used to determine differences in self-rated informatics competencies pre- and post-IEBP and between cohorts at the end of the BS year of the combined BS/MS program. The types of Computer Skill competencies on which the students rated themselves as competent (> or =3) on admission were generic in nature and reflective of basic computer literacy. Informatics competencies increased significantly from admission to BS graduation in all areas for the class of 2002 and in all, but three areas, for the class of 2003. None of the three cohorts achieved competence in Computer Skills: Education despite curricular revisions. There were no significant differences between classes at the end of the BS year. Innovative educational approaches, such as the one described in this paper demonstrate promise as a method to achieve informatics competence. It is essential to integrate routine measurement of informatics competency into the curriculum so that approaches can be refined as needed to ensure informatics competent graduates.

Clinical Competence↗