Biomedical subjects

Vimla Patel

Publications and source records attributed to Vimla Patel.

6 recordsLinked to original sources

PubMed2006

A cognitive blueprint of collaboration in context: distributed cognition in the psychiatric emergency department.

OBJECTIVE: The complex cognitive processes that underlie human performance in 'messy' contexts such as critical care medicine suggest a need for a cognitive model with broad scope to support the understanding of error in such domains. The objective of this research is to characterize the cognition that underlies patient care in the domain of emergency psychiatry in order to enhance the understanding of error in this context. METHODS AND MATERIALS: The theoretical framework of distributed cognition has been used to study collaborative decision-making in a number of similarly complex environments such as airline cockpits and air traffic control towers. These environments share certain characteristics with the critical care domain: the work is collaborative in nature, it is supported by artifacts that can be studied directly, and the consequences of error are dire. However, the nature of the work in this domain and the artifacts used to support it are unique. The application of the theoretical constructs of distributed cognition to this context is necessary in order to characterize the collective thinking that underlies critical care. Our research uses a combination of ethnographic and interview data to derive a distributed cognitive model of the psychiatric emergency department (PED), a high volume clinical unit dealing exclusively with the acute phases of psychiatric crises. The dynamics of workflow within the department are complex: several types of clinician collaborate by forming temporary multidisciplinary teams that attach to and manage particular patients. The component members of these teams change over time. RESULTS: Using the theoretical framework of distributed cognition, we interpreted the collected data to derive a cognitive model of the distribution of work and information flow in the PED. This modeling process has revealed several latent flaws in the system related to the underlying distribution of cognition across teams, time, space and artifacts. CONCLUSIONS: The characterization of this distribution has enhanced our understanding of the cognitive dynamics underlying error in this environment, and will serve to guide future research on error management in the ED and inform the development of context-appropriate error-management systems.

Artificial Intelligence↗

PubMed2005

Customizing clinical narratives for the electronic medical record interface using cognitive methods.

OBJECTIVE: As healthcare practice transitions from paper-based to computer-based records, there is increasing need to determine an effective electronic format for clinical narratives. Our research focuses on utilizing a cognitive science methodology to guide the conversion of medical texts to a more structured, user-customized presentation in the electronic medical record (EMR). DESIGN: We studied the use of discharge summaries by psychiatrists with varying expertise-experts, intermediates, and novices. Experts were given two hypothetical emergency care scenarios with narrative discharge summaries and asked to verbalize their clinical assessment. Based on the results, the narratives were presented in a more structured form. Intermediate and novice subjects received a narrative and a structured discharge summary, and were asked to verbalize their assessments of each. MEASUREMENTS: A qualitative comparison of the interview transcripts of all subjects was done by analysis of recall and inference made with respect to level of expertise. RESULTS: For intermediate and novice subjects, recall was greater with the structured form than with the narrative. Novices were also able to make more inferences (not always accurate) from the structured form than with the narrative. Errors occurred in assessments using the narrative form but not the structured form. CONCLUSIONS: Our cognitive methods to study discharge summary use enabled us to extract a conceptual representation of clinical narratives from end-users. This method allowed us to identify clinically relevant information that can be used to structure medical text for the EMR and potentially improve recall and reduce errors.

Cognitive Science↗

PubMed2005

Exploring dangerous neighborhoods: latent semantic analysis and computing beyond the bounds of the familiar.

Certain applications require computer systems to approximate intended human meaning. This is achievable in constrained domains with a finite number of concepts. Areas such as psychiatry, however, draw on concepts from the world-at-large. A knowledge structure with broad scope is required to comprehend such domains. Latent Semantic Analysis (LSA) is an unsupervised corpus-based statistical method that derives quantitative estimates of the similarity between words and documents from their contextual usage statistics. The aim of this research was to evaluate the ability of LSA to derive meaningful associations between concepts relevant to the assessment of dangerousness in psychiatry. An expert reference model of dangerousness was used to guide the construction of a relevant corpus. Derived associations between words in the corpus were evaluated qualitatively. A similarity-based scoring function was used to assign dangerousness categories to discharge summaries. LSA was shown to derive intuitive relationships between concepts and correlated significantly better than random with human categorization of psychiatric discharge summaries according to dangerousness. The use of LSA to derive a simulated knowledge structure can extend the scope of computer systems beyond the boundaries of constrained conceptual domains.

Artificial Intelligence↗

PubMed2004

Cognitive evaluation of an innovative psychiatric clinical knowledge enhancement system.

Psychiatric Clinical Knowledge Enhancement System (PSYCKES) is an innovative information system that presents patient medication history in tabular and graphical form. The system is designed to support therapeutic decision making. In this paper, we present a multifaceted cognitive evaluation of this system. The evaluation includes a cognitive walkthrough which is a task-analytic method for usability evaluation. We also conducted cognitive studies of two trainee and two attending psychiatrists using the system. One of the attending subjects is presented as a case study. An objective of this research is to characterize the way PSYCKES mediates reasoning. The study found that clinicians were able to use the system effectively to extract and coordinate information and draw appropriate inferences. The expert clinicians were better able to construct a coherent patient representation. The study also documented a few usability problems pertaining to the temporal integration of patient data. PSYCKES is a multifaceted tool that can significantly enhance therapeutic decision making.

Cognitive Science↗

PubMed2003

Clinical information needs in context: an observational study of clinicians while using a clinical information system.

INTRODUCTION: The development of tools to meet the information needs of clinicians requires an understanding of the clinician and the context in which clinical decisions are being made. METHODS: We conducted an observational study of clinicians' information needs via think-aloud protocols during which we observed physicians and nurses as they used the clinical information system. Protocol analysis was then used to identify the information needs events, the types of questions that were asked, the method of meeting that need, the success or failure of meeting the specific information need, and the context in which it arose. RESULTS: Results indicated that a) unmet information needs occur frequently and that b) the predominant feature of these unmet needs is that they are patient-related or domain-specific. Two categories of context: laboratory and medical communication accounted for more than half of the events.

Hospital Information Systems↗

PubMed2003

Characterizing information needs and cognitive processes during CIS use.

Medical errors are often associated with inadequate cognitive processing that is based upon impaired access to information.1 Understanding the information needs of nurses and physicians' when using a clinical information system (CIS) is difficult largely because there are few systematic attempts made to do so. We collected 15.5 hours of data of nurses and physicians' CIS interactions in three clinical environments (cardiac ICU, a general medical/surgical nursing, and an ambulatory clinic). We accomplished this through observational, cognitive-based methods (e.g., thinking aloud during interaction) and the video capturing of events with a portable usability laboratory.2 We developed a systematic approach to identify and define in-context clinical information needs while using a CIS, and determine how to categorize and code such events. 3

Cognition↗