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PubMed2004

Nurses' views of using computerized decision support software in NHS Direct.

BACKGROUND: Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. AIMS: To explore nurses' views of their roles and the computerized decision support software in NHS Direct. METHODS: Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. FINDINGS: Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. CONCLUSIONS: The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice.

Attitude of Health Personnel↗
PubMed2005

Speech recognition software as an assistive device: a pilot study of user satisfaction and psychosocial impact.

The purpose of this study was to gather data concerning the psychosocial (quality of life) impact of speech recognition software on individuals with physical disabilities and to identify how satisfied these individuals were with this software as a computer access method. Two standardized questionnaires, the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) were administered to ten participants with physical disabilities who received speech recognition software following an assistive technology evaluation. The results of this study indicated that 90% of the participants were quite satisfied with speech recognition software as an assistive device and that the software had a somewhat positive psychosocial impact on their lives. Four themes emerged concerning what the participants liked most about the software: 1) the software provided a method of access when they were not previously accessing a computer, 2) the software increased independence, 3) the software made computer use more efficient, and 4) the software provided a choice or flexibility in computer access. Although this study demonstrated that these speech recognition software users are generally satisfied with the software and it has had a positive impact on their life, it also suggests that there is a need to examine the role of training on satisfaction and successful use of the software.

Adult↗
PubMed2000

Decision support software to help primary care physicians triage skin cancer: a pilot study.

OBJECTIVE: To determine whether decision support software can help primary care physicians proficiently triage lesions suggestive of basal cell and squamous cell carcinoma. DESIGN/MEASURES: Physicians selected triage options for 15 digitized images of skin lesions, with and without use of the decision support software. PARTICIPANTS/SETTINGS: Twenty primary care physicians practicing in a health maintenance organization or a city health clinic. INTERVENTION: Decision support software designed to help physicians arrive at a triage recommendation consisted of a clinical information form, a decision tree, and support features (teaching points, example images, and diagrams). RESULTS: Without using the decision support software, physicians chose the wrong triage decision 36.7% of the time; using the decision support software, they chose the wrong response only 13.3% of the time. Not using the decision support software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions 22.1% of the time; using the software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions only 3.6% of the time. Physicians scored an average of 3 points (of a possible 15 points) higher when they used the software (signed rank, 101.0; P<.001). They scored an average of 1 point higher on the 7 cancerous lesions when they used the software (signed rank, 65.5; P<.001). CONCLUSIONS: Use of decision support software could improve primary care physicians' triage decisions for lesions suggestive of nonmelanoma skin cancer, and potentially reduce morbidity and health care costs. We are designing a larger study to evaluate the accuracy and utility of the software with patients seen in clinical practice.

Basal Cell Carcinoma↗
PubMedDate not supplied

Comparative evaluation of three continuous speech recognition software packages in the generation of medical reports.

OBJECTIVE: To compare out-of-box performance of three commercially available continuous speech recognition software packages: IBM ViaVoice 98 with General Medicine Vocabulary; Dragon Systems NaturallySpeaking Medical Suite, version 3.0; and L&H Voice Xpress for Medicine, General Medicine Edition, version 1.2. DESIGN: Twelve physicians completed minimal training with each software package and then dictated a medical progress note and discharge summary drawn from actual records. MEASUREMENTS: Errors in recognition of medical vocabulary, medical abbreviations, and general English vocabulary were compared across packages using a rigorous, standardized approach to scoring. RESULTS: The IBM software was found to have the lowest mean error rate for vocabulary recognition (7.0 to 9.1 percent) followed by the L&H software (13.4 to 15.1 percent) and then Dragon software (14.1 to 15.2 percent). The IBM software was found to perform better than both the Dragon and the L&H software in the recognition of general English vocabulary and medical abbreviations. CONCLUSION: This study is one of a few attempts at a robust evaluation of the performance of continuous speech recognition software. Results of this study suggest that with minimal training, the IBM software outperforms the other products in the domain of general medicine; however, results may vary with domain. Additional training is likely to improve the out-of-box performance of all three products. Although the IBM software was found to have the lowest overall error rate, successive generations of speech recognition software are likely to surpass the accuracy rates found in this investigation.

Evaluation Studies as Topic↗
PubMed2006

Diagnostic accuracy of two software modalities for detection of caries lesions in digital radiographs from four dental systems.

OBJECTIVE: To compare the caries diagnostic accuracy of two software modalities used in the assessment of digital radiographs obtained with four different dental systems, and to evaluate whether the software used for image assessment influenced the mutual comparison of those four dental systems relating to their caries diagnostic accuracy. METHODS: Under in vitro and standardized conditions 122 teeth (with 228 unrestored approximal and 99 occlusal surfaces) were radiographed in blocks of 3 test teeth and 2 non-test teeth using two storage phosphor plate systems: Digora (Soredex, Helsinki, Finland) and DenOptix (Gendex, Dentsply, Milan, Italy) and two charge coupled device (CCD)-based sensor systems: Dixi (Planmeca, Helsinki, Finland) and Sidexis (Sirona, Bensheim, Germany). The images were displayed and examined in two software modalities: their own dedicated software and a general software. Three observers examined all images for the presence of approximal enamel and dentine and occlusal dentine caries lesions using a 5-point confidence scale. The true presence of caries was validated by ground section histology. The diagnostic accuracy of the software modalities was expressed as ROC curve areas (A(z)) and differences between modalities were tested by paired t-test. Comparison of systems was analysed by post hoc t-test. RESULTS: Results of approximal and occlusal surfaces assessed together revealed nearly identical mean A(z) with the two software modalities on images obtained with the Digora (A(z)=0.71) and DenOptix (A(z)=0.72) systems. On Dixi images the mean A(z) was 0.75 using the system's own software and 0.73 using the general software. On Sidexis images the corresponding mean A(z)s were 0.79 and 0.75. None of those differences were significant. CONCLUSION: No significant difference in caries diagnostic accuracy was found between two software modalities used for examination of digital radiographs obtained with four different digital systems, and the software modality did not influence the mutual rank of the four systems relating to their diagnostic accuracy.

Data Display↗
PubMedDate not supplied

Building quality into medical product software design.

The software engineering and quality assurance disciplines are a requisite to the design of safe and effective software-based medical devices. It is in the areas of software methodology and process that the most beneficial application of these disciplines to software development can be made. Software is a product of complex operations and methodologies and is not amenable to the traditional electromechanical quality assurance processes. Software quality must be built in by the developers, with the software verification and validation engineers acting as the independent instruments for ensuring compliance with performance objectives and with development and maintenance standards. The implementation of a software quality assurance program is a complex process involving management support, organizational changes, and new skill sets, but the benefits are profound. Its rewards provide safe, reliable, cost-effective, maintainable, and manageable software, which may significantly speed the regulatory review process and therefore potentially shorten the overall time to market. The use of a trial project can greatly facilitate the learning process associated with the first-time application of a software quality assurance program.

California↗
PubMed2005

Development of instructional, interactive, multimedia anatomy dissection software: a student-led initiative.

Although dissection provides an unparalleled means of teaching gross anatomy, it constitutes a significant logistical and financial investment for educational institutions. The increasing availability and waning cost of computer equipment has enabled many institutions to supplement their anatomy curriculum with Computer Aided Learning (CAL) software. At the Royal College of Surgeons in Ireland, two undergraduate medical students designed and produced instructional anatomy dissection software for use by first and second year medical students. The software consists of full-motion, narrated, QuickTime MPG movies presented in a Macromedia environment. Forty-four movies, between 1-11 min in duration, were produced. Each movie corresponds to a dissection class and precisely demonstrates the dissection and educational objectives for that class. The software is distributed to students free of charge and they are encouraged to install it on their Apple iBook computers. Results of a student evaluation indicated that the software was useful, easy to use, and improved the students' experience in the dissection classes. The evaluation also indicated that only a minority of students regularly used the software or had it installed on their laptop computers. Accordingly, effort should also be directed toward making the software more accessible and increasing students' comfort and familiarity with novel instructional media. The successful design and implementation of this software demonstrates that CAL software can be employed to augment, enhance and improve anatomy instruction. In addition, effective, high quality, instructional multimedia software can be tailored to an educational institution's requirements and produced by novice programmers at minimal cost.

Anatomy↗
PubMed1997

Why certification of medical software would be useful?

Human drugs and medical devices have to be approved by the health authorities before they can enter the market. For medical software this is not needed. The main argument to resist all attempts to regulate medical software has been that it is impossible to guarantee that software is error-free. This is true of all software. However, in medical software the correctness of medical knowledge is at least as important as the correctness of the code itself. The medical contents of the software could usually be evaluated but the end-users do not have the time or possibilities to do so. The Internet makes it possible to provide commercial services designed by non-professionals. For health care, there are already several commercial services on the net. Since there is no quality assurance or regulation of medical software anyone can sell medical software on the net. Even if physicians were cautious enough not to use untested software, there is a possibility that patients do. In Finland, where over 10% of the population is using the Internet at least weekly, the problem is real. It is impossible to remove poor services from the net and therefore, it is essential to guide the users to use high quality services. The paper discusses different aspects of evaluation of medical software.

Certification↗
PubMed1999

Comparison of two different software systems for electron-beam CT-derived quantification of coronary calcification.

OBJECTIVE: The growing interest in coronary calcium quantification by electron-beam CT (EBCT) has led to the development of various software systems for the analysis of EBCT raw data, but it is unknown whether these software systems yield comparable results. METHODS: Two sets of EBCT scans were obtained in 73 asymptomatic patients less than 15 minutes apart. Both scans of each patient were analyzed using two different software systems, the Mayo Clinic software and the AccuImage Scoring System. The authors compared the calcium quantities yielded by the two different software systems, analyzed the interscan variability, and calculated the interobserver variability. Finally, they investigated the influence of the CT density factor inherent in the widely used Agatston score for the quantification of coronary calcium on reproducibility. RESULTS: The mean score determined by the Mayo Clinic software was 14% greater than that determined by the AccuImage system. The mean difference between the two systems was 14% +/- 25%, and the median difference was 3%. The relative mean and the median difference between the two scans of one patient were 15.3% and 6% determined by the AccuImage system and 17% and 6.5% determined by the Mayo Clinic software. The interobserver reliability calculated by the Mayo Clinic software was better than that of the AccuImage system. There was a trend for better reproducibility using calcium area rather than the Agatson score. CONCLUSIONS: Two different scoring systems do not necessarily yield the same result. Calcium quantities were systematically determined to be greater by one system than the other, and there were significant differences with regard to interobserver reliability. Hence, software should be tested with regard to reproducibility data, and the interpretation of calcium quantities should acknowledge which type of software was used.

Adult↗
PubMed1999

Comparison of adult and paediatric spine and whole body software for the Lunar dual energy X-ray absorptiometer.

Simple phantoms were devised to compare the performance of adult (software 3.64) and paediatric (software 3.8 g) spine and whole body software developed for the Lunar dual energy X-ray absorptiometer. Rectangular slabs of aluminium with high (1.18 g cm-2) and low (0.57 g cm-2) density were used to represent bone mineral. For spine measurements, the phantoms were scanned in water at depths of 5-20 cm. For whole body measurements, the phantoms were scanned with known amounts of oil and water to represent fat and lean tissue. This simulated tissue depths of 5.5-19.7 cm and body composition ranging from 14-29% fat. There were systematic differences in spine and whole body bone mineral content (BMC), bone area (BA) and bone mineral density (BMD) measurements and also between adult and paediatric software versions. The magnitude and direction of these differences were dependent on BMD of the phantom and tissue depth. Similar systematic differences were observed in vivo when volunteers were scanned using adult and paediatric software. Paediatric software enabled measurements to be made at low tissue depths. The weights of fat, lean and total soft tissue measured by the adult and paediatric whole body software were similar to the values calculated from the known composition of the phantom. Precision estimates for all softwares were excellent. In conclusion, paediatric software should improve bone mineral measurements of children but the discrepancies between adult and paediatric softwares may cause problems in longitudinal studies of skeletal growth and when compiling reference data from infancy through to adulthood.

Absorptiometry, Photon↗
PubMed2005

Integrating software into PRA: a test-based approach.

Probabilistic risk assessment (PRA) is a methodology to assess the probability of failure or success of a system's operation. PRA has been proved to be a systematic, logical, and comprehensive technique for risk assessment. Software plays an increasing role in modern safety critical systems. A significant number of failures can be attributed to software failures. Unfortunately, current probabilistic risk assessment concentrates on representing the behavior of hardware systems, humans, and their contributions (to a limited extent) to risk but neglects the contributions of software due to a lack of understanding of software failure phenomena. It is thus imperative to consider and model the impact of software to reflect the risk in current and future systems. The objective of our research is to develop a methodology to account for the impact of software on system failure that can be used in the classical PRA analysis process. A test-based approach for integrating software into PRA is discussed in this article. This approach includes identification of software functions to be modeled in the PRA, modeling of the software contributions in the ESD, and fault tree. The approach also introduces the concepts of input tree and output tree and proposes a quantification strategy that uses a software safety testing technique. The method is applied to an example system, PACS.

Journal Article↗
PubMed2005

Treatment delivery software for a new clinical grade ultrasound system for thermoradiotherapy.

A detailed description of a clinical grade Scanning Ultrasound Reflector Linear Array System (SURLAS) applicator was given in a previous paper [Med. Phys. 32, 230-240 (2005)]. In this paper we concentrate on the design, development, and testing of the personal computer (PC) based treatment delivery software that runs the therapy system. The SURLAS requires the coordinated interaction between the therapy applicator and several peripheral devices for its proper and safe operation. One of the most important tasks was the coordination of the input power sequences for the elements of two parallel opposed ultrasound arrays (eight 1.5 cm x 2 cm elements/array, array 1 and 2 operate at 1.9 and 4.9 MHz, respectively) in coordination with the position of a dual-face scanning acoustic reflector. To achieve this, the treatment delivery software can divide the applicator's treatment window in up to 64 sectors (minimum size of 2 cm x 2 cm), and control the power to each sector independently by adjusting the power output levels from the channels of a 16-channel radio-frequency generator. The software coordinates the generator outputs with the position of the reflector as it scans back and forth between the arrays. Individual sector control and dual frequency operation allows the SURLAS to adjust power deposition in three dimensions to superficial targets coupled to its treatment window. The treatment delivery software also monitors and logs several parameters such as temperatures acquired using a 16-channel thermocouple thermometry unit. Safety (in particular to patients) was the paramount concern and design criterion. Failure mode and effects analysis (FMEA) was applied to the applicator as well as to the entire therapy system in order to identify safety issues and rank their relative importance. This analysis led to the implementation of several safety mechanisms and a software structure where each device communicates with the controlling PC independently of the others. In case of a malfunction in any part of the system or a violation of a user-defined safety criterion based on temperature readings, the software terminates treatment immediately and the user is notified. The software development process consisting of problem analysis, design, implementation, and testing is presented in this paper. Once the software was finished and integrated with the hardware, the therapy system was extensively tested. Results demonstrated that the software operates the SURLAS as intended with minimum risk to future patients.

Algorithms↗