Overlaying multiple sources of data to identify bottlenecks in clinical workflow

Evidence for Shifting Cognitive Strategies when Icons Appear in Unexpected Locations

OBJECTIVE

The present study examines the cognitive effects of placing icons in unexpected spatial locations within websites.

BACKGROUND

Prior research has revealed evidence for cognitive conflict when web icons occur in unexpected locations (e.g., cart, top left), generally consistent with a dynamical systems models. Here, we compare the relative strength of evidence for both dual and dynamical systems models.

METHODS

Participants clicked on icons located in either expected (e.g., cart, top right) or unexpected (e.g., cart, top left) locations while mouse trajectories were continuously recorded. Trajectories were classified according to prototypes associated with each cognitive model. The dynamical systems model predicts curved trajectories, while the dual-systems model predicts straight and change of mind trajectories.

RESULTS

Trajectory classification revealed that curved trajectories increased (+11%), while straight and change of mind trajectories decreased (-12%) when target icons occurred in unexpected locations (p < .001).

CONCLUSION

Rather than employing a single cognitive strategy, users shift from a primarily dual-systems to dynamical systems strategy when icons occur in unexpected locations.

APPLICATION

Potential applications of this work include the assessment of cognitive impacts such as mental workload and cognitive conflict during real-time interaction with websites and other screen-based interfaces, personalization and adaptive interfaces based on an individual's cognitive strategy, and data-driven A/B testing of alternative interface designs.

Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary Approach

The Centers for Disease Control and Prevention's Adapting Clinical Guidelines for the Digital Age initiative aims to redesign and improve guideline development, implementation, and standardization. Historically, aspects of guideline development and implementation have been siloed. This leads to long lag times for guidelines to reach patient care, unnecessary redundancy, and potential for misinterpretation, leading to inconsistencies in how the recommendations are applied. A multidisciplinary, multiorganizational holistic approach brought together experts in guideline development, informatics, communication, implementation, and evaluation to understand and identify problems in guideline development and implementation, define an ideal state with no constraints, and then design a future state that advances the process close to the ideal state. The Adapting Clinical Guidelines for the Digital Age workgroups each worked on one focus area and included experts from the other areas to help analyze the current state and develop holistic solutions for the future state. Each workgroup produced interrelated standards, processes, and tools that can be used across the continuum of guideline development and implementation.

Team is brain: leveraging EHR audit log data for new insights into acute care processes

OBJECTIVE

To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes.

MATERIALS AND METHODS

We selected one widely-used process outcome: emergency department (ED)-based team time to deliver tissue plasminogen activator (tPA) to patients with acute ischemic stroke (AIS). We evaluated Epic audit log data (that tracks EHR user-interactions) for 3052 AIS patients aged 18+ who received tPA after presenting to an ED at three Northern California health systems (Stanford Health Care, UCSF Health, and Kaiser Permanente Northern California). Our primary outcome was door-to-needle time (DNT) and we assessed bivariate and multivariate relationships with six audit log-derived measures of treatment team busyness and prior team experience.

RESULTS

Prior team experience was consistently associated with shorter DNT; teams with greater prior experience specifically on AIS cases had shorter DNT (minutes) across all sites: (Site 1: -94.73, 95% CI: -129.53 to 59.92; Site 2: -80.93, 95% CI: -130.43 to 31.43; Site 3: -42.95, 95% CI: -62.73 to 23.17). Teams with greater prior experience across all types of cases also had shorter DNT at two sites: (Site 1: -6.96, 95% CI: -14.56 to 0.65; Site 2: -19.16, 95% CI: -36.15 to 2.16; Site 3: -11.07, 95% CI: -17.39 to 4.74). Team busyness was not consistently associated with DNT across study sites.

CONCLUSIONS

EHR audit log data offers a novel, scalable approach to measure key contextual factors relevant to clinical process outcomes across multiple sites. Audit log-based measures of team experience were associated with better process outcomes for AIS care, suggesting opportunities to study underlying mechanisms and improve care through deliberate training, team-building, and scheduling to maximize team experience.

Sensors and digital medicine in orthopaedic surgery

Digital health principles are starting to be evident in medicine. Orthopaedic trauma surgery is also being impacted —indirectly by all other improvements in the health ecosystem but also in particular efforts aimed at trauma surgery. Data acquisition is changing how evidence is gathered and utilized. Sensors are the pen and paper of the next wave of data acquisition. Sensors are gathering wide arrays of information to facilitate digital health relevance and adoption. Early adaption of sensor technology by the nonlegacy health environment is what has made sensor driven data acquisition so palatable to the normal health care system. As it applies to orthopaedic trauma, current sensor driven diagnostics and surveillance are nowhere near as developed as in the larger medical community. Digital health is being explored for health care records, data acquisition in diagnostics and rehabilitation, wellness to health care translation, intraoperative monitoring, surgical technique improvement, as well as some early-stage projects in long-term monitoring with implantable devices. The internet of things is the next digital wave that will undoubtedly affect medicine and orthopaedics. Internet of things (loT) devices are now being used to enable remote health monitoring and emergency notification systems. This article reviews current and future concepts in digital health that will impact trauma care.