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Sims MH, Hodges Shaw M, Gilbertson S, Storch J, Halterman MW. Legal and ethical issues surrounding the use of crowdsourcing among healthcare providers. Health Informatics J 2018; 25:1618-1630. [PMID: 30192688 DOI: 10.1177/1460458218796599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the pace of medical discovery widens the knowledge-to-practice gap, technologies that enable peer-to-peer crowdsourcing have become increasingly common. Crowdsourcing has the potential to help medical providers collaborate to solve patient-specific problems in real time. We recently conducted the first trial of a mobile, medical crowdsourcing application among healthcare providers in a university hospital setting. In addition to acknowledging the benefits, our participants also raised concerns regarding the potential negative consequences of this emerging technology. In this commentary, we consider the legal and ethical implications of the major findings identified in our previous trial including compliance with the Health Insurance Portability and Accountability Act, patient protections, healthcare provider liability, data collection, data retention, distracted doctoring, and multi-directional anonymous posting. We believe the commentary and recommendations raised here will provide a frame of reference for individual providers, provider groups, and institutions to explore the salient legal and ethical issues before they implement these systems into their workflow.
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Affiliation(s)
| | | | - Seth Gilbertson
- University at Buffalo, The State University of New York, USA
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Duffy FF, Fochtmann LJ, Clarke DE, Barber K, Hong SH, Yager J, Mościcki EK, Plovnick RM. Psychiatrists' Comfort Using Computers and Other Electronic Devices in Clinical Practice. Psychiatr Q 2016; 87:571-84. [PMID: 26667248 PMCID: PMC4907880 DOI: 10.1007/s11126-015-9410-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This report highlights findings from the Study of Psychiatrists' Use of Informational Resources in Clinical Practice, a cross-sectional Web- and paper-based survey that examined psychiatrists' comfort using computers and other electronic devices in clinical practice. One-thousand psychiatrists were randomly selected from the American Medical Association Physician Masterfile and asked to complete the survey between May and August, 2012. A total of 152 eligible psychiatrists completed the questionnaire (response rate 22.2 %). The majority of psychiatrists reported comfort using computers for educational and personal purposes. However, 26 % of psychiatrists reported not using or not being comfortable using computers for clinical functions. Psychiatrists under age 50 were more likely to report comfort using computers for all purposes than their older counterparts. Clinical tasks for which computers were reportedly used comfortably, specifically by psychiatrists younger than 50, included documenting clinical encounters, prescribing, ordering laboratory tests, accessing read-only patient information (e.g., test results), conducting internet searches for general clinical information, accessing online patient educational materials, and communicating with patients or other clinicians. Psychiatrists generally reported comfort using computers for personal and educational purposes. However, use of computers in clinical care was less common, particularly among psychiatrists 50 and older. Information and educational resources need to be available in a variety of accessible, user-friendly, computer and non-computer-based formats, to support use across all ages. Moreover, ongoing training and technical assistance with use of electronic and mobile device technologies in clinical practice is needed. Research on barriers to clinical use of computers is warranted.
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Affiliation(s)
- Farifteh F Duffy
- Practice Research Network, American Psychiatric Association Foundation, 1000 Wilson Blvd., Suite 1825, Arlington, VA, 22209, USA.
| | - Laura J Fochtmann
- Departments of Psychiatry, Pharmacological Sciences and Biomedical Informatics, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Diana E Clarke
- Practice Research Network, American Psychiatric Association Foundation, 1000 Wilson Blvd., Suite 1825, Arlington, VA, 22209, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Keila Barber
- Practice Research Network, American Psychiatric Association Foundation, 1000 Wilson Blvd., Suite 1825, Arlington, VA, 22209, USA
| | - Seung-Hee Hong
- Quality Improvement and Psychiatric Services, American Psychiatric Association, 1000 Wilson Blvd., Arlington, VA, 22209, USA
| | - Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Eve K Mościcki
- Practice Research Network, American Psychiatric Association Foundation, 1000 Wilson Blvd., Suite 1825, Arlington, VA, 22209, USA
| | - Robert M Plovnick
- Quality Improvement Programs Department, American Society of Hematology, 2021 L Street NW, Suite 900, Washington, DC, 20036, USA
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Eldredge JD, Hall LJ, McElfresh KR, Warner TD, Stromberg TL, Trost J, Jelinek DA. Rural providers' access to online resources: a randomized controlled trial. J Med Libr Assoc 2016; 104:33-41. [PMID: 26807050 DOI: 10.3163/1536-5050.104.1.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. METHODS In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. RESULTS Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to "about right amounts of information" at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d. CONCLUSION Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.
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Shenson JA, Ingram E, Colon N, Jackson GP. Application of a Consumer Health Information Needs Taxonomy to Questions in Maternal-Fetal Care. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1148-1156. [PMID: 26958254 PMCID: PMC4765568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pregnancy is a time when expectant mothers may have numerous questions about their unborn children, especially when congenital anomalies are diagnosed prenatally. We sought to characterize information needs of pregnant women seen in the Vanderbilt Children's Hospital Fetal Center. Participants recorded questions from diagnosis through delivery. Questions were categorized by two researchers using a hierarchical taxonomy describing consumer health information needs. Consensus category assignments were made, and inter-rater reliability was measured with Cohen's Kappa. Sixteen participants reported 398 questions in 39 subcategories, of which the most common topics were prognosis (53 questions; 13.3%) and indications for intervention (31 questions; 7.8%). Inter-rater reliability of assignments showed moderate (κ=0.57) to substantial (κ=0.75) agreement for subcategories and primary categories, respectively. Pregnant women with prenatal diagnoses have diverse unmet information needs; a taxonomy of consumer health information needs may improve the ability to meet such needs through content and system design.
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Affiliation(s)
| | - Ebone Ingram
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nadja Colon
- Vanderbilt University Medical Center, Nashville, Tennessee
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Prakash V, Hariohm K, Balaganapathy M. Barriers in implementing evidence-informed health decisions in rural rehabilitation settings: a mixed methods pilot study. J Evid Based Med 2014; 7:178-84. [PMID: 25154508 DOI: 10.1111/jebm.12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/07/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Literature on the barriers to implementing research findings into physiotherapy practice are often urban centric, using self report based on the hypothetical patient scenario. The objective of this study was to investigate the occurrence of barriers, encountered by evidence informed practice-trained physiotherapists in the management of "real world" patients in rural rehabilitation settings. METHODS A mixed-methods research design was used. Physiotherapists working in rural outpatient rehabilitation settings participated in the study. In the first phase, we asked all participants (N = 5) to maintain a log book for a 4-week period to record questions that arose during their routine clinical encounters and asked them also to follow first four of the five steps of evidence-informed practice (ask, access, appraise and apply). In the second phase (after 4 weeks), we conducted a semistructured, direct interviews with the participants exploring their experiences involved in the process of implementing evidence-informed clinical decisions made during the study period. RESULTS At the end of 4 weeks, 30 questions were recorded. For 17 questions, the participants found evidence but applied that evidence into their practice only in 9 instances. Being generalist practitioners, lack of outcomes specific to the patients were reported as barriers more so than time constraints in implementing evidence-informed practice. CONCLUSIONS Practice setting, lack of patient-centered research and evidence-informed practice competency of physiotherapists can be significant barriers to implementing evidence-informed health decisions in rural rehabilitation setting.
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Affiliation(s)
- V Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, CHARUSAT Campus, Changa, Petlad, Anand, Gujarat, 388421, India
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Anton B, Woodson SM, Twose C, Roderer NK. The persistence of clinical questions across shifts on an intensive care unit: an observational pilot study. J Med Libr Assoc 2014; 102:201-5. [PMID: 25031562 DOI: 10.3163/1536-5050.102.3.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
How do clinical questions emerge and move toward resolution in the intensive care setting over the course of 24 hours? In a 20-bed surgical intensive care unit in a large, tertiary-care teaching hospital, informationists shadowed clinicians for 2 48-hour periods to record questions, noting when they were asked and whether they were answered. Thirty-eight percent of 112 recorded questions remained unanswered. Some unanswered questions persisted across shifts, and clinicians' information-seeking behaviors changed over time. Clinical information services can be improved and integrated more fully into clinical workflows based on a fuller understanding of the life cycle of clinical inquiry.
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Affiliation(s)
- Blair Anton
- , Associate Director, Clinical Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-212, Baltimore, MD 21287; , Associate Director for Digital Collections, Welch Medical Library, Johns Hopkins University, 5801 Smith Avenue, Suite 305, Baltimore, MD 21209; , Associate Director, Public Health and Basic Sciences Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-213, Baltimore, MD 21287; , Professor Emerita, Division of Health Sciences Informatics, Johns Hopkins University, 2024 East Monument Street, Suite 1-200, Baltimore, MD 21287
| | - Sue M Woodson
- , Associate Director, Clinical Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-212, Baltimore, MD 21287; , Associate Director for Digital Collections, Welch Medical Library, Johns Hopkins University, 5801 Smith Avenue, Suite 305, Baltimore, MD 21209; , Associate Director, Public Health and Basic Sciences Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-213, Baltimore, MD 21287; , Professor Emerita, Division of Health Sciences Informatics, Johns Hopkins University, 2024 East Monument Street, Suite 1-200, Baltimore, MD 21287
| | - Claire Twose
- , Associate Director, Clinical Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-212, Baltimore, MD 21287; , Associate Director for Digital Collections, Welch Medical Library, Johns Hopkins University, 5801 Smith Avenue, Suite 305, Baltimore, MD 21209; , Associate Director, Public Health and Basic Sciences Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-213, Baltimore, MD 21287; , Professor Emerita, Division of Health Sciences Informatics, Johns Hopkins University, 2024 East Monument Street, Suite 1-200, Baltimore, MD 21287
| | - Nancy K Roderer
- , Associate Director, Clinical Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-212, Baltimore, MD 21287; , Associate Director for Digital Collections, Welch Medical Library, Johns Hopkins University, 5801 Smith Avenue, Suite 305, Baltimore, MD 21209; , Associate Director, Public Health and Basic Sciences Informationist Services, Welch Medical Library, Johns Hopkins University, 2024 East Monument Street, Suite 1-213, Baltimore, MD 21287; , Professor Emerita, Division of Health Sciences Informatics, Johns Hopkins University, 2024 East Monument Street, Suite 1-200, Baltimore, MD 21287
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Workman TE, Fiszman M, Hurdle JF. Text summarization as a decision support aid. BMC Med Inform Decis Mak 2012; 12:41. [PMID: 22621674 PMCID: PMC3461485 DOI: 10.1186/1472-6947-12-41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 04/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background PubMed data potentially can provide decision support information, but PubMed was not exclusively designed to be a point-of-care tool. Natural language processing applications that summarize PubMed citations hold promise for extracting decision support information. The objective of this study was to evaluate the efficiency of a text summarization application called Semantic MEDLINE, enhanced with a novel dynamic summarization method, in identifying decision support data. Methods We downloaded PubMed citations addressing the prevention and drug treatment of four disease topics. We then processed the citations with Semantic MEDLINE, enhanced with the dynamic summarization method. We also processed the citations with a conventional summarization method, as well as with a baseline procedure. We evaluated the results using clinician-vetted reference standards built from recommendations in a commercial decision support product, DynaMed. Results For the drug treatment data, Semantic MEDLINE enhanced with dynamic summarization achieved average recall and precision scores of 0.848 and 0.377, while conventional summarization produced 0.583 average recall and 0.712 average precision, and the baseline method yielded average recall and precision values of 0.252 and 0.277. For the prevention data, Semantic MEDLINE enhanced with dynamic summarization achieved average recall and precision scores of 0.655 and 0.329. The baseline technique resulted in recall and precision scores of 0.269 and 0.247. No conventional Semantic MEDLINE method accommodating summarization for prevention exists. Conclusion Semantic MEDLINE with dynamic summarization outperformed conventional summarization in terms of recall, and outperformed the baseline method in both recall and precision. This new approach to text summarization demonstrates potential in identifying decision support data for multiple needs.
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Affiliation(s)
- T Elizabeth Workman
- Department of Biomedical Informatics, University of Utah, HSEB 5775, Salt Lake City, UT 84112, USA.
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Schnall R, Cimino JJ, Currie LM, Bakken S. Information needs of case managers caring for persons living with HIV. J Am Med Inform Assoc 2011; 18:305-8. [PMID: 21270131 DOI: 10.1136/jamia.2010.006668] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The goals of this study were to explore the information needs of case managers who provide services to persons living with HIV (PLWH) and to assess the applicability of the Information Needs Event Taxonomy in a new population. DESIGN The study design was observational with data collection via an online survey. MEASUREMENTS Responses to open-ended survey questions about the information needs of case managers (n=94) related to PLWH of three levels of care complexity were categorized using the Information Needs Event Taxonomy. RESULTS The most frequently identified needs were related to patient education resources (33%), patient data (23%), and referral resources (22%) accounting for 79% of all (N=282) information needs. LIMITATIONS Study limitations include selection bias, recall bias, and a relatively narrow focus of the study on case-manager information needs in the context of caring for PLWH. CONCLUSION The study findings contribute to the evidence base regarding information needs in the context of patient interactions by: (1) supporting the applicability of the Information Needs Event Taxonomy and extending it through addition of a new generic question; (2) providing a foundation for the addition of context-specific links to external information resources within information systems; (3) applying a new approach for elicitation of information needs; and (4) expanding the literature regarding addressing information needs in community-based settings for HIV services.
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Curran JA, Murphy AL, Abidi SSR, Sinclair D, McGrath PJ. Bridging the gap: knowledge seeking and sharing in a virtual community of emergency practice. Eval Health Prof 2009; 32:312-25. [PMID: 19696084 DOI: 10.1177/0163278709338570] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disparities exist between rural and urban emergency departments with respect to knowledge resources such as online journals and clinical specialists. As knowledge is a critical element in the delivery of quality care, a web-based learning project was proposed to address the knowledge needs of emergency clinicians. One objective of this project was to evaluate the effectiveness of the online environment for knowledge exchange among rural and urban emergency clinicians. Descriptive and content analysis of the online discussion board revealed 202 postings with rural participants contributing the largest number of postings (75%; 152/202). Postings were used to establish a clinical presence (87/202), seek clinical information (52/202), and share clinical information (63/202). Postintervention survey results indicate that this modality introduced participants to new clinical experts and resources. The results provide direction for design of a virtual community of practice, which may reduce current knowledge resource disparities.
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Del Fiol G, Haug PJ, Cimino JJ, Narus SP, Norlin C, Mitchell JA. Effectiveness of topic-specific infobuttons: a randomized controlled trial. J Am Med Inform Assoc 2008; 15:752-9. [PMID: 18755999 DOI: 10.1197/jamia.m2725] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Infobuttons are decision support tools that provide links within electronic medical record systems to relevant content in online information resources. The aim of infobuttons is to help clinicians promptly meet their information needs. The objective of this study was to determine whether infobutton links that direct to specific content topics ("topic links") are more effective than links that point to general overview content ("nonspecific links"). DESIGN Randomized controlled trial with a control and an intervention group. Clinicians in the control group had access to nonspecific links, while those in the intervention group had access to topic links. MEASUREMENTS Infobutton session duration, number of infobutton sessions, session success rate, and the self-reported impact that the infobutton session produced on decision making. RESULTS The analysis was performed on 90 subjects and 3,729 infobutton sessions. Subjects in the intervention group spent 17.4% less time seeking for information (35.5 seconds vs. 43 seconds, p = 0.008) than those in the control group. Subjects in the intervention group used infobuttons 20.5% (22 sessions vs. 17.5 sessions, p = 0.21) more often than in the control group, but the difference was not significant. The information seeking success rate was equally high in both groups (89.4% control vs. 87.2% intervention, p = 0.99). Subjects reported a high positive clinical impact (i.e., decision enhancement or knowledge update) in 62% of the sessions. Limitations The exclusion of users with a low frequency of infobutton use and the focus on medication-related information needs may limit the generalization of the results. The session outcomes measurement was based on clinicians' self-assessment and therefore prone to bias. CONCLUSION The results support the hypothesis that topic links are more efficient than nonspecific links regarding the time seeking for information. It is unclear whether the statistical difference demonstrated will result in a clinically significant impact. However, the overall results confirm previous evidence that infobuttons are effective at helping clinicians to answer questions at the point of care and demonstrate a modest incremental change in the efficiency of information delivery for routine users of this tool.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
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