Interactive computerized health care education

Design, Implementation, and Evaluation of Self-Describing Diabetes Medical Records: A Pilot Study

Background

Each patient’s medical record consists of data specific to that patient and is therefore an appropriate source to adapt educational information content.

Objectives

This study aimed to design and implement an information provision system based on the medical records of diabetic patients and to investigate the attitudes of users toward using this product.

Methods

The study was organized into three phases: need analysis, design and implementation, and final evaluation. The aim of the need analysis phase was to investigate the questioning behavior of the patient in the real-world context. The design and implementation phase consisted of four stages: determining the minimum dataset for diabetes medical records, collecting and validating content, designing and implementing a diabetes electronic medical record system, and data entry. Evaluating the final system was done based on the constructs of the technology acceptance model in the two dimensions of perceived usefulness and perceived ease of use. A semistructured interview was used for this purpose.

Results

Three main categories were extracted for the patient’s perceived usefulness of the system: raising the self-awareness and knowledge of patients, improving their self-care, and improving doctor-patient interaction. Both patients and physicians perceived the personalized sense of information as a unique feature of the application and believed that this feature could have a positive effect on the patient’s motivation for learning and using information in practice. Specialists believed that providing personal feedback on the patient’s lab test results along with general explanations encourages the patients to read the content more precisely. Moreover, accessing medical records and helpful notes was a new and useful experience for the patients.

Conclusions

One of the key perceived benefits of providing tailored information in the context of medical records was raising patient awareness and knowledge. The results obtained from field observations and interviews have shown that patients were ready to accept the system and had a positive attitude when it was put into practice. The findings related to user attitude can be used as a guideline to design the next phase of the research (ie, investigation of system effectiveness on patient outcomes).

A Pilot Study Evaluating the Usability and Usefulness of a Multi-language Online Patient Education Tool for Patients Undergoing Radiation Treatment: Findings from a Student Project

PURPOSE

Treatment-related information is the most important informational need of cancer patients and online media sources are gaining popularity as a cancer communication method. Our aim was to determine if new multilanguage patient online education modules in radiation therapy are usable and beneficial for the multicultural cancer patient population who may face language barriers.

METHODS

Eight new patients from the radiation oncology clinic at the Odette Cancer Centre (OCC) were recruited to participate in the study over a 3-month period. Testing involved a combination of interviewing, observation, think-aloud methodology, and short survey. Results were analyzed using thematic analysis of responses to the interviews and open-ended survey questions, in addition to Likert scale ratings.

RESULTS

Patients were satisfied with the survey (mean = 96/100) and indicated a high usability score citing the general ease of navigation and clear presentation of information. The usefulness mean score was relatively lower; participants wanted more specific information related to their treatment site and anticipated side effects. There was no consensus on the accessibility of the module. Although all participants appreciated the multilanguage capabilities of the modules, they indicated that the number of languages represented in the modules should be increased.

CONCLUSION

Multilanguage online modules were a good communication tool for patients; however, improvements on the content and language availability were indicated by the study participants.

Customization of medical report data

Structured reporting offers a number of theoretical advantages, perhaps the most important of which is creation of standardized report databases. The standardized data created can in turn be used to customize data display, report content, historical data retrieval, interpretation analysis, and results communication in both a context and user-specific manner. In addition, these referenceable report databases can be used to facilitate the practice of evidence based medicine, through data-driven meta-analysis and determination of best practice guidelines. This concept will only be realized if the customized data delivery technology provides real and tangible value to end users, accentuates workflow, can be seamlessly integrated into existing information system technologies, and be shown to yield reproducibility of the evidence domain. The time is here for the medical imaging and clinical communities to embrace this vision in order to improve clinical outcomes and patient safety.

Development and performance usability testing of a theory-based, computerized, tailored intervention

Technology offers innovative and promising methods of delivering health messages to provide knowledge and potentially facilitate improved health behaviors. Theory was foundational to the development of a new intervention using a tailored Web site and a handheld computer. A performance usability study was conducted to determine if women could use this newly developed intervention delivered via a Web site and pocket computer accurately and in a timely manner in real-world settings. A convenience sample of 15 women between 35 and 55 years of age were observed as they used "Complete a Task" and "Talk Aloud" performance usability methods. Results identified several problems affecting the ability of participants to use the Web site and handheld computer.

Filling a void: thyroid cancer surgery information on the internet

BACKGROUND

Thyroid cancer incidence is increasing, making it an important public health issue. Many patients use the Internet for health-related decisions. Our purposes were to measure the quality of thyroid cancer surgery information on the Internet, and to identify quality predictors.

METHODS

The 50 most popular thyroid cancer websites from Google, Yahoo, and MSN were identified. A novel 55-point instrument based on current clinical practice guidelines was designed and used by a Delphi panel of 5 "blinded" endocrine surgeons to assess website information. Each website was independently evaluated by two surgeons. Quality was related to website demographic data using the Student's t-test, chi-square, and ANOVA analyses.

RESULTS

Inter-rater reliability for quality scores was excellent (kappa = 0.81). Mean (% of overall quality) score was 21 (38%), and mean score for surgical content was low at 3.5 (29%). Only 50% of sites discussed indications for surgery; 8% length of surgery/anesthesia; 42% the role of lymphadenectomy; 44% recurrent laryngeal nerve injury/hoarseness and 42% hypoparathyroidism as potential complications; 16% recovery; and 20% recommendations for choosing a thyroid surgeon. Only 38% were updated within 2 years. On univariate analysis, no significant associations were found between surgical quality score and website country of origin, currency, sponsorship, authorship, oversight, or references.

CONCLUSIONS

Thyroid cancer surgery websites on the Internet are incomplete and outdated. No predictors of quality were identified. Significant improvement is needed in regulating information about thyroid cancer surgery on the Internet, and surgeons may contribute to this effort.

Outdated and incomplete: a review of thyroid cancer on the World Wide Web

OBJECTIVE

To evaluate the most frequently searched thyroid cancer websites for completeness, accuracy, and consumer friendliness.

DESIGN

The 50 most popular thyroid cancer websites were evaluated using a novel instrument developed by a Delphi panel of endocrine experts and based on practice guidelines. Each website received independent scores for disease-specific information and a final quality score. Quality was related to website demographics using the Student t test, chi-square, and ANOVA analyses.

MAIN OUTCOMES

Interrater reliability was excellent (kappa = 0.81). Most websites were not specific to thyroid cancer alone (72%), contained advertisements (72%), lacked references (66%), and were privately sponsored (50%). Only 38% had been updated within 2 years. "Government" and "Non-Profit" websites were the most consumer friendly. Mean quality score of medical content was 38%, with websites receiving the highest score in "Anatomy/Physiology" (55%) and lowest in "Surgery" (29%). Low quality score was attributed to information deficiency rather than inaccuracy. On univariate analysis, no significant associations were found between quality score and country of origin, currency, sponsorship, authorship, administration, advertisements, or references.

CONCLUSIONS

Thyroid cancer websites are out of date and incomplete, lacking important information sought by patients, particularly surgical information. An accurate, comprehensive, easily available, and patient-oriented thyroid cancer Internet resource is needed for patients.

In a randomized controlled trial, patients preferred electronic data collection of breast cancer risk-factor information in a mammography setting

BACKGROUND AND OBJECTIVE

We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting.

METHODS

We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n = 86) or paper survey (control group, n = 74). We evaluated patient acceptance and data completeness.

RESULTS

Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > or = 60 years did not find the tablet as easy to use as did women < 60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P = .04).

CONCLUSION

Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.

Empowering patients with essential information and communication support in the context of diabetes

OBJECTIVES

Patients with diabetes need to be aware of essential information to be involved in decision-making, manage diabetes properly, and communicate with doctors and other healthcare providers effectively. We have developed Violet Technology (VT) to provide features beyond previous health information tailoring systems by dynamically prioritizing diabetes learning topics and providing integrated direct support for patient-provider communication through formulation of individualized agendas to take to healthcare encounters.

METHODS

A particular feature of the VT approach is a Diabetes Information Profile (DIP) that models psychosocial and educational exposure features, as well as clinical characteristics, and considers expressed patient information preferences and recent information browsing history. The agenda facility recommends questions that the patients may have based on their profile, as well as helping to initialize a patient empowerment protocol. The technology uses a modular and extensible approach for key components, including consumer health information, prioritization rules, and methods of instantiating the DIP. VT has been implemented into a web portal for patient use. Two phases of evaluation studies have been conducted to collect patient and healthcare provider feedback.

RESULTS AND CONCLUSIONS

Results indicate that VT prioritizes relevant and important information for individual patients. Moreover, both patients and providers indicate that formulating an agenda of questions is important for patients. More extensive system use is needed to establish if the technology can deliver an improved patient-provider partnership and, ultimately, improved health outcomes.

Adapting the contents of computer-based instruction based on knowledge tests maintains effectiveness of nutrition education

BACKGROUND

Nutrition education of many medical students continues to be inadequate. Computer-based instruction in nutrition is a resource that introduces a new level of flexibility for instructors and students while maintaining a high level of educational quality. Previous evaluations have demonstrated the efficacy of our programs on nutrient physiology and the role of nutrition in the disease process, but some students complained about the time spent on content that they had covered in other courses.

OBJECTIVE

We wanted to explore the effectiveness of an abbreviated program version that bypassed topics that the students had mastered already.

DESIGN

Multiple-choice questions were used to determine knowledge of 117 second-year medical students in each of the main knowledge areas covered by our Nutrition and Cancer instructional module. The students were then randomly assigned to complete either the full version or a shortened version adapted to their demonstrated knowledge. Four days later the same as well as new questions were used to compare knowledge gain between the 2 groups.

RESULTS

The shorter time spent with the tailored version than with the full version (2.5 h versus <1.5 h) decreased learning efficacy to only a small extent. More tailored-version users than full-version users were interested in further computer-based instruction (59% versus 41%, P < 0.05), suggesting better acceptance.

CONCLUSIONS

Our experience underscores the power of computer-based instruction to bring nutrition education to medical students. The newly developed adaptive features of the nutrition programs may also be helpful for practicing physicians to efficiently bridge knowledge gaps.

The patient-computer interview: a neglected tool that can aid the clinician

In this article, I (1) review the process of interviewing patients by computer, (2) summarize computer-interviewing work done in 1968, (3) address the weaknesses of collecting information with the traditional history-taking methods or paper questionnaires, (4) discuss commercial software designed for computer interviewing, and (5) focus on the strengths and weaknesses of interviewing patients with a computer. The strengths of this process compared with traditional interviewing are that computer interviewing allows the physician to gather more data; gives the patient more time to complete an interview; uncovers more sensitive information; provides more adaptability to non-English-speaking patients, patients with hearing impairment, or patients who are illiterate; and provides structured information for research. The weaknesses of computer interviewing are that it generates false-positive responses, is not accepted by a minority of patients, is unable to detect nonverbal behavior, and requires changes in work flow. With the advent of an electronic medical record and the financial rewards for comprehensive history recording, the gathering of history and documentation from patients is increasingly important and favors adaptation to computer interviewing.

Review of computer-generated outpatient health behavior interventions: clinical encounters "in absentia"

OBJECTIVE

To evaluate evidence of the effectiveness of computer-generated health behavior interventions-clinical encounters "in absentia"-as extensions of face-to-face patient care in an ambulatory setting.

DATA SOURCES

Systematic electronic database and manual searches of multiple sources (1996-1999) plus search for gray literature were conducted to identify clinical trials using computer-generated health behavior interventions to motivate individuals to adopt treatment regimens, focusing on patient-interactive interventions and use of health behavior models.

STUDY SELECTION

Eligibility criteria included randomized controlled studies with some evidence of instrument reliability and validity; use of at least one patient-interactive targeted or tailored feedback, reminder, or educational intervention intended to influence or improve a stated health behavior; and an association between one intervention variable and a health behavior.

DATA EXTRACTION

Studies were described by delivery device (print, automated telephone, computer, and mobile communication) and intervention type (personalized, targeted, and tailored). We employed qualitative methods to analyze the retrieval set and explore the issue of patient interactive computer-generated behavioral intervention systems.

DATA SYNTHESIS

Studies varied widely in methodology, quality, subject number, and characteristics, measurement of effects and health behavior focus. Of 37 eligible trials, 34 (91.9 percent) reported either statistically significant or improved outcomes. Fourteen studies used targeted interventions; 23 used tailored. Of the 14 targeted intervention studies, 13 (92.9 percent) reported improved outcomes. Of the 23 tailored intervention studies, 21 (91.3 percent) reported improved outcomes.

CONCLUSIONS

The literature indicates that computer-generated health behavior interventions are effective. While there is evidence that tailored interventions can more positively affect health behavior change than can targeted, personalized or generic interventions, there is little research comparing different tailoring protocols with one another. Only those studies using print and telephone devices reported a theoretic basis for their methodology. Future studies need to identify which models are best suited to which health behavior, whether certain delivery devices are more appropriate for different health behaviors, and how ambulatory care can benefit from patients' use of portable devices.

The impact of the Internet on quality measurement

Consumers are eager for information about health. However, their use of such data has been limited to date. When consumers do consider data in making health care choices, they rely more on word-of-mouth reputation than on traditional quality measures, although this information has not necessarily been readily accessible. The Internet changes the exercise of quality measurement in several ways. First, quality information--including reputation--will be more readily available. Second, consumers will increasingly use it. Third, the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others. However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care.