Publications by authors named "Sriram Iyengar"

37 Publications

Evidence-Based Health Informatics as the Foundation for the COVID-19 Response: A Joint Call for Action.

Methods Inf Med 2021 May 11. Epub 2021 May 11.

Center for Biomedical Data Science, Yale University, New Haven, Connecticut, United States.

Background:  As a major public health crisis, the novel coronavirus disease 2019 (COVID-19) pandemic demonstrates the urgent need for safe, effective, and evidence-based implementations of digital health. The urgency stems from the frequent tendency to focus attention on seemingly high promising digital health interventions despite being poorly validated in times of crisis.

Aim:  In this paper, we describe a joint call for action to use and leverage evidence-based health informatics as the foundation for the COVID-19 response and public health interventions. Tangible examples are provided for how the working groups and special interest groups of the International Medical Informatics Association (IMIA) are helping to build an evidence-based response to this crisis.

Methods:  Leaders of working and special interest groups of the IMIA, a total of 26 groups, were contacted via e-mail to provide a summary of the scientific-based efforts taken to combat COVID-19 pandemic and participate in the discussion toward the creation of this manuscript. A total of 13 groups participated in this manuscript.

Results:  Various efforts were exerted by members of IMIA including (1) developing evidence-based guidelines for the design and deployment of digital health solutions during COVID-19; (2) surveying clinical informaticians internationally about key digital solutions deployed to combat COVID-19 and the challenges faced when implementing and using them; and (3) offering necessary resources for clinicians about the use of digital tools in clinical practice, education, and research during COVID-19.

Discussion:  Rigor and evidence need to be taken into consideration when designing, implementing, and using digital tools to combat COVID-19 to avoid delays and unforeseen negative consequences. It is paramount to employ a multidisciplinary approach for the development and implementation of digital health tools that have been rapidly deployed in response to the pandemic bearing in mind human factors, ethics, data privacy, and the diversity of context at the local, national, and international levels. The training and capacity building of front-line workers is crucial and must be linked to a clear strategy for evaluation of ongoing experiences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1726414DOI Listing
May 2021

Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1726484DOI Listing
April 2021

Extensive Review of Persuasive System Design Categories and Principles: Behavioral Obesity Interventions.

J Med Syst 2020 Jun 5;44(7):128. Epub 2020 Jun 5.

Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA.

In this extensive review of behavioral digital obesity interventions, we reviewed randomized control trials aimed at weight loss or maintaining weight loss and identifying persuasive categories and principles that drive these interventions. The following databases were searched for long-term obesity interventions: Medline, PsycINFO, Academic Search Complete, CINAHL and Scopus. The inclusion criteria included the following search terms: obesity, overweight, weight reduction, weight loss, obesity management, and diet control. Additional criteria included randomized control trial, ≥ 6 months intervention, ≥ 100 participants and must include persuasive technology. Forty-six publications were in the final review. Primary task support was the most frequently utilized persuasive system design (PSD) category and self-monitoring was the most utilized PSD principle. Behavioral obesity interventions that utilized PSD with a behavior change theory more frequently produced statistically significant weight loss findings. Persuasive technology and PSD in digital health play a significant role in the management and improvement of obesity especially when aligned with behavior change theories. Understanding which PSD categories and principles work best for behavioral obesity interventions is critical and future interventions might be more effective if they were based on these specific PSD categories and principles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10916-020-01591-wDOI Listing
June 2020

A Bayesian analysis of strategies to rule out COVID19 using reverse transcriptase-polymerase chain reaction (RT-PCR).

Arch Pathol Lab Med 2020 Apr 27. Epub 2020 Apr 27.

Division of Clinical Data Analytics and Decision Support (Dr. Raschke, Dr. Curry, Dr. Iyengar), Department of Medicine (Dr Raschke, Dr. Curry, Dr. Gutierrez, Dr. Iyengar), University of Arizona College of Medicine - Phoenix, Phoenix, AZ; Medical/Surgical Intensive Care Unit, Honorhealth Osborn Medical Center, Scottsdale, AZ (Dr. Glenn); Department of Infectious Disease, Phoenix Veterans Administration Hospital, Phoenix, AZ (Dr. Gutierrez).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5858/arpa.2020-0196-LEDOI Listing
April 2020

Design and development of a mobile-based patient management and information system for infectious disease outbreaks in low resource environments.

Technol Health Care 2020 ;28(6):697-709

Grant Thornton LLP, NY, USA.

Background: The design of Patient Management and Information Systems during outbreaks of highly infectious diseases in low resource environments poses special challenges. Such systems necessitate special functional and design requirements to support patient care under austere conditions. A primary concern is to minimize spread of the disease to caregivers and non-infected individuals. Patient management in these conditions requires the design and development of systems customized for complex patient and caregiver workflows.

Objective: Design and develop a Patient Management and Information System for healthcare facilities on the frontlines of outbreaks of highly infectious diseases in low resource environments.

Methods: A team composed of clinicians with experience in Ebola care in affected areas of Africa and informaticians developed detailed hardware, software and functionality requirements. These were translated into hardware designs, software architectures, screen and interface designs and implemented using Common Off-The-Shelf hardware. An experimental app development system was used to develop mHealth software modules.

Results: The system was developed and implemented as a proof of concept. Acceptance testing showed that the system met functionality requirements.

Conclusion: Useful Patient Management and Information systems can be developed and implemented for frontline use in low-resource environments during outbreaks of highly infectious diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/THC-192100DOI Listing
January 2020

Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes.

JMIR Mhealth Uhealth 2020 03 16;8(3):e15927. Epub 2020 Mar 16.

School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, United States.

Background: Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking.

Objective: The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes.

Methods: The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants' classified usage of capABILITY.

Results: Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message.

Conclusions: Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention.

Trial Registration: ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/15927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105932PMC
March 2020

Understanding the role of m-health to improve well-being in spouses of patients with bipolar disorder.

J Affect Disord 2019 05 6;250:391-396. Epub 2019 Mar 6.

McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77054, USA. Electronic address:

Objectives: Spouses and partners of individuals with bipolar disorder (BD) experience significant burden. As there are some limitations to standard psychosocial caregiver interventions, mobile health technology (mHealth) may be a way to reduce burden and improve well-being in these caregivers. The purpose of this study was to explore how the well-being of spouses or partners of patients with BD can be improved through mHealth technology.

Methods: Using a qualitative design, we conducted five focus groups and one in-depth individual interview to collect information from participants about what they would expect from such a device. The sample consists of thirteen participants (eleven spouses and two partners). The age range was 29-65, with eight females and five males. Data were collected using minimally structured interviews and independently analyzed by the authors using content analysis.

Results: Results indicated that the mHealth device many be helpful in at least six areas: reduction of stressors, decreased social isolation, improving communication in the relationship between the spouses, speaking with children about the illness, managing medications, and providing information on resources.

Conclusion: Mobile health technology may be a feasible, available, and cost-effective support tool for spouses and partners of individuals with BD, especially in reducing caregiver stress. Future research is needed to develop the application and test its effectiveness on health outcomes in a larger trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2019.03.035DOI Listing
May 2019

Mobile persuasive technology for the teaching and learning in surgical safety: Content validation.

Nurse Educ Today 2018 Dec 29;71:129-134. Epub 2018 Sep 29.

Medicine A&M Health Science Center, TX, United States. Electronic address:

Background: Patient safety is a fundamental component of high-quality delivery of health care. However, despite scientific advances, surgical patients continue to face risks. Among the most common complications in surgery are operations on the wrong patient, performance of the wrong procedure or operation on the wrong surgical site, lack of adequate or required equipment, failure to prevent blood loss, and surgical items left inside patients. In this context, the planning and development of innovative educational strategies is important for prevention of adverse events and the improvement of surgical patient safety culture.

Objective: To describe the process of validating the content of mobile technology for education about surgical safety.

Methods: Content validation using the Delphi technique was carried out from December 2015 to January 2016 at a Federal University in South Brazil. Content development and animations were produced by the authors from a verification list for safety surgery and a safety surgery protocol. Twelve judges assessed five variables (Content, Language, Illustration, Layout and Motivation), for consensus on content validation. They evaluated quality of each item, using a rating scale consisting of five levels (1 to 5).

Results: Two assessment rounds were done, with a mean content validity index (CVI) of 0.95 and 1.0 and a kappa index of >0.83 and >0.92, respectively. The judges provided positive comments about each phase of the study, most of comments highlights were: choice of very relevant subject matter, excellent quality of the material and the motivation that the material can provide to the target audience.

Conclusion: The study validated the content of learning technology by general consensus of judges with a high level of concordance among evaluated items. The application was considered adequate for educating students and health professionals about surgical safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nedt.2018.09.030DOI Listing
December 2018

Persuasive technology in biomedical informatics.

J Biomed Inform 2018 09 31;85:136-137. Epub 2018 Jul 31.

University of Wollongong, Wollongong, Australia. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbi.2018.07.020DOI Listing
September 2018

Measuring Workload Demand of Informatics Systems with the Clinical Case Demand Index.

AMIA Annu Symp Proc 2017 16;2017:985-993. Epub 2018 Apr 16.

Center for Biomedical Informatics, College of Medicine, Texas A&M Health Science Center, Houston, TX, USA.

The increasing use of Health Information Technology (HIT) can add substantially to workload on clinical providers. Current methods for assessing workload do not take into account the nature of clinical cases and the use of HIT tools while solving them. The Clinical Case Demand Index (CCDI), consisting of a summary score and visual representation, was developed to meet this need. Consistency with current perceived workload measures was evaluated in a Randomized Control Trial of a mobile health system. CCDI is significantly correlated with existing workload measures and inversely related to provider performance. CCDI combines subjective and objective characteristics of clinical cases along with cognitive and clinical dimensions. Applications include evaluation of HIT tools, clinician scheduling, medical education. CCDI supports comparative effectiveness research of HIT tools. In addition, CCDI could have numerous applications including training, clinical trials, design of clinical workflows, and others.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977563PMC
March 2019

Rapid Development and Distribution of Mobile Media-Rich Clinical Practice Guidelines Nationwide in Colombia.

Stud Health Technol Inform 2017 ;245:1220

Oficina de Calidad, Ministerio de Salud y de la Protección Social, Colombia.

Development and electronic distribution of Clinical Practice Guidelines production is costly and challenging. This poster presents a rapid method to represent existing guidelines in auditable, computer executable multimedia format. We used a technology that enables a small number of clinicians to, in a short period of time, develop a substantial amount of computer executable guidelines without programming.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2018

Using Fault Trees to Advance Understanding of Diagnostic Errors.

Jt Comm J Qual Patient Saf 2017 11 2;43(11):598-605. Epub 2017 Oct 2.

Problem Definition: Diagnostic errors annually affect at least 5% of adults in the outpatient setting in the United States. Formal analytic techniques are only infrequently used to understand them, in part because of the complexity of diagnostic processes and clinical work flows involved. In this article, diagnostic errors were modeled using fault tree analysis (FTA), a form of root cause analysis that has been successfully used in other high-complexity, high-risk contexts. How factors contributing to diagnostic errors can be systematically modeled by FTA to inform error understanding and error prevention is demonstrated.

Initial Approach: A team of three experts reviewed 10 published cases of diagnostic error and constructed fault trees. The fault trees were modeled according to currently available conceptual frameworks characterizing diagnostic error. The 10 trees were then synthesized into a single fault tree to identify common contributing factors and pathways leading to diagnostic error.

Key Insights: FTA is a visual, structured, deductive approach that depicts the temporal sequence of events and their interactions in a formal logical hierarchy. The visual FTA enables easier understanding of causative processes and cognitive and system factors, as well as rapid identification of common pathways and interactions in a unified fashion. In addition, it enables calculation of empirical estimates for causative pathways. Thus, fault trees might provide a useful framework for both quantitative and qualitative analysis of diagnostic errors.

Next Steps: Future directions include establishing validity and reliability by modeling a wider range of error cases, conducting quantitative evaluations, and undertaking deeper exploration of other FTA capabilities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjq.2017.06.007DOI Listing
November 2017

Novel technology as platform for interventions for caregivers and individuals with severe mental health illnesses: A systematic review.

J Affect Disord 2018 01 14;226:169-177. Epub 2017 Sep 14.

Biomedical Informatics Core, Clinical Science & Translational Research, Texas A & M University, Houston, TX, USA.

Background: Severe mental illnesses (SMIs) have been found to be associated with both increases in morbidity-mortality, need for treatment care in patients themselves, and burden for relatives as caregivers. A growing number of web-based and mobile software applications have appeared that aim to address various barriers with respect to access to care. Our objective was to review and summarize recent advancements in such interventions for caregivers of individuals with a SMI.

Methods: We conducted a systematic search for papers evaluating interactive mobile or web-based software (using no or only minimal support from a professional) specifically aimed at supporting informal caregivers. We also searched for those supporting patients with SMI so as to not to miss any which might include relatives.

Results: Out of a total of 1673 initial hits, we identified 11 articles reporting on 9 different mobile or web-based software programs. The main result is that none of those studies focused on caregivers, and the ones we identified using mobile or web-based applications were just for patients and not their relatives.

Limitations: Differentiating between online and offline available software might not always have been totally reliable, and we might have therefore missed some studies.

Conclusions: In summary, the studies provided evidence that remotely accessible interventions for patients with SMI are feasible and acceptable to patients. No such empirically evaluated program was available for informal caregivers such as relatives. Keeping in mind the influential role of those informal caregivers in the process of treatment and self-management, this is highly relevant for public health. Supporting informal caregivers can improve well-being of both caregivers and patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2017.09.012DOI Listing
January 2018

Persuasive technology in teaching acute pain assessment in nursing: Results in learning based on pre and post-testing.

Nurse Educ Today 2017 Mar 22;50:109-114. Epub 2016 Dec 22.

Medicine A&M Health Science Center, United States. Electronic address:

Background: Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn.

Objective: To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention.

Design: This is a quasi-experimental, non-equivalent study using pre-and post-testing.

Setting: Federal University of Santa Catarina, Brazil.

Participants: 75 undergraduate nursing students.

Methods: Our study was conducted in three steps (pre-test, education intervention, post-test). Data were collected from November 2013 to February 2014. The educational intervention was performed using online access to virtual learning object about acute pain assessment, which students accessed on their mobile devices.

Conclusion: A significant difference was seen in student learning (p<0.001) in the post-test compared with the pre-test results. The students understood the importance of the topic, and were satisfied and motivated by the technology and method applied. The use of persuasive technology such as small mobile devices as mediators of online educational interventions broadens learning spaces in an innovative, flexible, motivational, and promising manner.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nedt.2016.12.019DOI Listing
March 2017

Mobile Virtual Learning Object for the Assessment of Acute Pain as a Learning Tool to Assess Acute Pain in Nursing: An Analysis of the Mental Workload.

JMIR Med Educ 2015 Nov 6;1(2):e15. Epub 2015 Nov 6.

Science Health Center, Department of Nursing, Federal University of Santa Catarina, Florianópolis, Brazil.

Background: The inclusion of new technologies in education has motivated the development of studies on mental workload. These technologies are now being used in the teaching and learning process. The analysis enables identification of factors intervening in this workload as well as planning of overload prevention for educational activities using these technologies.

Objective: To analyze the mental workload of an educational intervention with the Mobile Virtual Learning Object for the Assessment of Acute Pain in adults and newborns, according to the NASA Task Load Index criteria.

Methods: A methodological study with data collected from 5 nurses and 75 students, from November of 2013 to February of 2014.

Results: The highest students' and specialists' means were in the dimensions of "Mental demand" (57.20 ± 22.27; 51 ± 29.45) and "Performance" (58.47 ± 24.19; 73 ± 28.85). The specialists' mental workload index was higher (50.20 ± 7.28) when compared with students' (47.87 ± 16.85) on a scale from 0 to 100 (P=.557).

Conclusions: The instrument allowed for the assessment of mental workload after an online educational intervention with a mobile learning virtual object. An excessive overload was not identified among participants. Assessing mental workload from the use of educational technologies at the end of a task is a key to their applicability, with the aim of providing a more effective, stimulating, and long-lasting experience of the learning process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/mededu.4958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041357PMC
November 2015

Persuasive Technology in Nursing Education About Pain.

Stud Health Technol Inform 2016 ;225:272-6

Biomedical Informatics Core, Clinical Science & Translational Research, Medicine Texas A&M Health Science Center, TX, United States.

Mobile devices, as persuasive technologies, represent an important platform to promote changes in attitudes and behaviors. They are not only understood as tools, but as a learning process that provides different opportunities to learn how to learn. The objectives of the study were to measure the quality of a virtual mobile learning object, to measure the mental workload of the educational intervention, and to evaluate the learning results. This is a technological production study with a mixed method, quasi-experimental approach. Three simulated clinical scenarios comprise the m-OVADor@, allowing for a simulated evaluation of acute pain through interactive tools. The technology met the quality criteria for educational software, with low mental workload, demonstrating a significant strategy for learning about pain among nursing students.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2017

A Methodology for Adapting Psychoeducational Content to Mobile Platforms.

Stud Health Technol Inform 2015 ;216:999

School of Biomedical Informatics, University of Texas Health Science Center at Houston.

Unlabelled: Studies show that current modes of psychoeducation (PE) cannot be availed of by a substantial population of those in need. Mobile health technologies have great potential to serve such populations. However converting PE to mobile platforms is challenging. We present a methodology for this purpose based on existing learning styles theory, and developed PE apps successfully, using it.

Conclusion: Useful PE apps can be developed easily using the proposed method.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2016

Persuasive attributes of medication adherence interventions for older adults: a systematic review.

Technol Health Care 2014 Jan;22(2):189-98

University of Texas Health Science Center at Houston, Houston, TX, USA.

Background: Low adherence to prescribed medications leads to serious negative health consequences in older adults. Effective interventions that improve adherence are often labor-intensive and complex. However, most studies do not analyze the separate effects of the components.

Objective: Persuasive System Design (PSD) is framework that analyzes the motivations that change behavior. In this paper, we aim to apply the model to changing the pill-taking behaviors of the aging population and determine which persuasive elements in interventions drive improvement in medication adherence.

Methods: Systematic review using the databases Medline (1977 to February 2012), Cochrane library (2000 to June 2013); Cinahl (1975 to June 2013), and Psycinfo (2002 to June 2012). Inclusion criteria were experimental trials with participants' mean age ⩾ 60 years and had medication adherence as a primary or secondary measure.

Results: Meta-analysis (40 studies) demonstrated a significant association of tailoring, or one-on-one counseling, with medication adherence. Interventions with simulation (showing the causal relationship between non-adherence and negative effects) and rehearsal (miming medication-taking behavior) also showed evidence for improved adherence.

Conclusions: Future medication adherence interventions might be more effective if they were based on persuasive technology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/THC-140812DOI Listing
January 2014

Mobile phone-based clinical guidance for rural health providers in India.

Health Informatics J 2015 Dec 12;21(4):253-66. Epub 2014 Mar 12.

University of Texas Health Science Center at Houston, USA.

There are few tried and tested mobile technology applications to enhance and standardize the quality of health care by frontline rural health providers in low-resource settings. We developed a media-rich, mobile phone-based clinical guidance system for management of fevers, diarrhoeas and respiratory problems by rural health providers. Using a randomized control design, we field tested this application with 16 rural health providers and 128 patients at two rural/tribal sites in Tamil Nadu, Southern India. Protocol compliance for both groups, phone usability, acceptability and patient feedback for the experimental group were evaluated. Linear mixed-model analyses showed statistically significant improvements in protocol compliance in the experimental group. Usability and acceptability among patients and rural health providers were very high. Our results indicate that mobile phone-based, media-rich procedural guidance applications have significant potential for achieving consistently standardized quality of care by diverse frontline rural health providers, with patient acceptance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1460458214523153DOI Listing
December 2015

Representing second opinion requests from primary care within the Brazilian tele-health program: international classification of primary care, second edition.

Stud Health Technol Inform 2013 ;192:1190

School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.

Standardization of second opinion question-answer pairs with a classification system can be used to facilitate data sharing and reuse. The Brazilian telehealth program faces the problem of representing biomedical knowledge from the primary care second opinion demands generated by rural health care teams. The objective is to determine if one of the medical classification systems has a superior ability to standardize Portuguese-language second opinion question-answer pairs. Data from 2,638 second opinions from 2010 were randomly reduced to a 264 question-answer pair data set. The semantic meaning of the question-answer pairs was manually assigned to an International Classification of Primary Care, Second edition (ICPC2) code. Eight question-answer pairs did not contain sufficient medical semantic meaning to allow for mapping to an ICPC2 code; 53 question-answer pairs did contain sufficient medical semantic meaning for mapping, however an appropriate ICPC2 code did not exist; and 203 question-answer pairs did contain sufficient medical semantic meaning for mapping to an ICPC2 code. A review of the literature indicates that there is no baseline to compare the 77% success rate against.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2015

Decreasing workload among community health workers using interactive, structured, rich-media guidelines on smartphones.

Technol Health Care 2013 ;21(2):113-23

School of Biomedical Informatics, University of Texas, Houston, TX, USA.

Background: Currently, in developing countries, there is considerable interest in using mobile phones as job-aids for community health workers (CHWs) to improve the care they provide. However, acceptance of new technologies can be inhibited if the workload imposed is perceived as excessive compared to existing methods.

Objective: To compare perceived workload of CHWs using clinical care guidelines presented on mobile phones versus using conventional paper-based guidelines.

Methods: Validated clinical practice guidelines were developed as Interactive Structured Rich-Medical guidelines (ISRMGs) on Windows Mobile 6.5 mobile phones. A prospective randomized controlled study was performed in Colombia in which 50 CHWs used the ISRMGs, and paper-based materials with the same information, in a cross-over design to diagnose and treat 15 matched pairs of medical cases presented on Human Patient simulators. The NASA Task Load Index, a validated measure of perceived workload, was administered and results compared by means of a mixed model analysis.

Results: When using the ISRMGs on mobile phones the health workers reported statistically significant decreases in mental demand, frustration, and overall workload as compared to using paper-based job-aids.

Conclusions: Use of ISRMGs on mobile phones by community health workers in developing countries has the potential to decrease their perceived workload, fatigue, and enhance their ability to provide better care for more patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/THC-130713DOI Listing
September 2013

Designing human centered GeoVisualization application--the SanaViz--for telehealth users: a case study.

Technol Health Care 2012 ;20(6):473-88

Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68164, USA.

Background: Public health data is typically organized by geospatial unit. GeoVisualization (GeoVis) allows users to see information visually on a map.

Objectives: Examine telehealth users' perceptions towards existing public health GeoVis applications and obtains users' feedback about features important for the design and development of Human Centered GeoVis application "the SanaViz".

Methods: We employed a cross sectional study design using mixed methods approach for this pilot study. Twenty users involved with the NUTES telehealth center at Federal University of Pernambuco (UFPE), Recife, Brazil were enrolled. Open and closed ended questionnaires were used to gather data. We performed audio recording for the interviews. Information gathered included socio-demographics, prior spatial skills and perception towards use of GeoVis to evaluate telehealth services. Card sorting and sketching methods were employed. Univariate analysis was performed for the continuous and categorical variables. Qualitative analysis was performed for open ended questions.

Results: Existing Public Health GeoVis applications were difficult to use. Results found interaction features zooming, linking and brushing and representation features Google maps, tables and bar chart as most preferred GeoVis features.

Conclusions: Early involvement of users is essential to identify features necessary to be part of the human centered GeoVis application "the SanaViz".
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/THC-2012-0697DOI Listing
May 2013

A human centered GeoVisualization framework to facilitate visual exploration of telehealth data: a case study.

Technol Health Care 2012 ;20(6):457-71

Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.

Purpose: Public health data is typically organized by geospatial units. Routine geographic monitoring of health data enables an understanding of the spatial patterns of events in terms of causes and controls. GeoVisualization (GeoVis) allows users to see information hidden both visually and explicitly on a map. Despite the applicability of GeoVis in public health, it is still underused for visualizing public health data. The objective of this study is to examine the perception of telehealth users' to utilize GeoVis as a proof of concept to facilitate visual exploration of telehealth data in Brazil using principles of human centered approach and cognitive fit theory.

Methods: A mixed methods approach combining qualitative and quantitative assessments was utilized in this cross sectional study conducted at the Telehealth Center of the Federal University of Pernambuco (NUTE-UFPE), Recife, Brazil. A convenient sample of 20 participants currently involved in NUTES was drawn during a period of Sep-Oct 2011. Data was gathered using previously tested questionnaire surveys and in-person interviews. Socio-demographic Information such as age, gender, prior education, familiarity with the use of computer and GeoVis was gathered. Other information gathered included participants' prior spatial analysis skills, level of motivation and use of GeoVis in telehealth. Audio recording was done for all interviews conducted in both English and Portuguese, and transcription of the audio content to English was done by a certified translator. Univariate analysis was performed and means and standard deviations were reported for the continuous variables and frequency distributions for the categorical variables. For the open-ended questions, we utilized a grounded theory to identify themes and their relationship as they emerge from the data. Analysis of the quantitative data was performed using SAS V9.1 and qualitative data was performed using NVivo9.

Results: The average age of participants was 28 years (SD=7), a majority of them were females and 100% were professionals with graduate degrees. The users had diverse backgrounds including nursing, computer science, biomedical informatics, statistics, dentistry, administration and engineering. The users had varied roles and responsibilities, used computers frequently but only 5% of them were familiar with GeoVis. Google maps were the most common GeoVis application that the users were familiar with. Despite having minimal spatial skills, there was a strong motivation and relevance among the telehealth users to use GeoVis to facilitate visual exploration of telehealth data for better informed decision making. Results also showed that of the 60% participants with no GeoVis familiarity; 33% had moderate to large data exploratory role, 83% had no spatial skills but 58% preferred analyzing both spatial and temporal dimensions of the data. Majority of the participants agreed to have maps as the first choice to represent the data as it will be able to display the events both in place and time.

Discussion: The results demonstrate a potentially growing need for the use of GeoVis applications to evaluate telehealth data. Understanding of user needs is essential to ensure that the technology is appropriately functional and will be useful to complete the tasks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/THC-2012-0683DOI Listing
May 2013

Data driven linear algebraic methods for analysis of molecular pathways: application to disease progression in shock/trauma.

J Biomed Inform 2012 Apr 17;45(2):372-87. Epub 2011 Dec 17.

Department of Pathology and Laboratory Medicine, Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.

Motivation: Although trauma is the leading cause of death for those below 45years of age, there is a dearth of information about the temporal behavior of the underlying biological mechanisms in those who survive the initial trauma only to later suffer from syndromes such as multiple organ failure. Levels of serum cytokines potentially affect the clinical outcomes of trauma; understanding how cytokine levels modulate intra-cellular signaling pathways can yield insights into molecular mechanisms of disease progression and help to identify targeted therapies. However, developing such analyses is challenging since it necessitates the integration and interpretation of large amounts of heterogeneous, quantitative and qualitative data. Here we present the Pathway Semantics Algorithm (PSA), an algebraic process of node and edge analyses of evoked biological pathways over time for in silico discovery of biomedical hypotheses, using data from a prospective controlled clinical study of the role of cytokines in multiple organ failure (MOF) at a major US trauma center. A matrix algebra approach was used in both the PSA node and PSA edge analyses with different matrix configurations and computations based on the biomedical questions to be examined. In the edge analysis, a percentage measure of crosstalk called XTALK was also developed to assess cross-pathway interference.

Results: In the node/molecular analysis of the first 24h from trauma, PSA uncovered seven molecules evoked computationally that differentiated outcomes of MOF or non-MOF (NMOF), of which three molecules had not been previously associated with any shock/trauma syndrome. In the edge/molecular interaction analysis, PSA examined four categories of functional molecular interaction relationships--activation, expression, inhibition, and transcription--and found that the interaction patterns and crosstalk changed over time and outcome. The PSA edge analysis suggests that a diagnosis, prognosis or therapy based on molecular interaction mechanisms may be most effective within a certain time period and for a specific functional relationship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbi.2011.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346262PMC
April 2012

The promise of the CCD: challenges and opportunity for quality improvement and population health.

AMIA Annu Symp Proc 2011 22;2011:285-94. Epub 2011 Oct 22.

School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.

Interoperability is a requirement of recent electronic health record (EHR) adoption incentive programs in the United States. One approved structure for clinical data exchange is the continuity of care document (CCD). While primarily designed to promote communication between providers during care transitions, coded data in the CCD can be re-used to aggregate data from different EHRs. This provides an opportunity for provider networks to measure quality and improve population health from a consolidated database. To evaluate such potential, this research collected CCDs from 14 organizations and developed a computer program to parse and aggregate them. In total, 139 CCDs were parsed yielding 680 data in the core content modules of problems, medications, allergies and results. Challenges to interoperability were catalogued and potential quality metrics evaluated based on available content. This research highlights the promise of CCDs for population health and recommends changes for future interoperability standards.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243208PMC
February 2013

Evaluation of a tele-education programme in Brazil.

J Telemed Telecare 2011 20;17(7):341-5. Epub 2011 Sep 20.

Center for Global Health and Development, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.

We evaluated a tele-education programme for primary care staff in Pernambuco State, Brazil. During 2008 and 2009, tele-education sessions occurred four times each week for one hour per day. The topics included public health, child and adolescent health, mental health and nursing. After each session, participants completed an evaluation questionnaire. A total of 73 municipalities and 141 health centres participated in the programme. There were 254 tele-education sessions scheduled during the 20-month study period; of these, 224 sessions were successfully performed and 30 were cancelled. We collected 3504 responses from the satisfaction survey. There was high acceptance of the programme: 97% rated it as excellent or good.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1258/jtt.2011.101209DOI Listing
March 2012

Optimizing medical resources for spaceflight using the integrated medical model.

Aviat Space Environ Med 2011 Sep;82(9):890-4

NASA Johnson Space Center, Houston, TX, USA.

Introduction: Efficient allocation of medical resources for spaceflight is important for crew health. The Integrated Medical Model (IMM) was developed to estimate medical event occurrences, mitigation, and resource requirements. An optimization module was created for IMM that uses a systematic process of elimination and preservation to maximize crew health outcomes subject to resource constraints.

Methods: A maximum medical kit is identified and resources are eliminated according to their relative impact on outcomes of interest. Additional steps allow opportunities for resources to be added back into the medical kit if possible. The effectiveness of the module is demonstrated under six alternative mission profiles by optimizing the medical kit to maximize the expected Crew Health Index (CHI), and comparisons are made with minimum and maximum kits.

Results: The optimum and maximum kits had similar expected CHI, but CHI was more variable for the optimum kit. The maximum kit resulted in the best outcomes, but required at least 13.7 times the mass of the optimum kit and 26.6 times the volume. The largest difference in mean CHI between the optimum and maximum kits occurred for four crewmembers on a 180-d mission (91.1% vs. 95.4%).

Conclusions: The optimization module may be used as an objective tool to assist with the efficient allocation of medical resources for spaceflight. The module provides a flexible algorithm that may be used in conjunction with the IMM model to assist in medical kit requirements and design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3357/asem.3028.2011DOI Listing
September 2011