Leveraging Electronic Tablets for General Pediatric Care

V. Anand; S. McKee; T.M. Dugan; S.M. Downs

doi:10.4338/ACI-2014-09-RA-0071

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2015; 06(01): 1-15
DOI: 10.4338/ACI-2014-09-RA-0071

Research Article

Schattauer GmbH

Leveraging Electronic Tablets for General Pediatric Care

A pilot study

Authors

V. Anand

¹Pediatric Institute, Cleveland Clinic, Cleveland, OH
S. McKee

²Childrens Health Services Research, School of Medicine, Indiana University, IN
T.M. Dugan

²Childrens Health Services Research, School of Medicine, Indiana University, IN
S.M. Downs

²Childrens Health Services Research, School of Medicine, Indiana University, IN

³Regenstrief Institute for Healthcare, IN

Abstract

Summary

Background: We have previously shown that a scan-able paper based interface linked to a computerized clinical decision support system (CDSS) can effectively screen patients in pediatric waiting rooms and support the physician using evidence based care guidelines at the time of clinical encounter. However, the use of scan-able paper based interface has many inherent limitations including lacking real time communication with the CDSS and being prone to human and system errors. An electronic tablet based user interface can not only overcome these limitations, but may also support advanced functionality for clinical and research use. However, use of such devices for pediatric care is not well studied in clinical settings.

Objective: In this pilot study, we enhance our pediatric CDSS with an electronic tablet based user interface and evaluate it for usability as well as for changes in patient questionnaire completion rates.

Methods: Child Health Improvement through Computers Leveraging Electronic Tablets or CHICLET is an electronic tablet based user interface. It is developed to augment the existing scan-able paper interface to our CDSS. For the purposes of this study, we deployed CHICLET in one outpatient pediatric clinic. Usability factors for CHICLET were evaluated via caregiver and staff surveys.

Results: When compared to the scan-able paper based interface, we observed an 18% increase or 30% relative increase in question completion rates using CHICLET. This difference was statistically significant. Caregivers and staff survey results were positive for using CHICLET in clinical environment.

Conclusions: Electronic tablets are a viable interface for capturing patient self-report in pediatric waiting rooms. We further hypothesize that the use of electronic tablet based interfaces will drive advances in computerized clinical decision support and create opportunities for patient engagement.

Citation: Anand V, McKee S, Dugan TM, Downs SM. Leveraging electronic tablets for general pediatric care – a pilot study. Appl Clin Inf 2015; 6: 1–15

http://dx.doi.org/10.4338/ACI-2014-09-RA-0071

Keywords

Electronic tablets - clinical decision support system - CDSS - pediatrics - children - EMR

Volltext

Referenzen

References
1 Hing E, Hsiao CJ. Electronic medical record use by office-based physicians and their practices: United States, 2007. Natl Health Stat Report. 2010; 23: 1-11. Epub 2010/07/17. PubMed PMID: 20632518.
2 Kreps GL, Neuhauser L. New directions in eHealth communication: opportunities and challenges. Patient Educ Couns 2010; 78 (03) 329-336. Epub 2010/03/06. doi: S0738–3991(10)00022–4 [pii] 10.1016/j.pec.2010.01.013. PubMed PMID: 20202779.
3 Garner AS, Shonkoff JP, Siegel BS, Dobbins MI, Earls MF, McGuinn L, Pascoe J, Wood DL. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics 2012; 129 (01) e224-e231. Epub 2011/12/28. doi: peds.2011–2662 [pii] 10. 1542/peds.2011–2662. PubMed PMID: 22201148.
4 Mangione-Smith R, DeCristofaro AH, Setodji CM, Keesey J, Klein DJ, Adams JL, Schuster MA, McGlynn EA. The quality of ambulatory care delivered to children in the United States. N Engl J Med 2007; 357 (15) 1515-1523. Epub 2007/10/12. doi: 357/15/1515 [pii] 10.1056/NEJMsa064637. PubMed PMID: 17928599.
5 Koppel R, Kreda DA. Healthcare IT usability and suitability for clinical needs: challenges of design, work-flow, and contractual relations. Stud Health Technol Inform 2010; 157: 7-14. Epub 2010/06/15. PubMed PMID: 20543360.
6 Anand V, Biondich PG, Liu G, Rosenman M, Downs SM. Child Health Improvement through Computer Automation: the CHICA system. Stud Health Technol Inform 2004; 107 Pt 1 187-191. Epub 2004/09/14. doi: D040004973 [pii]. PubMed PMID: 15360800.
7 Biondich PG, Anand V, Downs SM, McDonald CJ. Using adaptive turnaround documents to electronically acquire structured data in clinical settings. AMIA Annu Symp Proc. 2003: 86-90. Epub 2004/01/20. doi: D030003628 [pii]. PubMed PMID: 14728139; PubMed Central PMCID: PMC1480055.
8 Biondich PG, Downs SM, Anand V, Carroll AE. Automating the recognition and prioritization of needed preventive services: early results from the CHICA system. AMIA Annu Symp Proc. 2005: 51-55. Epub 2006/06/17. doi: 58031 [pii]. PubMed PMID: 16779000; PubMed Central PMCID: PMC1560868.
9 Downs SM, Anand V, Dugan TM, Carroll AE. You can lead a horse to water: physicians’ responses to clinical reminders. AMIA Annu Symp Proc 2010; 2010: 167-171. Epub 2011/02/25. PubMed PMID: 21346962; PubMed Central PMCID: PMC3041342.
10 Downs SM, Carroll AE, Anand V, Biondich PG. Human and system errors, using adaptive turnaround documents to capture data in a busy practice. AMIA Annu Symp Proc. 2005: 211-215. Epub 2006/06/17. PubMed PMID: 16779032; PubMed Central PMCID: PMC1560802.
11 Anand V, Biondich PG, Liu G, Rosenman M, Downs SM. Child Health Improvement through Computer Automation: the CHICA system. Stud Health Technol Inform 2004; 107 Pt 1 187-191. Epub 2004/09/14. PubMed PMID: 15360800.
12 Biondich PG, Downs SM, Anand V, Carroll AE. Automating the recognition and prioritization of needed preventive services: early results from the CHICA system. AMIA. 2005 Annual Symposium Proceedings/ AMIA Symposium 51–55. PubMed PMID: 16779000.
13 Downs SM, Biondich PG, Anand V, Zore M, Carroll AE. Using Arden Syntax and adaptive turnaround documents to evaluate clinical guidelines. AMIA Annu Symp Proc. 2006: 214-218. Epub 2007/01/24. PubMed PMID: 17238334; PubMed Central PMCID: PMC1839583.
14 Biondich PG, Anand V, Downs SM, McDonald CJ. Using adaptive turnaround documents to electronically acquire structured data in clinical settings. AMIA Annu Symp Proc. 2003: 86-90. Epub 2004/01/20. PubMed PMID: 14728139; PubMed Central PMCID: PMC1480055.
15 Downs SM, Carroll AE, Anand V, Biondich PG. Human and system errors, using adaptive turnaround documents to capture data in a busy practice. AMIA. 2005: 211-215. PubMed PMID: 16779032.
16 Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, Miranda J, Tierney WM. Cooking up an open source EMR for developing countries: OpenMRS –a recipe for successful collaboration. AMIA. 2006: 529-533. Epub 2007/01/24. doi: 86578 [pii]. PubMed PMID: 17238397; PubMed Central PMCID: PMC1839638.
17 McDonald CJ, Overhage JM, Tierney WM, Dexter PR, Martin DK, Suico JG, Zafar A, Schadow G, Blevins L, Glazener T, Meeks-Johnson J, Lemmon L, Warvel J, Porterfield B, Warvel J, Cassidy P, Lindbergh D, Belsito A, Tucker M, Williams B, Wodniak C. The Regenstrief Medical Record System: a quarter century experience. International journal of medical informatics 1999; 54 (03) 225-253. PubMed PMID: 10405881.
18 Anand V, Biondich PG, Carroll AE, Downs SM. Tailoring Interface for Spanish Language: A Case Study with CHICA System. Proceedings of the 1st International Conference on Human Centered Design: Held as Part of HCI International. 2009 San Diego, CA. 1601681:. Springer-Verlag: 2009: 398-407.
19 Hripcsak G, Ludemann P, Pryor T, Wigertz O, Clayton P. Rationale for the Arden Syntax. Computers and Biomedical Research 1994; 4: 291-324.
20 Jenders RA, Hripcsak G, Sideli RV, DuMouchel W, Zhang H, Cimino JJ, Johnson SB, Sherman EH, Clayton PD. Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center. Proc Annu Symp Comput Appl Med Care. 1995: 169-173. PubMed PMID: 8563259.
21 Downs SM, Uner H. Expected value prioritization of prompts and reminders. Proceedings / AMIA Annual Symposium AMIA Symposium. 2002: 215-219. Epub 2002/12/05. doi: D020002217 [pii]. PubMed PMID: 12463818.
22 Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol 1997; 22 (03) 313-328. Epub 1997/06/01. PubMed PMID: 9212550.
23 Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol 2003; 28 (08) 559-567. Epub 2003/11/07. PubMed PMID: 14602846.
24 Diana L, Robins PD. Modified Checklist for Autism in Toddlers (M-CHAT). 1999
25 Anand V, Carroll AE, Downs SM. Automated primary care screening in pediatric waiting rooms. Pediatrics 2012; 129 (05) e1275-e1281. Epub 2012/04/18. doi: 10.1542/peds.2011–2875. PubMed PMID: 22508925; PubMed Central PMCID: PMC3340595.
26 Carroll A, Anand V, Dugan T, Sheley M, Xu S, SM D. Increased Physician Diagnosis of Asthma with the CHICA Decision Support System. Pediatric Allergy, Immunology, and Pulmonology 2012; 25 (03) 168-171.
27 Carroll AE, Bauer NS, Dugan TM, Anand V, Saha C, Downs SM. Use of a computerized decision aid for ADHD diagnosis: a randomized controlled trial. Pediatrics 2013; 132 (03) e623-e629. Epub 2013/08/21. doi: 10.1542/peds.2013–0933. PubMed PMID: 23958768; PubMed Central PMCID: PMC3876764.
28 Carroll AE, Bauer NS, Dugan TM, Anand V, Saha C, Downs SM. Use of a Computerized Decision Aid for Developmental Surveillance and Screening: A Randomized Clinical Trial. JAMA pediatrics. 2014 Epub 2014/07/16. doi: 10.1001/jamapediatrics.2014.464. PubMed PMID: 25022724.
29 Carroll AE, Biondich P, Anand V, Dugan TM, Downs SM. A randomized controlled trial of screening for maternal depression with a clinical decision support system. J Am Med Inform Assoc 2013; 20 (02) 311-316. Epub 2012/06/30. doi: 10.1136/amiajnl-2011–000682. PubMed PMID: 22744960; PubMed Central PMCID: PMC3638168.
30 Carroll AE, Biondich PG, Anand V, Dugan TM, Sheley ME, Xu SZ, Downs SM. Targeted screening for pediatric conditions with the CHICA system. J Am Med Inform Assoc 2011; 18 (04) 485-490. Epub 2011/06/16. doi: 10.1136/amiajnl-2011–000088. PubMed PMID: 21672910; PubMed Central PMCID: PMC3128399.
31 Kadivar H, Thompson L, Wegman M, Chisholm T, Khan M, Eddleton K, Muszynski M, Shenkman E. Adolescent views on comprehensive health risk assessment and counseling: assessing gender differences. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2014; 55 (01) 24-32. Epub 2014/03/13. doi: 10.1016/j.jadohealth.2013.12.002. PubMed PMID: 24613096.
32 Parker MJ, Manan A, Urbanski S. Prospective evaluation of direct approach with a tablet device as a strategy to enhance survey study participant response rate. BMC research notes 2012; 5: 605. Epub 2012/11/01. doi: 10.1186/1756–0500–5–605. PubMed PMID: 23110849; PubMed Central PMCID: PMC3522021.
33 Bauer NS, Anand V, Carroll AE, Downs SM. Secondhand Smoke Exposure, Parental Depressive Symptoms and Preschool Behavioral Outcomes. Journal of pediatric nursing. 2014 Epub 2014/07/16. doi: 10.1016/j.pedn.2014.06.004. PubMed PMID: 25017291.
34 Downs SM, Zhu V, Anand V, Biondich PG, Carroll AE. The CHICA smoking cessation system. AMIA Annu Symp Proc. 2008: 166-170. Epub 2008/11/13. PubMed PMID: 18998823; PubMed Central PMCID: PMC2655976.
35 Brennan PF, Strombom I. Improving health care by understanding patient preferences: the role of computer technology. Journal of the American Medical Informatics Association: JAMIA 1998; 5 (03) 257-262. Epub 1998/06/03. PubMed PMID: 9609495; PubMed Central PMCID: PMC61299.
36 Eysenbach G. Consumer health informatics. Bmj 2000; 320 7251 1713-1716. Epub 2000/06/23. PubMed PMID: 10864552; PubMed Central PMCID: PMC1127483.
37 Jimison HB, Sher PP, Jimison JJB. Decision Support for Patients Clinical Decision Support Systems. In: Berner ES. editor. Springer New York: 2007: 249-261.
38 Ruland CM. Handheld technology to improve patient care: evaluating a support system for preference-based care planning at the bedside. Journal of the American Medical Informatics Association: JAMIA 2002; 9 (02) 192-201. Epub 2002/02/28. PubMed PMID: 11861634; PubMed Central PMCID: PMC344576.
39 Ruland CM, Bakken S. Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration. J Biomed Inform 2002; 35 5–6 313-321. Epub 2003/09/13. PubMed PMID: 12968780.
40 van der Weijden T, Legare F, Bolvin A, Burgers JS, van Veenendaal H, Stiggelbout AM, Faber M, Elwyn G. How to integrate individual patient values and preferences in clinical practice guidelines? A research protocol. Implementation science: IS 2010; 5: 10.

Zusatzmaterial