Sriram Iyengar, PhD, Joseph F. Sucher, MD, Stephen L. Jones, MD, Todd R. Johnson, PhD, Jiajie Zhang, PhD, Dean F. Sittig, PhD

Transcription

1 Informatics Research on Decision Support Systems for Critical Care Environments Sriram Iyengar, PhD, Joseph F. Sucher, MD, Stephen L. Jones, MD, Todd R. Johnson, PhD, Jiajie Zhang, PhD, Dean F. Sittig, PhD

2 School of Health Information Sciences First school in the USA devoted exclusively to graduate programs in Health Informatics (created 1997) Recognized nationally and internationally for its commitment to collaboration and interdisciplinary approaches to research, education and entrepreneurship Give researchers better tools to advance treatments and cures Doctors will have better diagnostics and ways to access information Patients better access to personalized care

3 The Fundamental Theorem of Medicine To help, or at least to do no harm. ( + ) >

4 The Fundamental Theorem of Biomedical Informatics A person working in partnership with an information resource is better than that same person unassisted.

5 The GuideView System M. Sriram Iyengar, PhD Asst. Professor, School of Health Information Sciences, University of Texas Health Science Center at Houston Informatics Research Scientist, Medical Informatics and Health Care Systems, NASA Johnson Space Center, Houston, TX

6 When the Doctor is Really Far away! Low availability of MDs & RNs is a problem War zones Less developed countries US Navy vessels Medics/non-physician health workers provide initial care for wounded or sick people GuideView presents clinical guidelines using rich media that can easily be understood and used by such individuals

7 GuideView User Interface Each step of the guideline is presented in rich media: Text Voice Pictures Full motion Video GuideView is highly interactive History log is created automatically for case documentation

8 Cell Phone Guideview Guideline is stored in the cell phone memory or SD-card Can call remote experts (physicians, specialists, clinic) if algorithm determines need Can enhance productivity and decrease costs Can serve as a triage tool

9 GuideView Author guideview.shis.uth.tmc.edu Graphical interface for creating protocol flows Supports insertion of text, voice, pictures, and video Features to include automatic telephone calls, IM,

10 Intelligent Video Displays to Augment Clinical Decision Support in the SICU Joseph F. Sucher, M.D., F.A.C.S. 1,2 Stephen L. Jones, M.D. 2,3 Todd R. Johnson, PhD 3 Jiajie Zhang, PhD 3 1 Weill Cornell Medical College 2 The Methodist Hospital, Houston, TX 3 University of Texas School of Health Information Sciences

11 Challenges: Patient care in the SICU is complex, significant risk to patients errors of both omission and commission. SICU is a high risk environment >178 interventions / patient /day estimated 2 errors / day / patient* The combination of new biomedical technologies, together with increased access to data through health care IT, is increasingly overwhelming health professionals ability to make sense of individual findings.!" #$ %&!'' Photograph courtesy of Dr. Joseph F. Sucher, M.D.

12 Situation Awareness "#() *** +*,-.)

13 Proximity Compatibility Principle Tasks requiring integration of multiple sources of information, are best supported when that information is displayed in close proximity. Current generation HIT systems deployed in ICUs have not adequately addressed the PCP. The form factor for video display of information is too small. The quality of information display is suboptimal. The number of discrete screens necessary to identify all salient data is cumbersome. Objective of the proposed research is to derive the elements that experts and novices require in the SICU and display them in the most 'readable'manner so the viewer has the highest probability of making the best decision..// 01."#,2* '' 6

14 Complexity and Decision Making in Critical Care Jiajie Zhang, Ph.D. UTH School of Health Information Sciences Vimla Patel, Ph.D. Arizona State University

15 Overview Focus on decision making and medical error in critical care (ER and ICU) A system perspective Methods include Ethnography activity monitoring (tags) agent-based simulation complexity theory & operations research decision support tools

16 The Teams

17 The System View A4 P2 Space Pn P1 A1 An A2 Time

18 Complex Socio-Technical Systems Non-determinism Individual thought process does not determine collaborative decision Limited functional decomposability Roles not rigidly defined Distributed nature of information and representations Decisions based on collective awareness of team Emergence and self-organization Decisions emerge from cognitive activities of entire team Dynamic team structure: aggregation in response to emergencies

19 Data Collection Radio Identification (RID) Tracking Track clinicians using RID badges Infer clinician interaction based on audio recording and proximity Simulation Use RID data and ethnographic observation data to develop simulation Use RID data to validate simulation

20 ER Activities of One Individual Activities Time Interruptions

21 ER Activities of A Team ER Communication Flow - Proximity as a proxy for communication - Tracked by RID tags (Radio Frequency Identification)

22 Work Domain Ontology of ED

23 Agent-Based Simulation of ED Computational model leverages social agent meta-model and results from taxonomy from ethnographic observation Model is being implemented using Repast Simphony Simulation will allow for exploration of hypothesis Example: Simulate effects of overcrowding Example: Simulate resource allocation strategies

24 ER Decision Making Dashboard Design dashboard for better situation awareness, decision making, and planning Integrate with tagging data to provide real time decision support

25 Ensuring Safe Use of Health Information Technology in Critical Care Environments Dean F. Sittig, Ph.D.

26 Ensuring Safe Use of HIT 1) Right System 2) Right Content 8 Rights! 3) Right Human-Computer User Interface 4) Right People 5) Right Workflow / Communication 6) Right Organizational Characteristics 7) Right State & Federal Rules & Regulations 8) Right Monitoring

27 We are developing Methods of measuring and monitoring HIT A software hazard tracking system A shared repository of CDS content Instructional modules for clinicians & IT pros Methods to identify, record, improve workflow Methods to assess EHR-related Safety Culture

28 Thank you! For more information: