44 results found
Seah CEL, Zhang Z, Sun S, et al., 2022, Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives., JMIR Aging, Vol: 5
BACKGROUND: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. OBJECTIVE: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. METHODS: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. RESULTS: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. CONCLUSIONS: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers.
Drake A, Sassoon I, Balatsoukas P, et al., 2022, The relationship of socio-demographic factors and patient attitudes to connected health technologies: A survey of stroke survivors, HEALTH INFORMATICS JOURNAL, Vol: 28, ISSN: 1460-4582
Karampela M, Porat T, Mylonopoulou V, et al., 2021, Needs of head and neck cancer patients and stakeholders: case study, Frontiers in Oncology, Vol: 11, Pages: 1-14, ISSN: 2234-943X
Background: The incidents of Head and Neck cancer (HNC) are rising worldwide, suggesting that this type of cancer is becoming more common. The foreseen growth of incidents signifies that future rehabilitation services will have to meet the needs of a wider population. Objective: The aim of this paperis to explore the needs of patients, caregivers and healthcare professionals during HNC rehabilitation. Methods:This paper reports the empirical findings from a case study that was conducted in a cancer rehabilitation center in Copenhagen to elicit the needs of HNC cancer patients, informal caregivers and healthcare professionals. Results: Four areas of needs during the rehabilitation process were identified: service delivery, emotional, social and physicalneeds. Service delivery needs and emotional needs have been identified as the most prevalent. Conclusions: Stakeholders’ needs during the rehabilitation process were found to be interrelated. All stakeholders faced service delivery challenges in the form of provision and distribution of information, including responsibilities allocation between municipalities, hospitals and rehabilitation services. Emotional andsocial needs have been reported by HNC patients and informal caregivers, underlining the importance of inclusion of all actors in the design of future healthcare interventions.Connected Health (CH) solutions could be valuable in provision and distribution of information.
Porat T, Burnell R, Calvo R, et al., 2021, 'Vaccine Passports’ may backfire: findings from a cross-sectional study in the UK and Israel on willingness to vaccinate against Covid-19, Vaccines, Vol: 9, Pages: 1-11, ISSN: 2076-393X
Domestic “vaccine passports” are being implemented across the world, as a way ofincreasing vaccinated people’s freedom of movement and to encourage vaccination. However, thesevaccine passports may affect people’s vaccination decisions in unintended and undesirable ways.This cross-sectional study investigated whether people’s willingness and motivation to getvaccinated relate to their psychological needs (autonomy, competence and relatedness), and howvaccine passports might affect these needs. Across two countries and 1358 participants we foundthat need frustration – particularly autonomy frustration – was associated with lower willingnessto vaccinate and with a shift from self-determined to external motivation. In Israel (a country withvaccine passports), people reported greater autonomy frustration than in the UK (a country withoutvaccine passports). Our findings suggest that control measures, such as domestic vaccine passportsmay have detrimental effects on people’s autonomy, motivation, and willingness to get vaccinated.Policies should strive to achieve a highly vaccinated population by supporting individuals’autonomous motivation to be vaccinated and using messages of autonomy and relatedness, ratherthan applying pressure and external controls.
Ford E, Edelman N, Somers L, et al., 2021, Barriers and facilitators to the adoption of electronic clinical decision support systems: a qualitative interview study with UK general practitioners, BMC Medical Informatics and Decision Making, Vol: 21, ISSN: 1472-6947
BACKGROUND: Well-established electronic data capture in UK general practice means that algorithms, developed on patient data, can be used for automated clinical decision support systems (CDSSs). These can predict patient risk, help with prescribing safety, improve diagnosis and prompt clinicians to record extra data. However, there is persistent evidence of low uptake of CDSSs in the clinic. We interviewed UK General Practitioners (GPs) to understand what features of CDSSs, and the contexts of their use, facilitate or present barriers to their use. METHODS: We interviewed 11 practicing GPs in London and South England using a semi-structured interview schedule and discussed a hypothetical CDSS that could detect early signs of dementia. We applied thematic analysis to the anonymised interview transcripts. RESULTS: We identified three overarching themes: trust in individual CDSSs; usability of individual CDSSs; and usability of CDSSs in the broader practice context, to which nine subthemes contributed. Trust was affected by CDSS provenance, perceived threat to autonomy and clear management guidance. Usability was influenced by sensitivity to the patient context, CDSS flexibility, ease of control, and non-intrusiveness. CDSSs were more likely to be used by GPs if they did not contribute to alert proliferation and subsequent fatigue, or if GPs were provided with training in their use. CONCLUSIONS: Building on these findings we make a number of recommendations for CDSS developers to consider when bringing a new CDSS into GP patient records systems. These include co-producing CDSS with GPs to improve fit within clinic workflow and wider practice systems, ensuring a high level of accuracy and a clear clinical pathway, and providing CDSS training for practice staff. These recommendations may reduce the proliferation of unhelpful alerts that can result in important decision-support being ignored.
Tapuria A, Porat T, Kalra D, et al., 2021, Impact of patient access to their electronic health record: systematic review., Informatics for Health and Social Care, Vol: 46, Pages: 194-204, ISSN: 0959-8316
Patient access to their own electronic health records (EHRs) is likely to become an integral part of healthcare systems worldwide. It has the potential to decrease the healthcare provision costs, improve access to healthcare data, self-care, quality of care, and health and patient-centered outcomes. This systematic literature review is aimed at identifying the impact in terms of benefits and issues that have so far been demonstrated by providing patients access to their own EHRs, via providers' secure patient portals from primary healthcare centers and hospitals. Searches were conducted in PubMed, MEDLINE, CINHAL, and Google scholar. Over 2000 papers were screened and were filtered based on duplicates, then by reading the titles and finally based on their abstracts or full text. In total, 74 papers were retained, analyzed, and summarized. Papers were included if providing patient access to their own EHRs was the primary intervention used in the study and its impact or outcome was evaluated. The search technique used to identify relevant literature for this paper involved input from five experts. While findings from 54 of the 74 papers showed positive outcome or benefits of patient access to their EHRs via patient portals, 10 papers have highlighted concerns, 8 papers have highlighted both and 2 have highlighted absence of negative outcomes. The benefits range from re-assurance, reduced anxiety, positive impact on consultations, better doctor-patient relationship, increased awareness and adherence to medication, and improved patient outcomes (e.g., improving blood pressure and glycemic control in a range of study populations). In addition, patient access to their health information was found to improve self-reported levels of engagement or activation related to self-management, enhanced knowledge, and improve recovery scores, and organizational efficiencies in a tertiary level mental health care facility. However, three studies did not find any statistically signific
Patel AM, Porat T, Baxter WL, 2021, Enhancing situation awareness and decision making in primary care: clinicians’ views, 2020 IEEE International Conference on Healthcare Informatics (ICHI), Publisher: IEEE, Pages: 1-9
Primary care clinicians face the need to process and interpret an ever-increasing amount of patient data, which challenges their ability to review all relevant information needed to make informed decisions that influence patients' lives. Healthcare professionals report frustration in locating, customising and prioritising data in the electronic health records, which was found to impair their situation awareness and have an impact on decision making and quality of care. Towards eliciting opportunities in enhancing physicians' situation awareness and reducing their cognitive overload, we conducted interviews with eight General Practitioners to explore what important information is required before and during the GP-patient consultation to enhance situation awareness, when is the right time to display this information, what is the desired format and what are the main barriers to gaining situation awareness. The Situation Awareness model was used as a conceptual framework to classify emergent themes. Information visualization has the potential to enhance situation awareness during the clinical consultation.
Porat T, Nyrup R, Calvo RA, et al., 2020, Public health and risk communication during COVID-19 – enhancing psychological needs to promote sustainable behaviour change, Frontiers in Public Health, Vol: 8, Pages: 1-15, ISSN: 2296-2565
Background:The current COVID-19 pandemic requires sustainable behaviour change to mitigate the impact of the virus. A phenomenon which has arisen in parallel with this pandemic is an infodemic –an over-abundance of information, of which some is accurate and some isnot, making it hard for people to find trustworthy and reliable guidance to make informed decisions. This infodemic has also been found to create distress and increase risks for mental health disorders, such as depression and anxiety. Aim:To propose practical guidelines for public health and risk communication that will enhance current recommendations and will cut through the infodemic, supporting accessible, reliable, actionable and inclusive communication. The guidelines aim to support basic human psychological needs of autonomy, competence and relatedness to support wellbeing and sustainable behaviour change. Method:We applied the Self-Determination Theory (SDT) and concepts from psychology, philosophy and human computer interaction to better understand human behaviours and motivations and propose practical guidelines for public health communication focusing on wellbeing and sustainable behaviour change. We then systematically searched the literature for research on health communication strategies during COVID-19 to discuss our proposed guidelines in light of the emerging literature. We illustrate the guidelines in a communication case study: wearing face-coverings. Findings: We propose five practical guidelines for public health and risk communication that will cut through the infodemic and support wellbeing and sustainable behaviour change: (1) create an autonomy-supportive health care climate; (2) provide choice; (3) apply a bottom-up approach to communication; (4) create solidarity; (5) be transparent and acknowledge uncertainty. Conclusion:Health communication that starts by fostering wellbeing and basic human psychological needs has the potential to cut through the infodemic and promote effe
Frost E, Porat T, Malhotra P, et al., 2020, Collaborative design of a gamified application for auditory-cognitive training, JMIR Human Factors, Vol: 7, ISSN: 2292-9495
Background:Multiple gaming applications under the dementia umbrella for skills such as navigation exist, but there has yet to be an application designed specifically to investigate the role hearing loss may have in the process of cognitive decline. There is a demonstrable gap in utilising serious games to further the knowledge of the potential relationship between hearing loss and dementia.Objective:The aim of this study was to identify the needs, facilitators and barriers in designing a novel auditory-cognitive training gaming application.Methods:A participatory design approach was used to engage key stakeholders across audiology and cognitive disorders specialisms. Two rounds, including paired semi-structured interviews and focus groups were completed and thematically analysed.Results:18 stakeholders participated in total and 6 themes were identified to inform the next stage of the application’s development.Conclusions:The findings can now be implemented into the development of the beta-version of the application. The application will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life and usability.
Patel AM, Porat T, Baxter WL, 2020, 2020 IEEE International Conference on Healthcare Informatics (ICHI), 2020, 2020 IEEE International Conference on Healthcare Informatics (ICHI), 2020
Balatsoukas P, Porat T, Sassoon IK, et al., 2019, User involvement in the design of a data-driven self-management decision support tool for stroke survivors, 18th IEEE International Conference on Smart Technologies, EUROCON 2019, Publisher: IEEE
Many chronic conditions can be better managed by patients themselves with the use of decision support tools. This becomes even more necessary in the case of multimorbidity (i.e. presence of multiple chronic diseases) or in conditions where several underlying risk factors need to be managed and monitored in order to avoid relapse or the reoccurrence of an event, like in the case of stroke. However, despite the fact that these decision support systems are becoming prevalent, little is known about the best practices in designing for end-users - patients and their carers. The aim of the present paper is to report on the process of involving users to inform the design of a novel data-driven self-management mobile decision support tool for stroke survivors, called CONSULT. User involvement was facilitated through the use of a two-phase participatory design approach. During both phases a total of 44 stakeholders participated, including stroke survivors, carers, healthcare professionals and researchers. The paper documents the findings of the participatory design process, in the form of design recommendations, and describes their implications for user interface design.
Background:This paper examines the development of the Connected Health research landscape with a view on providing a historical perspective on existing Connected Health research. Connected Health has become a rapidly growing research field as our healthcare system is facing pressured to become more proactive and patient centred.Objective:We aimed to identify the extent and coverage of the current body of knowledge in Connected Health. With this, we want to identify which topics have drawn the attention of Connected health researchers, and if there are gaps or interdisciplinary opportunities for further research.Methods:We used a systematic mapping study that combines scientific contributions from research on medicine, business, computer science and engineering. We analyse the papers with seven classification criteria, publication source, publication year, research types, empirical types, contribution types research topic and the condition studied in the paper.Results:Altogether, our search resulted in 208 papers which were analysed by a multidisciplinary group of researchers. Our results indicate a slow start for Connected Health research but a more recent steady upswing since 2013. The majority of papers proposed healthcare solutions (37%) or evaluated Connected Health approaches (23%). Case studies (28%) and experiments (26%) were the most popular forms of scientific validation employed. Diabetes, cancer, multiple sclerosis, and heart conditions are among the most prevalent conditions studied.Conclusions:We conclude that Connected Health research seems to be an established field of research, which has been growing strongly during the last five years. There seems to be more focus on technology driven research with a strong contribution from medicine, but business aspects of Connected health are not as much studied.
Porat T, Marshall I, Sadler E, et al., 2019, Collaborative design of a decision aid for stroke survivors with multimorbidity: a qualitative study in the UK engaging key stakeholders, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives: Effective secondary stroke prevention strategies are sub-optimally used. Noveldevelopment of interventions to enable healthcare professionals and stroke survivors to manage riskfactors for stroke recurrence are required. We sought to engage key stakeholders in the design andevaluation of an intervention informed by a Learning Health System approach, to improve risk factormanagement and secondary prevention for stroke survivors with multimorbidity.Design: Qualitative, including focus groups, semi-structured interviews and usability evaluations. Datawas audio-recorded, transcribed and coded thematically.Participants: Stroke survivors, carers, health and social care professionals, commissioners, policymakers and researchers.Setting: Stroke survivors were recruited from the South London Stroke Register; health and social careprofessionals through South London general practices and King’s College London (KCL) networks;carers, commissioners, policy-makers and researchers through KCL networks.Results: 53 stakeholders in total participated in focus groups, interviews and usability evaluations.Thirty-seven participated in focus groups and interviews, including stroke survivors and carers (N=11),health and social care professionals (N=16), commissioners and policy-makers (N=6) and researchers(N=4). Sixteen participated in usability evaluations, including stroke survivors (N=8) and generalpractitioners (GPs; N=8). Eight themes informed the collaborative design of DOTT (Deciding onTreatments Together), a decision aid integrated with the electronic health record system, to be usedin primary care during clinical consultations between the healthcare professional and stroke survivor.DOTT aims to facilitate shared decision making on personalised treatments leading to improvedtreatment adherence and risk control. DOTT was found acceptable and usable among stroke survivorsand GPs during a series of evaluations.Conclusions: Adopting a user-centred data-driven design a
, 2019, Welcome to IEEE ICHI 2019, 2019 IEEE International Conference on Healthcare Informatics (ICHI), Publisher: IEEE
Karampela M, Porat T, Mylonopoulou V, 2019, Needs of head and neck cancer patients and stakeholders during rehabilitation, 13th EAI International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth), Publisher: ACM, Pages: 415-421, ISSN: 2153-1633
The foreseen growth of Head and Neck cancer (HNC) incidents will require future rehabilitation services to meet the needs of a wider population. This study reports the empirical findings of a case study conducted at a cancer rehabilitation center in Copenhagen, aiming to elicit the needs of HNC patients, informal caregivers and healthcare professionals (HCPs). Our results point out that patients and stakeholders' needs are interrelated, as they faced common challenges pertinent to provision and distribution of information. This study, though preliminary, underlines the importance of inclusion of all actors in the design of future interventions.
Karampela M, Isomursu M, Porat T, et al., 2019, The extent and coverage of current knowledge of connected health: systematic mapping study, Publisher: JMIR Publications
Background: This study examines the development of the connected health (CH) research landscape with a view to providing an overview of the existing CH research. The research field of CH has experienced rapid growth coinciding with increasing pressure on health care systems to become more proactive and patient centered.Objective: This study aimed to assess the extent and coverage of the current body of knowledge in CH. In doing so, we sought to identify specific topics that have drawn the attention of CH researchers and to identify research gaps, in particular those offering opportunities for further interdisciplinary research.Methods: A systematic mapping study that combined scientific contributions from research in the disciplines of medicine, business, computer science, and engineering was used. Overall, seven classification criteria were used to analyze the papers, including publication source, publication year, research type, empirical type, contribution type, research topic, and the medical condition studied.Results: The search resulted in 208 papers that were analyzed by a multidisciplinary group of researchers. The results indicated a slow start for CH research but showed a more recent steady upswing since 2013. The majority of papers proposed health care solutions (77/208, 37.0%) or evaluated CH approaches (49/208, 23.5%). Case studies (59/208, 28.3%) and experiments (55/208, 26.4%) were the most popular forms of scientific validation used. Diabetes, cancer, multiple sclerosis, and heart conditions were among the most prevalent medical conditions studied.Conclusions: We conclude that CH research has become an established field of research that has grown over the last five years. The results of this study indicate a focus on technology-driven research with a strong contribution from medicine, whereas the business aspects of CH have received less research attention.
Porat T, Garaizar P, Ferrero M, et al., 2019, Content and source analysis of popular tweets following a recent case of diphtheria in Spain, European Journal of Public Health, Vol: 29, Pages: 117-122, ISSN: 1101-1262
BackgroundDespite major progress in global vaccination coverage, immunization rates are falling, resulting in outbreaks of vaccine-preventable diseases. This study analyses content and source of the most popular tweets related to a recent case in Spain where an unvaccinated child contracted and later died from diphtheria. Understanding the characteristics of these tweets in the context of vaccination could inform efforts by health promotion professionals to increase their reach and impact.MethodsWe extracted tweets containing keywords related to the diphtheria case (from 1 May to 15 July 2015). We explored the prevalence of terms relating to policy and misinformation and manually coded the 194 most popular tweets (retweeted 100 or more times) with regard to source, topic, tone and sentiment.ResultsA total of 722 974 tweets were collected. Prevalence of terms relating to policy and misinformation increased at the onset of the case and after the death of the child. Popular tweets (194) were either pro-vaccination (58%) or neutral, with none classified as anti-vaccination. Popular topics included criticism towards anti-vaccination groups (35%) and effectiveness of immunization (22%). Popular tweets were informative (47%) or opinions (53%), which mainly expressed frustration (24%) or humour/sarcasm (23%). Popular Twitter accounts were newspaper and TV channels (15%), as well as individual journalists and authors of popular science (13.4%).ConclusionsHealthcare organizations could collaborate with popular journalists or news outlets and employ authors of popular science to disseminate health information on social media, while addressing public concerns and misinformation in accessible ways.
Balatsoukas P, Porat T, Sassoon I, et al., 2019, L se involvement in the design of a data -driven self-management decision support tool for stroke survivors, 18th IEEE International Conference on Smart Technologies (IEEE EUROCON), Publisher: IEEE
Porat T, Kokciyan N, Sassoon I, et al., 2018, Stakeholders’ views on a collaborative decision support system to promote multimorbidity self-management: barriers, facilitators and design implications, AMIA 2018 Annual Symposium
Kokciyan N, Sassoon I, Young AP, et al., 2018, Towards an Argumentation System for Supporting Patients in Self-Managing their Chronic Conditions, Thirty-Second AAAI Conference on Artificial Intelligence
Porat T, Liao Z, Curcin V, 2018, Engaging stakeholders in the design and usability evaluation of a decision aid to improve secondary stroke prevention., Studies in Health Technology and Informatics, Vol: 247, Pages: 765-769, ISSN: 0926-9630
Stroke survivors have a nearly 40% risk of recurrent stroke during the first 10 years. Effective secondary stroke prevention strategies are sub-optimally used, and hence, developing interventions to enable healthcare professionals and stroke survivors to manage risk factors more effectively are required. In this paper we describe the usability evaluation of a decision aid designed in collaboration with stakeholders to reduce the risk of a recurrent stroke. The decision aid was found usable and acceptable by both general practitioners and stroke survivors. Concerns and suggestions for improving the decision aid are discussed.
Fairweather E, Alper P, Porat T, et al., 2018, Architecture for Template-Driven Provenance Recording, 7th International Provenance and Annotation Workshop (IPAW), Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 217-221, ISSN: 0302-9743
Porat T, Delaney BC, Kostopoulou, 2017, The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients, BMC Medical Informatics and Decision Making, Vol: 17, ISSN: 1472-6947
BackgroundClinical decision support systems (DSS) aimed at supporting diagnosis are not widely used. This is mainly due to usability issues and lack of integration into clinical work and the electronic health record (EHR). In this study we examined the usability and acceptability of a diagnostic DSS prototype integrated with the EHR and in comparison with the EHR alone.MethodsThirty-four General Practitioners (GPs) consulted with 6 standardised patients (SPs) using only their EHR system (baseline session); on another day, they consulted with 6 different but matched for difficulty SPs, using the EHR with the integrated DSS prototype (DSS session). GPs were interviewed twice (at the end of each session), and completed the Post-Study System Usability Questionnaire at the end of the DSS session. The SPs completed the Consultation Satisfaction Questionnaire after each consultation.ResultsThe majority of GPs (74%) found the DSS useful: it helped them consider more diagnoses and ask more targeted questions. They considered three user interface features to be the most useful: (1) integration with the EHR; (2) suggested diagnoses to consider at the start of the consultation and; (3) the checklist of symptoms and signs in relation to each suggested diagnosis. There were also criticisms: half of the GPs felt that the DSS changed their consultation style, by requiring them to code symptoms and signs while interacting with the patient. SPs sometimes commented that GPs were looking at their computer more than at them; this comment was made more often in the DSS session (15%) than in the baseline session (3%). Nevertheless, SP ratings on the satisfaction questionnaire did not differ between the two sessions.ConclusionsTo use the DSS effectively, GPs would need to adapt their consultation style, so that they code more information during rather than at the end of the consultation. This presents a potential barrier to adoption. Training GPs to use the system in a patient-centred way
Corrigan D, Munelley G, Kazienko P, et al., 2017, Requirements and validation of a prototype learning health system for clinical diagnosis, Learning Health Systems, Vol: 1, ISSN: 2379-6146
IntroductionDiagnostic error is a major threat to patient safety in the context of family practice. The patient safety implications are severe for both patient and clinician. Traditional approaches to diagnostic decision support have lacked broad acceptance for a number of well-documented reasons: poor integration with electronic health records and clinician workflow, static evidence that lacks transparency and trust, and use of proprietary technical standards hindering wider interoperability. The learning health system (LHS) provides a suitable infrastructure for development of a new breed of learning decision support tools. These tools exploit the potential for appropriate use of the growing volumes of aggregated sources of electronic health records.MethodsWe describe the experiences of the TRANSFoRm project developing a diagnostic decision support infrastructure consistent with the wider goals of the LHS. We describe an architecture that is model driven, service oriented, constructed using open standards, and supports evidence derived from electronic sources of patient data. We describe the architecture and implementation of 2 critical aspects for a successful LHS: the model representation and translation of clinical evidence into effective practice and the generation of curated clinical evidence that can be used to populate those models, thus closing the LHS loop.Results/ConclusionsSix core design requirements for implementing a diagnostic LHS are identified and successfully implemented as part of this research work. A number of significant technical and policy challenges are identified for the LHS community to consider, and these are discussed in the context of evaluating this work: medico-legal responsibility for generated diagnostic evidence, developing trust in the LHS (particularly important from the perspective of decision support), and constraints imposed by clinical terminologies on evidence generation.
Sadler E, Porat T, Marshall I, et al., 2017, Shaping innovations in long-term care for stroke survivors with multimorbidity through stakeholder engagement, PLoS ONE, Vol: 12, ISSN: 1932-6203
BackgroundStroke, like many long-term conditions, tends to be managed in isolation of its associated risk factors and multimorbidity. With increasing access to clinical and research data there is the potential to combine data from a variety of sources to inform interventions to improve healthcare. A ‘Learning Health System’ (LHS) is an innovative model of care which transforms integrated data into knowledge to improve healthcare. The objective of this study is to develop a process of engaging stakeholders in the use of clinical and research data to co-produce potential solutions, informed by a LHS, to improve long-term care for stroke survivors with multimorbidity.MethodsWe used a stakeholder engagement study design informed by co-production principles to engage stakeholders, including service users, carers, general practitioners and other health and social care professionals, service managers, commissioners of services, policy makers, third sector representatives and researchers. Over a 10 month period we used a range of methods including stakeholder group meetings, focus groups, nominal group techniques (priority setting and consensus building) and interviews. Qualitative data were recorded, transcribed and analysed thematically.Results37 participants took part in the study. The concept of how data might drive intervention development was difficult to convey and understand. The engagement process led to four priority areas for needs for data and information being identified by stakeholders: 1) improving continuity of care; 2) improving management of mental health consequences; 3) better access to health and social care; and 4) targeting multiple risk factors. These priorities informed preliminary design interventions. The final choice of intervention was agreed by consensus, informed by consideration of the gap in evidence and local service provision, and availability of robust data. This shaped a co-produced decision support tool to improve secondary
Chana N, Porat T, Whittlesea C, et al., 2017, Improving specialist drug prescribing in primary care using task and error analysis: an observational study, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 67, Pages: E157-E167, ISSN: 0960-1643
Background Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs.Aim To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS.Design and setting Semi-structured interviews with key informants followed by an observational study involving GPs in the UK.Method Twelve key informants were interviewed to investigate the use of CDSSs in the UK. Nine GPs were observed while performing case scenarios depicting requests from hospitals or patients to prescribe a specialist drug. Activity diagrams, hierarchical task analysis, and systematic human error reduction and prediction approach analyses were performed.Results The current process of prescribing specialist drugs by GPs is prone to error. Errors of omission due to lack of information were the most common errors, which could potentially result in a GP prescribing a specialist drug that should only be prescribed in hospitals, or prescribing a specialist drug without reference to a shared care protocol. Half of all possible errors in the prescribing process had a high probability of occurrence.Conclusion A CDSS supporting GPs during the process of prescribing specialist drugs is needed. This could, first, support the decision making of whether or not to undertake prescribing, and, second, provide drug-specific parameters linked to shared care protocols, which could reduce the errors identified and increase patient safety.
Kostopoulou O, Porat T, Corrigan D, et al., 2017, Diagnostic accuracy of GPs when using an early-intervention decision support system: a high-fidelity simulation, British Journal of General Practice, Vol: 67, Pages: e201-e208, ISSN: 1478-5242
Background Observational and experimental studies of the diagnostic task have demonstrated the importance of the first hypotheses that come to mind for accurate diagnosis. A prototype decision support system (DSS) designed to support GPs’ first impressions has been integrated with a commercial electronic health record (EHR) system.Aim To evaluate the prototype DSS in a high-fidelity simulation.Design and setting Within-participant design: 34 GPs consulted with six standardised patients (actors) using their usual EHR. On a different day, GPs used the EHR with the integrated DSS to consult with six other patients, matched for difficulty and counterbalanced.Method Entering the reason for encounter triggered the DSS, which provided a patient-specific list of potential diagnoses, and supported coding of symptoms during the consultation. At each consultation, GPs recorded their diagnosis and management. At the end, they completed a usability questionnaire. The actors completed a satisfaction questionnaire after each consultation.Results There was an 8–9% absolute improvement in diagnostic accuracy when the DSS was used. This improvement was significant (odds ratio [OR] 1.41, 95% confidence interval [CI] = 1.13 to 1.77, P<0.01). There was no associated increase of investigations ordered or consultation length. GPs coded significantly more data when using the DSS (mean 12.35 with the DSS versus 1.64 without), and were generally satisfied with its usability. Patient satisfaction ratings were the same for consultations with and without the DSS.Conclusion The DSS prototype was successfully employed in simulated consultations of high fidelity, with no measurable influences on patient satisfaction. The substantially increased data coding can operate as motivation for future DSS adoption.
Porat T, Oron-Gilad T, Rottem-Hovev M, et al., 2016, Supervising and controlling unmanned systems: a multi-phase study with subject matter experts, Frontiers in Psychology, Vol: 7, ISSN: 1664-1078
Proliferation in the use of Unmanned Aerial Systems (UASs) in civil and military operations has presented a multitude of human factors challenges; from how to bridge the gap between demand and availability of trained operators, to how to organize and present data in meaningful ways. Utilizing the Design Research Methodology (DRM), a series of closely related studies with subject matter experts (SMEs) demonstrate how the focus of research gradually shifted from “how many systems can a single operator control” to “how to distribute missions among operators and systems in an efficient way”. The first set of studies aimed to explore the modal number, i.e., how many systems can a single operator supervise and control. It was found that an experienced operator can supervise up to 15 UASs efficiently using moderate levels of automation, and control (mission and payload management) up to three systems. Once this limit was reached, a single operator's performance was compared to a team controlling the same number of systems. In general, teams led to better performances. Hence, shifting design efforts toward developing tools that support teamwork environments of multiple operators with multiple UASs (MOMU). In MOMU settings, when the tasks are similar or when areas of interest overlap, one operator seems to have an advantage over a team who needs to collaborate and coordinate. However, in all other cases, a team was advantageous over a single operator. Other findings and implications, as well as future directions for research are discussed.
Liang SF, Porat T, Tapuria A, et al., 2016, MeTMapS-Medical terminology mapping system, AMIA Joint Summits in Translational Science, ISSN: 1613-0073
Motivation: Medical terminology mapping is a long-standing challenge for projects requiring retrieval, querying and integration of heterogeneous patient data. Current tools fail to fully utilise the richness of the underlying coding systems, and can be difficult to install and maintain. For example, National Library of Medicine's UMLS provides a rich collection of terminology mapping, however, its search results are displayed in a simplistic general purpose interface that cannot easily be navigated and results filtered according to user's preferences. Specifically, returned results cannot be visualised in a tree to show positions and relationships. BioPortal offers a large number of terminologies and ontologies, each of which can be viewed in a tree structure, however it does not allow for multiple ontologies to be viewed and compared on a single page. Our work aims to address these issues and provide a simple and easy to use terminology mapping software. Results: MeTMapS was evaluated with academic and clinical research users. The users have tested the mapping between ICD10, Read CTV2, V3 in Hypertension. It was also tested on a list of clinical terms from the inclusion and exclusion criteria of the INFORM clinical trial protocol. Our initial evaluation produced positive results. Availability: We are currently in the process of updating the design based on some improvements suggested by the participants. MeTMapS is developed under Apache V2 license and is currently hosted at KCL for internal use and will shortly be opened to the public once the internal security concerns are resolved. In the meantime, the tool is available from the author upon request.
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