Comp 15 - Usability & Human Factors

1. Comp 15 - Usability & Human Factors Unit 7 - Decision Support Systems: a Human Factors Approach This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.

2. Outline Health IT Workforce Curriculum Version 2.0/Spring 2011

3. Patient Safety Health IT Workforce Curriculum Version 2.0/Spring 2011

4. Human Factors Approach Health IT Workforce Curriculum Version 2.0/Spring 2011

5. Understanding Decisions Health IT Workforce Curriculum Version 2.0/Spring 2011

6. Medical Decision Making Research Health IT Workforce Curriculum Version 2.0/Spring 2011

7. Heuristics and Biases Health IT Workforce Curriculum Version 2.0/Spring 2011

8. Hindsight Bias Health IT Workforce Curriculum Version 2.0/Spring 2011

9. Hindsight Bias: So What? Health IT Workforce Curriculum Version 2.0/Spring 2011

10. Confirmation Bias Health IT Workforce Curriculum Version 2.0/Spring 2011

11. The Cost of Confirmation Bias Health IT Workforce Curriculum Version 2.0/Spring 2011

12. Classic DM Problem (Eddy, 1982) • Estimate the probability that a woman has breast cancer given that she has a positive mammogram on the basis of the following information: • The probability that a patient has breast cancer is 1%. (This provides the prior probability) • If the patient has breast cancer, the probability that the radiologist will correctly diagnose it is 80% (This provides the sensitivity or hit rate) • If the patient has a benign lesion (no breast cancer), the probability that the radiologist will misdiagnose it is 9.6% (This provides the false positive rate). • What is the probability that a patient with a positive mammogram actually has breast cancer? • Probability of breast cancer is only 7.8%, while Eddy reports that 95 out of 100 • 95 out of 100 doctors estimated this probability to be between greater than 75% Health IT Workforce Curriculum Version 2.0/Spring 2011

13. Framing Effect Health IT Workforce Curriculum Version 2.0/Spring 2011

14. Survival vs. Mortality • McNeil et al (1982) presented a hypothetical lung cancer decision scenario to physicians and patients • The treatment options were radiation therapy, which had an immediate higher survival (lower mortality) rate, but a lower 5 year survival rate. • Frame 1: treatments were described in terms of survival rates • Frame 2: treatments were described in terms of mortality rates • Results: • Survival frame, clear preference for surgery, • Mortality frame, the two choices were preferred almost equally. • One possible explanation is that the positive framing leads to more risk averse choices, while the negative framing increases risk-seeking decision making Health IT Workforce Curriculum Version 2.0/Spring 2011

15. DM in Naturalistic Settings Health IT Workforce Curriculum Version 2.0/Spring 2011

16. Decision Support Systems Health IT Workforce Curriculum Version 2.0/Spring 2011

17. Clinical Decision Support Systems Health IT Workforce Curriculum Version 2.0/Spring 2011

18. Star Trek Tricorder: The Ultimate Clinical Decision Support Tool Health IT Workforce Curriculum Version 2.0/Spring 2011

19. Forms of CDSS Advice Health IT Workforce Curriculum Version 2.0/Spring 2011

20. The Case for Clinical Decision Support Health IT Workforce Curriculum Version 2.0/Spring 2011

21. Degrees of CDSS Computerization Health IT Workforce Curriculum Version 2.0/Spring 2011

22. Degrees of Computerization Continued (6-10) Health IT Workforce Curriculum Version 2.0/Spring 2011

23. Computerized Provider Order Entry Systems (CPOE) Health IT Workforce Curriculum Version 2.0/Spring 2011

24. Promise of Order-Entry Systems Health IT Workforce Curriculum Version 2.0/Spring 2011

25. Some Advantages of CPOE Systems Health IT Workforce Curriculum Version 2.0/Spring 2011

26. ADrug-Drug Interaction Scenario “When ordering a new medication, a prescriber may not be aware that two drugs interact, or may not be keeping in mind the other medications that the patient is taking. As an example, consider the case of a hospitalized patient who is being treated with venlafaxine (Effexor) for chronic depression and develops an infection with a drug resistant bacterium requiring treatment with linezolid, a new antimicrobial agent. The interaction between linezolid and venlafaxine (serotonin syndrome -- altered mental status, including agitation, confusion and coma, neuromuscular hyperactivity, and autonomic dysfunction) is very severe but may not be known to the practitioner. While writing the order for linezolid, an alert screen can warn the practitioner that these two drugs should not be used together. The alert screen may offer the prescriber the opportunity to cancel the order, to discontinue the existing medication that interacts with the newly ordered medication, or to order a test that could detect the interaction or monitor therapy. The alert screen may prompt the physician to have a conversation with the patient regarding potential side effects of the medications. Any of these consequences of the decision support software could be beneficial.” Kuperman et al, 2007. Online JAMIA Data Supplement doi: 10.1197/jamia.M2170 J Am Med Inform Assoc 1 January 2007 vol. 14 no. 1 29-40 Health IT Workforce Curriculum Version 2.0/Spring 2011

27. Challenges with Order Entry Health IT Workforce Curriculum Version 2.0/Spring 2011

28. CPOE Paradox Health IT Workforce Curriculum Version 2.0/Spring 2011

29. Cognitive Evaluation of Interaction with a CDSS Health IT Workforce Curriculum Version 2.0/Spring 2011

30. Weight-Based Heparin Ordering Health IT Workforce Curriculum Version 2.0/Spring 2011

31. Methods Health IT Workforce Curriculum Version 2.0/Spring 2011

32. CPOE Screen Health IT Workforce Curriculum Version 2.0/Spring 2011

33. Weight-based IV Heparin Protocols Health IT Workforce Curriculum Version 2.0/Spring 2011

34. Results - Presentation Salience Health IT Workforce Curriculum Version 2.0/Spring 2011

35. Results - User Behavior Health IT Workforce Curriculum Version 2.0/Spring 2011

36. Summary 36 Health IT Workforce Curriculum Version 2.0/Spring 2011

37. Role of CPOE Systems in Facilitating Medical Errors Health IT Workforce Curriculum Version 2.0/Spring 2011

38. Information Errors: Fragmentation and Systems Integration Failure 1 Health IT Workforce Curriculum Version 2.0/Spring 2011

39. Information Errors: Fragmentation and Systems Integration Failure 2 Health IT Workforce Curriculum Version 2.0/Spring 2011

40. Human-Machine Interface Flaws Health IT Workforce Curriculum Version 2.0/Spring 2011

41. Automation Bias Health IT Workforce Curriculum Version 2.0/Spring 2011

42. Anti-Automation Bias • Errors of dismissal, where computer advice is ignored • Clinicians routinely disable or ignore the alarms or alerts on clinical monitoring devices • Legitimate reasons such as high false alarm rates [or repetition of the same alarms • Less valid reasons such as not wanting to be interrupted Health IT Workforce Curriculum Version 2.0/Spring 2011

43. Barriers to Prescriber Decision-Making and Clinical Workflow Health IT Workforce Curriculum Version 2.0/Spring 2011

44. 15 Barriers to Prescriber Decision-Making Health IT Workforce Curriculum Version 2.0/Spring 2011

45. Barriers Continued Health IT Workforce Curriculum Version 2.0/Spring 2011

46. Barriers Elaborated Health IT Workforce Curriculum Version 2.0/Spring 2011

47. Human Factors and Information Management Health IT Workforce Curriculum Version 2.0/Spring 2011

48. Situation Awareness Health IT Workforce Curriculum Version 2.0/Spring 2011

49. Mental Workload Health IT Workforce Curriculum Version 2.0/Spring 2011

50. CPOE/CDSS Design Recommendations Health IT Workforce Curriculum Version 2.0/Spring 2011 50