Browsing by Author "Hill, Jordan R."

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    Going Remote: Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment with Older Adults
    (JMIR, 2021-03) Hill, Jordan R.; Harrington, Addison B.; Adeoye, Philip; Campbell, Noll L.; Holden, Richard J.; Medicine, School of Medicine
    Background: The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective: Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods: We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention—a medication management app—and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results: In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions: The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them.
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    Reducing Anticholinergic Medication Exposure among Older Adults using Consumer Technology: Protocol for a Randomized Clinical Trial
    (Elsevier, 2021) Abebe, Ephrem; Campbell, Noll L.; Clark, Daniel O.; Tu, Wanzhu; Hill, Jordan R.; Harrington, Addison B.; O’Neal, Gracen; Trowbridge, Kimberly S.; Vallejo, Christian; Yang, Ziyi; Bo, Na; Knight, Alexxus; Alamer, Khalid A.; Carter, Allie; Valenzuela, Robin; Adeoye, Philip; Boustani, Malaz A.; Holden, Richard J.; Medicine, School of Medicine
    Introduction: A growing body of scientific evidence points to the potentially harmful cognitive effects of anticholinergic medications among older adults. Most interventions designed to promote deprescribing of anticholinergics have directly targeted healthcare professionals and have had mixed results. Consumer-facing technologies may provide a unique benefit by empowering patients and can complement existing healthcare professional-centric efforts. Methods: We initiated a randomized clinical trial to evaluate the effectiveness of a patient-facing mobile application (Brain Safe app) compared to an attention control medication list app in reducing anticholinergic exposure among community-dwelling older adults. Study participants are adults aged 60 years and above, currently using at least one prescribed strong anticholinergic, and receiving primary care. The trial plans to enroll a total of 700 participants, randomly allocated in 1:1 proportion to the two study arms. Participants will have the Brain Safe app (intervention arm) or attention control medication list app (control arm) loaded onto a smartphone (study provided or personal device). All participants will be followed for 12 months and will have data collected at baseline, at 6 months, and 12 months by blinded outcome assessors. The primary outcome of the study is anticholinergic exposure measured as total standard daily dose (TSDD) computed from medication prescription electronic records. Secondary outcomes of the study are cognitive function and health-related quality of life. Discussion: A consumer-facing intervention to promote deprescribing of potentially high-risk medications can be part of a multi-pronged approach to reduce inappropriate medication use among older adult patients. Delivering a deprescribing intervention via a mobile app is a novel approach and may hold great promise to accelerate deployment of medication safety initiatives across diverse patient populations.
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    Usability-In-Place—Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review
    (JMIR, 2021-11-02) Hill, Jordan R.; Brown, Janetta C.; Campbell, Noll L.; Holden, Richard J.; Medicine, School of Medicine
    Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature-a lack of remote usability testing methods, tools, and strategies for older adults, despite this population's increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals.
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    Use, Impact, Weaknesses, and Advanced Features of Search Functions for Clinical Use in Electronic Health Records: A Scoping Review
    (Thieme, 2021-05) Hill, Jordan R.; Visweswaran, Shyam; Ning, Xia; Schleyer, Titus K.; Medicine, School of Medicine
    Objective: Although vast amounts of patient information are captured in electronic health records (EHRs), effective clinical use of this information is challenging due to inadequate and inefficient access to it at the point of care. The purpose of this study was to conduct a scoping review of the literature on the use of EHR search functions within a single patient's record in clinical settings to characterize the current state of research on the topic and identify areas for future study. Methods: We conducted a literature search of four databases to identify articles on within-EHR search functions or the use of EHR search function in the context of clinical tasks. After reviewing titles and abstracts and performing a full-text review of selected articles, we included 17 articles in the analysis. We qualitatively identified themes in those articles and synthesized the literature for each theme. Results: Based on the 17 articles analyzed, we delineated four themes: (1) how clinicians use search functions, (2) impact of search functions on clinical workflow, (3) weaknesses of current search functions, and (4) advanced search features. Our review found that search functions generally facilitate patient information retrieval by clinicians and are positively received by users. However, existing search functions have weaknesses, such as yielding false negatives and false positives, which can decrease trust in the results, and requiring a high cognitive load to perform an inclusive search of a patient's record. Conclusion: Despite the widespread adoption of EHRs, only a limited number of articles describe the use of EHR search functions in a clinical setting, despite evidence that they benefit clinician workflow and productivity. Some of the weaknesses of current search functions may be addressed by enhancing EHR search functions with collaborative filtering.