Browsing by Author "Mamlin, Burke W."

Now showing 1 - 9 of 9
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    Assessing the use of a clinical decision support tool for pain management in primary care
    (Oxford University Press, 2022-09-15) Apathy, Nate C.; Sanner, Lindsey; Adams, Meredith C.B.; Mamlin, Burke W.; Grout, Randall W.; Fortin, Saura; Hillstrom, Jennifer; Saha, Amit; Teal, Evgenia; Vest, Joshua R.; Menachemi, Nir; Hurley, Robert W.; Harle, Christopher A.; Mazurenko, Olena; Health Policy and Management, School of Public Health
    Objective: Given time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial. Materials and methods: The tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals. Results: Overall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9-32]; site 2: median: 8 [IQR 5-16]). Seven "power users" accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites. Discussion: Modest OneSheet use was observed relative to the number of eligible patients seen with chronic pain. Conclusions: Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows.
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    Evaluating a Prototype Clinical Decision Support Tool for Chronic Pain Treatment in Primary Care
    (Thieme, 2022) Allen, Katie S.; Danielson, Elizabeth C.; Downs, Sarah M.; Mazurenko, Olena; Diiulio, Julie; Salloum, Ramzi G.; Mamlin, Burke W.; Harle, Christopher A.; Health Policy and Management, School of Public Health
    Objectives: The Chronic Pain Treatment Tracker (Tx Tracker) is a prototype decision support tool to aid primary care clinicians when caring for patients with chronic noncancer pain. This study evaluated clinicians' perceived utility of Tx Tracker in meeting information needs and identifying treatment options, and preferences for visual design. Methods: We conducted 12 semi-structured interviews with primary care clinicians from four health systems in Indiana. The interviews were conducted in two waves, with prototype and interview guide revisions after the first six interviews. The interviews included exploration of Tx Tracker using a think-aloud approach and a clinical scenario. Clinicians were presented with a patient scenario and asked to use Tx Tracker to make a treatment recommendation. Last, participants answered several evaluation questions. Detailed field notes were collected, coded, and thematically analyzed by four analysts. Results: We identified several themes: the need for clinicians to be presented with a comprehensive patient history, the usefulness of Tx Tracker in patient discussions about treatment planning, potential usefulness of Tx Tracker for patients with high uncertainty or risk, potential usefulness of Tx Tracker in aggregating scattered information, variability in expectations about workflows, skepticism about underlying electronic health record data quality, interest in using Tx Tracker to annotate or update information, interest in using Tx Tracker to translate information to clinical action, desire for interface with visual cues for risks, warnings, or treatment options, and desire for interactive functionality. Conclusion: Tools like Tx Tracker, by aggregating key information about past, current, and potential future treatments, may help clinicians collaborate with their patients in choosing the best pain treatments. Still, the use and usefulness of Tx Tracker likely relies on continued improvement of its functionality, accurate and complete underlying data, and tailored integration with varying workflows, care team roles, and user preferences.
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    Evaluation of electronic recruitment efforts of primary care providers as research subjects during the COVID-19 pandemic
    (BMC, 2022-04-28) Mazurenko, Olena; Sanner, Lindsey; Apathy, Nate C.; Mamlin, Burke W.; Menachemi, Nir; Adams, Meredith C.B.; Hurley, Robert W.; Fortin Erazo, Saura; Harle, Christopher A.; Medicine, School of Medicine
    Background: Recruiting healthcare providers as research subjects often rely on in-person recruitment strategies. Little is known about recruiting provider participants via electronic recruitment methods. In this study, conducted during the COVID-19 pandemic, we describe and evaluate a primarily electronic approach to recruiting primary care providers (PCPs) as subjects in a pragmatic randomized controlled trial (RCT) of a decision support intervention. Methods: We adapted an existing framework for healthcare provider research recruitment, employing an electronic consent form and a mix of brief synchronous video presentations, email, and phone calls to recruit PCPs into the RCT. To evaluate the success of each electronic strategy, we estimated the number of consented PCPs associated with each strategy, the number of days to recruit each PCP and recruitment costs. Results: We recruited 45 of 63 eligible PCPs practicing at ten primary care clinic locations over 55 days. On average, it took 17 business days to recruit a PCP (range 0-48) and required three attempts (range 1-7). Email communication from the clinic leaders led to the most successful recruitments, followed by brief synchronous video presentations at regularly scheduled clinic meetings. We spent approximately $89 per recruited PCP. We faced challenges of low email responsiveness and limited opportunities to forge relationships. Conclusion: PCPs can be efficiently recruited at low costs as research subjects using primarily electronic communications, even during a time of high workload and stress. Electronic peer leader outreach and synchronous video presentations may be particularly useful recruitment strategies.
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    Examining primary care provider experiences with using a clinical decision support tool for pain management
    (Oxford University Press, 2023-08-09) Mazurenko, Olena; McCord, Emma; McDonnell, Cara; Apathy, Nate C.; Sanner, Lindsey; Adams, Meredith C. B.; Mamlin, Burke W.; Vest, Joshua R.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public Health
    Objective: To evaluate primary care provider (PCP) experiences using a clinical decision support (CDS) tool over 16 months following a user-centered design process and implementation. Materials and methods: We conducted a qualitative evaluation of the Chronic Pain OneSheet (OneSheet), a chronic pain CDS tool. OneSheet provides pain- and opioid-related risks, benefits, and treatment information for patients with chronic pain to PCPs. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems. Results: PCPs stated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs used OneSheet for distinct subgroups of patients with chronic pain, including patients prescribed opioids, with poorly controlled pain, or new to a provider or clinic. PCPs reported variable workflow integration and selective use of certain OneSheet features driven by their preferences and patient population. PCPs recommended broadening OneSheet access to clinical staff and patients for data entry to address clinician time constraints. Discussion: Differences in patient subpopulations and workflow preferences had an outsized effect on CDS tool use even when the CDS contained the right information identified in a user-centered design process. Conclusions: To increase adoption and use, CDS design and implementation processes may benefit from increased tailoring that accommodates variation and dynamics among patients, visits, and providers.
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    Information Needs and Requirements for Decision Support in Primary Care: An Analysis of Chronic Pain Care
    (AMIA, 2018) Harle, Christopher A.; Apathy, Nate C.; Cook, Robert L.; Danielson, Elizabeth C.; DiIulio, Julie; Downs, Sarah M.; Hurley, Robert W.; Mamlin, Burke W.; Militello, Laura G.; Anders, Shilo; Health Policy and Management, School of Public Health
    Decision support system designs often do not align with the information environments in which clinicians work. These work environments may increase Clinicians’ cognitive workload and harm their decision making. The objective of this study was to identify information needs and decision support requirements for assessing, diagnosing, and treating chronic noncancer pain in primary care. We conducted a qualitative study involving 30 interviews with 10 primary care clinicians and a subsequent multidisciplinary systems design workshop. Our analysis identified four key decision requirements, eight clinical information needs, and four decision support design seeds. Our findings indicate that clinicians caring for chronic pain need decision support that aggregates many disparate information elements and helps them navigate and contextualize that information. By attending to the needs identified in this study, decision support designers may improve Clinicians’ efficiency, reduce mental workload, and positively affect patient care quality and outcomes.
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    OpenMRS as an emergency EMR—How we used a global good to create an emergency EMR in a week
    (Elsevier, 2021) Mamlin, Burke W.; Shivers, Jennifer E.; Glober, Nancy K.; Dick, Jonathan J.; Medicine, School of Medicine
    Background: As the coronavirus pandemic progressed through the United States, Indianapolis Emergency Medical Services (IEMS) identified a gap between the health system capacity and the projected need to support an overwhelmed health care system. In addressing emergencies or special cases, each medical institution in a metropolitan area typically has a siloed process for capturing emergency patient records. These approaches vary in technical capabilities and may include use of an electronic medical record system (EMR) or a hybrid paper/EMR process. Given the projected volume of patients for the COVID-19 pandemic and the proposed multi-institutional team approach needed in case of significant provider illness, IEMS sought a simple, efficient, consolidated EMR solution to support planning for the potential capacity gap. IEMS approached Regenstrief Institute (RI), an established partner with experience in supporting OpenMRS, a global good EMR platform that had been deployed in multiple settings globally. Objective: The purpose of this project was to determine if OpenMRS, a global good, could be used to quickly stand up a system that would meet the needs for health emergency data collection and reporting. Design and implementation methods: The team used an "all hands on deck" approach, bringing together technical and subject matter experts, and a human-centered and iterative process to ensure the system met the key needs of IEMS. The OpenMRS Reference Application was adapted to the specific need and deployed as Docker containers to servers within the Indiana Health Information Exchange. Project outcomes and lessons learned: In less than two weeks, the Regenstrief team was able to install, configure and set up a working version of OpenMRS to support the desired electronic record requirements for the IEMS disaster field clinics. Using a human-centered approach, the RI team developed, tested, and released a user-friendly, installation-ready solution complete with an end user manual and a base support plan. IEMS and RI are sharing this approach to demonstrate how a global good can quickly generate a solution for COVID-19 and other disaster responses. Conclusions: Open source global goods can rapidly be adapted to meet local needs in an emergency. OpenMRS can be adapted to meet the needs of basic emergency medical services registration, triage, and basic data collection.
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    Overcoming the Maternal Care Crisis: How Can Lessons Learnt in Global Health Informatics Address US Maternal Health Outcomes?
    (AMAI, 2018-04-16) Kasthurirathne, Suranga N.; Mamlin, Burke W.; Purkayastha, Saptarshi; Cullen, Theresa; BioHealth Informatics, School of Informatics and Computing
    Despite unprecedented spending, US maternal outcomes have worsened drastically over the past decade. In comparison, maternal outcomes of many Low and Middle-Income Countries (LMIC) have improved. Lessons learnt by their success may be applicable to the US. We performed a literature review to identify innovations that had met with success across LMIC, and should be considered for adoption in the US. mHealth and patient facing alerts, Telehealth, patient controlled health records, inclusion of patient relationship data in health information systems and positioning empowered community health workers as catalysts of maternal care delivery were identified as innovations worthy of further evaluation. These innovations were categorized into several themes; knowledge, technology, patient/community empowerment, coordination and process change. Tools that place informed and empowered patients and community members at the center of maternal care has greatly improved maternal outcomes, and are suitable to be considered for the US healthcare system.
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    The Promise of Information and Communication Technology In Health Care: Extracting Value from the Chaos
    (Elsevier, 2016-01) Mamlin, Burke W.; Tierney, William M.; Department of Medicine, IU School of Medicine
    Healthcare is an information business with expanding use of information and communication technologies (ICTs). Current ICT tools are immature, but a brighter future looms. We examine 7 areas of ICT in healthcare: electronic health records (EHRs), health information exchange (HIE), patient portals, telemedicine, social media, mobile devices and wearable sensors and monitors, and privacy and security. In each of these areas, we examine the current status and future promise, highlighting how each might reach its promise. Steps to better EHRs include a universal programming interface, universal patient identifiers, improved documentation and improved data analysis. HIEs require federal subsidies for sustainability and support from EHR vendors, targeting seamless sharing of EHR data. Patient portals must bring patients into the EHR with better design and training, greater provider engagement and leveraging HIEs. Telemedicine needs sustainable payment models, clear rules of engagement, quality measures and monitoring. Social media needs consensus on rules of engagement for providers, better data mining tools and approaches to counter disinformation. Mobile and wearable devices benefit from a universal programming interface, improved infrastructure, more rigorous research and integration with EHRs and HIEs. Laws for privacy and security need updating to match current technologies, and data stewards should share information on breaches and standardize best practices. ICT tools are evolving quickly in healthcare and require a rational and well-funded national agenda for development, use and assessment.
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    Regenstrief teaching electronic medical record (tEMR) platform: a novel tool for teaching and evaluating applied health information technology
    (Oxford University Press, 2021-03-17) Takesue, Blaine Y.; Tierney, William M.; Embi, Peter J.; Mamlin, Burke W.; Warvel, Jeff; Litzelman, Debra K.; Medicine, School of Medicine
    The objective of this study is to provide an overview of the Regenstrief Teaching Electronic Medical Record (tEMR), how the tEMR could be used, and how it is currently being used in health professions education. The tEMR is a derivative of a real-world electronic health record (EHR), a large, pseudonymized patient database, and a population health tool designed to support curricular goals. The tEMR has been successfully adopted at 12 health professional, public health, and health information technology (HIT) schools, with over 11 800 unique student users and more than 74 000 logins, for case presentation, to develop diagnostic and therapeutic plans, and to practice documentation skills. With the exponential growth of health-related data and the impact of HIT on work-life balance, it is critical for students to get early EHR skills practice and understand how EHR’s work. The tEMR is a promising, scalable, flexible application to help health professional students learn about common HIT tools and issues.