User login
Enhancing Usability of Health Information Technology: Comparative Evaluation of Workflow Support Tools
BACKGROUND
The Breast and Gynecologic System of Excellence (BGSOE) program has developed a workflow support tool using health information technology to assist clinicians, coordinators and stakeholders in identifying, tracking and supporting Veterans with breast and gynecological cancers. This tool was designed and implemented through a novel process that involved clarifying program aims, defining workflows in process delivery diagrams, and identifying data, analytic products, and user needs. To determine the optimal tool for the program, a comparative usability evaluation was conducted, comparing the new workflow support tool with a previous tool that shared identical aims but utilized a different approach.
METHODS
Usability evaluation employed the System Usability Scale (SUS) and measured acceptance using modified items from a validated instrument used in a national survey of electronic health records. Task efficiency was evaluated based on time taken and the number of clicks required to complete tasks.
RESULTS
Eight healthcare professionals with experience in the BGSOE program or similar programs in the VA participated in the usability evaluation. This group comprised physicians (38%), clinical pharmacist (25%), health care coordinators (25%), and registered nurse (12%). The workflow support tool achieved an impressive SUS score of 89.06, with acceptance scores of 93% (positive statements) and 6% (negative statements), outperforming the standard tool, which scored score of 57.5 on the SUS and had acceptance scores of 53% (positive statements) and 50% (negative statements). In the comparative ranking, 100% of the users preferred the workflow support tool, citing its userfriendliness, intuitiveness, and ease of use. On average, users completed all tasks using the workflow support tool in 8 minutes with 31 clicks, while the standard tool required 18 minutes and 124 clicks.
CONCLUSIONS
The adoption of a workflow support tool in the design of health information technology interventions leads to improved usability, efficiency, and adoption. Based on the positive results from the usability evaluation, the BGSOE program has chosen to adopt the workflow support tool as its preferred health information technology solution.
BACKGROUND
The Breast and Gynecologic System of Excellence (BGSOE) program has developed a workflow support tool using health information technology to assist clinicians, coordinators and stakeholders in identifying, tracking and supporting Veterans with breast and gynecological cancers. This tool was designed and implemented through a novel process that involved clarifying program aims, defining workflows in process delivery diagrams, and identifying data, analytic products, and user needs. To determine the optimal tool for the program, a comparative usability evaluation was conducted, comparing the new workflow support tool with a previous tool that shared identical aims but utilized a different approach.
METHODS
Usability evaluation employed the System Usability Scale (SUS) and measured acceptance using modified items from a validated instrument used in a national survey of electronic health records. Task efficiency was evaluated based on time taken and the number of clicks required to complete tasks.
RESULTS
Eight healthcare professionals with experience in the BGSOE program or similar programs in the VA participated in the usability evaluation. This group comprised physicians (38%), clinical pharmacist (25%), health care coordinators (25%), and registered nurse (12%). The workflow support tool achieved an impressive SUS score of 89.06, with acceptance scores of 93% (positive statements) and 6% (negative statements), outperforming the standard tool, which scored score of 57.5 on the SUS and had acceptance scores of 53% (positive statements) and 50% (negative statements). In the comparative ranking, 100% of the users preferred the workflow support tool, citing its userfriendliness, intuitiveness, and ease of use. On average, users completed all tasks using the workflow support tool in 8 minutes with 31 clicks, while the standard tool required 18 minutes and 124 clicks.
CONCLUSIONS
The adoption of a workflow support tool in the design of health information technology interventions leads to improved usability, efficiency, and adoption. Based on the positive results from the usability evaluation, the BGSOE program has chosen to adopt the workflow support tool as its preferred health information technology solution.
BACKGROUND
The Breast and Gynecologic System of Excellence (BGSOE) program has developed a workflow support tool using health information technology to assist clinicians, coordinators and stakeholders in identifying, tracking and supporting Veterans with breast and gynecological cancers. This tool was designed and implemented through a novel process that involved clarifying program aims, defining workflows in process delivery diagrams, and identifying data, analytic products, and user needs. To determine the optimal tool for the program, a comparative usability evaluation was conducted, comparing the new workflow support tool with a previous tool that shared identical aims but utilized a different approach.
METHODS
Usability evaluation employed the System Usability Scale (SUS) and measured acceptance using modified items from a validated instrument used in a national survey of electronic health records. Task efficiency was evaluated based on time taken and the number of clicks required to complete tasks.
RESULTS
Eight healthcare professionals with experience in the BGSOE program or similar programs in the VA participated in the usability evaluation. This group comprised physicians (38%), clinical pharmacist (25%), health care coordinators (25%), and registered nurse (12%). The workflow support tool achieved an impressive SUS score of 89.06, with acceptance scores of 93% (positive statements) and 6% (negative statements), outperforming the standard tool, which scored score of 57.5 on the SUS and had acceptance scores of 53% (positive statements) and 50% (negative statements). In the comparative ranking, 100% of the users preferred the workflow support tool, citing its userfriendliness, intuitiveness, and ease of use. On average, users completed all tasks using the workflow support tool in 8 minutes with 31 clicks, while the standard tool required 18 minutes and 124 clicks.
CONCLUSIONS
The adoption of a workflow support tool in the design of health information technology interventions leads to improved usability, efficiency, and adoption. Based on the positive results from the usability evaluation, the BGSOE program has chosen to adopt the workflow support tool as its preferred health information technology solution.
Hepatitis B Virus (HBV) Testing in Veterans Receiving Systemic Anticancer Treatment
Purpose
Examine hepatitis B virus (HBV) testing in veterans receiving systemic anticancer treatment (SACT) in the Veterans Health Administration (VHA).
Background
HBV reactivation is reported in patients with chronic (HB surface antigen, HBsAg, positive) or prior (HB core antibody, HBcAb, positive) HBV infection, who receive SACT. A recent American Society of Clinical Oncology provisional clinical opinion update recommended HBV screening for all patients prior to initiation of SACT (excluding hormonal therapy). HBV testing and the incidence of hepatitis in veterans receiving SACT in the VHA has not been reported.
Methods/Data Analysis
VHA EHR data were used to identify veterans receiving SACT (01/2010-12/2021). Testing for HBsAg, HBcAb and alanine aminotransferase (ALT) was extracted. Patients known to have HBV or elevated ALT prior to first SACT, and those receiving anti-CD20 were excluded. Patients were followed until two years after the last SACT or 12/2021, whichever occurred first. Patients receiving intravenous SACT and those receiving oral SACT are described separately.
Results
Between 2010 and 2021, 215,395 veterans received an intravenous SACT, while 80,752 veterans received an oral SACT. Of patients treated with an SACT, 80% had no evidence of HBsAg or HBcAb testing prior to treatment initiation, and 8-12% experienced at least one elevated ALT between treatment initiation and two years after the last SACT. There was no evidence of increased ALT elevation in patients who were not tested compared to those that were tested prior to treatment initiation. In patients with at least one ALT elevation, approximately 30% were tested for HBV and of these, 3% tested positive.
Conclusions/Implications
Most veterans receiving SACT are not tested for HBV prior to treatment initiation, and do not experience elevated ALTs. In patients with elevated ALT during or subsequent to SACT, the majority are not tested for HBV. Veterans that are tested reveal an HBV prevalence of about 10%. Our results suggest that HBV testing prior to SACT initiation should not be at the expense of delaying treatment, given the magnitude of proposed change from current practice and the anticipated low probability of benefit.
Purpose
Examine hepatitis B virus (HBV) testing in veterans receiving systemic anticancer treatment (SACT) in the Veterans Health Administration (VHA).
Background
HBV reactivation is reported in patients with chronic (HB surface antigen, HBsAg, positive) or prior (HB core antibody, HBcAb, positive) HBV infection, who receive SACT. A recent American Society of Clinical Oncology provisional clinical opinion update recommended HBV screening for all patients prior to initiation of SACT (excluding hormonal therapy). HBV testing and the incidence of hepatitis in veterans receiving SACT in the VHA has not been reported.
Methods/Data Analysis
VHA EHR data were used to identify veterans receiving SACT (01/2010-12/2021). Testing for HBsAg, HBcAb and alanine aminotransferase (ALT) was extracted. Patients known to have HBV or elevated ALT prior to first SACT, and those receiving anti-CD20 were excluded. Patients were followed until two years after the last SACT or 12/2021, whichever occurred first. Patients receiving intravenous SACT and those receiving oral SACT are described separately.
Results
Between 2010 and 2021, 215,395 veterans received an intravenous SACT, while 80,752 veterans received an oral SACT. Of patients treated with an SACT, 80% had no evidence of HBsAg or HBcAb testing prior to treatment initiation, and 8-12% experienced at least one elevated ALT between treatment initiation and two years after the last SACT. There was no evidence of increased ALT elevation in patients who were not tested compared to those that were tested prior to treatment initiation. In patients with at least one ALT elevation, approximately 30% were tested for HBV and of these, 3% tested positive.
Conclusions/Implications
Most veterans receiving SACT are not tested for HBV prior to treatment initiation, and do not experience elevated ALTs. In patients with elevated ALT during or subsequent to SACT, the majority are not tested for HBV. Veterans that are tested reveal an HBV prevalence of about 10%. Our results suggest that HBV testing prior to SACT initiation should not be at the expense of delaying treatment, given the magnitude of proposed change from current practice and the anticipated low probability of benefit.
Purpose
Examine hepatitis B virus (HBV) testing in veterans receiving systemic anticancer treatment (SACT) in the Veterans Health Administration (VHA).
Background
HBV reactivation is reported in patients with chronic (HB surface antigen, HBsAg, positive) or prior (HB core antibody, HBcAb, positive) HBV infection, who receive SACT. A recent American Society of Clinical Oncology provisional clinical opinion update recommended HBV screening for all patients prior to initiation of SACT (excluding hormonal therapy). HBV testing and the incidence of hepatitis in veterans receiving SACT in the VHA has not been reported.
Methods/Data Analysis
VHA EHR data were used to identify veterans receiving SACT (01/2010-12/2021). Testing for HBsAg, HBcAb and alanine aminotransferase (ALT) was extracted. Patients known to have HBV or elevated ALT prior to first SACT, and those receiving anti-CD20 were excluded. Patients were followed until two years after the last SACT or 12/2021, whichever occurred first. Patients receiving intravenous SACT and those receiving oral SACT are described separately.
Results
Between 2010 and 2021, 215,395 veterans received an intravenous SACT, while 80,752 veterans received an oral SACT. Of patients treated with an SACT, 80% had no evidence of HBsAg or HBcAb testing prior to treatment initiation, and 8-12% experienced at least one elevated ALT between treatment initiation and two years after the last SACT. There was no evidence of increased ALT elevation in patients who were not tested compared to those that were tested prior to treatment initiation. In patients with at least one ALT elevation, approximately 30% were tested for HBV and of these, 3% tested positive.
Conclusions/Implications
Most veterans receiving SACT are not tested for HBV prior to treatment initiation, and do not experience elevated ALTs. In patients with elevated ALT during or subsequent to SACT, the majority are not tested for HBV. Veterans that are tested reveal an HBV prevalence of about 10%. Our results suggest that HBV testing prior to SACT initiation should not be at the expense of delaying treatment, given the magnitude of proposed change from current practice and the anticipated low probability of benefit.
Implementation of a Pilot Study Evaluating the Feasibility of Delivery of Attune, a Digital Cognitive-Behavioral Stress Management (CBSM) Software Application for Treatment of Anxiety and Depressive Symptoms in Veterans with Cancer
Purpose
To assess promoters and obstacles of enrollment in a decentralized clinical research study, where veterans with cancer-related depressive symptoms are electronically prescribed a 10-session digitally administered Cognitive-Behavioral Stress Management (CBSM) program, called Attune.
Background
The US Department of Veterans Affairs (VA) National TeleOncology (NTO) Program has served 5688 veterans since inception, 3100 of which reside in rural areas (55%). Previous studies demonstrate clinically significant levels of psychosocial distress in up to 52% of patients with cancer. It is unknown if veterans with cancer experiencing psychosocial distress will benefit from a CBSM app. Traditional research studies often underrepresent rural cancer patients, so the VA-Attune clinical trial was designed for implementation in a decentralized fashion for NTO VA facilities serving a more predominant rural population.
Methods
We manually screened veteran appointments to identify potentially eligible veterans. NTO providers were notified if their patients were potentially eligible, providers asked patients if they wanted more information. Research staff then contacted veterans by telephone to confirm eligibility. Consent and HIPAA authorization were mailed to interested veterans and the consent process occurred via telephone. Descriptive statistics were used to summarize the patient population screened and consented.
Results
Between January and May 2022, there were 467 veterans screened and 15 veterans enrolled (mean [SD] age, 67.2 [8.28] years; 12 men and 3 women). 15 veterans received the electronic prescription of the Attune App and providers viewed the CBSM App as feasible. Promotors of implementation included convenience of a virtual format and use of the veteran’s mobile device to deliver the digital CBSM. Barriers identified by veterans were not having an appropriate mobile device, inadequate knowledge on using a mobile device, and insufficient time to commit to regularly using the Attune app.
Conclusions/Implications
This VA-Attune study demonstrated that clinical trials can be implemented in the VA in a decentralized fashion, enrolling rural and urban veterans. We identified significant barriers to enrollment and engagement despite our approach of remote consent. The VA-Attune research study continues to enroll veterans nationally, highlighting best practices and opportunities to improve the implementation of decentralized cancer clinical trials in the VA.
Purpose
To assess promoters and obstacles of enrollment in a decentralized clinical research study, where veterans with cancer-related depressive symptoms are electronically prescribed a 10-session digitally administered Cognitive-Behavioral Stress Management (CBSM) program, called Attune.
Background
The US Department of Veterans Affairs (VA) National TeleOncology (NTO) Program has served 5688 veterans since inception, 3100 of which reside in rural areas (55%). Previous studies demonstrate clinically significant levels of psychosocial distress in up to 52% of patients with cancer. It is unknown if veterans with cancer experiencing psychosocial distress will benefit from a CBSM app. Traditional research studies often underrepresent rural cancer patients, so the VA-Attune clinical trial was designed for implementation in a decentralized fashion for NTO VA facilities serving a more predominant rural population.
Methods
We manually screened veteran appointments to identify potentially eligible veterans. NTO providers were notified if their patients were potentially eligible, providers asked patients if they wanted more information. Research staff then contacted veterans by telephone to confirm eligibility. Consent and HIPAA authorization were mailed to interested veterans and the consent process occurred via telephone. Descriptive statistics were used to summarize the patient population screened and consented.
Results
Between January and May 2022, there were 467 veterans screened and 15 veterans enrolled (mean [SD] age, 67.2 [8.28] years; 12 men and 3 women). 15 veterans received the electronic prescription of the Attune App and providers viewed the CBSM App as feasible. Promotors of implementation included convenience of a virtual format and use of the veteran’s mobile device to deliver the digital CBSM. Barriers identified by veterans were not having an appropriate mobile device, inadequate knowledge on using a mobile device, and insufficient time to commit to regularly using the Attune app.
Conclusions/Implications
This VA-Attune study demonstrated that clinical trials can be implemented in the VA in a decentralized fashion, enrolling rural and urban veterans. We identified significant barriers to enrollment and engagement despite our approach of remote consent. The VA-Attune research study continues to enroll veterans nationally, highlighting best practices and opportunities to improve the implementation of decentralized cancer clinical trials in the VA.
Purpose
To assess promoters and obstacles of enrollment in a decentralized clinical research study, where veterans with cancer-related depressive symptoms are electronically prescribed a 10-session digitally administered Cognitive-Behavioral Stress Management (CBSM) program, called Attune.
Background
The US Department of Veterans Affairs (VA) National TeleOncology (NTO) Program has served 5688 veterans since inception, 3100 of which reside in rural areas (55%). Previous studies demonstrate clinically significant levels of psychosocial distress in up to 52% of patients with cancer. It is unknown if veterans with cancer experiencing psychosocial distress will benefit from a CBSM app. Traditional research studies often underrepresent rural cancer patients, so the VA-Attune clinical trial was designed for implementation in a decentralized fashion for NTO VA facilities serving a more predominant rural population.
Methods
We manually screened veteran appointments to identify potentially eligible veterans. NTO providers were notified if their patients were potentially eligible, providers asked patients if they wanted more information. Research staff then contacted veterans by telephone to confirm eligibility. Consent and HIPAA authorization were mailed to interested veterans and the consent process occurred via telephone. Descriptive statistics were used to summarize the patient population screened and consented.
Results
Between January and May 2022, there were 467 veterans screened and 15 veterans enrolled (mean [SD] age, 67.2 [8.28] years; 12 men and 3 women). 15 veterans received the electronic prescription of the Attune App and providers viewed the CBSM App as feasible. Promotors of implementation included convenience of a virtual format and use of the veteran’s mobile device to deliver the digital CBSM. Barriers identified by veterans were not having an appropriate mobile device, inadequate knowledge on using a mobile device, and insufficient time to commit to regularly using the Attune app.
Conclusions/Implications
This VA-Attune study demonstrated that clinical trials can be implemented in the VA in a decentralized fashion, enrolling rural and urban veterans. We identified significant barriers to enrollment and engagement despite our approach of remote consent. The VA-Attune research study continues to enroll veterans nationally, highlighting best practices and opportunities to improve the implementation of decentralized cancer clinical trials in the VA.