This chapter is designed to introduce the concept of computer-based decision support systems for ... more This chapter is designed to introduce the concept of computer-based decision support systems for patients. With the rapid growth of computing technology available to consumers and the virtual explosion of health information available on the World Wide Web, patient decision aids and computer-based health interventions are now a more common part of routine medical care. The new field of consumer
Machine Intelligence and Pattern Recognition, 1990
Many real world models can be characterized as weak, meaning that there is significant uncertaint... more Many real world models can be characterized as weak, meaning that there is significant uncertainty in both the data input and inferences. This lack of determinism makes it especially difficult for users of computer decision aids to understand and have confidence in the models. This paper presents a representation for uncertainty and utilities that serves as a framework for graphical summary and computer-generated explanation of decision models. The application described that tests the methodology is a computer decision aid designed to enhance the clinician-patient consultation process for patients with angina (chest pain due to lack of blood flow to the heart muscle). The angina model is represented as a Bayesian decision network. Additionally, the probabilities and utilities are treated as random variables with probability distributions on their range of possible values. The initial distributions represent information on all patients with anginal symptoms, and the approach allows for rapid tailoring to more patient-specific distributions. This framework provides a metric for judging the importance of each variable in the model dynamically.
outcomes. We support this mission through a shared infrastructure that promoted the use of state-... more outcomes. We support this mission through a shared infrastructure that promoted the use of state-of-the-art technology to facilitate the timeliness, scalability and effectiveness of self-management interventions. Each presentation describes the results of an innovative technologysupported intervention to improve quality of life in older adults. Howard compares results of a comprehensive assessment and wellness coaching program in two diverse. Douglas presents a self-management intervention for older black women with high blood pressure using a smart phone application. Poghosyan explores the characteristics of a diverse group of current and former smokers and shares the results of a feasibility trial for a sensor-based intervention. Saczynski and Ramdin report on the feasibility of using a mobile cognitive assessment in atrial fibrillation patients. Ye shares preliminary results of a mobile-based dyadic intervention for individuals using CPAP therapy and their partners. The session chair will lead a discussion with the audience about the intersection of technology and nursing science.
Neural Information Processing Systems, Dec 8, 2008
Unexpected stimuli are a challenge to any machine learning algorithm. Here we identify distinct t... more Unexpected stimuli are a challenge to any machine learning algorithm. Here we identify distinct types of unexpected events, focusing on 'incongruent events'when 'general level' and 'specific level' classifiers give conflicting predictions. We define a formal framework for the representation and processing of incongruent events: starting from the notion of label hierarchy, we show how partial order on labels can be deduced from such hierarchies. For each event, we compute its probability in different ways, based on adjacent levels (according to the partial order) in the label hierarchy. An incongruent event is an event where the probability computed based on some more specific level (in accordance with the partial order) is much smaller than the probability computed based on some more general level, leading to conflicting predictions. We derive algorithms to detect incongruent events from different types of hierarchies, corresponding to class membership or part membership. Respectively, we show promising results with real data on two specific problems: Out Of Vocabulary words in speech recognition, and the identification of a new sub-class (e.g., the face of a new individual) in audiovisual facial object recognition.
Journal of the American Medical Informatics Association, Jul 1, 2005
The aim of this study was to evaluate the impact of introducing health information technology (HI... more The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. Design: This was a longitudinal pre-post study: two months before and one and seven months after introduction of examination room computers. Patient questionnaires (n = 313) after primary care visits with physicians (n = 8) within an integrated delivery system. There were three patient satisfaction domains: (1) satisfaction with visit components, (2) comprehension of the visit, and (3) perceptions of the physician's use of the computer. Results: Patients reported that physicians used computers in 82.3% of visits. Compared with baseline, overall patient satisfaction with visits increased seven months after the introduction of computers (odds ratio [OR] = 1.50; 95% confidence interval [CI]: 1.01-2.22), as did satisfaction with physicians' familiarity with patients (OR = 1.60, 95% CI: 1.01-2.52), communication about medical issues (OR = 1.61; 95% CI: 1.05-2.47), and comprehension of decisions made during the visit (OR = 1.63; 95% CI: 1.06-2.50). In contrast, there were no significant changes in patient satisfaction with comprehension of self-care responsibilities, communication about psychosocial issues, or available visit time. Seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28-2.42) compared with the first month after introduction. There were no other significant changes in patient perceptions of the computer use over time. Conclusion: The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits.
Annual Symposium on Computer Application in Medical Care, 1993
Recent studies of patients with chronic disease have shown that patient satisfaction and health o... more Recent studies of patients with chronic disease have shown that patient satisfaction and health outcomes are improved when patients and their families learn to better understand their disease and when they actively participate in treatment decisions and in the management of their care at home. There are several advantages to using computers to assist in providing such health and decision-making information to patients. Consumer health information systems have been useful in providing patients with access to information on health, disease, diagnosis, and treatment. However, to make systems for patients more useful, substantial progress needs to be made in providing a properly focused, patient-tailored and summarized view of the relevant information. Patients need to have medical information presented in a way that facilitates informed and active participation in decisions regarding their health care.
This chapter is designed to introduce the concept of computer-based decision support systems for ... more This chapter is designed to introduce the concept of computer-based decision support systems for patients. With the rapid growth of computing technology available to consumers and the virtual explosion of health information available on the World Wide Web, patient decision aids and computer-based health interventions are now a more common part of routine medical care. The new field of consumer health informatics deals with “developing and evaluating methods and applications to integrate consumer needs and preferences into information management systems in clinical practice, education, and research.”1 This technology, both hardware and software, is part of a growing trend toward empowering consumers to take a more active role in their own health care and to provide the necessary information to enhance their decision making. Today, more than ever, consumers are using information technology as an important supplement to the information provided by healthcare professionals in the course of clinical encounters.
This chapter is designed to introduce the concept of computer-based decision support systems for ... more This chapter is designed to introduce the concept of computer-based decision support systems for patients. With the rapid growth of computing technology available to consumers and the virtual explosion of health information available on the World Wide Web, patient decision aids and computer-based health interventions are now a more common part of routine medical care. The new field of consumer
Machine Intelligence and Pattern Recognition, 1990
Many real world models can be characterized as weak, meaning that there is significant uncertaint... more Many real world models can be characterized as weak, meaning that there is significant uncertainty in both the data input and inferences. This lack of determinism makes it especially difficult for users of computer decision aids to understand and have confidence in the models. This paper presents a representation for uncertainty and utilities that serves as a framework for graphical summary and computer-generated explanation of decision models. The application described that tests the methodology is a computer decision aid designed to enhance the clinician-patient consultation process for patients with angina (chest pain due to lack of blood flow to the heart muscle). The angina model is represented as a Bayesian decision network. Additionally, the probabilities and utilities are treated as random variables with probability distributions on their range of possible values. The initial distributions represent information on all patients with anginal symptoms, and the approach allows for rapid tailoring to more patient-specific distributions. This framework provides a metric for judging the importance of each variable in the model dynamically.
outcomes. We support this mission through a shared infrastructure that promoted the use of state-... more outcomes. We support this mission through a shared infrastructure that promoted the use of state-of-the-art technology to facilitate the timeliness, scalability and effectiveness of self-management interventions. Each presentation describes the results of an innovative technologysupported intervention to improve quality of life in older adults. Howard compares results of a comprehensive assessment and wellness coaching program in two diverse. Douglas presents a self-management intervention for older black women with high blood pressure using a smart phone application. Poghosyan explores the characteristics of a diverse group of current and former smokers and shares the results of a feasibility trial for a sensor-based intervention. Saczynski and Ramdin report on the feasibility of using a mobile cognitive assessment in atrial fibrillation patients. Ye shares preliminary results of a mobile-based dyadic intervention for individuals using CPAP therapy and their partners. The session chair will lead a discussion with the audience about the intersection of technology and nursing science.
Neural Information Processing Systems, Dec 8, 2008
Unexpected stimuli are a challenge to any machine learning algorithm. Here we identify distinct t... more Unexpected stimuli are a challenge to any machine learning algorithm. Here we identify distinct types of unexpected events, focusing on 'incongruent events'when 'general level' and 'specific level' classifiers give conflicting predictions. We define a formal framework for the representation and processing of incongruent events: starting from the notion of label hierarchy, we show how partial order on labels can be deduced from such hierarchies. For each event, we compute its probability in different ways, based on adjacent levels (according to the partial order) in the label hierarchy. An incongruent event is an event where the probability computed based on some more specific level (in accordance with the partial order) is much smaller than the probability computed based on some more general level, leading to conflicting predictions. We derive algorithms to detect incongruent events from different types of hierarchies, corresponding to class membership or part membership. Respectively, we show promising results with real data on two specific problems: Out Of Vocabulary words in speech recognition, and the identification of a new sub-class (e.g., the face of a new individual) in audiovisual facial object recognition.
Journal of the American Medical Informatics Association, Jul 1, 2005
The aim of this study was to evaluate the impact of introducing health information technology (HI... more The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. Design: This was a longitudinal pre-post study: two months before and one and seven months after introduction of examination room computers. Patient questionnaires (n = 313) after primary care visits with physicians (n = 8) within an integrated delivery system. There were three patient satisfaction domains: (1) satisfaction with visit components, (2) comprehension of the visit, and (3) perceptions of the physician's use of the computer. Results: Patients reported that physicians used computers in 82.3% of visits. Compared with baseline, overall patient satisfaction with visits increased seven months after the introduction of computers (odds ratio [OR] = 1.50; 95% confidence interval [CI]: 1.01-2.22), as did satisfaction with physicians' familiarity with patients (OR = 1.60, 95% CI: 1.01-2.52), communication about medical issues (OR = 1.61; 95% CI: 1.05-2.47), and comprehension of decisions made during the visit (OR = 1.63; 95% CI: 1.06-2.50). In contrast, there were no significant changes in patient satisfaction with comprehension of self-care responsibilities, communication about psychosocial issues, or available visit time. Seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28-2.42) compared with the first month after introduction. There were no other significant changes in patient perceptions of the computer use over time. Conclusion: The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits.
Annual Symposium on Computer Application in Medical Care, 1993
Recent studies of patients with chronic disease have shown that patient satisfaction and health o... more Recent studies of patients with chronic disease have shown that patient satisfaction and health outcomes are improved when patients and their families learn to better understand their disease and when they actively participate in treatment decisions and in the management of their care at home. There are several advantages to using computers to assist in providing such health and decision-making information to patients. Consumer health information systems have been useful in providing patients with access to information on health, disease, diagnosis, and treatment. However, to make systems for patients more useful, substantial progress needs to be made in providing a properly focused, patient-tailored and summarized view of the relevant information. Patients need to have medical information presented in a way that facilitates informed and active participation in decisions regarding their health care.
This chapter is designed to introduce the concept of computer-based decision support systems for ... more This chapter is designed to introduce the concept of computer-based decision support systems for patients. With the rapid growth of computing technology available to consumers and the virtual explosion of health information available on the World Wide Web, patient decision aids and computer-based health interventions are now a more common part of routine medical care. The new field of consumer health informatics deals with “developing and evaluating methods and applications to integrate consumer needs and preferences into information management systems in clinical practice, education, and research.”1 This technology, both hardware and software, is part of a growing trend toward empowering consumers to take a more active role in their own health care and to provide the necessary information to enhance their decision making. Today, more than ever, consumers are using information technology as an important supplement to the information provided by healthcare professionals in the course of clinical encounters.
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Papers by Holly Jimison