Clinical decision-making using a data-driven display

描述(由申请人提供)：与按实验室部分组织的显示相比，按生理系统或概念层次组织的临床实验室数据显示可提高临床决策的速度和/或准确性。非医学认知分析研究表明，与表格数字数据相比，数据的图形表示与改进的决策有关，特别是在时间紧迫的情况下。我们假设，临床实验室数据中重要时间关系的识别和显式图形表示将提高临床医生做出快速和正确决策的能力。我们开发了一个框架，用于确定时间序列数据中的统计模式以及这些模式之间的时间关系。我们建议1)将我们的框架结合到一个面向问题的显示中，该显示根据数据中的时间模式类型自适应地区分临床实验室数据的优先级和可视化，2)进行患者案例模拟，其中临床医生使用传统的、面向问题的和临时的数据驱动显示来访问临床实验室数据，以及3)在这些模拟的案例条件下评估临床医生在这些模拟的案例条件下做出决策的效率和准确性，并使用在决策过程中对临床医生进行视频和录音的“大声思考”技术。这三个用户界面对决策的影响将通过以下几个方面进行评估：与专家临床黄金标准相比订单的准确性，案例分析期间信息获取与信息评估认知步骤的相对比例，案例处理所需的总认知步骤(认知负荷)，以及查看的屏幕和数据元素总数。我们预计，面向问题的显示将通过提高信息收集的效率来支持改进的临床决策；时态数据驱动的显示可能通过将注意力集中在通常必须推断的重要关系上并直接可视化来进一步增强决策。

DESCRIPTION (provided by applicant): Clinical laboratory data displays organized by physiologic system or concept hierarchies may improve the speed and/or accuracy of clinical decisions as compared with displays organized by laboratory section. Nonmedical cognitive analysis studies indicate that graphical representation of data is associated with improved decision making in comparison with tabular numerical data, particularly in time-pressured situations. We hypothesize that identification and explicit graphical representation of important temporal relationships in clinical laboratory data will improve the ability of clinicians to reach decisions rapidly and correctly. We have developed a framework for identifying statistical patterns in timeseries data and temporal relationships between those patterns. We propose to 1) incorporate our framework into a problem-oriented display that prioritizes and visualizes clinical laboratory data adaptively based on types of temporal patterns in the data, 2) conduct patient case simulations in which clinician subjects access clinical laboratory data using traditional, problem-oriented, and temporal data-driven displays, and 3) evaluate the efficiency and accuracy of decision-making by clinicians under these simulated case conditions with mild time pressure, using "think aloud" techniques in which clinicians are video- and audiotaped during decision-making. The influence of these three user interfaces on decision-making will be evaluated by the accuracy of orders in comparison with an expert clinical gold standard, the relative proportions of information acquisition vs. information evaluation cognitive steps during case analysis, the total cognitive steps (cognitive load) required for case disposition, and the total number of screens and data elements viewed. We anticipate that the problem oriented display will support improved clinical decision-making through increasing the efficiency of information gathering; the temporal data-driven display may enhance decision-making further by focusing attention on, and directly visualizing, important relationships that would ordinarily have to be inferred.