Significant effects were found for protocols across provider types, regardless of expertise or area of clinical focus. It also appears that more thorough protocols lead to more information being passed, especially when those protocols consist of 12 or more items. Given these findings, publication bias is an apparent feature of this literature base. Recommendations to reduce the apparent publication bias in the field include changing the way articles are screened and published.
ObjectiveImplementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project.Materials and MethodsWe developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled “Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE).” The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics.ResultsOverall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5].DiscussionWe observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects.ConclusionsECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools’ impact on medical decision making, clinical practice, and health outcomes.
Purpose of Review The goal of this paper was to provide a narrative review of human factors considerations for telemedicine. It also sought to provide readers a foundation of human factors thinking and methods that could be employed within their own practice. Recent Findings There are only a handful of articles that discuss the importance of user-centered design and human factors principles in relation to telemedicine systems. Summary Most articles come to the conclusion that design flaws could have been avoided by involving stakeholders in the design and implementation of telemedicine. However, many of them lack the guidance for those who find themselves having to choose, implement, or use unwieldy systems. With this in mind, this paper provides a series of human factors principles, realworld questions, methods, and resources for those who may find themselves considering, implementing, sustaining, or using telemedicine in their own healthcare settings.
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