Mike Rayo | Ohio State University (original) (raw)

Papers by Mike Rayo

Research paper thumbnail of Barriers and facilitators to adoption of soft copy interpretation from the user perspective: Lessons learned from filmless radiology for slideless pathology

Journal of Pathology Informatics, 2011

Background:Adoption of digital images for pathological specimens has been slower than adoption of... more Background:Adoption of digital images for pathological specimens has been slower than adoption of digital images in radiology, despite a number of anticipated advantages for digital images in pathology.In this paper, we explore the factors that might explain this slower rate of adoption. Materials and Method: Semi-structured interviews on barriers and facilitators to the adoption of digital images were conducted with two radiologists, three pathologists, and one pathologist's assistant. Results: Barriers and facilitators to adoption of digital images were reported in the areas of performance, workflow-efficiency, infrastructure, integration with other software, and exposure to digital images.The primary difference between the settings was that performance with the use of digital images as compared to the traditional method was perceived to be higher in radiology and lower in pathology. Additionally, exposure to digital images was higher in radiology than pathology, with some radiologists exclusively having been trained and/or practicing with digital images.The integration of digital images both improved and reduced efficiency in routine and nonroutine workflow patterns in both settings, and was variable across the different organizations. A comparison of these findings with prior research on adoption of other health information technologies suggests that the barriers to adoption of digital images in pathology are relatively tractable. Conclusions: Improving performance using digital images in pathology would likely accelerate adoption of innovative technologies that are facilitated by the use of digital images, such as electronic imaging databases, electronic health records, double reading for challenging cases, and computer-aided diagnostic systems.

Research paper thumbnail of Comparing the Effectiveness of Alerts and Dynamically Annotated Visualizations (DAVs) in Improving Clinical Decision Making

Human Factors: The Journal of the Human Factors and Ergonomics Society, 2015

The aim of this study was to compare the effectiveness of two types of real-time decision support... more The aim of this study was to compare the effectiveness of two types of real-time decision support, an interrupting pop-up alert and a noninterrupting dynamically annotated visualization (DAV), in reducing clinically inappropriate diagnostic imaging orders. Alerts in electronic health record software are frequently disregarded due to high false-alarm rates, interruptions, and uncertainty about what triggered the alert. In other settings, providing visualizations and improving understandability of the guidance has been shown to improve overall decision making. Using a between-subject design, we examined the effect of two forms of decision support, alerts and DAVs, on reducing the proportion of inappropriate diagnostic imaging orders for 11 patients in a simulated environment. Nine attending and 11 resident physicians with experience using an electronic health record were randomly assigned to the form of decision support. Secondary measures were self-reported understandability, algorithm transparency, and clinical relevance. Fewer inappropriate diagnostic imaging tests were ordered with DAVs than with alerts (18% vs. 34%, p < .001). The DAV was rated higher for all three secondary measures (p < .001) for all participants. DAVs were more effective than alerts in reducing inappropriate imaging orders and were preferred for all patient scenarios, especially scenarios where guidance was ambiguous or based on inaccurate information. Creating visualizations that are permanently displayed and vary in the strength of their guidance can mitigate the risk of system performance degradation due to incomplete or incorrect data. This interaction paradigm may be applicable for other settings with high false-alarm rates or where there is a need to reduce interruptions during decision making.

Research paper thumbnail of Authors' reply

Journal of pathology informatics, 2011

Research paper thumbnail of Online Training for Resilient Communication during Shift Change Handovers

Research paper thumbnail of Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners

BMJ quality & safety, 2014

Although there is a growing recognition of the importance of active communication behaviours from... more Although there is a growing recognition of the importance of active communication behaviours from the incoming clinician receiving a patient handover, there are currently no agreed-upon measures to objectively describe those behaviours. This study sought to identify differences in incoming clinician communication behaviours across levels of clinical training for physicians and nurses. Handover observations were conducted during shift changes for attending physicians, resident physicians, registered nurses and nurse practitioners in three medical intensive care units from July 2011 to August 2012. Measures were the number of interjections from the incoming clinician and the communication mode of those interjections. Each collaborative cross-check, a specific type of interactive question, was subsequently classified by level of assertiveness. 133 patient handovers were analysed. Statistical differences were found in both measures. Higher levels of training were associated with fewer i...

Research paper thumbnail of Determining the Rate of Change in Exposure to Ionizing Radiation From CT Scans: A Database Analysis From One Hospital

Journal of the American College of Radiology, 2014

Purpose: Cancer risks associated with radiation from CT procedures have recently received increas... more Purpose: Cancer risks associated with radiation from CT procedures have recently received increased attention. An important question is whether the combined impact of CT volume and dose reduction strategies has reduced radiation exposure to adult patients undergoing CT examinations. The aim of this study was to determine differences in radiation exposure from 2008 to 2012 to patients receiving CT scans of the abdomen, head, sinus, and lumbar spine at a midwestern academic medical center that implemented dose reduction strategies.

Research paper thumbnail of Detecting Emerging Undesired Effects Sooner

ABSTRACT Abstract: In order to reduce the impact of incidents causing harm to patients, we must d... more ABSTRACT Abstract: In order to reduce the impact of incidents causing harm to patients, we must detect and rectify them sooner. The system of patient care, which is comprised of a number of human and machine agents, must improve in order to better detect the causes of the incidents that in turn cause harm to patients. To effectively do this, all agents in the system must readily have access to the information necessary to ascertain whether (1) everything is going according to plan, and (2) if they current plan is still appropriate. Using this paradigm as a backdrop, the goal of the study was to understand the frequency and speed at which a given technology solution, an infusion pump, detects medication misadministrations as compared to the frequency and speed of clinician detection. To research this, data were gathered from three hospitals. Observational data were gathered in four-hour observation periods, after which an interview was given to ascertain if medication errors had occurred during the course of the observation period. Data was also gathered from infusion pumps for all three hospitals. The pump data set was culled to only include pump alerts during the observation periods, and the two data sets were compared. The results show that infusion pumps detected 3% of all plan breakdowns that were detected during the observation period. Clinicians detected the remaining 97%. The infusion pump detected 100% of plan breakdowns before they reached the patient. Of those detected by the clinician, only 7% were detected before reaching the patient. On the other end of the continuum, 11% were detected only after they caused harm to the patient, and an additional 18% required that the patient be monitored to ensure that no harm was done. It was concluded that infusion pumps play only a small role in the detection of medication administrations, detection of inappropriate plans, and detection of deviations from the plan. In order for the system to improve its performance, there needs to be better system visibility to the plan, the intent behind the plan, and any deviations to that plan. By comparing observation data and pump alerts from the same time period, the detection performance of the technology is properly framed in the context of the entire system's performance. Thesis (M.S.)--Ohio State University, 2007. Includes bibliographical references (leaves 56-61).

Research paper thumbnail of Go Shush Yourself: Student Habitus at the New Thompson Library

Research paper thumbnail of Handoff Communication: Implications For Design

Proceedings of the …, 2012

Handoff communication is one of the most typical clinical communication mechanisms in a healthcar... more Handoff communication is one of the most typical clinical communication mechanisms in a healthcare setting to transfer information and responsibilities of the care provider. Handoff communication is varied across settings, provider type, and even within a clinical unit. Information technology has the capability to support handoff communication, with better understanding of handoff communication needs and variations. This panel examines (1) how handoff communication happens in the healthcare setting through mini-cases (2) insights on information technology design for handoff communication.

Research paper thumbnail of Assessing medication safety technology in the intensive care unit

Proceedings of the Human …, 2007

Understanding the strengths and weaknesses of a technology in the context of the distributed syst... more Understanding the strengths and weaknesses of a technology in the context of the distributed system in which it is working is critical to assessing and improving the performance of that system. Taking a systems approach requires knowledge about how all agents in a system work together to achieve the goals of that system. With these aims, the alerting mechanism of infusion pumps containing Dose-Error Reduction Software (DERS) was studied to determine its effectiveness in the Intensive Care Units (ICU's) of three hospitals. In 1,146 of the 9,557 pump alerts (12.0 %), the alert caused the clinician to change the input. Of these, 1,030 were changed to within the hospital's recommended dosing limits. The alert was overridden for 8,400 (88.0%) of the alerts. The data show that this technology successfully informed clinicians over 1000 times that unintended doses had been inputted and stopped those doses from reaching the patient, thereby averting potential Medication Events. The data also suggest that, because nearly 90% of the alerts were overridden, a well-intended and valuable alert may be perceived by the clinicians as a false alarm and may be overlooked. Another key finding from this analysis was that clinicians may have used potentially unsafe workarounds to administer intravenous drug boluses (i.e., more rapid infusion of a defined dose or volume) and to keep the patient's line active between infusions. In a separate parallel study, clinician selfreport of potentially harmful medication events was studied. During 559 hours of direct observation, clinicians detected 27 (IV and non-IV) medication events. All of the reported events were outside of the scope of what DERS technology was designed to detect. In addition, during the same time period the technology detected five potentially harmful IV medication events that the clinicians did not report. The results of these two studies indicate two possible classes of solutions that could reduce the impact and likelihood of medication administration errors. One class of solutions involves the procedures and policies of the hospital, ensuring that process and technology implementations are optimally tuned, taking human performance and the current practice of the clinicians into account. The other class of solutions involves using new strategies and technologies to ensure that each system agent has access to other agents' perspectives, and the broader system's perspective. Studies such as these can provide insight into the use of safety technology during critical care processes and provide direction for future research, including more effective design of alerting mechanisms of ICU devices.

Research paper thumbnail of Barriers and facilitators to adoption of soft copy interpretation from the user perspective: Lessons learned from filmless radiology for slideless pathology

Journal of pathology …, 2011

Background:Adoption of digital images for pathological specimens has been slower than adoption of... more Background:Adoption of digital images for pathological specimens has been slower than adoption of digital images in radiology, despite a number of anticipated advantages for digital images in pathology. In this paper, we explore the factors that might explain this slower rate of adoption.Materials and Method:Semi-structured interviews on barriers and facilitators to the adoption of digital images were conducted with two radiologists, three pathologists, and one pathologist's assistant.Results:Barriers and facilitators to adoption of digital images were reported in the areas of performance, workflow-efficiency, infrastructure, integration with other software, and exposure to digital images. The primary difference between the settings was that performance with the use of digital images as compared to the traditional method was perceived to be higher in radiology and lower in pathology. Additionally, exposure to digital images was higher in radiology than pathology, with some radiologists exclusively having been trained and/or practicing with digital images. The integration of digital images both improved and reduced efficiency in routine and non-routine workflow patterns in both settings, and was variable across the different organizations. A comparison of these findings with prior research on adoption of other health information technologies suggests that the barriers to adoption of digital images in pathology are relatively tractable.Conclusions:Improving performance using digital images in pathology would likely accelerate adoption of innovative technologies that are facilitated by the use of digital images, such as electronic imaging databases, electronic health records, double reading for challenging cases, and computer-aided diagnostic systems.

Research paper thumbnail of Barriers and facilitators to adoption of soft copy interpretation from the user perspective: Lessons learned from filmless radiology for slideless pathology

Journal of Pathology Informatics, 2011

Background:Adoption of digital images for pathological specimens has been slower than adoption of... more Background:Adoption of digital images for pathological specimens has been slower than adoption of digital images in radiology, despite a number of anticipated advantages for digital images in pathology.In this paper, we explore the factors that might explain this slower rate of adoption. Materials and Method: Semi-structured interviews on barriers and facilitators to the adoption of digital images were conducted with two radiologists, three pathologists, and one pathologist's assistant. Results: Barriers and facilitators to adoption of digital images were reported in the areas of performance, workflow-efficiency, infrastructure, integration with other software, and exposure to digital images.The primary difference between the settings was that performance with the use of digital images as compared to the traditional method was perceived to be higher in radiology and lower in pathology. Additionally, exposure to digital images was higher in radiology than pathology, with some radiologists exclusively having been trained and/or practicing with digital images.The integration of digital images both improved and reduced efficiency in routine and nonroutine workflow patterns in both settings, and was variable across the different organizations. A comparison of these findings with prior research on adoption of other health information technologies suggests that the barriers to adoption of digital images in pathology are relatively tractable. Conclusions: Improving performance using digital images in pathology would likely accelerate adoption of innovative technologies that are facilitated by the use of digital images, such as electronic imaging databases, electronic health records, double reading for challenging cases, and computer-aided diagnostic systems.

Research paper thumbnail of Comparing the Effectiveness of Alerts and Dynamically Annotated Visualizations (DAVs) in Improving Clinical Decision Making

Human Factors: The Journal of the Human Factors and Ergonomics Society, 2015

The aim of this study was to compare the effectiveness of two types of real-time decision support... more The aim of this study was to compare the effectiveness of two types of real-time decision support, an interrupting pop-up alert and a noninterrupting dynamically annotated visualization (DAV), in reducing clinically inappropriate diagnostic imaging orders. Alerts in electronic health record software are frequently disregarded due to high false-alarm rates, interruptions, and uncertainty about what triggered the alert. In other settings, providing visualizations and improving understandability of the guidance has been shown to improve overall decision making. Using a between-subject design, we examined the effect of two forms of decision support, alerts and DAVs, on reducing the proportion of inappropriate diagnostic imaging orders for 11 patients in a simulated environment. Nine attending and 11 resident physicians with experience using an electronic health record were randomly assigned to the form of decision support. Secondary measures were self-reported understandability, algorithm transparency, and clinical relevance. Fewer inappropriate diagnostic imaging tests were ordered with DAVs than with alerts (18% vs. 34%, p < .001). The DAV was rated higher for all three secondary measures (p < .001) for all participants. DAVs were more effective than alerts in reducing inappropriate imaging orders and were preferred for all patient scenarios, especially scenarios where guidance was ambiguous or based on inaccurate information. Creating visualizations that are permanently displayed and vary in the strength of their guidance can mitigate the risk of system performance degradation due to incomplete or incorrect data. This interaction paradigm may be applicable for other settings with high false-alarm rates or where there is a need to reduce interruptions during decision making.

Research paper thumbnail of Authors' reply

Journal of pathology informatics, 2011

Research paper thumbnail of Online Training for Resilient Communication during Shift Change Handovers

Research paper thumbnail of Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners

BMJ quality & safety, 2014

Although there is a growing recognition of the importance of active communication behaviours from... more Although there is a growing recognition of the importance of active communication behaviours from the incoming clinician receiving a patient handover, there are currently no agreed-upon measures to objectively describe those behaviours. This study sought to identify differences in incoming clinician communication behaviours across levels of clinical training for physicians and nurses. Handover observations were conducted during shift changes for attending physicians, resident physicians, registered nurses and nurse practitioners in three medical intensive care units from July 2011 to August 2012. Measures were the number of interjections from the incoming clinician and the communication mode of those interjections. Each collaborative cross-check, a specific type of interactive question, was subsequently classified by level of assertiveness. 133 patient handovers were analysed. Statistical differences were found in both measures. Higher levels of training were associated with fewer i...

Research paper thumbnail of Determining the Rate of Change in Exposure to Ionizing Radiation From CT Scans: A Database Analysis From One Hospital

Journal of the American College of Radiology, 2014

Purpose: Cancer risks associated with radiation from CT procedures have recently received increas... more Purpose: Cancer risks associated with radiation from CT procedures have recently received increased attention. An important question is whether the combined impact of CT volume and dose reduction strategies has reduced radiation exposure to adult patients undergoing CT examinations. The aim of this study was to determine differences in radiation exposure from 2008 to 2012 to patients receiving CT scans of the abdomen, head, sinus, and lumbar spine at a midwestern academic medical center that implemented dose reduction strategies.

Research paper thumbnail of Detecting Emerging Undesired Effects Sooner

ABSTRACT Abstract: In order to reduce the impact of incidents causing harm to patients, we must d... more ABSTRACT Abstract: In order to reduce the impact of incidents causing harm to patients, we must detect and rectify them sooner. The system of patient care, which is comprised of a number of human and machine agents, must improve in order to better detect the causes of the incidents that in turn cause harm to patients. To effectively do this, all agents in the system must readily have access to the information necessary to ascertain whether (1) everything is going according to plan, and (2) if they current plan is still appropriate. Using this paradigm as a backdrop, the goal of the study was to understand the frequency and speed at which a given technology solution, an infusion pump, detects medication misadministrations as compared to the frequency and speed of clinician detection. To research this, data were gathered from three hospitals. Observational data were gathered in four-hour observation periods, after which an interview was given to ascertain if medication errors had occurred during the course of the observation period. Data was also gathered from infusion pumps for all three hospitals. The pump data set was culled to only include pump alerts during the observation periods, and the two data sets were compared. The results show that infusion pumps detected 3% of all plan breakdowns that were detected during the observation period. Clinicians detected the remaining 97%. The infusion pump detected 100% of plan breakdowns before they reached the patient. Of those detected by the clinician, only 7% were detected before reaching the patient. On the other end of the continuum, 11% were detected only after they caused harm to the patient, and an additional 18% required that the patient be monitored to ensure that no harm was done. It was concluded that infusion pumps play only a small role in the detection of medication administrations, detection of inappropriate plans, and detection of deviations from the plan. In order for the system to improve its performance, there needs to be better system visibility to the plan, the intent behind the plan, and any deviations to that plan. By comparing observation data and pump alerts from the same time period, the detection performance of the technology is properly framed in the context of the entire system's performance. Thesis (M.S.)--Ohio State University, 2007. Includes bibliographical references (leaves 56-61).

Research paper thumbnail of Go Shush Yourself: Student Habitus at the New Thompson Library

Research paper thumbnail of Handoff Communication: Implications For Design

Proceedings of the …, 2012

Handoff communication is one of the most typical clinical communication mechanisms in a healthcar... more Handoff communication is one of the most typical clinical communication mechanisms in a healthcare setting to transfer information and responsibilities of the care provider. Handoff communication is varied across settings, provider type, and even within a clinical unit. Information technology has the capability to support handoff communication, with better understanding of handoff communication needs and variations. This panel examines (1) how handoff communication happens in the healthcare setting through mini-cases (2) insights on information technology design for handoff communication.

Research paper thumbnail of Assessing medication safety technology in the intensive care unit

Proceedings of the Human …, 2007

Understanding the strengths and weaknesses of a technology in the context of the distributed syst... more Understanding the strengths and weaknesses of a technology in the context of the distributed system in which it is working is critical to assessing and improving the performance of that system. Taking a systems approach requires knowledge about how all agents in a system work together to achieve the goals of that system. With these aims, the alerting mechanism of infusion pumps containing Dose-Error Reduction Software (DERS) was studied to determine its effectiveness in the Intensive Care Units (ICU's) of three hospitals. In 1,146 of the 9,557 pump alerts (12.0 %), the alert caused the clinician to change the input. Of these, 1,030 were changed to within the hospital's recommended dosing limits. The alert was overridden for 8,400 (88.0%) of the alerts. The data show that this technology successfully informed clinicians over 1000 times that unintended doses had been inputted and stopped those doses from reaching the patient, thereby averting potential Medication Events. The data also suggest that, because nearly 90% of the alerts were overridden, a well-intended and valuable alert may be perceived by the clinicians as a false alarm and may be overlooked. Another key finding from this analysis was that clinicians may have used potentially unsafe workarounds to administer intravenous drug boluses (i.e., more rapid infusion of a defined dose or volume) and to keep the patient's line active between infusions. In a separate parallel study, clinician selfreport of potentially harmful medication events was studied. During 559 hours of direct observation, clinicians detected 27 (IV and non-IV) medication events. All of the reported events were outside of the scope of what DERS technology was designed to detect. In addition, during the same time period the technology detected five potentially harmful IV medication events that the clinicians did not report. The results of these two studies indicate two possible classes of solutions that could reduce the impact and likelihood of medication administration errors. One class of solutions involves the procedures and policies of the hospital, ensuring that process and technology implementations are optimally tuned, taking human performance and the current practice of the clinicians into account. The other class of solutions involves using new strategies and technologies to ensure that each system agent has access to other agents' perspectives, and the broader system's perspective. Studies such as these can provide insight into the use of safety technology during critical care processes and provide direction for future research, including more effective design of alerting mechanisms of ICU devices.

Research paper thumbnail of Barriers and facilitators to adoption of soft copy interpretation from the user perspective: Lessons learned from filmless radiology for slideless pathology

Journal of pathology …, 2011

Background:Adoption of digital images for pathological specimens has been slower than adoption of... more Background:Adoption of digital images for pathological specimens has been slower than adoption of digital images in radiology, despite a number of anticipated advantages for digital images in pathology. In this paper, we explore the factors that might explain this slower rate of adoption.Materials and Method:Semi-structured interviews on barriers and facilitators to the adoption of digital images were conducted with two radiologists, three pathologists, and one pathologist's assistant.Results:Barriers and facilitators to adoption of digital images were reported in the areas of performance, workflow-efficiency, infrastructure, integration with other software, and exposure to digital images. The primary difference between the settings was that performance with the use of digital images as compared to the traditional method was perceived to be higher in radiology and lower in pathology. Additionally, exposure to digital images was higher in radiology than pathology, with some radiologists exclusively having been trained and/or practicing with digital images. The integration of digital images both improved and reduced efficiency in routine and non-routine workflow patterns in both settings, and was variable across the different organizations. A comparison of these findings with prior research on adoption of other health information technologies suggests that the barriers to adoption of digital images in pathology are relatively tractable.Conclusions:Improving performance using digital images in pathology would likely accelerate adoption of innovative technologies that are facilitated by the use of digital images, such as electronic imaging databases, electronic health records, double reading for challenging cases, and computer-aided diagnostic systems.