The Academy’s Center for Cognitive Studies in Medicine and Public Health is a multidisciplinary research center devoted to empirical analysis of the decision-making behaviors of health care providers and their interactions with patients. These studies use methods of data collection and analysis that are grounded in social, cognitive and information sciences. During provider-patient interactions, errors may be generated and these errors may impact patient outcomes. Errors of this type may also influence patient education and health policy recommendations. The role health information technology (e.g., electronic health records) plays in mitigating these errors, and in developing informed educational and training programs for patient safety, is an important part of the Center’s work.  

CURRENT PROJECTS

The Role of EHRs in Clinical Workflow in Emergency Departments

Advances in health information technology such as Electronic Health Records (EHRs) can reduce the burden of complexity on clinicians, potentially improving quality, safety, and efficiency of health care. In research conducted in collaboration with the Icahn School of Medicine at Mount Sinai and Mayo Clinic, we use an evidence-based, empirical approach to investigate three specific critical elements of emergency department (ED) workflow: information seeking, team interaction, and decision making in the context of clinicians’ use of EHRs, where workflow elements are evaluated using a set of five clinical quality and efficiency metrics, both before and after meaningful use criteria, for stages one and two. We use convergent methodologies such as clinician shadowing, EHR log-file analysis, continuous screen capture and use sensor-based tracking such as radio frequency identification. The results will contribute to the development of generalizable design guidelines that are better integrated into the social fabric of the clinical environment, and patient-safety measures. It will also provide the Office of the National Coordinator and the Centers for Medicare & Medicaid Services with evidence to guide the evolving certification criteria for EHR vendors, and future regulations promoting meaningful use of EHRs. The project is funded by the Agency for Healthcare Research and Quality.

Cognitive Analysis of Use of Mhealth Tools by Community Health Workers for Early Identification of Depression and Suicide Risk

Many countries are facing high rates of mental illness among residents. Due to a scarcity of qualified psychiatrists, particularly in the remote areas, training Community Health Nurses (CHNs) as the front line to identify persons at high risk becomes very important. Working in collaboration with Texas A&M, Fiji National University, and Fiji Ministry of Health, the  goal of our research is to reduce the current high rates of depression and suicide in the Pacific Island Countries (Fiji is the primary site) by increasing screening, early identification, and referral of high-risk individuals to psychiatric care. Mobile health technologies (Mhealth) offer great promise to aid in this task-shifting scheme. In this study, we investigate cognitive processes underlying CHNs assessment of these mental health problems, with and without Mhealth tools, and use the results to guide the design and development of optimal mobile mental health systems. In addition, we hope to help develop Mhealth research capacity in Fiji through training and education, working with the Ministry of Health in the Fiji Islands. The project is funded by the National Institute of Mental Health.

Cognitive Informatics in Healthcare and Biomedicine: Understanding and Modeling Health Behaviors 

The third volume in Cognitive Informatics and Biomedicine series, the book brings together research in the fields of cognition, informatics and personal health behaviors. The goal is to enhance our understanding of health promotion and disease prevention in our modern technological society and to investigate methods for bringing about not only individual, but population behavioral changes that will lead to better health. This book offers research that investigates several major themes, including the role of cognitive issues in health behaviors and the design of interventions; understanding public health beliefs; how cognition relates to health behavior; the link between information technology and cognitive support; and behavioral health measures and interventions.

Effects of Noise on Cognitive Function

There is sufficient evidence to show that multitasking and interruptions compromise performance. In urban environments, including hospitals, excessive noise is a form of interruption and has been shown to exhibit a detrimental effect on cognitive function and communication, generating errors. Our team, in collaboration with Columbia University, is collecting preliminary data to assess noise levels in the patient care environment during care team transitions, using sound measurement and simulation technology. 


SELECTED PUBLICATIONS
  • Contextual Computing: A Bluetooth-based Approach for Tracking Healthcare Providers in the Emergency Room (Journal of Biomedical Informatics, 2017).
  • Cognitive Informatics in Health and Biomedicine: Understanding and Modeling Health Behaviors. (Springer, 2017).
  • “Cognitive Informatics for Biomedicine: Human Computer Interaction in Healthcare” (Springer book, 2015)
  • “Cognitive Informatics in Health and Biomedicine: Case Studies on Critical Care, Complexity and Errors” (Springer book, 2014)
  • “Cognitive and Learning Sciences in Biomedical and Health Instructional Design: A Review with Lessons for Biomedical Informatics Education”(Journal of Biomedical Informatics, 2009)
  • “Lay Public’s Knowledge and Decisions In Response to Symptoms of Acute Myocardial Infarction” (Advances in Health Sciences Education, 2009)
  • “Diagnostic Reasoning and Decision Making in the Context of Health Information Technology” (Reviews of Human Factors and Ergonomics, 2013)