PMID- 23735522
OWN - NLM
STAT- MEDLINE
DCOM- 20140325
LR  - 20130909
IS  - 1873-2860 (Electronic)
IS  - 0933-3657 (Linking)
VI  - 59
IP  - 1
DP  - 2013 Sep
TI  - Safety and usability evaluation of a web-based insulin self-titration system for 
      patients with type 2 diabetes mellitus.
PG  - 23-31
LID - S0933-3657(13)00072-9 [pii]
LID - 10.1016/j.artmed.2013.04.009 [doi]
AB  - OBJECTIVE: The rising incidence of type 2 diabetes mellitus (T2DM) induces severe 
      challenges for the health care system. Our research group developed a web-based 
      system named PANDIT that provides T2DM patients with insulin dosing advice using 
      state of the art clinical decision support technology. The PANDIT interface 
      resembles a glucose diary and provides advice through pop-up messages. Diabetes 
      nurses (DNs) also have access to the system, allowing them to intervene when 
      needed. The objective of this study was to establish whether T2DM patients can 
      safely use PANDIT at home. To this end, we assessed whether patients experience 
      usability problems with a high risk of compromising patient safety when 
      interacting with the system, and whether PANDIT's insulin dosing advice are 
      clinically safe. RESEARCH DESIGN AND METHODS: The study population consisted of 
      patients with T2DM (aged 18-80) who used a once daily basal insulin as well as 
      DNs from a university hospital. The usability evaluation consisted of think-aloud 
      sessions with four patients and three DNs. Video data, audio data and verbal 
      utterances were analyzed for usability problems encountered during PANDIT 
      interactions. Usability problems were rated by a physician and a usability expert 
      according to their potential impact on patient safety. The usability evaluation 
      was followed by an implementation with a duration of four weeks. This 
      implementation took place at the patients' homes with ten patients to evaluate 
      clinical safety of PANDIT advice. PANDIT advice were systematically compared with 
      DN advice. Deviating advice were evaluated with respect to patient safety by a 
      panel of experienced physicians, which specialized in diabetes care. RESULTS: We 
      detected seventeen unique usability problems, none of which was judged to have a 
      high risk of compromising patient safety. Most usability problems concerned the 
      lay-out of the diary, which did not clearly indicate which data entry fields had 
      to be entered in order to obtain an advice. 27 out of 74 (36.5%) PANDIT advice 
      differed from those provided by DNs. However, only one of these (1.4%) was 
      considered unsafe by the panel. CONCLUSION: T2DM patients with no prior 
      experience with the web-based self-management system were capable of consulting 
      the system without encountering significant usability problems. Furthermore, the 
      large majority of PANDIT advice were considered clinically safe according to the 
      expert panel. One advice was considered unsafe. This could however easily be 
      corrected by implementing a small modification to the system's knowledge base.
CI  - Copyright (c) 2013 Elsevier B.V. All rights reserved.
FAU - Simon, Airin C R
AU  - Simon AC
AD  - Department of Medical Informatics, Academic Medical Center, Meibergdreef 9, 1105 
      AZ Amsterdam, The Netherlands; Department of Internal Medicine, Academic Medical 
      Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: 
      a.c.simon@amc.uva.nl.
FAU - Holleman, Frits
AU  - Holleman F
FAU - Gude, Wouter T
AU  - Gude WT
FAU - Hoekstra, Joost B L
AU  - Hoekstra JB
FAU - Peute, Linda W
AU  - Peute LW
FAU - Jaspers, Monique W M
AU  - Jaspers MW
FAU - Peek, Niels
AU  - Peek N
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130602
PL  - Netherlands
TA  - Artif Intell Med
JT  - Artificial intelligence in medicine
JID - 8915031
RN  - 0 (Insulin)
SB  - IM
MH  - Aged
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Female
MH  - Humans
MH  - Insulin/*administration & dosage/adverse effects/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Self Care
OTO - NOTNLM
OT  - Clinical decision support systems
OT  - Diabetes mellitus type 2
OT  - Insulin
OT  - Patient safety
OT  - Self care
EDAT- 2013/06/06 06:00
MHDA- 2014/03/26 06:00
CRDT- 2013/06/06 06:00
PHST- 2012/06/30 00:00 [received]
PHST- 2013/04/08 00:00 [revised]
PHST- 2013/04/24 00:00 [accepted]
PHST- 2013/06/06 06:00 [entrez]
PHST- 2013/06/06 06:00 [pubmed]
PHST- 2014/03/26 06:00 [medline]
AID - S0933-3657(13)00072-9 [pii]
AID - 10.1016/j.artmed.2013.04.009 [doi]
PST - ppublish
SO  - Artif Intell Med. 2013 Sep;59(1):23-31. doi: 10.1016/j.artmed.2013.04.009. Epub 
      2013 Jun 2.