Browsing by Author "Starren, Justin"
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- ItemAccuracy and reliability of remote retinopathy of prematurity diagnosis.(2006-03-14) Chiang, Michael F; Keenan, Jeremy D; Starren, Justin; Du, Yunling E; Schiff, William M; Barile, Gaetano R; Li, Joan; Johnson, Rose Anne; Hess, Ditte J; Flynn, John TTo determine the accuracy and reliability of retinopathy of prematurity ROP diagnosis using remote review of digital images by 3 masked ophthalmologist readers
- ItemAssessment of image-based technology: impact of referral cutoff on accuracy and reliability of remote retinopathy of prematurity diagnosis.(2006-06-16) Chiang, Michael F; Keenan, Jeremy D; Du, Yunling E; Schiff, William; Barile, Gaetano; Li, Joan; Hess, Ditte J; Johnson, Rose Anne; Flynn, John T; Starren, JustinTelemedicine has potential to improve the delivery quality and accessibility of ophthalmic care for infants with Retinopathy of Prematurity ROP Using a telemedicine screening strategy three potential diagnostic cutoffs may be used to define disease that warrants ophthalmologic referral presence of any ROP presence of moderate type 2 prethreshold ROP or presence of severe ROP requiring treatment This study examines the relationship between accuracy and reliability of diagnosis by three masked ophthalmologist graders at each of these diagnostic cutoffs The sensitivity specificity inter grader reliability and intra grader reliability showed significant variation depending on the diagnostic cutoff with best results at cutoffs of type 2 prethreshold ROP or treatment requiring ROP Before the large scale adoption of telemedicine for image based screening of diseases such as ROP standards defining clinically relevant referral cutoffs must be established and diagnostic accuracy and reliability at these cutoffs must be characterized
- ItemChildren's contributions to designing a communication tool for children with cancer.(2007-10-03) Ruland, Cornelia M; Slaughter, Laura; Starren, Justin; Vatne, Torun M; Moe, Elisabeth YIn this paper we describe the roles played as well as contributions made by child participants in the design of an innovative communication tool for children with cancer SISOM is a handheld portable computer application with a graphical user interface that is meant to 1 help children with cancer communicate their symptoms problems in a child friendly age adjusted manner and 2 assist clinicians in addressing children s experienced symptoms and problems in patient care Unlike other applications for children the purpose of SISOM is not to provide information to ill children but to elicit personal information from them Thus the application has a unique set of design issues Healthy and ill children played an important role in different stages in the design process They made significant contributions to the graphical design of the system s interface selection of understandable child friendly terms used by the system to describe symptoms iconic and graphical representations and its usability We describe the participatory design methods we used that included children and share important insights from this collaborative design process
- ItemA cognitive framework for understanding barriers to the productive use of a diabetes home telemedicine system.(2004-01-19) Kaufman, David R; Starren, Justin; Patel, Vimla L; Morin, Philip C; Hilliman, Charlyn; Pevzner, Jenia; Weinstock, Ruth S; Goland, Robin; Shea, StevenTelemedicine has the potential to transcend geographic and socio cultural barriers to the delivery of high quality health care to the medically underserved populations However there are significant cognitive and usability barriers This paper presents a multifaceted cognitive evaluation of the IDEATel diabetes education and telemedicine program The evaluation included a cognitive walkthrough analysis to characterize task complexity and identify potential problems as well as field usability testing in patients homes The study revealed dimensions of the interface that impeded optimal access to system resources In addition we found significant obstacles corresponding to perceptual motoric skills mental models of the system and health literacy The objective of this work is to contribute to a design framework so that participants with a wide range of skills can better manage their chronic illnesses
- ItemColumbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: rationale and design.(2001-12-25) Shea, Steven; Starren, Justin; Weinstock, Ruth S; Knudson, Paul E; Teresi, Jeanne; Holmes, Douglas; Palmas, Walter; Field, Lesley; Goland, Robin; Tuck, Catherine; Hripcsak, George; Capps, Linnea; Liss, DavidThe Columbia University Informatics for Diabetes Education and Telemedicine IDEATel Project is a four year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility acceptability effectiveness and cost effectiveness of telemedicine in the management of older patients with diabetes The study is designed as a randomized controlled trial and is being conducted by a state wide consortium in New York Eligibility requires that participants have diabetes are Medicare beneficiaries and reside in federally designated medically underserved areas A total of 1 500 participants will be randomized half in New York City and half in other areas of the state Intervention participants receive a home telemedicine unit that provides synchronous videoconferencing with a project based nurse electronic transmission of home fingerstick glucose and blood pressure data and Web access to a project Web site End points include glycosylated hemoglobin blood pressure and lipid levels patient satisfaction health care service utilization and costs The project is intended to provide data to help inform regulatory and reimbursement policies for electronically delivered health care services
- ItemColumbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) project: technical implementation.(2001-12-25) Starren, Justin; Hripcsak, George; Sengupta, Soumitra; Abbruscato, C R; Knudson, Paul E; Weinstock, Ruth S; Shea, StevenThe Columbia University Informatics for Diabetes Education and Telemedicine IDEATel project is a four year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility acceptability effectiveness and cost effectiveness of telemedicine The focal point of the intervention is the home telemedicine unit HTU which provides four functions synchronous videoconferencing over standard telephone lines electronic transmission for fingerstick glucose and blood pressure readings secure Web based messaging and clinical data review and access to Web based educational materials The HTU must be usable by elderly patients with no prior computer experience Providing these functions through the HTU requires tight integration of six components the HTU itself case management software a clinical information system Web based educational material data security and networking and telecommunications These six components were integrated through a variety of interfaces providing a system that works well for patients and providers With more than 400 HTUs installed IDEATel has demonstrated the feasibility of large scale home telemedicine
- ItemDepression and glycemic control in elderly ethnically diverse patients with diabetes: the IDEATel project.(2006-03-28) Trief, Paula M; Morin, Philip C; Izquierdo, Roberto; Teresi, Jeanne; Eimicke, Joseph P; Goland, Robin; Starren, Justin; Shea, Steven; Weinstock, Ruth SThe purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly ethnically diverse diabetic patients
- ItemDesiderata for personal electronic communication in clinical systems.(2002-04-24) Sarkar, Indra Neil; Starren, JustinElectronic communication among clinicians and patients is becoming an essential part of medical practice Evaluation and selection of these electronic systems called personal clinical electronic communication PCEC systems can be a difficult task in institutions that have no prior experience with such systems It is particularly difficult in the clinical context To directly address this point the authors consulted a group of potential users affiliated with a nationally recognized telemedicine project to determine important characteristics of a hypothetical PCEC system They compiled a list of these characteristics and produced a desiderata or list of desired features for PCEC systems Two conventional e mail implementations and three Web based PCEC systems were evaluated with respect to the features The Web based systems all scored higher than conventional e mail It is the hope of the authors that this paper will initiate further discussions about the features of PCEC systems and how to evaluate them
- ItemDetection and remediation of medically urgent situations using telemedicine case management for older patients with diabetes mellitus.(2008-05-19) Izquierdo, Roberto; Meyer, Suzanne; Starren, Justin; Goland, Robin; Teresi, Jeanne; Shea, Steven; Weinstock, Ruth SDetection and response to medically urgent situations in patients with diabetes mellitus can improve the process and outcomes of care and potentially decrease morbidity and mortality We examined the detection and remediation of medically urgent situations among older patients receiving telemedicine case management for diabetes
- ItemDeveloping computer skills and competencies in seniors.(2006-06-16) Pevzner, Jenia; Kaufmann, David R; Hilliman, Charlyn; Shea, Steven; Weinstock, Ruth S; Starren, JustinWe developed a training protocol for elderly participants of a home telemedicine study grounded in prior usability research The training aimed to reduce barriers in developing system mastery Our findings are indicative of both the promises and challenges involved in bridging the digital divide Sixteen participants of a diabetes study were trained to use the computer applications
- ItemDevelopment, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire.(2006-11-20) Bakken, Suzanne; Grullon-Figueroa, Lorena; Izquierdo, Roberto; Lee, Nam-Ju; Morin, Philip; Palmas, Walter; Teresi, Jeanne; Weinstock, Ruth S; Shea, Steven; Starren, Justin; ,To describe the development and validation of low literacy English and Spanish versions of the 26 item Telemedicine Satisfaction and Usefulness Questionnaire TSUQ report telemedicine satisfaction and usefulness ratings of urban and rural participants in the Informatics for Diabetes Education and Telemedicine IDEATel project and explore relationships between utilization and perceptions of satisfaction and usefulness
- ItemDiagnostic performance of a telemedicine system for ophthalmology: advantages in accuracy and speed compared to standard care.(2011-02-24) Chiang, Michael F; Wang, Lu; Kim, David; Scott, Karen; Richter, Grace; Kane, Steven; Flynn, John; Starren, JustinTelemedicine has potential to improve quality and delivery of medical care particularly in image oriented specialties where decisions are based on appearance of morphological features during examination In the ophthalmology domain nearly all published telemedicine studies have measured accuracy against a gold standard of ophthalmoscopic examination The purposes of this study are to examine difficulties in defining an absolute gold standard and to compare diagnostic speed in a representative disease retinopathy of prematurity We compare results from ophthalmoscopic and telemedicine examinations by the same physicians In 180 86 5 of 208 eyes the two examinations produced the same diagnosis In some discrepancies there was rationale suggesting that telemedicine may have provided a more accurate diagnosis than ophthalmoscopic examination The quantity and nature of these disagreements has important implications for evaluation of telemedicine systems in image based specialties and for the definition of gold standards in future studies
- ItemFederal demonstation project tackles diabetes with telemedicine.(2005-02-17) Starren, Justin
- ItemPrimary care providers' perceptions of home diabetes telemedicine care in the IDEATel project.(2007-02-15) Tudiver, Fred; Wolff, L Thomas; Morin, Philip C; Teresi, Jeanne; Palmas, Walter; Starren, Justin; Shea, Steven; Weinstock, Ruth SFew telemedicine projects have systematically examined provider satisfaction and attitudes
- ItemPsychosocial outcomes of telemedicine case management for elderly patients with diabetes: the randomized IDEATel trial.(2007-04-30) Trief, Paula M; Teresi, Jeanne A; Izquierdo, Roberto; Morin, Philip C; Goland, Robin; Field, Leslie; Eimicke, Joseph P; Brittain, Rebecca; Starren, Justin; Shea, Steven; Weinstock, Ruth S
- ItemA randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus.(2006-01-02) Shea, Steven; Weinstock, Ruth S; Starren, Justin; Teresi, Jeanne; Palmas, Walter; Field, Lesley; Morin, Philip; Goland, Robin; Izquierdo, Roberto E; Wolff, L Thomas; Ashraf, Mohammed; Hilliman, Charlyn; Silver, Stephanie; Meyer, Suzanne; Holmes, Douglas; Petkova, Eva; Capps, Linnea; Lantigua, Rafael ATelemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness
- ItemRetinopathy of prematurity management using single-image vs multiple-image telemedicine examinations.(2008-07-28) Lajoie, Alexandra; Koreen, Susan; Wang, Lu; Kane, Steven A; Lee, Thomas C; Weissgold, David J; Berrocal, Audina M; Du, Yunling E; Coki, Osode; Flynn, John T; Starren, Justin; Chiang, Michael FTo compare performance of single image vs multiple image telemedicine examinations for retinopathy of prematurity ROP diagnosis
- ItemThe role of nurses in installing telehealth technology in the home.(2005-07-19) Starren, Justin; Tsai, Christopher; Bakken, Suzanne; Aidala, Angela; Morin, Philip C; Hilliman, Charlyn; Weinstock, Ruth S; Goland, Robin; Teresi, Jeanne; Shea, Steven; ,Home telehealth involves the use of video conferencing or remote monitoring equipment in patients homes The installation of hardware and training of patients has historically been performed by nurses typically RNs This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine IDEATel project where RNs were responsible for the installation of the Home Telemedicine Units HTUs and for training patients in the use of the HTUs blood pressure cuffs and fingerstick glucose meters Average installation and training time was 166 minutes SD 51 min Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in home time Technology related problems especially those related to telecommunications were the primary cause of installation difficulties Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process
- ItemA systematic review of user interface issues related to PDA-based decision support systems in health care.(2006-06-16) Lee, Nam-Ju; Starren, Justin; Bakken, SuzanneThis paper explores user interface issues in the design and implementation of a personal digital assistant based decision support system PDA DSS in health care An automated literature search found 15 studies addressing the main PDA user interface issues which can be categorized as display security memory Web browser and communication
- ItemTelemedical diagnosis of retinopathy of prematurity intraphysician agreement between ophthalmoscopic examination and image-based interpretation.(2008-07-07) Scott, Karen E; Kim, David Y; Wang, Lu; Kane, Steven A; Coki, Osode; Starren, Justin; Flynn, John T; Chiang, Michael FTo evaluate the intraphysician agreement between ophthalmoscopic examination and image based telemedical interpretation for retinopathy of prematurity ROP diagnosis when performed by the same expert physician grader