title: Evaluating the effects of cognitive support on psychiatric clinical comprehension.
abstract: OBJECTIVE
  Clinicians' attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians' decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts.
  
  
  METHODS
  To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the case were evaluated. In addition the transcripts from both groups were compared to an expert derived reference standard using latent semantic analysis (LSA).
  
  
  RESULTS
  Qualitative analysis showed that users of the system better attended to specific clinically important aspects of both cases when these were highlighted by the system, and revealed ways in which the system mediates hypotheses generation and evaluation. Analysis of the summary data showed differences in emphasis with and without the system. The LSA analysis suggested users of the system were more "expert-like" in their emphasis, and that cognitive support was more effective in the more complex case.
  
  
  CONCLUSIONS
  Cognitive support impacts upon clinical comprehension. This appears to be largely helpful, but may also lead to neglect of information (such as the psychosocial history) that the system does not highlight. The results have implications for the design of CSSs for clinical narratives including the role of information organization and textual embellishments for more efficient clinical case presentation and comprehension.
authors.affiliation: National Center for Cognitive Informatics and Decision Making in Healthcare School of Biomedical Informatics University of Texas Health Science Center, 7000 Fannin St, Houston, 77030 TX, USA.
authors.forename: Venkata V
authors.initials: VV
authors.lastname: Dalai
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health The New York Academy of Medicine, 1216 5th Avenue, New York, 10029 NY, USA.
authors.forename: Sana
authors.initials: S
authors.lastname: Khalid
authors.affiliation: National Center for Cognitive Informatics and Decision Making in Healthcare School of Biomedical Informatics University of Texas Health Science Center, 7000 Fannin St, Houston, 77030 TX, USA.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Gottipati
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health The New York Academy of Medicine, 1216 5th Avenue, New York, 10029 NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kannampallil
authors.affiliation: Psychiatry and Behavioral Sciences University of Texas Medical School at Houston University of Texas Health Science Center, 6341 Fannin St, Houston, 77030 TX, USA.
authors.forename: Vineeth
authors.initials: V
authors.lastname: John
authors.affiliation: Psychiatric Emergency Services New York Presbyterian Hospital, 622 West 168th St, New York, 10032 NY, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Blatter
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health The New York Academy of Medicine, 1216 5th Avenue, New York, 10029 NY, USA.
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
authors.affiliation: National Center for Cognitive Informatics and Decision Making in Healthcare School of Biomedical Informatics University of Texas Health Science Center, 7000 Fannin St, Houston, 77030 TX, USA. Electronic address: trevor.cohen@uth.tmc.edu.
authors.forename: Trevor
authors.initials: T
authors.lastname: Cohen
mesh_terms: D003071:Cognition; D032882:Comprehension; D006801:Humans; D011570:Psychiatry; D014584:User-Computer Interface
keywords: Biomedical informatics; Clinical comprehension; Cognitive science; Cognitive support; Emergency psychiatry; Latent semantic analysis; Propositional analysis; Psychiatry; Verbal protocol analysis