Optimizing physicians' instruction of PACS through e-learning: cognitive load theory applied.

This article outlines the strategy used by our hospital to maximize the knowledge transfer to referring physicians on using a picture archiving and communication system (PACS). We developed an e-learning platform underpinned by the cognitive load theory (CLT) so that in depth knowledge of PACS' abilities becomes attainable regardless of the user's prior experience with computers. The application of the techniques proposed by CLT optimizes the learning of the new actions necessary to obtain and manipulate radiological images. The application of cognitive load reducing techniques is explained with several examples. We discuss the need to safeguard the physicians' main mental processes to keep the patient's interests in focus. A holistic adoption of CLT techniques both in teaching and in configuration of information systems could be adopted to attain this goal. An overview of the advantages of this instruction method is given both on the individual and organizational level.

[Do hospital physicians really want to go digital? --Acceptance of a picture archiving and communication system in a university hospital]. / Möchten Krankenhausärzte wirklich auf digitale Systeme umsteigen?--Die Akzeptanz gegenüber einem Bildarchivierungs- und Ubermittlungssystem in einer Universitätsklinik.

PURPOSE: Radiology departments are making the transition from analog film to digital images by means of PACS (Picture Archiving and Communication System). It is critical for the hospital that its physicians adopt and accept the new digital work method regarding radiological information. The aim of this study is to investigate hospital physicians' acceptance of PACS using questionnaires pre- and post-implementation and to identify main influencing factors. MATERIALS AND METHODS: The study was conducted in an 1169 bed university hospital. The UTAUT (Unified Theory of Acceptance and Use of Technology) questionnaire was administered at two times: one month pre-implementation (T1) and 1.5 years post-implementation (T2) of PACS, targeting all hospital physicians with the exemption of radiologists. The UTAUT scales (Behavioral Intention BI; Facilitating Conditions FC; Effort Expectancy EE; Performance Expectancy PE; Anxiety ANX; Social Influence SI; System Use USE; Attitude toward technology ATT; Self-Efficacy SE) were used to assess questions regarding: a) PACS' usefulness, b) PACS' ease of learning/using, c) PACS support availability, d) the perceived pressure to use PACS, e) physicians' attitude towards PACS and f) physicians' intention to use and actual use of PACS. RESULTS: At T 1 scale ratings were positive toward the PACS implementation. The ratings on all scales with the exception of self-efficacy improved at T 2. Regression analysis revealed that the key factor for intention to use PACS at T 1 was the usefulness of PACS, while the availability and awareness of support was its most important predictor at T 2. Overall, PE was the best predictor of BI, but all four UTAUT-determinants (PE, FC, EE and SI) were salient for its prediction. Variance explained in BI ranged from 31 to 37 % while variance explained in USE was very low (3 %). CONCLUSION: The implementation of PACS has succeeded. At T 1 the physicians were welcoming PACS and this was confirmed at T 2. Experience with PACS led to an overall improved attitude toward PACS. The key factors for physicians' intentions to use PACS were the usefulness of PACS (at T 1 and overall) and the availability of support (at T 2).

User acceptance of a picture archiving and communication system. Applying the unified theory of acceptance and use of technology in a radiological setting.

OBJECTIVE: The aim of this study is to gain insight into the individual user acceptance of PACS by the radiology department staff of the Ghent University Hospital. Hereto a basic--direct effects only--form of UTAUT was assessed. METHODS: Ninety-four questionnaires were distributed and 56 usable questionnaires were returned (19 radiologists - 37 technologists). The questionnaire consisted of scales of Venkatesh et al. [13] for performance expectancy (PE), effort expectancy (EE), facilitating conditions (FC), social influence (SI), self-efficacy (SE), attitude (ATT), anxiety (ANX) and behavioral intention (BI), and a scale of Moore et al. [22] to assess the perceived voluntariness of PACS-use. RESULTS: The reliability of all scales, except FC and voluntariness, was acceptable to good. The voluntariness scale was divided into a mandatoriness (MAN) and a voluntariness (VOL) measure. Both radiologists and technologists seem to welcome PACS, with radiologists having higher ratings on PE, EE, ATT, VOL and BI. Only PE and FC were salient for predicting BI, while EE and SI were not salient. Variance explained in behavioral intention to use PACS was 48%. CONCLUSION: Both radiologists and technologists were positive towards PACS and had strong intentions to use PACS. As other healthcare professionals, they appear to make their technology acceptance decision independent from their superiors, hereby focusing on usefulness rather than on ease of use. It is also important that support is supplied. Basic UTAUT is an adequate model to assess technology acceptance in a radiological setting.

Design and implementation of an open source indexing solution for a large set of radiological reports and images.

This paper hopes to share the insights we experienced during designing, building, and running an indexing solution for a large set of radiological reports and images in a production environment for more than 3 years. Several technical challenges were encountered and solved in the course of this project. One hundred four million words in 1.8 million radiological reports from 1989 to the present were indexed and became instantaneously searchable in a user-friendly fashion; the median query duration is only 31 ms. Currently, our highly tuned index holds 332,088 unique words in four languages. The indexing system is feature-rich and language-independent and allows for making complex queries. For research and training purposes it certainly is a valuable and convenient addition to our radiology informatics toolbox. Extended use of open-source technology dramatically reduced both implementation time and cost. All software we developed related to the indexing project has been made available to the open-source community covered by an unrestricted Berkeley Software Distribution-style license.

Adult age differences in monitoring of practical problem-solving performance.

A scale measuring practical problem-solving ability in adulthood was developed in a preliminary study and demonstrated to have satisfactory psychometric properties for research purposes: there was satisfactory internal consistency, discriminant validity, and there were significant relationships between performance and a measure of subjective experience. The purpose of the main investigation was to examine performance awareness on this measure of practical problem-solving ability. Younger (19-40 years) and older (59-84 years) subjects estimated performance either before and after taking the test (prediction/postdiction condition) or only after exposure to the materials (postdiction only). When the unsigned discrepancies between actual and expected performances were considered, there were no age differences in performance awareness of either time of estimation, but neither age group demonstrated improved accuracy from prediction to postdiction. When the directions of estimation errors were considered, older adults were significantly more likely to overestimate performance at both times of estimation compared to younger adults, who underestimated performance. Importantly, the same pattern of results was obtained with subjects who estimated only after taking the test and those who made predictions and postdictions.

Comparison of within-group variabilities across older and younger adults: a meta-analysis.

The hypothesis that individual differences in performance scores increase with increasing adult age was reviewed. A meta-analysis of memory articles appearing in the Journal of Gerontology from 1985 to 1990 was conducted to examine potential age differences in within-group variabilities. There was no strong evidence in the data reported here that overall younger adults are consistently more alike in their memory abilities than are older adults. This result was obtained whether the younger group consisted of students or nonstudents, which suggests that the use of unequal age ranges does not contribute to heterogeneity of variances in memory research.

Memory performance awareness in younger and older adults.

Reports on the course of memory-monitoring skills across adulthood are discrepant in conclusions and limited in scope. The purpose of this study was to build a large data base (3 samples and 7 different tasks) to assess performance awareness. Younger (19-41 years) and older (59-93 years) Ss estimated performance either before (i.e., predictions) or after (i.e., postdictions) completing each task. Predictions were less accurate than postdictions at both age levels, suggesting Ss monitored performance during the study-test cycle. Overall, the data suggested no consistent age effects in performance awareness: Age differences in monitoring occurred only in predictions and only for some tasks. Between-tasks differences in age effects could not be attributed to a single mediating mechanism like those suggested in previous reports. Why previous research has produced conflicting conclusions about metacognitive development in adulthood is discussed in light of these data.