Evaluation as a Field - Evaluation Methods in Biomedical Informatics - page 41

2. T-HELPER II, an enhanced version of T-HELPER I, incorporated
active decision support capabilities to encourage enrollment in and com-
pliance with protocol-based therapy.
3. T-HELPER I and T-HELPER II were installed at two large county-
operated AIDS clinics in northern California: the Immunocompromised
Host Clinic at ABC Medical Center and the XYZ AIDS program.
4. A rigorous evaluation of the T-HELPER systems was undertaken. The
studies explored the effect of each version of the system on (i) the rate of
patient enrollment in clinical trial protocols, and (ii) physician satisfaction
with the T-HELPER system. The study design allowed assessment of the
incremental value of the decision support functions provided in T-HELPER
II.
I. Development group : The project was divided into three general
areas of effort: (i) system development (supervised by Dr. M); (ii)
system installation and user training (supervised by Dr. F); and (iii)
system evaluation (supervised by Dr. C). The project was under the
overall supervision of Dr. M. Several research staff members and grad-
uate students were employed over the five years on various aspects of
the project.
II. Trial/evaluation sites : ABC Medical Center is a 722-bed facility
and a teaching hospital of the Stanford University School of Medicine.
At the outset of the project, six HIV-related protocols from the Cali-
fornia Cooperative Treatment Group (CCTG) were operative at this
center. In addition, a number of privately sponsored protocols were in
progress. Twenty-eight percent of HIV-infected residents in its home
county seek care at ABC, a group that is estimated to be 22% His-
panic, 8% African American, 9% female, and 14% intravenous (IV)
drug users. At the project outset, the XYZ AIDS clinic provided care
to an estimated 377 HIV-infected patients annually. The patient pop-
ulation was approximately 33% African American, 16% Hispanic,
24% women, and 36% IV drug users.
III. System installation : Full utilization of the T-HELPER system
required three main logistical requirements: (i) installing appropriate
networks in the two clinics, (ii) interfacing with the registration
systems at each clinic, and (iii) arranging for laboratory data connec-
tions. The networking is necessary to allow healthcare providers to use
the system in multiple locations throughout the clinic: in each exami-
nation room, in each provider workroom, and in the nursing and reg-
istration work areas. Registration data connections were necessary to
simplify the importing of demographic data into T-HELPER and
provide data about which patients are active in the clinic at a partic-
ular time. Laboratory data were required to provide input to the deci-
sion support modules and give additional clinical information to
providers that would help attract users to the workstation to complete
their work. Each installation site expressed concerns about patient