The Research design will follow a randomized crossover with two groups of individuals, two treatments or interventions over two periods of time.This design allows to make every subject its own control and balance for learning after tasks. There are methods to identify the effect of the ordering. Differences among groups are the order that they receive the treatments, or in this particular case the order in which the use the different type of job aid.
1. M. Sriram Iyengar, PhD
Assistant Professor, School of Health Information Sciences
University of Texas Health Science Center at Houston
This entire presentation is Copyright © 2009 -2010, M Sriram Iyengar. Please do not distribute any
part, or the whole, without permission. Contact firstname.lastname@example.org
2.  GuideView is a technology for creating and delivering healthcare
advice on multiple platforms especially mobile devices such as
PDAs and cell phones (Windows mobile and iPhones. Others
 It delivers clinical guidelines in an interactive, step-by-step
format that includes rich media: text, voice/audio, images and
video. This reduces cognitive load.
 This content (called a guideview) is stored in the cell phone – can
operate in resource-poor environments where cellular network
or internet does not exist.
 It is communications-enabled: can automatically make phone
calls (or send emails) to pre-stored phone numbers (or e-mail
addresses) stored in the underlying guideview.
 Two main user components: GuideView Author
and GuideView Player(s).
3. Can easily create the guideline flow as interconnected steps, and embed
text, voice (any language), images/video in each step.
Phone Numbers and email addresses can also be included.
4. Displays the guidelines step by
Does not need access to cell
network or internet.
Information provided with
text, audio (voice) images and
video: can be used even when
patients have low literacy
Records execution of each step
along with time stamp in a
history log. Also includes GPS
location of patient encounter
Can automatically make phone
calls or send emails. SMS
messaging being developed.
Picture shows Spanish
language AIEPI pediatric
protocol executing on Windows
Mobile cell phone
5.  Low availability of physicians and
trained nurses is endemic in many
◦ Developing countries
◦ Rural areas of developed
 Community Health Workers,
barefoot Doctors, promotores de
salud and similar non-physician
care providers are often the primary
(and only) providers of healthcare to
hundreds of millions.
 These CHWs are mobile
However, studies have shown that
Community Health Workers (CHWs)
performance is less than optimal
even with support of paper-based
6.  Subjects: 50 community health workers in
 Randomized two-groups two-treatment two-period
crossover – each subject is own control
Period 1 Period 2
Group A Used GuideView on cell phone Used Traditional methods
Group B Used Traditional methods
Used GuideView on cell phone
8.  Use of Cell phone GuideView reduces Error rate by
35.15% (p=0.001) as compared to paper materials
 GuideView increases protocol adherence by 35%
 Decreases mental workload
 Decreases frustration
 Decreases overall workload
 Acceptability and intention to use > 90%
9.  Providing interactive, structured rich media clinical
guidelines on cell phones can reduce errors
 Performance of Community health Workers can be
 Very high levels of intention to use and usability
indicate that CHWs will find the technology greatly
10.  Microsoft Research: Global competition, Cellphone as
platform for Healthcare
 US Army Telemedicine Advanced Technology research
 NASA Johnson Space Center (GuideView originally
developed here to assist astronauts provide medical
care to each other on long duration space missions)
Contact: Sriram Iyengar, email@example.com
Mobile: 281 793 4733