Modeling Clinicians’ Cognitive and Collaborative Work in Post-Operative Hospital Care

abstract: Clinicians confront formidable challenges with information management and coordination activities. When not properly integrated into clinical workflow, technologies can further burden clinicians’ cognitive resources, which is associated with medical errors and risks to patient safety. An understanding of workflow is necessary to redesign information technologies (IT) that better support clinical processes. This is particularly important in surgical care, which is among the most clinical and resource intensive settings in healthcare, and is associated with a high rate of adverse events. There are a growing number of tools to study workflow; however, few produce the kinds of in-depth analyses needed to understand health IT-mediated workflow. The goals of this research are to: (1) investigate and model workflow and communication processes across technologies and care team members in post-operative hospital care; (2) introduce a mixed-method framework, and (3) demonstrate the framework by examining two health IT-mediated tasks. This research draws on distributed cognition and cognitive engineering theories to develop a micro-analytic strategy in which workflow is broken down into constituent people, artifacts, information, and the interactions between them. It models the interactions that enable information flow across people and artifacts, and identifies dependencies between them. This research found that clinicians manage information in particular ways to facilitate planned and emergent decision-making and coordination processes. Barriers to information flow include frequent information transfers, clinical reasoning absent in documents, conflicting and redundant data across documents and applications, and that clinicians are burdened as information managers. This research also shows there is enormous variation in how clinicians interact with electronic health records (EHRs) to complete routine tasks. Variation is best evidenced by patterns that occur for only one patient case and patterns that contain repeated events. Variation is associated with the users’ experience (EHR and clinical), patient case complexity, and a lack of cognitive support provided by the system to help the user find and synthesize information. The methodology is used to assess how health IT can be improved to better support clinicians’ information management and coordination processes (e.g., context-sensitive design), and to inform how resources can best be allocated for clinician observation and training.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

Examining the Design and Usability of Telemedicine Communications: A Mixed-methods Study

This dissertation describes a mixed-methods study that examines the usability of telemedicine provider interfaces. This study consisted of content analysis, survey, and think aloud methodologies, which afford a multifaceted corpus of data for which to draw inferences and identify design features and functions that negatively impact usability. Usability is a critical component of the user experience with a telemedicine provider interface and can suede or impede the acceptance and adoption of telemedicine. Telemedicine has the potential to increase quality healthcare access and positive health outcomes for individuals who use it, and usability is a key component of technology acceptance and effective use. Empirical testing of health information technology (HIT) and telemedicine is advocated for as it is the most valuable method of research to understand humans\u27 cognitive processing of information as they interact with technology. In addition, using activity theory and mobile interface theory as a lens in which to understand human activities and interaction with telemedicine provider interfaces, including the telemedicine provider websites and their mobile-responsive websites in this study, is an effective tool for drawing reasonable inferences regarding the usability of telemedicine communications. Considering the rate at which an unprecedented amount of health information becomes available online and HIT facilitates the delivery of healthcare, usability testing and user-centered, iterative design practices become increasingly essential in order to design effective—and safe—health information and technology that enhance the patient-experience, the affordability and accessibility of healthcare, health literacy and patient empowerment, and positive health outcomes. Usability testing plays an increasingly important role in characterizing obstacles to achieving these initiatives of the modern patient-centered health paradigm and telemedicine. The mixed-methods usability testing performed in this study offers a principled approach to usability testing and is ecologically valid because it involves real human subjects. This study fulfills a void in research on the usability of telemedicine communications and reveals usability problems that may not be anticipated by designers of HIT and health information providers. Drawing from the insight gained from this mixed-method study, design features and functions that enhance the usability of health communications are offered. This study draws insight from the human factors, technical communication, and health and medical fields to develop systematic, practical usability testing methods that can be replicated and applied in many fields. The design recommendations resulting from this study will be valuable to programmers; systems analysts; clinicians and nurses; technical communicators; information architects; visual designers; and others in similar roles