Effective ways to use nonpersonal information in healthcare: report from a workshop held at University College London 15-16 April 2004

New information technologies are being introduced in the UK National Health Service as resources for the acquisition of clinical knowledge. These are forcing working practices to adapt and are affecting and challenging perceived roles, relationships and expectations of patients and health professionals alike. Effective ways to use nonpersonal information in healthcare was a two-day workshop hosted by UCL Interaction Centre at University College London intended to provide a forum for practioners and researchers working in the area of clinical health information delivery to come together to discuss access to health information, and to consider how the various challenges and opportunities relating to electronic information provision can be managed most effectively. For the first day of the workshop, the theme for presentations and discussion was information provision for and access by health professionals. Talks were given by Julius Weinberg (City University, London), Roger Slack (University of Edinburgh) and Anne Adams (University College London). The theme for the second day was information provision and access by patients. Presentations were given by Mig Muller (NHS Direct), Jane Wilson (Whittington Hospital and Medi-notes), Andrew Herxheimer (University of Oxford) and Henry Potts (University College London). On both days, delegates formed into three groups for breakout sessions in which they discussed and reported back on: information quality and use, social and organisational context, and user requirements and training in relation to the respective daily theme (health practitioners/patients). This report summerises each of the presentations and the reports by the breakout groups

A study of general practitioners' perspectives on electronic medical records systems in NHS Scotland

<b>Background</b> Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. <p></p><b> Methods</b> We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. <p></p> <b>Results</b> The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. <b>Conclusion </b>Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors

Pervasive Technologies and Support for Independent Living

A broad range of pervasive technologies are used in many domains, including healthcare: however, there appears to be little work examining the role of such technologies in the home, or the different wants and needs of elderly users. Additionally, there exist ethical issues surrounding the use of highly personal healthcare-related data, and interface issues centred on the novelty of the technologies and the disabilities experienced by the users. This report examines these areas, before considering the ways in which they might come together to help support independent-living users with disabilities which may be age-related

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Appropriation of Information Systems: Using Cognitive Mapping for Eliciting Users\u27 Sensemaking

This paper explores the use of cognitive mapping for eliciting users\u27 sensemaking during information system (IS) appropriation. Despite the potential usefulness of sensemaking, few studies in IS research use it as a theoretical lens to address IS appropriation. A possible reason for this may be that sensemaking does not easily lend itself to be used in practice. We introduce cognitive mapping as a way to elicit users\u27 sensemaking and illustrate its value by reporting on findings from an empirical study of the introduction of an Electronic Patient Record (EPR) system. The contribution of the paper is threefold: first, our findings demonstrate cognitive mapping\u27s use for eliciting users\u27 sensemaking during IS appropriation. Second, our findings illustrate how cognitive mapping can be used as a dynamic approach facilitating collective negotiation of meaning. Third, we contribute with a thorough discussion of the epistemological and methodological assumptions underlying cognitive mapping to ensure its validity and trustworthiness

Information Technology and Computing Topics and Their Relevance to Medical Undergraduate and Graduate Program Curricula at RIT

Two healthcare domain related programs in which this author has curricular relationships are the undergraduate Diagnostic Ultrasound (DU), and the graduate Master of Science in Health Informatics (MSHI). He teaches one course in the former and is the program coordinator for the latter. The undergraduate course is titled, “Computers in Medicine”, and is a rough 50% combination of a first-semester computing hardware course taught to our IT undergrads and another 50% of material from a textbook covering all the ways in which computing has benefitted various healthcare domains like, surgery, pharmacy, imaging, dentistry, psychiatry, remote medicine and the like. The MSHI program is a 30 semester credit hour program offered in an online format with a capstone experience (no thesis required) that was designed for professionals expecting to retool themselves for continued employment in a healthcare setting. This paper will discuss the details of the DU course and the MSHI program, the kind of computing content covered in each, and the rationale for and program design input of each. In conclusion, the reader will be left with an understanding of the what, when, how and why computing topics are necessarily required by these curricula, our justification for such, and how we might use that information in the development of future healthcare-related computing courses and potential programs. Course definition and program outline documents will be attached as appendices to the paper

Social and interactional practices for disseminating current awareness information in an organisational setting.

Current awareness services are designed to keep users informed about recent developments based around user need profiles. In organisational settings, they may operate through both electronic and social interactions aimed at delivering information that is relevant, pertinent and current. Understanding these interactions can reveal the tensions in current awareness dissemination and help inform ways of making services more effective and efficient. We report an in-depth, observational study of electronic current awareness use within a large London law firm. The study found that selection, re-aggregation and forwarding of information by multiple actors gives rise to a complex sociotechnical distribution network. Knowledge management staff act as a layer of “intelligent filters” sensitive to complex, local information needs; their distribution decisions address multiple situational relevance factors in a situation fraught with information overload and restrictive time-pressures. Their decisions aim to optimise conflicting constraints of recall, precision and information quantity. Critical to this is the use of dynamic profile updates which propagate back through the network through formal and informal social interactions. This supports changes to situational relevance judgements and so allows the network to ‘self-tune’. These findings lead to design requirements, including that systems should support rapid assessment of information items against an individual’s interests; that it should be possible to organise information for different subsequent uses; and that there should be back-propagation from information consumers to providers, to tune the understanding of their information needs

SCOPE FOR USABILITY TESTS IN IS DEVELOPMENT

Despite being a common, established concept in wide usage, usability tests can vary greatly in goals, techniques and results. A usability test purchased and performed for a specific software product, may result in either minor user interface improvements or radical U-turns in the development. Such variation has been discussed as a problem of the scientific reliability and validity of the testing method. In practice it is more important what ‘kind of data’ one can expect of the selected method than whether it is reliably always the same data. This expectation of information content or ‘scope’ is of importance for evaluators, who select and conduct usability tests for a specific purpose. However, the scope is not explicitly stated or even discussed: Too often the premise is that, because a usability test involves users, it brings the (necessary) user-centeredness to the design i.e. takes socio-technical fundamentals as inherently given. Through a literature review of testing practices and analytical considerations, we search for the scope of a usability test, which could deliberately approach the socio-technical tradition and equally develop both the system and the user organization. A case example represents a possible realization of the extended scope of usability test

Review of health information technology usability study methodologies

Usability factors are a major obstacle to health information technology (IT) adoption. The purpose of this paper is to review and categorize health IT usability study methods and to provide practical guidance on health IT usability evaluation. 2025 references were initially retrieved from the Medline database from 2003 to 2009 that evaluated health IT used by clinicians. Titles and abstracts were first reviewed for inclusion. Full-text articles were then examined to identify final eligibility studies. 629 studies were categorized into the five stages of an integrated usability specification and evaluation framework that was based on a usability model and the system development life cycle (SDLC)-associated stages of evaluation. Theoretical and methodological aspects of 319 studies were extracted in greater detail and studies that focused on system validation (SDLC stage 2) were not assessed further. The number of studies by stage was: stage 1, task-based or user–task interaction, n=42; stage 2, system–task interaction, n=310; stage 3, user–task–system interaction, n=69; stage 4, user–task–system–environment interaction, n=54; and stage 5, user–task–system–environment interaction in routine use, n=199. The studies applied a variety of quantitative and qualitative approaches. Methodological issues included lack of theoretical framework/model, lack of details regarding qualitative study approaches, single evaluation focus, environmental factors not evaluated in the early stages, and guideline adherence as the primary outcome for decision support system evaluations. Based on the findings, a three-level stratified view of health IT usability evaluation is proposed and methodological guidance is offered based upon the type of interaction that is of primary interest in the evaluation

WHAT CONCERNS USERS OF MEDICAL APPS? EXPLORING NON-FUNCTIONAL REQUIREMENTS OF MEDICAL MOBILE APPLICATIONS

The increased use of internet through smartphones and tablets enables the development of new consumer-focused mobile applications (apps) in health care. Concerns including these apps´ safety, usability, privacy, and dependability have been raised. In this paper the authors present the results of a grounded theory-approach to finding what non-functional requirements of medical apps potential users view as most important. A document study and interviews with stakeholders yielded nine non-functional requirements for medical apps: accessibility, certifiability, portability, privacy, safety, security, stability, trustability, and usability. Six of these were evaluated with two groups (differing by age) of potential users through a vignette study. This revealed differences between the age groups regarding the importance each attributed to apps´ usability and certifiability. Furthermore, and contrary to consensus in literature, privacy was considered one of the least important attributes for medical apps by both groups. Trustability, security, and, for the younger group, certifiability, were considered the most important non-functional requirements for medical apps. The implications of these results for developing medical mobile applications are briefly visited