Implementation Science Meets Software Development to Create eHealth Components for an Integrated Care Model for Allogeneic Stem Cell Transplantation Facilitated by eHealth: The SMILe Study as an Example

To describe a process of creating eHealth components for an integrated care model using an agile software development approach, user-centered design and, via the Behavior Change Wheel, behavior theory-guided content development. Following the principles of implementation science and using the SMILe project (integrated care model for allogeneic stem cell transplantation facilitated by eHealth) as an example, this study demonstrates how to narrow the research-to-practice gap often encountered in eHealth projects.; We followed a four-step process: (a) formation of an interdisciplinary team; (b) a contextual analysis to drive the development process via behavioral theory; (c) transfer of content to software following agile software development principles; and (d) frequent stakeholder and end user involvement following user-centered design principles.; Our newly developed comprehensive development approach allowed us to create a running eHealth component and embed it in an integrated care model. An interdisciplinary team's collaboration at specified interaction points supported clear, timely communication and interactions between the specialists. Because behavioral theory drove the content development process, we formulated user stories to define the software features, which were prioritized and iteratively developed using agile software development principles. A prototype intervention module has now been developed and received high ratings on the System Usability Scale after two rounds of usability testing.; Following an agile software development process, structured collaboration between nursing scientists and software specialists allowed our interdisciplinary team to develop meaningful, theory-based eHealth components adapted to context-specific needs.; The creation of high-quality, accurately fitting eHealth components specifically to be embedded in integrated care models should increase the chances of uptake, adoption, and sustainable implementation in clinical practice

A systematic review of game technologies for pediatric patients

[EN] Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation.This work is supported by the Spanish Ministry of Economy and Competitiveness and the European Development Regional Fund (EDRF-FEDER) with Project TIN2014-60077-R.El Jurdi, S.; Montaner-Marco, J.; García Sanjuan, F.; Jaén Martínez, FJ.; Nácher-Soler, VE. (2018). A systematic review of game technologies for pediatric patients. Computers in Biology and Medicine. 97:89-112. https://doi.org/10.1016/j.compbiomed.2018.04.019S891129

Co-designing patient-centred technology for chronic kidney disease : supporting the patient journey

Chronic kidney disease (CKD) patients endure their chronic condition, in addition to complicated treatment pathways and trajectories, high treatment burden and great volumes of information which is not always applicable to their individual situations. There are calls for more patient-centred care, with greater patient involvement in treatment decisions and routine collection of patient outcomes. Digital health innovations have the potential to address these points, but poorly designed or implemented interventions can increase treatment burden, and many fail to reach implementation, described as “pilotitis” in the literature. This thesis explores the use of a Participatory Action Research approach to designing CKD interventions, involving multidisciplinary stakeholders and patients in the design process. First a scoping review on implemented technology-based and patient-centred interventions for high treatment burden populations was conducted, with results providing factors for promoting patient-centredness in technological interventions. A multidisciplinary group of domain experts from academia and medicine was then formed, to identify issues within the community, provide initial design requirements and guide development of a prototype intervention. This prototype would be implemented and evaluated after 6 weeks use by CKD patients in routine care, as part of a vascular access-specific quality-of-life measure (VASQoL) validation study. This resulted in a System Usability Scale (SUS) evaluation and qualitative feedback from 26 CKD patients as well the feedback and observations of a clinical researcher. This evaluation identifies further design requirements as well as the idiosyncratic needs of dialysing CKD patients, such as situational impairment and perceived value of technology. The focus then shifted to patient education, with iterative design and feedback on prototype designs with the MDG, clinical stakeholders and CKD patients in online and in-person workshops, and an interactive symposium. Through multidisciplinary co-design and iterative development, the research produced extensive design requirements and prototype systems for CKD patient education and decision-making aids.Chronic kidney disease (CKD) patients endure their chronic condition, in addition to complicated treatment pathways and trajectories, high treatment burden and great volumes of information which is not always applicable to their individual situations. There are calls for more patient-centred care, with greater patient involvement in treatment decisions and routine collection of patient outcomes. Digital health innovations have the potential to address these points, but poorly designed or implemented interventions can increase treatment burden, and many fail to reach implementation, described as “pilotitis” in the literature. This thesis explores the use of a Participatory Action Research approach to designing CKD interventions, involving multidisciplinary stakeholders and patients in the design process. First a scoping review on implemented technology-based and patient-centred interventions for high treatment burden populations was conducted, with results providing factors for promoting patient-centredness in technological interventions. A multidisciplinary group of domain experts from academia and medicine was then formed, to identify issues within the community, provide initial design requirements and guide development of a prototype intervention. This prototype would be implemented and evaluated after 6 weeks use by CKD patients in routine care, as part of a vascular access-specific quality-of-life measure (VASQoL) validation study. This resulted in a System Usability Scale (SUS) evaluation and qualitative feedback from 26 CKD patients as well the feedback and observations of a clinical researcher. This evaluation identifies further design requirements as well as the idiosyncratic needs of dialysing CKD patients, such as situational impairment and perceived value of technology. The focus then shifted to patient education, with iterative design and feedback on prototype designs with the MDG, clinical stakeholders and CKD patients in online and in-person workshops, and an interactive symposium. Through multidisciplinary co-design and iterative development, the research produced extensive design requirements and prototype systems for CKD patient education and decision-making aids

Integrating cancer survivors' experiences into UK cancer registries: design and development of the ePOCS system (electronic Patient-reported Outcomes from Cancer Survivors)

BACKGROUND: Understanding the psychosocial challenges of cancer survivorship, and identifying which patients experience ongoing difficulties, is a key priority. The ePOCS (electronic patient-reported outcomes from cancer survivors) project aims to develop and evaluate a cost-efficient, UK-scalable electronic system for collecting patient-reported outcome measures (PROMs), at regular post-diagnostic timepoints, and linking these with clinical data in cancer registries. METHODS: A multidisciplinary team developed the system using agile methods. Design entailed process mapping the system's constituent parts, data flows and involved human activities, and undertaking usability testing. Informatics specialists built new technical components, including a web-based questionnaire tool and tracking database, and established component-connecting data flows. Development challenges were overcome, including patient usability and data linkage and security. RESULTS: We have developed a system in which PROMs are completed online, using a secure questionnaire administration tool, accessed via a public-facing website, and the responses are linked and stored with clinical registry data. Patient monitoring and communications are semiautomated via a tracker database, and patient correspondence is primarily Email-based. The system is currently honed for clinician-led hospital-based patient recruitment. CONCLUSIONS: A feasibility test study is underway. Although there are possible challenges to sustaining and scaling up ePOCS, the system has potential to support UK epidemiological PROMs collection and clinical data linkage

Analysis and Design of an Information System for Blood Component Donations

In the UK, NHS Blood and Transplant (NHSBT) administers the blood and transplantation service to National Health Service (NHS), overseeing blood collection in England and transplant facilities in the United Kingdom. This research focuses on improving blood component donations by using an information system. This paper presents system analysis and user interface design of an information system for blood component donations to improve the current process. The software system requirements were gathered via a focus group consisting of employees from a Blood Donation Centre in the UK. The problem space in the component donation process was analysed and human factors has been explored for potential users of the component donation information system. Both low-fidelity and high-fidelity designs have been designed where interactive user interfaces have been made on Adobe XD tool. Usability evaluation has been performed with potential users from the focus group using a cognitive walk through to examine usability concerns and user experience of the design prototype. Conclusions and future work have been presented for potential further research opportunities

HCI for health and wellbeing: challenges and opportunities

In terms of Human–Computer Interaction, healthcare presents paradoxes: on the one hand, there is substantial investment in innovative health technologies, particularly around “big data” analytics and personal health technologies; on the other hand, most interactive health technologies that are currently deployed at scale are difficult to use and few innovative technologies have achieved significant market penetration. We live in a time of change, with a shift from care being delivered by professionals towards people being expected to be actively engaged and involved in shared decision making. Technically, this shift is supported by novel health technologies and information resources; culturally, the pace of change varies across contexts. In this paper, I present a “space” of interactive health technologies, users and uses, and interdependencies between them. Based on a review of the past and present, I highlight opportunities for and challenges to the application of HCI methods in the design and deployment of digital health technologies. These include threats to privacy, patient trust and experience, and opportunities to deliver healthcare and empower people to manage their health and wellbeing in ways that better fit their lives and values

ASSESSMENT OF THE USERS' PERSPECTIVES ON THE PERFORMANCE OF ELECTRONIC PATIENT'S DRUG CHART IN THE PHARMACY INFORMATION SYSTEM

Introduction: The targeted application of the technology for the record of the drug information may substantially assist the healthcare service providers supporting the drug-related decisions. This study intended to assess the performance of the electronic patient's drug chart integrated in the pharmacy information system PIS] by comparing the users' viewpoints before and after its administration. Methods: This study was conducted using applied and descriptive-analytical research method in 2016. Research population consisted of the nursing staff, pharmacy technicians as well as pharmacists from which a sample of 317 subjects was selected using purposive non-probability sampling method from Nour & Ali Asqar hospital of Isfahan city. Data collection tool was a self-designed questionnaire developed on the basis of American Society of Health System Pharmacists ASHP] the validity of which was confirmed by both pooling the ideas of the respective well-known professors and estimating cronbach's alpha that was found to be 82%. The study was conducted in the following three steps: 1] exploring the viewpoints of the users on the development of the electronic patient's drug chart, 2] converting the current drug chart to the electronic format 3] re-assessing the users' viewpoints on the performance of electronic patient's drug chart. The collected data were analyzed using pretest-posttest and paired sample ttest with Spss16 software. As for quantitative variables, the measures of mean score, standard deviation and 95% confidence interval were used. Results: As per the obtained results, there was a significant difference between the mean scores obtained for the viewpoints of the users on four domains in question including the rate of access to the patient drug's information p < 0.001], the patient's demographic information p< 0.005], the patient's complaints and signs information p< 0.001] and patient's medical information p< 0.001] before and after the implementation of electronic patient's drug chart. Conclusion: Based on the results, it can be concluded that implementation of electronic patient's drug chart in the PIS would increase the users' access rate to the drug and medical information. This, in turn, has a positive effect on lowering the illegible handwriting errors, controlling the drug dosage administered and decreasing the medicine waste

Yale Nurse

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