Consumer Health Informatics: Empowering Healthy-Lifestyle-Seekers Through mHealth

People are at risk from noncommunicable diseases (NCD) and poor health habits, with interventions like medications and surgery carrying further risk of adverse effects. This paper addresses ways people are increasingly moving to healthy living medicine (HLM) to mitigate such health threats. HLM-seekers increasingly leverage mobile technologies that enable control of personal health information, collaboration with clinicians/other agents to establish healthy living practices. For example, outcomes from consumer health informatics research include empowering users to take charge of their health through active participation in decision-making about healthcare delivery. Because the success of health technology depends on its alignment/integration with a person's sociotechnical system, we introduce SEIPS 2.0 as a useful conceptual model and analytic tool. SEIPS 2.0 approaches human work (i.e., life's effortful activities) within the complexity of the design and implementation of mHealth technologies and their potential to emerge as consumer-facing NLM products that support NCDs like diabetes

Supporting Information Management in ICU Rounding

Team rounds on patients in the hospital's intensive care unit (ICU) results in the generation of several paper-based and digital notes. Paper-based notes, although short-lived, act as translational artifacts that help organize and coordinate patient information and care. Maintaining double records of paper and digital notes can introduce several awareness and coordination problems such as contextually situating clinicians as to a patient's on-going care. Based on the design requirements derived from our fieldwork, we propose a new technology, PANI (Patient-centered Notes and Information Manager). PANI is a clinical tool that integrates the use of a mobile application, paper-based artifacts, and a wearable device (such as FitBit) in one system to support the management of notes and action-items that are generated throughout a typical ICU clinical shift. In this paper, we present the functional design of PANI and our preliminary findings of a participatory study that included 15 clinician participants

Simulated Clinical Encounters Using Patient-Operated mHealth: Experimental Study to Investigate Patient-Provider Communication

BACKGROUND: This study investigates patient-centered mobile health (mHealth) technology in terms of the secondary user experience (UX). Specifically, it examines how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient's health care during their first visit to a provider. Common ground, a theory about language use, is used as the theoretical basis to examine interactions. A novel concept of this study is that it is one of the first empirical studies to explore the relative meaningfulness of a secondary UX for specific health care tasks. OBJECTIVE: The objective of this study was to investigate the extent that patient-operated mHealth technology can be designed to improve the communication between the patient and provider during an initial face-to-face encounter. METHODS: The experimental study was conducted in 2 large Midwestern cities from February 2016 to May 2016. A custom-designed smartphone app prototype was used as the study treatment. The experimental design was posttest-only control group and included video-recorded simulated face-to-face clinical encounters in which an actor role-played a patient. Experienced clinicians consisting of doctors (n=4) and nurses (n=8) were the study participants. A thematic analysis of qualitative data was performed. Quantitative data collected from time on task measurements were analyzed using descriptive statistics. RESULTS: Three themes that represent how grounding manifested during the encounter, what it meant for communication during the encounter, and how it influenced the provider's perception of the patient emerged from the qualitative analysis. The descriptive statistics were important for inferring evidence of efficiency and effectiveness of communication for providers. Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit. CONCLUSIONS: Combining the notions of common ground, human-computer interaction design, and smartphone technology resulted in a prototype that improved the efficiency and effectiveness of face-to-face collaboration for secondary users. The experimental study is one of the first studies to demonstrate that an investment in the secondary UX for high payoff tasks has value but that not all secondary UXs are meaningful for design. This observation is useful for prioritizing how resources should be applied when considering the secondary UX

Clinicians as Secondary Users of Patient-Centered Mobile Technology in Complex Healthcare Settings

This paper describes the preliminary research findings and prototype development of a Personal Health Record mobile application. A pilot study about patient-clinician interaction guided by common ground theory was performed. The goal of the pilot study was to gather requirements to support development of a smartphone application to be used in a future experimental study. Findings from the pilot study suggest that smartphones could be used to manage health information considered important for a successful healthcare consultation

Reconciling disparate information in continuity of care documents: Piloting a system to consolidate structured clinical documents

Background Due to the nature of information generation in health care, clinical documents contain duplicate and sometimes conflicting information. Recent implementation of Health Information Exchange (HIE) mechanisms in which clinical summary documents are exchanged among disparate health care organizations can proliferate duplicate and conflicting information. Materials and methods To reduce information overload, a system to automatically consolidate information across multiple clinical summary documents was developed for an HIE network. The system receives any number of Continuity of Care Documents (CCDs) and outputs a single, consolidated record. To test the system, a randomly sampled corpus of 522 CCDs representing 50 unique patients was extracted from a large HIE network. The automated methods were compared to manual consolidation of information for three key sections of the CCD: problems, allergies, and medications. Results Manual consolidation of 11,631 entries was completed in approximately 150 h. The same data were automatically consolidated in 3.3 min. The system successfully consolidated 99.1% of problems, 87.0% of allergies, and 91.7% of medications. Almost all of the inaccuracies were caused by issues involving the use of standardized terminologies within the documents to represent individual information entries. Conclusion This study represents a novel, tested tool for de-duplication and consolidation of CDA documents, which is a major step toward improving information access and the interoperability among information systems. While more work is necessary, automated systems like the one evaluated in this study will be necessary to meet the informatics needs of providers and health systems in the future

Impact of document consolidation on healthcare providers’ perceived workload and information reconciliation tasks: a mixed methods study

Background Information reconciliation is a common yet complex and often time-consuming task performed by healthcare providers. While electronic health record systems can receive “outside information” about a patient in electronic documents, rarely does the computer automate reconciling information about a patient across all documents. Materials and Methods Using a mixed methods design, we evaluated an information system designed to reconcile information across multiple electronic documents containing health records for a patient received from a health information exchange (HIE) network. Nine healthcare providers participated in scenario-based sessions in which they manually consolidated information across multiple documents. Accuracy of consolidation was measured along with the time spent completing 3 different reconciliation scenarios with and without support from the information system. Participants also attended an interview about their experience. Perceived workload was evaluated quantitatively using the NASA-TLX tool. Qualitative analysis focused on providers’ impression of the system and the challenges faced when reconciling information in practice. Results While 5 providers made mistakes when trying to manually reconcile information across multiple documents, no participants made a mistake when the system supported their work. Overall perceived workload decreased significantly for scenarios supported by the system (37.2% in referrals, 18.4% in medications, and 31.5% in problems scenarios, P < 0.001). Information reconciliation time was reduced significantly when the system supported provider tasks (58.8% in referrals, 38.1% in medications, and 65.1% in problem scenarios). Conclusion Automating retrieval and reconciliation of information across multiple electronic documents shows promise for reducing healthcare providers’ task complexity and workload

Extending knowledge domains for new media education: integrating interaction design theory and methods

Over the last 10 years, new media has ascended to a prominent place in many fields that utilize communication technologies. At the same time, new media education has evolved in such a way that students are often not prepared to understand the social context of new media design and development. To produce new media professionals who are adequately prepared to meet the needs of an online hyper-social marketplace, new media curricula must reflect those human-centered theories and practices found within the discipline of interaction design, in addition to formal new media technical knowledge. The authors propose a new three-by-three theoretical model, referred to as Knowledge-Operators-and-Domains (KOD). Applying this model suggests an approach that extends the practical boundaries of new media to include a range of human-centered theories and practices, such as ethnography and usability-based studies