User preferences for adaptive user interfaces in health information systems

An adaptive user interface requires identification of user requirements. Interface designers and engineers must understand end-user interaction with the system to improve user interface design. A combination of interviews and observations is applied for user requirement analysis in health information systems (HIS). Then, user preferences are categorized in this paper as either data entry, language and vocabulary, information presentation, or help, warning and feedback. The user preferences in these categories were evaluated using the focus group method. Focus group sessions with different types of HIS users comprising medical staff (with and without computer skills) and system administrators identified each user group’s preference for the initial adaptation of the HIS user interface. User needs and requirements must be identified to adapt the interface to users during data entry into the system. System designers must understand user interactions with the system to identify their needs and preferences. Without this, interface design cannot be adapted to users and users will not be comfortable using the system and eventually abandon its use

Anatomy of a failure: A sociothechnical evaluation of a laboratory physician order entry system implementation

Objective: To investigate the human, social and organizational issues surrounding a Computerized Physician Order Entry system for Laboratory ordering (CPOE-L) implementation process and to analyze their interrelated effects on the system implementation failure in an academic medical setting. Second, to provide lessons learned and recommendations on to how to manage challenges of human, social and organizational nature surrounding CPOE-L implementations. Methods: The themes surrounding CPOE introduction were identified by a heuristic analysis of literature on CPOE implementations. The resulting set of themes was applied as a reference model for 20 semi-structured interviews conducted during the CPOE-L implementation process with 11 persons involved in the CPOE-L project and in reviewing all CPOE- L related project documentation. Data was additionally gathered by user questionnaires, by user discussion rounds and through an ethnographical study performed at the involved clinical and laboratory departments. In analyzing the interview transcripts, project documentation and data from user questionnaires and discussion rounds a grounded theory approach was applied by the evaluation team to identify problem areas or issues deserving further analysis. Results: Outlined central problem areas concerning the CPOE- L implementation and their mutual relations were depicted in a conceptual interpretative model. Understanding of clinical workflow was identified as a key theme pressured by organizational, human and social issues ultimately influencing the entire implementation process in a negative way. Vast delays in CPOE introduction, system immaturity and under-functionality could all be directly attributed to a superficial understanding of workflow. Consequently, final CPOE integration into clinical and laboratory workflows was inhibited by both end-users as well as department managers and withdrawal of the CPOE- L system became inevitable. Conclusion: This case study demonstrates which human, social and organizational issues relevant to CPOE implementation cumulatively led to a failure outcome of the CPOE- L pilot introduction. The experiences and considerations described in this paper show important issues for CPOE systems to be successfully introduced and to be taken into account in future CPOE implementations. Understanding and consideration of (clinical) workflow aspects by project managers and the involved clinical organization is of extreme importance from the very start of a CPOE implementation process. (C) 2009 Elsevier Ireland Ltd. All rights reserve

Training inter-physician communication using the dynamic patient simulator((R))

Purpose: Clear and adequate communication between physicians is essential in modern medicine. Nevertheless, the medical curricula in The Netherlands lack an identifiable part in their education concerning inter-physician communication training. To train medical students in inter-physician communication skills using the Dynamic Patient Simulator (R) (DPS), the Academic Medical Center at the University of Amsterdam and the Leiden University Medical Center joined in a 2-year project sponsored by the Dutch government. DPS is an educational computer program to create and simulate virtual patients with a wide variety of medical conditions in different clinical settings and over different time frames. To evaluate whether DPS is a suitable method for training medical students in inter-physician communication, we assessed if medical students felt that they had improved their inter-collegial communication skills after the pilot with DPS. Besides, we inquired students on DPS' usability and their satisfaction with DPS. Methods: We first developed and implemented 20 patient simulations in DPS to be practiced upon by two students asynchronously during a week. These students were situated in different medical institutions, geographically spread over The Netherlands and had to treat the virtual patient as a team supported by DPS. The students had to report their findings and treatment plan in the electronic referral form of DPS. A total of 134 students participated in the pilot. To evaluate inter-physician communication training using DPS we conducted a survey amongst these students who were entering their internships. The evaluation focused on self-assessment of their communication skills, usability of the DPS program, and their satisfaction with DPS as educational format, using multiple questionnaires. Discussion: The outcome of the evaluation showed significant progression in students' feeling of improvement of their skills in different aspects concerning the referral of a patient after participating in the pilot. Besides, students evaluated the usability of DPS positive and were highly satisfied with the education in inter-physician communication training using DPS. Based on these outcomes, nowadays this form of training is incorporated in the curricula on a regular basis. (C) 2007 Elsevier Ireland Ltd. All rights reserve

An online survey to study the relationship between patients’ health literacy and coping style and their preferences for self-management-related information

Sandra Vosbergen,1 Niels Peek,1 Johanna MR Mulder-Wiggers,1 Hareld MC Kemps,1,2 Roderik A Kraaijenhagen,3 Monique WM Jaspers,1,4 Joyca PW Lacroix51Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands, 2Department of Cardiology, Máxima Medical Centre, Veldhoven, the Netherlands, 3NIPED Research Foundation, Amsterdam, the Netherlands, 4Center for Human Factors Engineering of Health Information Technology (HIT Lab), Academic Medical Center, Amsterdam, the Netherlands, 5Department of Brain, Body and Behavior, Philips Research, Eindhoven, the NetherlandsObjective: To evaluate patients’ preferences for message features and assess their relationships with health literacy, monitor–blunter coping style, and other patient-dependent characteristics.Methods: Patients with coronary heart disease completed an internet-based survey, which assessed health literacy and monitor–blunter coping style, as well as various other patient characteristics such as sociodemographics, disease history, and explicit information preferences. To assess preferences for message features, nine text sets differing in one of nine message features were composed, and participants were asked to state their preferences.Results: The survey was completed by 213 patients. For three of the nine text sets, a ­relationship was found between patient preference and health literacy or monitor–blunter coping style. Patients with low health literacy preferred the text based on patient experience. Patients with a monitoring coping style preferred information on short-term effects of their treatment and mentioning of explicit risks. Various other patient characteristics such as marital status, social support, disease history, and age also showed a strong association.Conclusion: Individual differences exist in patients’ preferences for message features, and these preferences relate to patient characteristics such as health literacy and monitor–blunter coping style.Keywords: patient preferences, patient education, monitor–blunter coping style, information tailoring, message feature

YAWL4Healthcare

Hospitals face increasing pressure to both improve the quality of the services delivered to patients and to reduce costs. As a consequence of the open-market approach adopted in healthcare provision, hospitals must compete with each other on the basis of performance indicators such as total treatment costs for a patient, waiting time before treatment can start, etc. Patients visiting the hospital will no longer accept long waiting times, and increasingly have specific demands with respect to the planning of their appointments and quality of services they will receive. The aforementioned issues place significant demands on hospitals in regard to how the organization, execution, and monitoring of work processes is performed. Workflow Management Systems (WfMSs) offer a potential solution as they support processes by managing the flow of work, such that individual work items are done at the right time by the proper person. The main benefit of utilizing these kinds of systems is that processes can be executed faster and more efficiently. In addition, these processes can be closely monitored, potentially enhancing patient safety. It is generally agreed that WfMSs are mature enough to support administrative processes that are relatively stable and fixed in form. However, hospital processes are typically diverse, require flexibility, and often involve multiple medical departments in diagnostic and treatment processes. Even for patients who have the same condition, the actual diagnostic and treatment process that they undergo may vary considerably. Furthermore, it is often necessary to change the course of the treatment process based on the results of tests performed and the way in which a patient responds to individual treatments