An audio personal health library of clinic visit recordings for patients and their caregivers (HealthPAL): User-centered design approach

Background: Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective: This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods: Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients\u27 primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results: We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one\u27s own recordings and others\u27 recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions: To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans

Contracted time and expanded space: The impact of circumnavigation on judgements of space and time

The ability to estimate distance and time to spatial goals is fundamental for survival. In cases where a region of space must be navigated around to reach a location (circumnavigation), the distance along the path is greater than the straight-line Euclidean distance. To explore how such circumnavigation impacts on estimates of distance and time, we tested participants on their ability to estimate travel time and Euclidean distance to learned destinations in a virtual town. Estimates for approximately linear routes were compared with estimates for routes requiring circumnavigation. For all routes, travel times were significantly underestimated, and Euclidean distances overestimated. For routes requiring circumnavigation, travel time was further underestimated and the Euclidean distance further overestimated. Thus, circumnavigation appears to enhance existing biases in representations of travel time and distance

Speed of time-compressed forward replay flexibly changes in human episodic memory

Remembering information from continuous past episodes is a complex task. On the one hand, we must be able to recall events in a highly accurate way that often includes exact timing; on the other hand, we can ignore irrelevant details and skip to events of interest. We here track continuous episodes, consisting of different sub-events, as they are recalled from memory. In behavioral and MEG data, we show that memory replay is temporally compressed and proceeds in a forward direction. Neural replay is characterized by the reinstatement of temporal patterns from encoding. These fragments of activity reappear on a compressed timescale. Herein, the replay of sub-events takes longer than the transition from one sub-event to another. This identifies episodic memory replay as a dynamic process in which participants replay fragments of fine-grained temporal patterns and are able to skip flexibly across sub-events