Impact of Age on Patients' Communication and Technology Preferences in the Era of Meaningful Use: Mixed Methods Study.

BACKGROUND: Identifying effective means of communication between patients and their health care providers has a positive impact on patients' satisfaction, adherence, and health-related outcomes. OBJECTIVE: This study aimed to identify the impact of patients' age on their communication and technology preferences when managing their health. We hypothesize that a patient's age affects their communication and technology preferences when interacting with clinicians and managing their health. METHODS: A mixed methods study was conducted to identify the preferences of patients with cardiovascular diseases. Results were analyzed based on the patients' age. Grounded theory was used to analyze the qualitative data. Patients were recruited based on age, gender, ethnicity, and zip code. RESULTS: A total of 104 patients were recruited: 34 young adults (19-39 years), 33 middle aged (40-64), and 37 senior citizens (>65). Young adults (mean 8.29, SD 1.66) reported higher computer self-efficacy than middle-aged participants (mean 5.56, SD 3.43; P<.05) and senior citizens (mean 47.55, SD 31.23; P<.05). Qualitative analysis identified the following three themes: (1) patient engagement (young adults favored mobile technologies and text messaging, middle-aged patients preferred phone calls, and senior citizens preferred direct interactions with the health care provider); (2) patient safety (young adults preferred electronic after-visit summaries [AVS] and medication reconciliation over the internet; middle-aged patients preferred paper-based or emailed AVS and medication reconciliation in person; senior citizens preferred paper-based summaries and in-person medication reconciliation); (3) technology (young adults preferred smartphones and middle-aged patients and senior citizens preferred tablets or PCs). Middle-aged patients were more concerned about computer security than any other group. A unique finding among senior citizens was the desire for caregivers to have access to their personal health record (PHR). CONCLUSIONS: Patients of different ages have different communication and technology preferences and different preferences with respect to how they would like information presented to them and how they wish to interact with their provider. The PHR is one approach to improving patient engagement, but nontechnological options need to be sustained to support all patients.

Developing a Serious Game for Nurse Education.

Future nursing education is challenged to develop innovative and effective programs that align with current changes in health care and to educate nurses with a high level of clinical reasoning skills, evidence-based knowledge, and professional autonomy. Serious games (SGs) are computer-based simulations that combine knowledge and skills development with video game-playing aspects to enable active, experiential, situated, and problem-based learning. In a PhD project, a video-based SG was developed to teach nursing students nursing care for patients with chronic obstructive pulmonary disease in home health care and hospital settings. The current article summarizes the process of the SG development and evaluation. [Journal of Gerontological Nursing, 44(1), 15-19.].

Crossing Borders: An Online Interdisciplinary Course in Health Informatics for Students From Two Countries.

A cross-countries and interprofessional novel approach for delivering an international interdisciplinary graduate health informatics course online is presented. Included in this discussion are the challenges, lessons learned, and pedagogical recommendations from the experiences of teaching the course. Four professors from three different fields and from three universities collaborated in offering an international health informatics course for an interdisciplinary group of 18 US and seven Norwegian students. Highly motivated students and professors, an online technology infrastructure that supported asynchronously communication and course delivery, the ability to adapt the curriculum to meet the pedagogy requirements at all universities, and the support of higher administration for international collaboration were enablers for success. This project demonstrated the feasibility and advantages of an interdisciplinary, interprofessional, and cross-countries approach in teaching health informatics online. Students were able to establish relationships and conduct professional conversations across disciplines and international boundaries using content management software. This graduate course can be used as a part of informatics, computer science, and/or health science programs.

Exploring wearable technology use and importance of health monitoring in the hazardous occupations of first responders and professional drivers.

OBJECTIVES: Hazardous materials (HAZMAT) pose risks to the health and safety of professionals involved with transportation and emergency responses. Two distinct occupational groups that encounter HAZMAT events are first responders and professional drivers. Wearable technology is a tool that can assist with monitoring the health of professionals involved in HAZMAT events. The aim of this study was to compare and evaluate the perceptions of first responders and professional drivers on wearable technology and attitudes toward health monitoring. METHODS: A survey was administered to first responders (n = 112) and professional drivers (n = 218). Statistical approaches included bivariate analysis, latent class analysis, logistic regression analysis, and path analysis for the variables of interest. RESULTS: There were significant differences between the groups in perceptions of the benefits of monitoring certain health indicators. Professional drivers were more likely to have a history of wearable technology use compared with first responders (odds ratio [OR] = 10.1; 95% CI, 4.42-22.9), reported greater exposure to HAZMAT (OR = 4.32; 95% CI, 2.24-8.32), and were more willing to have their health data monitored by someone other than themselves (OR = 9.27; 95% CI, 3.67-23.4). A multinomial regression model revealed that occupation was not a significant predictor of class preference for acceptance of monitoring specific health indicators. CONCLUSIONS: Occupation appeared to be important but further analysis uncovered that characteristics of individuals within the occupations were more salient to the use of wearable technology. HAZMAT exposure, someone else monitoring health data, and experience with wearable technology use were found to be important factors for perceptions about benefits of health monitoring with wearable technology.

Exploring First Responders' Use and Perceptions on Continuous Health and Environmental Monitoring.

First responders lose their lives in the line of duty each year, and many of these deaths result from strenuous physical exertion and exposure to harmful environmental agents. Continuous health monitoring may detect diseases and alert the first responder when vital signs are reaching critical levels. However, continuous monitoring must be acceptable to first responders. The purpose of this study was to discover first responders' current use of wearable technology, their perceptions of what health and environmental indicators should be monitored, and who should be permitted to monitor them. The survey was sent to 645 first responders employed by 24 local fire department stations. A total of 115 (17.8%) first responders answered the survey and 112 were used for analysis. Results found first responders perceived a need for health and environmental monitoring. The health and environmental indicators that respondents perceived as most important for monitoring in the field were heart rate (98.2%) and carbon monoxide (100%), respectively. Overall, using and wearing monitoring devices was not age-dependent and health and environmental concerns were important for first responders at any stage of their career. However, current wearable technology does not seem to be a viable solution for first responders due to device expense and durability issues.

Home testing for COVID-19 and other virus outbreaks: The complex system of translating to communities.

Home testing is an emerging innovation that can enable nations and health care systems to safely and efficiently test large numbers of patients to manage COVID-19 and other viral outbreaks.  In this position paper, we explore the process of moving home testing across the translational continuum from labs to households, and ultimately into practice and communities for optimal public health impact. We focus on the four translational science drivers to accelerate the implementation of systems-wide home testing programmes 1) collaboration and team science, 2) technology, 3) multilevel interventions, and 4) knowledge integration. We use the Socio Ecological Model (SEM) as a framework to illustrate our vision for the ideal future state of a comprehensive system of stakeholders utilising tech-enabled home testing for COVID-19 and other virus outbreaks, and we suggest SEM as a tool to address key translational readiness and response questions.

The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers.

BACKGROUND: In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. OBJECTIVE: The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. METHODS: A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). RESULTS: There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). CONCLUSIONS: In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients' use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients' preferences and abilities when developing effective user-friendly health information technologies.

Roadmap to a more useful and usable electronic health record.

Background: A decade after the Health Information Technology for Economic and Clinical Health (HITECH) Act, electronic health records (EHRs) largely remain poorly designed and contribute to clinician burnout. Objective: The purpose of this study was to understand clinicians' wants, needs, and perceived barriers imposed by the EHR; implement best practices in user-centered design; and create a clinician-centered EHR framework validated via a functional EHR prototype. Methods: Usability evaluations were performed using a simulated patient with a complex clinical scenario. Convergent parallel mixed methods linked to action research and agile development were used to create an EHR prototype based on clinician-centered design. Prototype functionality was validated via a final usability evaluation. Results: Between 2015 and 2017, 53 clinicians from 8 cardiology practices (4 academic and 4 private) participated in initial evaluations of their installed EHR. In 2019, 25 clinicians participated in final evaluations of their EHR vs our EHR prototype. Initial evaluations documented that clinicians judged the EHRs as poorly designed, scoring a mean of 47.1 on the System Usability Scale. Clinicians expressed that EHRs impeded workflow and communication and prolonged their workday. In the final evaluations, no improvement in installed EHRs was found (mean score 48.1); however, the EHR prototype was assessed as significantly more usable (mean score 77.8; P <.001). Conclusion: A decade after the HITECH Act, EHRs still receive low usability scores. By applying user-centered design, an EHR prototype with improved features, functionality, and workflow integration was developed. Clinician testing of the EHR prototype demonstrated it was significantly more useful and usable to clinicians, thus identifying a framework and pathway for substantive improvement of EHR systems.

Nursing students' perceptions of a video-based serious game's educational value: A pilot study.

BACKGROUND: Despite an increasing number of serious games (SGs) in nursing education, few evaluation studies specifically address their educational value in terms of face, content, and construct validity. OBJECTIVES: To assess nursing students' perceptions of a video-based SG in terms of face, content, and construct validity. In addition, the study assessed perceptions of usability, individual factors, and preferences regarding future use. DESIGN: A pilot study was conducted. SETTING AND PARTICIPANTS: An SG prototype was implemented as part of two simulation courses in nursing education: one for home health care and one for hospital medical-surgical wards. The SG aimed to teach clinical reasoning and decision-making skills to nursing students caring for patients with chronic obstructive pulmonary disease. A total of 249second-year nursing students participated in pilot testing of the SG. METHOD: A paper-based survey was used to assess students' perceptions of the SG's educational value. RESULTS: Overall, students from both simulation courses perceived the SG as educationally valuable and easy to use. No significant differences were found in perceptions of educational value between nursing students with previous healthcare experience versus those with none. However, significantly more students in the home healthcare simulation course indicated that the SG tested their clinical reasoning and decision-making skills. Students from both the medical-surgical and home healthcare simulation courses suggested that more video-based SGs should be developed and used in nursing education. CONCLUSIONS: Overall, the survey results indicate that the participants perceived the SG as educationally valuable, and that the SG has potential as an educational tool in nursing education, especially in caring for patients with chronic diseases and in home healthcare simulation. Showing a SG's educational value and user acceptance among nursing students may justify the development and application of more SGs in nursing education.

The utility of electronic health record-based hygiene notes for chlorhexidine bathing practice evaluation.

BACKGROUND: Unreliable compliance with infection prevention procedures necessitates an analysis of contributing factors. METHODS: A retrospective study explored utility of 3236 nursing hygiene notes in the electronic healthcare record system (EHR). This 2012-2013 study identified defects in the chlorhexidine (CHG) bathing practice for a hospital unit. RESULTS: The overall compliance with CHG bathing was 22.99%. Patients with length of stay less than 3 days, in most cases, did not have documentation for CHG bathing. Patient refusal to bathe was the most prevalent documented reason (66%) of the unsuccessful initial and repeated offers to bathe. The regular staff were statistically less successful in convincing patients to bathe. The 1455 notes produced by the regular staff (n = 10) demonstrated a significantly higher failure rate (56.08%) to execute this procedure in comparison with 1770 notes documented by the 246 temporary staff (31.19% failure rate) (P value <0.001) . DISCUSSION: This analysis yielded three main insights: lack of the CHG documentation in a large number of short admissions; inconsistent use of CHG baths; and presence of workarounds due to patient refusals to bathe. The study concluded that EHR structured and unstructured data can unlock the opportunity for identifying hidden defects and inform decision-makers about the need for change.

Empirical Study on the Impact of a Tactical Biosurveillance Information Visualization on Users' Situational Awareness.

Decisions on antibiotic-resistant infection (ARI) prevention in dynamic health care settings should be agile and target the right process at the right time. Health information technologies can aid the recognition of high-risk situations for ARI transmission and timely facilitate operators' situational awareness (SA) in various military and civilian health care locations or transport platforms. High SA is one of the significant predictors of better performance. The objective of this study was to evaluate the impact of the developed health information visualization (VIZ) on the users' SA regarding situations when risks of ARI transmission and exposure are high. The enrolled 19 subjects assessed the proposed VIZ artifacts representing 1 scenario, compared the VIZ effectiveness against the currently employed local methods, and reported their SA (perception and comprehension) with the use of a pre- and post-self-rating questionnaire. The results showed that the VIZ significantly increased SA in the study subjects and revealed the importance of communicating the risk of exposure to ARIs. The VIZ enabled the participants to quickly acknowledge the high-risk individuals (super-spreaders), locations (hot spots), and biosafety (deficient infection prevention). The study concluded that SA-oriented technologies may be promising for promoting better infection prevention practices.

The Use of Smartphones in Norwegian Social Care Services.

This study aims to understand how smartphone technology was perceived by social workers responsible for piloting social services software and the experiences of involving end-users as co-developers. The pilot resulted in an improved match between the smartphone software and workflow as well as mutual learning experiences among the social workers, clients, and the vendor. The pilot study revealed several graphical user interface (GUI) and functionality challenges. Implementing an ICT social service smartphone application may further improve efficiencies for social workers serving citizens, however; this study validates the importance to study end-users' experiences with communication and the real-time use of the system in order reap the anticipated benefits of ICT capabilities for smart phone social service applications.

A Serious Game for Teaching Nursing Students Clinical Reasoning and Decision-Making Skills.

The aim of this study was to design and pilot-test a serious game for teaching nursing students clinical reasoning and decision-making skills in caring for patients with chronic obstructive pulmonary disease. A video-based serious game prototype was developed. A purposeful sample of six participants tested and evaluated the prototype. Usability issues were identified regarding functionality and user-computer interface. However, overall the serious game was perceived to be useful, usable and likable to use.

Comprehension and Data-Sharing Behavior of Direct-To-Consumer Genetic Test Customers.

AIM: The aim of this study was to evaluate current direct-to-consumer (DTC) genetic customers' ability to interpret and comprehend test results and to determine if honest brokers are needed. METHOD: One hundred and twenty-two customers of the DTC genetic testing company 23andMe were polled in an online survey. The subjects were asked about their personal test results and to interpret the results of two mock test cases (type 2 diabetes and multiple sclerosis), where results were translated into disease probability for an individual compared to the public. RESULTS: When asked to evaluate the risk, 72.1% correctly assessed the first case and 77% were correct on the second case. Only 23.8% of those surveyed were able to interpret both cases correctly. x03C7;2 and logistic regression were used to interpret the results. Participants who took the time to read the DTC test-provided supplemental material were 3.93 times (p = 0.040) more likely to correctly interpret the test results than those who did not. The odds for correctly interpreting the test cases were 3.289 times (p = 0.011) higher for those who made more than USD 50,000 than those who made less. Survey results were compared to the Health Information National Trends Survey (HINTS) phase 4 cycle 3 data to evaluate national trends. CONCLUSIONS: Most of the subjects were able to correctly interpret the test cases, yet a majority did not share their results with a health-care professional. As the market for DTC genetic testing grows, test comprehension will become more critical. Involving more health professionals in this process may be necessary to ensure proper interpretations.

Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game.

BACKGROUND: Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care. AIMS: This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings. METHODS: A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom's taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics. RESULTS: The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user-computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings. CONCLUSIONS: Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user-computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process.

Forecasting the Spread of Mosquito-Borne Disease using Publicly Accessible Data: A Case Study in Chikungunya.

Mosquito-borne diseases account for multiple public health challenges in our modern world. The international health community has seen a number of mosquito-borne diseases come to the forefront in recent years, including West Nile virus, Chikungunya virus, and currently, Zika virus. Predicting the spread of mosquito-borne disease can aid early decision support for when and how to employ public health interventions within a community; however, accurate and fast predictions, months into the future, are difficult to achieve in urgent scenarios, particularly when little information is known about infection rates. New sources of information including social media have been proposed to accelerate the development of predictive models of disease progression. In this research, we adapted a previously described model for the spread of mosquito-borne disease using open intelligence sources. The novel implementation of a mixed-model for mosquito-borne disease was capable of being executed in minimal runtime. The results indicate that this model yields fast and relevant results with acceptable margins of error.

Experiences of Nursing Personnel Using PDAs in Home Health Care Services in Norwegian Municipalities.

Although nursing personnel have used personal digital assistants (PDAs) to support home health care services for the past ten years, little is known about their experiences. This study was conducted to examine experiences of nursing personnel using a specialized home health care computer software application called Gerica. In addition, this research analyzed how well this application aligned with the workflow of the nursing personnel in their daily care of patients. The evaluation methods included user observations and learnability testing. Nursing personnel from two different municipalities were observed while performing real tasks in natural settings. This study shows that the nursing personnel were satisfied with the PDA user interface and the Gerica software; however, they identified areas for improvement. For example, the nursing personnel were concerned about trusting the reliability of the PDA in order to eliminate the need for handwritten documentation. Solutions to meet these shortcomings for nursing managers and vendors are discussed.

The experiences of using a computerized decision support system.

The aim was to describe the facilitators and barriers influencing the ability of nursing personnel to effectively use a CDSS for planning and treating pressure ulcers and malnutrition in nursing homes. Usability evaluations and group interviews were conducted. Facilitators were ease of use, usefulness and a supportive work environment. Lack of training, resistance to using computers and limited integration of the CDSS with the electronic health record system were reported.

Evaluating the success of an emergency response medical information system.

OBJECTIVE: STATPack™ is an information system used to aid in the diagnosis of pathogens in hospitals and state public health laboratories. STATPack™ is used as a communication and telemedicine diagnosis tool during emergencies. This paper explores the success of this emergency response medical information system (ERMIS) using a well-known framework of information systems success developed by DeLone and McLean. METHOD: Using an online survey, the entire population of STATPack™ users evaluated the success of the information system by considering system quality, information quality, system use, intention to use, user satisfaction, individual impact, and organizational impact. RESULTS: The results indicate that the overall quality of this ERMIS (i.e., system quality, information quality, and service quality) has a positive impact on both user satisfaction and intention to use the system. However, given the nature of ERMIS, overall quality does not necessarily predict use of the system. Moreover, the user's satisfaction with the information system positively affected the intention to use the system. User satisfaction, intention to use, and system use had a positive influence on the system's impact on the individual. Finally, the organizational impacts of the system were positively influenced by use of the system and the system's individual impact on the user. CONCLUSIONS: The results of the study demonstrate how to evaluate the success of an ERMIS as well as introduce potential changes in how one applies the DeLone and McLean success model in an emergency response medical information system context.

The influence of user interface usability on rural consumers' trust of e-health services.

A critical challenge facing e-health care providers today is developing a web presence that not only compels the consumer, but also inspires trust. This research is the first empirical study that systematically investigates the influence User Interface (UI) usability factors have on establishing trust between e-health consumers and e-health service providers in the context of exchanging personal relationship-based information. The findings of this research suggest that UI usability factors are essential elements in conveying the trustworthiness of a web-based system and do affect consumers' perception of trust in personal relationship-based information exchanges.