HCI-modelling for improving the clinical usability of digital health technologies.

INTRODUCTION: Digital Health Technologies (DHTs) have been shown to have variable usability as measured by efficiency, effectiveness and user satisfaction despite large-scale government projects to regulate and standardise user interface (UI) design. We hypothesised that Human-Computer Interaction (HCI) modelling could improve the methodology for DHT design and regulation, and support the creation of future evidence-based UI standards and guidelines for DHTs. METHODOLOGY: Using a Design Science Research (DSR) framework, we developed novel UI components that adhered to existing standards and guidelines (combining the NHS Common User Interface (CUI) standard and the NHS Design System). We firstly evaluated the Patient Banner UI component for compliance with the two guidelines and then used HCI-modelling to evaluate the "Add New Patient" workflow to measure time to task completion and cognitive load. RESULTS: Combining the two guidelines to produce new UI elements is technically feasible for the Patient Banner and the Patient Name Input components. There are some inconsistencies between the NHS Design System and the NHS CUI when implementing the Patient Banner. HCI-modelling successfully quantified challenges adhering to the NHS CUI and the NHS Design system for the "Add New Patient" workflow. DISCUSSION: We successfully developed new design artefacts combing two major design guidelines for DHTs. By quantifying usability issues using HCI-modelling, we have demonstrated the feasibility of a methodology that combines HCI-modelling into a human-centred design (HCD) process could enable the development of standardised UI elements for DHTs that is more scientifically robust than HCD alone. CONCLUSION: Combining HCI-modelling and Human-Centred Design could improve scientific progress towards developing safer and more user-friendly DHTs.

Human factors in healthcare IT: Management considerations and trends.

A range of human factors issues are recognized as critical to the success of projects involving Health Information Technology (HIT). Problems related to the usability of HIT have come to the fore, with continued reports of systems that are non-intuitive and difficult to use and that may even pose safety risks. In this article, we consider a number of approaches from usability engineering and human factors that can be applied to improve the chances of system success and adoption. A range of methods focused around human factors can be employed throughout the system development cycle of HIT. The purpose of this article is to discuss human factors approaches that can be used to improve the likelihood of successful system adoption and also provide input into the selection and procurement process of HIT. The article concludes with recommendations regarding how understanding of human factors can be integrated into healthcare organizational decision making.

Health technology, quality and safety in a learning health system.

Health technology quality and safety is an important issue for health informatics (i.e. digital health) professionals. Health technologies have been used to (1) collect data that can be analyzed to improve the quality and safety of healthcare activities and (2) re-engineer and/or automate error-prone processes. Health technologies are also able to introduce new types of errors (i.e. technology-induced errors) and have been implicated in propagating errors across digital health ecosystems. To develop a learning health system, health technologies need to be considered in terms of how they can improve the quality and safety of health activities traditionally carried out by humans (patients and health professionals) and also how the technology's quality and safety can be improved. This article outlines how this can be done by integrating evidence from health informatics research into practice using a learning health systems approach.

Reinventing virtual care: Bridging the healthcare system and citizen silos to create an integrated future.

The pandemic has accelerated the move to virtual care. This has included remote monitoring and implementation of technologies that allow for patient care at home and assisted living for ageing in place. Technologies are available to help consumers to maintain their health and wellness. However, challenges associated with implementing virtual care remain. In this article, we describe some of these challenges, along with the need to develop new models for promoting effective and sustainable virtual care. This includes the need for integration of institutional efforts (eg, government and hospital) with emerging access to commercially available home technologies supplied to patients and citizens. The authors argue that consideration of a personal digital ecosystem and its relation to institutional digital health ecosystems is critical. The authors suggest virtual care be considered in the combined context of the person and healthcare system. Implications for future research directions for virtual care are discussed.

Improving the Usability and Safety of Digital Health Systems: The Role of Predictive Human-Computer Interaction Modeling.

In this paper, we describe techniques for predictive modeling of human-computer interaction (HCI) and discuss how they could be used in the development and evaluation of user interfaces for digital health systems such as electronic health record systems. Predictive HCI modeling has the potential to improve the generalizability of usability evaluations of digital health interventions beyond specific contexts, especially when integrated with models of distributed cognition and higher-level sociotechnical frameworks. Evidence generated from building and testing HCI models of the user interface (UI) components for different types of digital health interventions could be valuable for informing evidence-based UI design guidelines to support the development of safer and more effective UIs for digital health interventions.

Clinical simulation: A method for development and evaluation of clinical information systems.

Use of clinical simulation in the design and evaluation of eHealth systems and applications has increased during the last decade. This paper describes a methodological approach for using clinical simulations in the design and evaluation of clinical information systems. The method is based on experiences from more than 20 clinical simulation studies conducted at the ITX-lab in the Capital Region of Denmark during the last 5 years. A ten-step approach to conducting simulations is presented in this paper. To illustrate the approach, a clinical simulation study concerning implementation of Digital Clinical Practice Guidelines in a prototype planning and coordination module is presented. In the case study potential benefits were assessed in a full-scale simulation test including 18 health care professionals. The results showed that health care professionals can benefit from such a module. Unintended consequences concerning terminology and changes in the division of responsibility amongst healthcare professionals were also identified, and questions were raised concerning future workflow across sector borders. Furthermore unexpected new possible benefits concerning improved communication, content of information in discharge letters and quality management emerged during the testing. In addition new potential groups of users were identified. The case study is used to demonstrate the potential of using the clinical simulation approach described in the paper.

Diagnostic imaging ordering practices: physician perspectives and implications for decision support.

This study explored how referring physicians order diagnostic imaging (DI) services, and possible methods to reduce inappropriate ordering. Telephone interviews were conducted with non-radiologist physicians (general practitioners and specialists). Interview data were analyzed using grounded theory. Both appropriate and inappropriate DI ordering practices emerged as the overarching themes. Specifically, the majority of participants described their top methods of obtaining information support as (1) contacting another physician or (2) consulting the literature. Additionally, participants discussed contributing factors and solutions to inappropriate DI ordering, including clinical decision support systems. These results were used to inform the design of a DI decision support system prototype. This study explored ways to reduce inappropriate DI ordering and identified socio-technical factors that need to be considered when developing ways to mitigate this phenomenon. Promoting more appropriate ordering can improve patient safety and the responsible use of limited diagnostic imaging resources.

A Comprehensive Framework for Hospital@Home Care Models.

Hospital@home is a healthcare approach, where patients receive active treatment from health professionals in their own home for conditions that would normally necessitate a hospital stay. OBJECTIVE: To develop a framework of relevant features for describing hospital@home care models. METHODS: The framework was developed based on a literature review and thematic analysis. We considered 42 papers describing hospital@home care approaches. Extracted features were grouped and aggregated in a framework. RESULTS: The framework consists of nine dimensions: Persons involved, target patient population, service delivery, intended outcome, first point of contact, technology involved, quality, and data collection. The framework provides a comprehensive list of required roles, technologies and service types. CONCLUSION: The framework can act as a guide for researchers to develop new technologies or interventions to improve hospital@home, particularly in areas such as tele-health, wearable technology, and patient self-management tools. Healthcare providers can use the framework as a guide or blueprint for building or expanding upon their hospital@home services.

Canada's Digital Health Workforce: The Role of Innovation, Research and Policy.

The rapid growth of digital health and use of technology has led to an increased demand for qualified professionals in the areas of health informatics (HI) and health information management (HIM). This is reflected by the growth in the number of educational programs and graduates in these areas. However, to develop a culture of digital health innovation in Canada, the role of research needs to be critically examined. In this paper we discuss some of these issues around the relation between research and innovation, and the development of an innovation culture in health informatics, health information management and digital health in Canada. Recommendations for facilitating this development in terms of funding, granting and policy are also explored.

Empathetic and Emotive Design: A Scoping Review.

With the advent of the digital health era, there has emerged a new emphasis on collecting health information from patients and their families using technology platforms that are both empathetic and emotive in their design to meet the needs and situations of individuals, who are experiencing a health event or crisis. Digital empathy has emerged as an aspect of interactions between individuals and healthcare organizations especially in times of crises as more empathetic and emotive digital health platforms hold greater capacity to engage the user while collecting valuable health information that could be used to respond to the individuals' needs. In this paper we report on the results of a scoping review used to derive an initial set of evidence-based empathetic or emotive design heuristics.

Canadian employers' perspectives on a new framework for health informatics competencies.

Competencies are the knowledge, skills, and abilities needed to operate and perform successfully in the workplace. Due to the evolving nature of health informatics, it is important continuously examine and refine competencies in this field. In this study, we administered a questionnaire to Canadian employers (N = 29) of health informatics cooperative education (co-op) students to garner their feedback on competencies within a New Health Informatics Professional Competencies Framework. Overall, the findings supported this new framework. An average of ratings within each of the four competency categories revealed that participants perceived Management Science to be the most important, followed by Information & Computer Science, then Health Science and finally Data Science. Further, at least 20 (69 %) respondents rated nine of the 12 competencies as important. Of the 12 competencies, Biological and Clinical Science was rated the lowest. Findings from this study can potentially be used to inform curricula, career progression, and hiring practices in health informatics. Future work includes refining the questionnaire to assess the competencies more comprehensively and potentially exploring the importance of more transferable skills or general competencies (e.g., communication, problem-solving). Additionally, we want to survey a broader sample of health informatics professionals and integrate recent national and international work on health informatics competencies. Future work is also recommended towards the development of a maturity model for competencies of more experienced health informatics professionals.

Empathetic and Emotive Design Heuristics.

The design of user interfaces and systems that promote positive emotional interaction and reaction from end users is becoming a critical area in the design of applications and systems for use by the general population. In this paper we describe our work in the creation of a set of empathetic design heuristics that were developed from examination of the literature in this area within the context of healthcare user interface design. The heuristics and their potential application are explored.

Empathetic and Emotive Design Heuristics: Preliminary Results of Their Application to Evaluating Survey User Interfaces.

Empathetic and emotive design is becoming increasingly important in the digital age. In this research we describe the results of a combined cognitive walkthrough and heuristic evaluation using newly developed, empirically derived empathy or emotive design heuristics. We applied the heuristics to the evaluation of four commonly used survey platforms. Our preliminary findings revealed that the heuristics performed effectively in scoring survey platforms on their level of empathy. Survey platforms that are highly empathetic were scored highest.

Application of the Technological Pedagogical Content Knowledge framework in integrating an educational EMR into health informatics education.

The discipline of health informatics is highly immersed in information technology, specifically health information systems. Students graduating from Bachelor degree programs in health informatics are expected to be familiar with a variety of systems upon entering the workforce. The adoption of systems like electronic medical records is on the rise across Canada, therefore it would be highly beneficial for students to have exposure to such systems in their coursework. While some individual instructors have done this to some extent on an ad hoc basis, formal strategies for EMR integration do not exist. A prominent framework for technology integration in learning that has been applied in many scientific disciplines is the Technological Pedagogical Content Knowledge (TPCK) framework. This paper describes how TPCK was used and applied as the guiding conceptual framework for exploring the integration of an educational EMR into undergraduate health informatics education.

Tailoring decision support to suit user needs: a diagnostic imaging example.

Unnecessary diagnostic imaging (DI) examinations raise concerns for patient safety and place stress on human and financial resources. To reduce unnecessary DI examinations, several Canadian pilot studies have investigated how decision support systems (DSS) could be utilized. Based on interview results from our previous research, in addition to a literature review, themes emerged that influenced the features and design of a DI DSS prototype. Features include having the referring professional indicate how the results of the examination will be utilized (i.e. for diagnosis or patient management), increasing communication between referring physicians/nurse practitioners and radiologists, and displaying previous DI examinations (or orders that are scheduled to take place) to avoid duplicate orders. Presenting a patient's cumulative radiation exposure, and having resources for information support to guide physicians through challenging clinical decisions are two other features included in the DSS prototype. By incorporating physician perspectives and current literature into the design, this DSS aims to promote the appropriate use of DI resources by supporting physicians and nurse practitioners in their DI ordering practices.

Commercial versus in-situ usability testing of healthcare information systems: towards "public" usability testing in healthcare organizations.

The need for improved usability in healthcare IT has been widely recognized. In addition, methods from usability engineering, including usability testing and usability inspection have received greater attention. Many vendors of healthcare software are now employing usability testing methods in the design and development of their products. However, despite this, the usability of healthcare IT is still considered to be problematic and many healthcare organizations that have purchased systems that have been tested at vendor testing sites are still reporting a range of usability and safety issues. In this paper we explore the distinction between commercial usability testing (conducted at centralized vendor usability laboratories and limited beta test sites) and usability testing that is carried out locally within healthcare organizations that have purchased vendor systems and products (i.e. public "in-situ" usability testing). In this paper it will be argued that both types of testing (i.e. commercial vendor-based testing) and in-situ testing are needed to ensure system usability and safety.

Developing national level informatics competencies for undergraduate nurses: methodological approaches from Australia and Canada.

Health information systems are being implemented in countries by governments and regional health authorities in an effort to modernize healthcare. With these changes, there has emerged a demand by healthcare organizations for nurses graduating from college and university programs to have acquired nursing informatics competencies that would allow them to work in clinical practice settings (e.g. hospitals, clinics, home care etc). In this paper we examine the methods employed by two different countries in developing national level nursing informatics competencies expected of undergraduate nurses prior to graduation (i.e. Australia, Canada). This work contributes to the literature by describing the science and methods of nursing informatics competency development at a national level.

Decision Aids for Patients With Head and Neck Cancer: Qualitative Elicitation of Design Recommendations From Patient End Users.

BACKGROUND: Patients with head and neck cancer (HNC) carry a clinically significant symptom burden, have alterations in function (eg, impaired ability to chew, swallow, and talk), and decrease in quality of life. Furthermore, treatment impacts social activities and interactions as patients report reduced sexuality and shoulder the highest rates of depression across cancer types. Patients suffer undue anxiety because they find the treatment incomprehensible, which is partially a function of limited, understandable information. Patients' perceptions of having obtained adequate information prior to and during treatment are predictive of positive outcomes. Providing patient-centered decision support and utilizing visual images may increase understanding of treatment options and associated risks to improve satisfaction with their decision and consultation, while reducing decisional conflict. OBJECTIVE: This study aims to gather requirements from survivors of HNC on the utility of key visual components to be used in the design of an electronic decision aid (eDA) to assist with decision-making on treatment options. METHODS: Informed by a scoping review on eDAs for patients with HNC, screens and visualizations for an eDA were created and then presented to 12 survivors of HNC for feedback on their utility, features, and further requirements. The semistructured interviews were video-recorded and thematically analyzed to inform co-design recommendations. RESULTS: A total of 9 themes were organized into 2 categories. The first category, eDAs and decision support, included 3 themes: familiarity with DAs, support of concept, and versatility of the prototype. The second category, evaluation of mock-up, contained 6 themes: reaction to the screens and visualizations, favorite features, complexity, preference for customizability, presentation device, and suggestions for improvement. CONCLUSIONS: All participants felt an eDA, used in the presence of their oncologist, would support a more thorough and transparent explanation of treatment or augment the quality of education received. Participants liked the simple design of the mock-ups they were shown but, ultimately, desired customizability to adapt the eDA to their individual information needs. This research highlights the value of user-centered design, rooted in acceptability and utility, in medical health informatics, recognizing cancer survivors as the ultimate knowledge holders. This research highlights the value of incorporating visuals into technology-based innovations to engage all patients in treatment decisions.

Digital health as an enabler for hospital@home: A rising trend or just a vision?

Background: Hospital@home is a model of healthcare, where healthcare professionals actively treat patients in their homes for conditions that may otherwise require hospitalization. Similar models of care have been implemented in jurisdictions around the world over the past few years. However, there are new developments in health informatics including digital health and participatory health informatics that may have an impact on hospital@home approaches. Objectives: This study aims to identify the current state of implementation of emerging concepts into the hospital@home research and models of care; to identify strengths and weaknesses, opportunities, and threats associated with the models of care; and to suggest a research agenda. Methods: We employed two research methodologies, namely, a literature review and a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The literature from the last 10 years was collected from PubMed using the search string "hospital at home" OR "care at home" OR "patient at home." Relevant information was extracted from the included articles. Results: Title and abstract review were conducted on 1,371 articles. The full-text review was conducted on 82 articles. Data were extracted from 42 articles that met our review criteria. Most of the studies originated from the United States and Spain. Several medical conditions were considered. The use of digital tools and technologies was rarely reported. In particular, innovative approaches such as wearables or sensor technologies were rarely used. The current landscape of hospital@home models of care simply delivers hospital care in the patient's home. Tools or approaches from taking a participatory health informatics design approach involving a range of stakeholders (such as patients and their caregivers) were not reported in the literature reviewed. In addition, emerging technologies supporting mobile health applications, wearable technologies, and remote monitoring were rarely discussed. Conclusion: There are multiple benefits and opportunities associated with hospital@home implementations. There are also threats and weaknesses associated with the use of this model of care. Some weaknesses could be addressed by using digital health and wearable technologies to support patient monitoring and treatment at home. Employing a participatory health informatics approach to design and implementation could help to ensure the acceptance of such care models.

Updating professional competencies in health informatics: A scoping review and consultation with subject matter experts.

INTRODUCTION: The discipline of health informatics emerged to address the need for uniquely skilled professionals to design, develop, implement, and evaluate health information technology. Core competencies are an essential pre-requisite for establishing a professional discipline such as health informatics. In 2012, Digital Health Canada released a framework (DHC Framework) for Canadian health informatics competencies. Multiple perspectives on health informatics competencies have evolved to reflect global and unique country contexts. In this paper, we will describe a two-phase study in which we ultimately developed a new framework for health informatics competencies. METHODS: In Phase 1, we conducted a scoping review of to identify health informatics competencies from research articles and grey literature from professional associations. Of 1038 articles identified in the search, ultimately 38 met our inclusion criteria and were subject to in-depth analysis. We summarized our findings from this phase into a preliminary framework of health informatics competencies and then in Phase 2, we shared these findings with subject matter experts (SMEs; N = 5) to garner their feedback. The SMEs were all instructors in health informatics in Canada and held various roles (director, professor, advisor, and co-operative education coordinator). We used their insights into the current and forecasted Canadian health informatics landscape to iteratively develop a new framework until we achieved consensus amongst the subject matter experts. RESULTS: In Phase 1, all competencies of the DHC Framework were supported by the literature. However, we also identified two emergent competencies: Human Factors and Data Science. In Phase 2, consultations with SMEs guided the introduction of one new competency category and seven new competencies. One competency was renamed and two were removed from the DHC Framework. Additionally, we added new terms that encompass the framework and labelled the core of the framework Health Informatics Professionalism. DISCUSSION: We found that the DHC Framework did not capture all necessary competencies required by health informatics professionals. Based on the literature and consultations with SMEs, we extended the DHC Framework to better reflect the current Canadian context and propose a new Health Informatics Core Competencies Framework. The new framework can be used to inform Canadian health informatics programs to ensure graduates are equipped for careers in health informatics. Future work includes validating the new framework with Canadian health informatics employers to assess whether this new framework adequately reflects their needs, and more detail may be required to define specific skills necessary in each competency.