Presentation of laboratory test results in patient portals: influence of interface design on risk interpretation and visual search behaviour.

BACKGROUND: Patient portals are considered valuable instruments for self-management of long term conditions, however, there are concerns over how patients might interpret and act on the clinical information they access. We hypothesized that visual cues improve patients' abilities to correctly interpret laboratory test results presented through patient portals. We also assessed, by applying eye-tracking methods, the relationship between risk interpretation and visual search behaviour. METHODS: We conducted a controlled study with 20 kidney transplant patients. Participants viewed three different graphical presentations in each of low, medium, and high risk clinical scenarios composed of results for 28 laboratory tests. After viewing each clinical scenario, patients were asked how they would have acted in real life if the results were their own, as a proxy of their risk interpretation. They could choose between: 1) Calling their doctor immediately (high interpreted risk); 2) Trying to arrange an appointment within the next 4 weeks (medium interpreted risk); 3) Waiting for the next appointment in 3 months (low interpreted risk). For each presentation, we assessed accuracy of patients' risk interpretation, and employed eye tracking to assess and compare visual search behaviour. RESULTS: Misinterpretation of risk was common, with 65% of participants underestimating the need for action across all presentations at least once. Participants found it particularly difficult to interpret medium risk clinical scenarios. Participants who consistently understood when action was needed showed a higher visual search efficiency, suggesting a better strategy to cope with information overload that helped them to focus on the laboratory tests most relevant to their condition. CONCLUSIONS: This study confirms patients' difficulties in interpreting laboratories test results, with many patients underestimating the need for action, even when abnormal values were highlighted or grouped together. Our findings raise patient safety concerns and may limit the potential of patient portals to actively involve patients in their own healthcare.

Individual Factors Influencing the Public's Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey.

BACKGROUND: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. OBJECTIVE: This study aimed to assess what were the main individual factors influencing people's perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. METHODS: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants' perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents' lifestyle and sociodemographic characteristics. RESULTS: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (ß=0.2564; P<.001) and felt safer if vaccinated (ß=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed (ß=-0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic (ß=-0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. CONCLUSIONS: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher.

Why 'one size fits all' is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey.

OBJECTIVES: The present study explored public's willingness to use COVID-19 immunity certificates across six different domestic scenarios. DESIGN: Cross-sectional online survey. SETTING: UK representative survey conducted on 3 August 2021. PARTICIPANTS: 534 UK residents over 18 years old. INTERVENTIONS: Participants replied to the same set of questions. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents' sociodemographic characteristics. RESULTS: Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle. CONCLUSIONS: The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.

A Collaborative Decision Support Tool for Managing Chronic Conditions.

This paper describes work to assess the feasibility of using a decision support tool to help patients with chronic conditions, specifically stroke, manage their condition in collaboration with their carers and the health care professionals who are looking after them. The system contains several novel elements: the integration of data from commercial wellness sensors, electronic health records and clinical guidelines; the use of computational argumentation to track the source of data and to resolve conflicts and make recommendations; and argumentation-based dialogue to support interaction with patients. The proposed approach is implemented as an application that can run on smart devices (e.g. tablets). The users have personalised dashboards where they can visualise their health data and interact with a conversational chatbot that provides further explanations about their overall well-being.

The influence of patient portals on users' decision making is insufficiently investigated: A systematic methodological review.

BACKGROUND: Patient portals are considered valuable conduits for supporting patients' self-management. However, it is unknown why they often fail to impact on health care processes and outcomes. This may be due to a scarcity of robust studies focusing on the steps that are required to induce improvement: users need to effectively interact with the portal (step 1) in order to receive information (step 2), which might influence their decision-making (step 3). We aimed to explore this potential knowledge gap by investigating to what extent each step has been investigated for patient portals, and explore the methodological approaches used. METHODS: We performed a systematic literature review using Coiera's information value chain as a guiding theoretical framework. We searched MEDLINE and Scopus by combining terms related to patient portals and evaluation methodologies. Two reviewers selected relevant papers through duplicate screening, and one extracted data from the included papers. RESULTS: We included 115 articles. The large majority (n = 104) evaluated aspects related to interaction with patient portals (step 1). Usage was most often assessed (n = 61), mainly by analysing system interaction data (n = 50), with most authors considering participants as active users if they logged in at least once. Overall usability (n = 57) was commonly assessed through non-validated questionnaires (n = 44). Step 2 (information received) was investigated in 58 studies, primarily by analysing interaction data to evaluate usage of specific system functionalities (n = 34). Eleven studies explicitly assessed the influence of patient portals on patients' and clinicians' decisions (step 3). CONCLUSIONS: Whereas interaction with patient portals has been extensively studied, their influence on users' decision-making remains under-investigated. Methodological approaches to evaluating usage and usability of portals showed room for improvement. To unlock the potential of patient portals, more (robust) research should focus on better understanding the complex process of how portals lead to improved health and care.

Patient Portal Adoption Rates: A Systematic Literature Review and Meta-Analysis.

Despite the increasing availability of online patient portals that provide access to electronic health records, little is known about their adoption by patients. We systematically reviewed the literature to investigate adoption of patient portals across studies. We searched MEDLINE and Scopus to identify relevant papers. We included 40 studies: 24 were controlled experiments, with prospective data collection in an actively recruited population; 16 were real-world experiments, with adoption being evaluated retrospectively after system deployment in clinical practice. Our meta-analysis showed an overall mean adoption rate of 52% (95% Confidence Interval [CI], 42 to 62%). Rates differed markedly between study types: controlled experiments yielded a mean adoption rate of 71% (95% CI 64 to 79%), compared to 23% (95% CI, 13 to 33%) in real-world experiments. This difference was confirmed in a meta-regression analysis of the influence of study characteristics on adoption rates. Our findings suggest that adoption rates reported in controlled studies do not reflect those in everyday clinical practice. Until we understand how to effectively increase adoption, patient portals are unlikely to consistently lead to improvements in care processes and health outcomes.

Verbal protocols for assessing the usability of clinical decision support: the retrospective sense making protocol.

We compare the effectiveness of two types of verbal protocol, concurrent think aloud vs. retrospective sense making, for evaluating the usability of a clinical decision support tool. Thirty-five medical and nursing students participated in a usability experiment. Participants were asked to complete seven tasks using the system under evaluation. Eighteen students were allocated to the concurrent think aloud group and the remainder followed the retrospective protocol. The retrospective protocol was significantly more sensitive than the concurrent protocol in recording unique usability problems related to users' cognitive behaviour. These problems concerned the interpretation and comprehension of statistical output, search results and system messages. These findings can be explained by the retrospective protocol's greater ability to detect compound usability problems, capturing the cognitive dimensions of users' interactions with the interface in greater depth. Evaluations of clinical decision support systems should take an evidence-based approach to selecting protocols.

e-Labs and the stock of health method for simulating health policies.

Regional outcomes of national health policies are difficult to forecast. This is partly due to a lack of realistically complex models that can be used to appraise policy options and partly a lack of accessible and adaptable tools that can be used to simulate the consequences of policy decisions. These barriers might be overcome by exploiting the commoditization of massively parallel computing architectures, advances in machine learning, and the increased availability of large-scale linked healthcare data. This paper presents a novel modelling methodology, The Stock of Health, for harnessing emerging data and computational resources to simulate health policy, with application initially to coronary heart disease. We detail the use of multi-core graphical processing architectures to facilitate a micro-simulation approach. The simulation tools have been deployed through the IMPACT Framework. We explore how this framework can be extended to support the sharing and reuse of policy models and simulations based on the digital publishing concept of e-Lab.