Appendix: Summary of Best Papers Selected for the 2019 Edition of the IMIA Yearbook,
Section HFOI
Couture B, Lilley E, Chang F, DeBord Smith A, Cleveland J, Ergai A, Katsulis Z, Benneyan
J, Gershanik E, Bates DW, Collins SA
Applying user-centered design methods to the development of an mHealth application
for use in the hospital setting by patients and care partners
Appl Clin Inform 2018 Apr;9(2):302-12
M-Health applications are increasingly being used in the hospital setting, yet there
is a need for more research around patient/ care partner usability needs in the hospital
setting. The learning opportunities that e-Health tools for inpatient use open up
for researchers and health care systems are numerous and can help provide a new source
of information on patients and their care partners. In developing e-Health tools,
it is important to remember that hospitalized patients have different characteristics
than the general population, and within a given population of hospitalized patients
there can be wide variation of socioeconomic status, baseline use of technology, and
literacy and e-Health literacy levels. Care partners of hospitalized patients may
experience emotional stress and increased learning needs related to their loved one’s
hospitalization. These emotional and situational factors add to the importance of
conducting participatory design when developing an m-Health app for hospitalized patients
and their families. Participatory design with end users may lead moreover to better
engagement, and it is reported that more engaged patients have better outcomes, shorter
length of stay, and decreased costs as compared with less engaged patients.
This article describes the usability testing conducted with hospitalized patients
and care partners for the iterative design and refinement of the patient and care
partner facing the components of a web-based and mobile-enabled safety reporting application
that facilitates real-time communication of concerns and worrisome events from hospitalized
patients and care partners to clinical staff.
Miller A, Koola JD, Matheny ME, Ducom JH, Slagle JM, Groessl EJ, Minter FF, Garvin
JH, Weinger MB, Ho SB
Application of contextual design methods to inform targeted clinical decision support
interventions in sub-specialty care environments
Int J Med Inform 2018 Sep;117:55-65
Recent studies suggest that gaps and discontinuities from omitted or inappropriate
patient care are common, and can result in increased costs due to higher readmission
rates, and increased disease-related morbidities. Computerized clinical decision support
(CCDS) interventions that are integrated into electronic health records (EHRs) may
reduce discontinuities by presenting evidence-based guidelines at the point-of care.
However, CCDS systems have not fully demonstrated their value in terms of improved
care quality or safety. A commonly reported failing is CCDS’ ’poor fit’ to clinicians’
work and decision needs. The purposes of this study were to better understand physicians’
inpatient and outpatient work and decision needs, and to translate them into user
interface (UI) design guidelines.
Using HF design approaches, the authors focused on where and how CCDS might be integrated
within this environment. Their findings elucidate some characteristics of clinical
work that have received little attention in CCDS literature. The most significant
of these is the finding that clinical decision making is distributed across roles
and over time. In addition, decision-making is iterative, with each role filtering,
prioritizing, and aggregating information to enhance clarity and direction. Based
on these findings, guidelines for CCDS UI design are proposed to efficiently support
collective and iterative decision-making.
Tamblyn R, Winslade N, Lee TC, Motulsky A, Meguerditchian A, Bustillo M, Elsayed S,
Buckeridge DL, Couture I, Qian CJ, Moraga T, Huang A
Improving patient safety and efficiency of medication reconciliation through the development
and adoption of a computer assisted tool with automated electronic integration of
population-based community drug data: the RightRx project
J Am Med Inform Assoc 2018 May 1;25(5):482-95
Many countries recommend or require hospitals to implement medication reconciliation
at admission, transfer, and discharge for accreditation as a means of reducing medication
errors and avoidable morbidity and improving patient safety. One of the most challenging
and time-consuming aspects of medication reconciliation is accurately and reliably
documenting the community drug list. The authors developed a web-based software application
to semi-automate the medication reconciliation process by prepopulating the community
and hospital medication lists using a regional clinical data repository and the local
hospital pharmacy system. System development followed user-centered design and an
agile development process. They performed a cluster randomized trial to evaluate whether
the use of the given system increased medication reconciliation completion rates and
reported on the technical, professional, and medicolegal issues encountered in its
deployment and use. The authors used a clinical adoption framework to classify challenges
encountered in implementation, thus considering the sociotechnical aspects of health
care organizations at the macro, meso, and micro levels.
Tscholl DW, Handschin L, Neubauer P Weiss M, Seifert B, Spahn DR, Noethiger CB
Using an animated patient avatar to improve perception of vital sign information by
anaesthesia professionals
Br J Anaesth 2018 Sep;121(3):662-71
Situation awareness enables healthcare providers to correctly diagnose patient condition
and make informed clinical decisions. This might help care providers avoid errors
and improve patient safety. The authors developed a novel technology designed to improve
perception of vital sign information. To optimize the information gained from checking
a monitor, they developed an animated patient avatar to create an interface that transmits
the current status of vital signs to care providers as quickly as possible and with
minimal cognitive effort, which has been described as the goal for successful situation
awareness design. The study completed a comprehensive iterative development process
of the avatar and afterwards compared the final version with conventional monitoring.
The study provides some first empirical evidence that when anesthesia providers scan
patient monitors in real-life patient care, the avatar technology almost doubled the
number of perceived vital signs, improved care provider confidence, and reduced perceived
workload. Participants achieved these results after only watching an educational video
explaining the avatar, which suggests quick learnability and potential for real-life
usability.
