Health Information Technology Design Research Articles

Designing for caregiving networks: a case study of primary caregivers of children with medical complexity.

The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child's caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare. We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT. Thematic analysis identified 8 themes characterizing a wide range of primary caregivers' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network. Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user. This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.

College students and patient work: Health information management by emerging young adults

College students with a life experience of chronic illness and impairments grow into young adulthood as health information monitors as well as communicators with healthcare professionals. This interview study focused on the health information management practices of college and graduate students living with disabilities and chronic illness. SEIPS (Systems Engineering Initiative for Patient Safety), a work system model drawn from human factors engineering, was used as a conceptual framework for qualitative analysis. This revealed the importance of other people, particularly parents, in patients' information worlds. Digital technologies were ubiquitous; analog tools from business cards to binders were also key components of students' information systems. Using the SEIPS structure to interrogate the data allowed an understanding of how health experiences are integrated into everyday life. The findings of this research may provide health information technology designers and information science researchers insight into how to meet the needs of this population.

User-Centered Design of a Clinical Tool for Shared Decision-making About Diet in Primary Care.

Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice.

Human-centered design of team health IT for pediatric trauma care transitions

BackgroundAs problems of acceptance, usability and workflow integration continue to emerge with health information technologies (IT), it is critical to incorporate human factors and ergonomics (HFE) methods and design principles. Human-centered design (HCD) provides an approach to integrate HFE and produce usable technologies. However, HCD has been rarely used for designing team health IT, even though team-based care is expanding. ObjectiveTo describe the HCD process used to develop a usable team health IT (T3 or Teamwork Transition Technology) that provides cognitive support to pediatric trauma care teams during transitions from the emergency department to the operating room and the pediatric intensive care unit. MethodsThe HCD process included seven steps in three phases of analysis, design activities and feedback. ResultsThe HCD process involved multiple perspectives and clinical roles that were engaged in inter-related activities, leading to design requirements, i.e., goals for the technology, a set of 47 information elements, and a list of HFE design principles applied to T3. Results of the evaluation showed a high usability score for T3. ConclusionsHFE can be integrated in the HCD process through a range of methods and design principles. That design process can produce a usable technology that provides cognitive support to a large diverse team involved in pediatric trauma care transitions. Future research should continue to focus on HFE-based design of team health IT.

Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists: Workflow Analysis Based on Semistructured Interviews.

BackgroundThe hospitalist workday is cognitively demanding and dominated by activities away from patients’ bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use.ObjectiveThe purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists’ workflows. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists’ perspectives on mobile technology and apps.MethodsWe conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas.ResultsOver 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized.ConclusionsBased on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists’ workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists’ memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine.

Identifying the mechanisms that contribute to safe and effective electronic test result management systems- a multisite qualitative study.

Suboptimal design of health information technology (IT) systems can lead to the introduction of errors in the diagnostic process. We aimed to identify mechanisms that can affect the safety and effectiveness of these systems in hospital settings thus contributing to the building of an explicit and replicable understanding of the variables that can affect the functioning of IT systems. This qualitative study drew from observations and semistructured interviews from a purposive sample of 46 participants (26 emergency department and 20 laboratory and medical imaging staff) across 3 Australian hospitals. Iterative, inductive coding of the data led to the development of higher-level themes based on relationships between codes. Two overarching themes emerged: (1) usability and safety of the electronic test result management system; and (2) system redesign considerations about who is meant to follow up, when and how. The usability and safety of digital systems and the way these systems deal with accountability processes are triggered by mechanisms that are contextually dependent. Our findings highlighted the multitransactional nature of the test result management process involving numerous healthcare professionals across different settings. This communication requires integration of the systems utilized by different departments and transparency of the test result follow-up process to facilitate clear lines of responsibility and accountability. Identifying mechanisms that shape the functionality and sustainability of electronic result management can offer a valuable appreciation of key elements that need to be accounted for, and the circumstances in which they need to operate effectively.

50048 Closing the cross-institutional referral loop: Assessment of consultation note quality

ABSTRACT IMPACT: Results will inform the design of health information technologies that assess and improve clinicians’ interpersonal communication supporting co-management of care across health institutions. OBJECTIVES/GOALS: Poor communication and co-management of comorbidities during the referral process increase physician workload, patient burden, and safety risks. In this preliminary study, our objective was to understand how consultants’ notes support physician collaboration within and across health care institutions. METHODS/STUDY POPULATION: We reviewed medical records. Accessing the Indiana Network for Patient Care database, consultation notes were randomly selected from four specialties: cardiothoracic surgery, neurology, rheumatology, and oncology. These specialties were identified, in advance, as challenging in interprofessional communication. The notes reviewed were associated with in-person consultations at a medical network in the Midwest from 2016 to 2019, including internal and cross-institutional (i.e., external) referrals. The Quality of Consult Assessment tool was adapted to assess note quality and co-management facilitation. Two researchers reviewed all records independently. A consensus meeting was then held to discuss and resolve discrepancies. RESULTS/ANTICIPATED RESULTS: Medical records of ten patients with comorbidities were reviewed. The mean age was 67 (SD= 12 years); one patient was a child. All consultation notes contained clinical recommendations. Seventy percent of notes referred to explicit consultant responsibilities. Conversely, only one contained explicit responsibilities for referrers. Medical records denoted reliance on support staff to send messages among referrers, consultants, and patients via phone calls and facsimile. The use of fax machines to send medical records to referrers was more prominent after cross-institutional consultations. DISCUSSION/SIGNIFICANCE OF FINDINGS: Clinical documentation supported specialty referrals for transitions of care rather than co-management of care. Accessing medical records across institutions contributed to a lack of clinical context, and workflow inefficiencies, when attempting to co-manage clinical care.

Moving toward a sociotechnical systems approach to continuous health information technology design: the path forward for improving electronic health record usability and reducing clinician burnout.

Based on our analysis of descriptions provided by four EHR vendors on their EHR usability efforts, we provide three recommendations aimed at improving the usability of health information technology and reducing clinician burnout. First, EHR vendors need to dedicate increased attention to the design of the entire sociotechnical (work) system, including the EHR technology and its usability as well as the interactions of the technology with other system elements. Second, EHR vendors need to deepen and broaden their understanding of the work of clinicians and care teams by using diverse and mixed method. Third, in collaboration with health care organizations, EHR vendors should engage in cycles of continuous design and learning in order to improve the usability of health IT.

Patient Perspectives on Health Data Privacy and Implications for Adverse Drug Event Documentation and Communication: Qualitative Study.

BackgroundAdverse drug events are unintended and harmful effects of medication use. Using existing information and communication technologies (ICTs) to increase information sharing about adverse drug events may improve patient care but can introduce concerns about data privacy.ObjectiveThis study aims to examine the views of patients and their caregivers about data protection when using ICTs to communicate adverse drug event information to improve patient safety.MethodsWe conducted an exploratory qualitative study. A total of 4 focus groups were held among patients who had experienced or were at risk of experiencing an adverse drug event, their family members, and their caregivers. We recruited participants through multiple avenues and iteratively analyzed the data using situational analysis.ResultsOf the 47 participants recruited, 28 attended our focus groups. We identified 3 primary themes. First, participants felt that improved information sharing about adverse drug events within their circle of care would likely improve care. Second, participants were concerned about data handling and inappropriate access but believed that the benefits of information sharing outweighed the risks of privacy breaches. Finally, participants were more concerned about data privacy in the context of stigmatized health conditions.ConclusionsCurrent conditions for maintaining health data privacy are consistent with participants’ preferences, despite the fact that health data are susceptible to breaches and mismanagement. Information sharing that increases patient safety may justify potential privacy risks. Greater attention to patient concerns and the effect of social and contextual concerns in the design and implementation of health information technologies may increase patient confidence in the privacy of their information.

Proceedings of the 11th Conference on Health IT & Analytics

The Conference on Health IT and Analytics (CHITA) is an annual health information technology and analytics research summit, including a doctoral consortium that each year gathers prominent scholars from more than 40 research institutes, and leading policy and practitioner attendees in a vibrant setting to discuss opportunities and challenges in the design, implementation and management of health information technologies and advanced analytics including artificial intelligence and machine learning systems. CHITA’s goal is to deepen our understanding of strategy, policy and systems fostering health IT and analytics effective use, to stimulate new ideas with both policy and business implications, and to support the development of a health IT and healthcare advanced analytics research agenda. These Proceedings of the 11th Conference on Health IT & Analytics (CHITA 2020) represent the work of 45 papers and 146 authors working on the digitally-enabled future of healthcare. Convened by the Center for Health Information & Decision Systems (CHIDS), support for CHITA is provided by the Robert H. Smith School of Business, the University of Michigan School of Public Health, and the U.S. Agency for Healthcare Research and Quality.

Tracking the impact of nursing informatics

FigureToday's healthcare environment relies on nurses to deliver and manage care while keeping patients safe. Nurses need timely, accurate, and accessible data and information to make the right decisions to improve patient outcomes. Communication is an essential tool and nurses need appropriate access to patient information, including medical histories, medication lists, lab and imaging results, and clinician notes, to understand a patient's clinical status. Much of our current communication is in an electronic format, which requires new skills to ensure that health information is accurate, easy to use and understand, and accessible whenever and wherever it's needed. Nurse informaticists play an essential role in the design and use of health information technology (IT), including devices that enable clinicians to track data and deliver safe and efficient care. According to the American Nurses Association, nursing informatics is the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. The contribution of nurse informaticists in developing and improving technology, such as electronic medical records (EMRs) and clinical decision support (CDS), is essential for reducing medical errors, patient care delays, and healthcare costs. The expanding use of health IT and devices has led to new career opportunities, including the specialty of nursing informatics. Building on the foundation of the nursing process, informatics nurses apply their understanding of IT to assist the healthcare team in managing data and assimilating increasingly complex information to achieve the desired outcomes. The Healthcare Information and Management Systems Society (HIMSS) is a nonprofit professional society whose mission is to reform the global health ecosystem through the power of information and technology. HIMSS sponsors a vibrant nursing informatics community, which has grown to represent over 8,000 nurse informaticists, working in a wide variety of roles and settings. These roles build on functional areas that require informatics skills, including education, leadership and administration, consultation, systems analysis and design, policy development, quality and performance improvement, research, and evaluation.FigureSince 2004, HIMSS has tracked nursing informatics workforce data to assess the evolving status of the specialty. The HIMSS 2020 Nursing Informatics Workforce Survey continues to show that nurse informaticists play a crucial role in healthcare. Just as the continuum of care has expanded beyond the walls of the hospital, nursing informatics has expanded its scope to welcome innovation into its practice. Virtual care, mobile devices, and point-of-care CDS are among the many new tools and technologies in use today. The specialty of nursing informatics has followed this high-tech trajectory by managing increasingly sophisticated applications, performing expanded job roles, experiencing increased salaries, and achieving advanced educational preparation. Methodology An email invitation, with a link to the web-based survey, was sent to nurse informaticists in November and December 2019. Invitations to participate in the survey were also distributed by organizations that sponsored and supported the research, including the Alliance for Nursing Informatics—a collaboration of organizations representing more than 20,000 nurse informaticists, bringing together 25 distinct nursing informatics groups globally. One-thousand three-hundred and fifty-nine usable responses were received (see HIMSS Nursing Informatics Workforce Survey infographic). In comparison, the 2017 survey received 1,279 responses; the 2014 survey, 1,047; and the 2011 survey, 660. To reflect current workforce trends, new questions and response options were added in 2020. Respondents Over two-thirds (68%) of the 1,359 survey respondents work for a hospital or multifacility health system. Most of the remaining respondents work for a vendor/payer, government or military organization, or in an academic setting. Ambulatory informatics roles are increasing, with 6% of respondents reporting that the ambulatory environment is their primary workplace. The 2020 survey captured workforce data from a global audience, with 94 respondents reporting that they work primarily outside of the US. Distribution of nurse informaticists across the US in 2020 roughly matches the distribution of the population. Of note, more than half (53%) work at a Magnet®-recognized hospital, and 41% work at a HIMSS Electronic Medical Record Adoption Model Stage 6/7 hospital. These organizational achievements may correlate with the increased value of nursing informatics in overall health system accomplishments. Education. The 2020 survey reflected an increase in the percentage of respondents (62%) who have a master's degree in nursing (24%), nursing informatics (27%), or some other field (11%). In comparison, 59% of respondents reported having a master's degree in any field in 2017. This may correlate with the percentage of survey respondents who have increasing salaries and expanded leadership roles. Nurse informaticists with higher levels of formal education tend to have higher salaries; 61% of PhD or equivalent degree holders have a salary of over $100,000 compared with just 38% of those with a bachelor's degree. Nursing background. In terms of respondents' clinical experience before becoming a nurse informaticist, more respondents (25%) indicated that they have 6 to 10 years of clinical experience than in 2017 (22%). However, there was a noticeable decline in the number of respondents reporting having more than 20 years of experience at the bedside, from 26% in 2011 to 19% in 2020. Top areas of experience included medical-surgical (42%), critical care (33%), and administration (21%). Leadership. Noteworthy from this year's survey is the number of respondents (41%) whose organizations currently have a formal chief nursing informatics officer (CNIO) or senior nursing informatics officer role (see What's a CNIO?). Along with this increasing leadership status, salaries continue to rise, with nearly half (49%) of respondents making more than $100,000 per year. In 2020, 10% of respondents reported holding the title of manager of clinical informatics compared with just 1% in 2017. The percent of director-level respondents increased as well: 11% compared with 7% in 2017. Still, most respondents (24%) stated that their title is nursing informatics specialist, a small increase over 20% in 2017. This year's survey results also showed a significant change in reporting structure, with more nurse informaticists reporting to nursing (40%), quality (12%), and operations (9%) over the historical trend of reporting to IT (48%). Job responsibilities. The top job responsibilities of nurse informaticists continue to be systems implementation (44%) and systems utilization/optimization (41%). Although systems development remains ranked in the top three job responsibilities, only 34% of respondents reported currently working in this area. Because EMRs are more pervasive in 2020 than in previous survey time frames, this may be driving the focus on utilization/optimization of existing systems over new systems development. About a third (36%) of respondents manage at least one direct report, with 19% managing between one and five employees. Another 8% manage six to 10 employees. This year's job responsibilities data included two new categories: project management (30%) and change/control management (26%). Other key findings Applications. The 2020 survey highlights a trend over time as nurse informaticists are increasingly working with point-of-care CDS (44%) and decreasingly working with nursing clinical documentation (67%). Other applications that they're developing, implementing, or optimizing include EMRs (69%), computer-based provider order entry (40%), and electronic medication administration records (38%). Barriers to success. Over the history of the survey, there's been a shift in the identified barriers to success for the nurse informaticist. In the 2004 and 2007 surveys, respondents identified the lack of financial resources as the top barrier, whereas in 2011 it was the lack of integration and interoperability. In 2014 and 2017, a lack of administrative support and a lack of staffing resources were the primary barriers faced. This year, 21% of respondents identified IT priorities as the top barrier, followed by organizational structure (20%) and lack of administrative support (18%). Career satisfaction. Respondents' satisfaction in their current position and their career choice in informatics was rated using a 1-to-7 scale where 1 wasn't at all satisfied and 7 was highly satisfied. Just over half (51%) of respondents indicated that they're highly satisfied with their current position (score of 6 or above), down 7% from 2017 (58%). However, most respondents (77%) reported being highly satisfied with their informatics career choice, down 3% from 2017 (80%). Overall, respondents seem to have remained quite satisfied with their choice of career in informatics but not as satisfied with the current position they hold. Certification. The number of respondents with any professional certification took a significant jump from 49% in 2017 to 58% in 2020. In a new question for 2020, survey respondents selected enhanced credibility and marketability (49%) and personal satisfaction (45%) as the top reasons to pursue certification. These answers also topped the list when respondents were asked about the perceived value of certification, although personal satisfaction (81%) ranked slightly over enhanced credibility and marketability (78%). American Nurses Credentialing Center certification was the most common, held by 20% of nurse informaticists. Holding an informatics certification was associated with higher salaries, with 56% of those certified earning $100,000 or more. Certification was also found to have an impact on respondents' career paths. Forty-one percent of respondents received a new role with greater responsibility after achieving certification. The average rating for the impact that certification has on a career was 5.14 out of 7 compared with 4.96 in 2017. Informatics career. Nearly a third (31%) of respondents reported having more than 10 years of experience in nursing informatics, the same as in 2017. However, the percent with less than 1 year of experience increased from 8% in 2017 to 14% in 2020, which may indicate an increase in the number of nurses entering nursing informatics practice. The number of respondents who've been in their current role for more than 5 years also increased from 31% in 2017 to 38%, suggesting a maturing of the specialty. Salary. The number of respondents earning more than $150,000 a year has stayed the same (11%) since 2017. The number of respondents making $131,000 to $150,000 rose by 4% in the same time period and those making $116,000 to $130,000 increased by 3%. Similar to previous years, the majority of respondents (63%) stated that they earn a base annual salary between $61,000 and $115,000. Salary also correlates with level of education: Nearly a quarter (24%) of respondents with doctorates reported making $151,000 or more per year. More than two-thirds (70%) of respondents with 11 or more years of nursing informatics experience reported earning more than $100,000 per year. Training and education. Training and education continue to be a priority for nurse informaticists, and the 2020 survey results saw a significant rise in formal education. The percentage of respondents with a master's degree, DNP, or PhD was 66% compared with 61% in 2017. Fifteen percent of respondents reported having completed a vendor/supplier certification—a new category in the 2020 survey. On-the-job training continued its downward trend, with 54% of respondents reporting that they engaged in it compared with 56% in 2017 and 58% in 2014. The top three resources for continuing education were audio conferences/webinars (71%), professional organizations (59%), and national conferences (57%). Digitally enabled The National Academy of Medicine is evolving the Future of Nursing recommendations into the next decade, and nurse informaticists will continue to lead the mobilization of a digitally enabled nursing workforce. As implied by the results of the 2020 Nursing Informatics Workforce Survey, this highly capable workforce will eagerly respond to the Future of Nursing 2020-2030 call to improve the health of individuals, families, and communities by addressing social determinants of health and providing effective, efficient, equitable, and accessible care for all across the care continuum. What's a CNIO? The CNIO role is a strategic and operational role that supports not only nursing practice, but also the entire care delivery team in anticipating and adapting to changes in the healthcare environment. CNIOs combine the knowledge of patient care, informatics concepts, and change management to effectively address the information and knowledge needs of healthcare professionals and patients to promote safe, effective, and efficient use of digital health in clinical settings.

A Sociotechnical Framework for Safety-Related Electronic Health Record Research Reporting: The SAFER Reporting Framework.

Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. Success or failure depends not only on the characteristics and behaviors of individuals who are targeted by an intervention, but also on the technical characteristics of the intervention and the culture and environment of the health system that implements it. Current reporting guidelines do not capture the complexity of sociotechnical factors (technical and nontechnical factors, such as workflow and organizational issues) that confound or influence these interventions. This article proposes a methodological reporting framework for EHR interventions targeting patient safety and builds on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology. The Safety-related EHR Research (SAFER) Reporting Framework enables reporting of patient safety-focused EHR-based interventions while accounting for the multifaceted, dynamic sociotechnical context affecting intervention implementation, effectiveness, and generalizability. As an example, an EHR-based intervention to improve communication and timely follow-up of subcritical abnormal test results to operationalize the framework is presented. For each dimension, reporting should include what sociotechnical changes were made to implement an EHR-related intervention to improve patient safety, why the intervention did or did not lead to safety improvements, and how this intervention can be applied or exported to other health care organizations. A foundational list of research and reporting recommendations to address implementation, effectiveness, and generalizability of EHR-based interventions needed to effectively reduce preventable patient harm is provided. The SAFER Reporting Framework is not meant to replace previous research reporting guidelines, but rather provides a sociotechnical adjunct that complements their use.

The national health information technology human factors and ergonomics agenda

Health information technology (IT) implementation has encompassed much of the United States health care system over the past decade, and user frustration with health IT has steadily increased. Human factors and ergonomics (HFE) methods and approaches can improve the design, implementation, and use of health IT for clinicians and consumers. To better understand the effect of federal HFE in health IT research funding, the authors conducted a review of several key, specific initiatives. The review focused on the goals and accomplishments of these initiatives. Findings to date show that HFE is improving the usefulness of health IT, but additional research and new methods are needed. Corresponding research funding and policy priorities are identified. New HFE work and innovative approaches are needed to capitalize on HFE knowledge, principles, and methods to improve the design, implementation, and use of health IT at a broader scale.

Visualization of Electronic Health Record Data for Decision-Making in Diabetes and Congestive Heart Failure

Abstract Objective The aim of this study is to study the impact of graphical representation of health record data on physician decision-making to inform the design of health information technology. Materials and Methods We conducted a within participants crossover design study using a simulated electronic health record (EHR) in which we presented cases with and without visualized data designed to highlight important clinical trends or relationships, followed by assessment of the impact on decision-making about next steps for patients with chronic diseases. We then asked whether trends were observed and about usability and satisfaction using validated usability questions and asked open-ended questions as well. Time to answer questions was also collected. Results Twenty-one primary care providers participated in the study, including five for testing only and sixteen for the full study. Questions about clinical assessment or next actions were answered correctly 55% of the time. Regarding objective trends in the data, participants described noticing the trends 85% of the time. Differences in noticing trends or difficulty level of questions were not statistically significant. Satisfaction with the tool was high and participants agreed strongly that it helped them make better decisions without adding to the time it took. Discussion The simulation allowed us to test the impact of a visualization on clinician practice in a realistic setting. Designers of EHRs should consider the ways information presentation can affect decision-making. Conclusion Testing visualization tools can be done in a clinically realistic context. Providers desire visualizations and believe that they help them make better and faster decisions.

Proceedings of the 10th Conference on Health IT & Analytics

Proceedings of the 10th Conference on Health IT & Analytics (CHITA 2019). CHITA is an annual health IT and analytics research summit, including a doctoral consortium that each year gathers prominent scholars from more than 40 research institutes, and leading policy and practitioner attendees in a vibrant setting to discuss opportunities and challenges in the design, implementation and management of health information technology, artificial intelligence and advanced analytics. Its goal is to deepen our understanding of strategy, policy and systems fostering health IT and analytics effective use and to stimulate new research ideas with both policy and business implications. This forum provides a productive venue to facilitate interaction and collaboration among academia, government, and industry. Now in its tenth year, each year CHITA draws over 100 participants. Convened by the Center for Health Information & Decision Systems (CHIDS), support for CHITA is provided by the Robert H. Smith School of Business, the University of Michigan School of Public Health, and the U.S. Agency for Healthcare Research and Quality.

Patient-centered Design Grounded in User and Clinical Realities: Towards Valid Digital Health

Valid design of patient-centered digital health or health information technology (IT) systems is based on a thorough and accurate understanding of both “user reality” and “clinical reality.” Type 1 Design Error (User-Reality Error) occurs when designers do not accommodate user characteristics, tasks, context of use, needs, or preferences. Type 2 Design Error (Clinical-Reality Error) occurs when designers do not accommodate the clinical reality, including biomedical knowledge, clinical workflows, and organizational requirements. Both types of errors can invalidate the design, leading to products being rejected by patient end-users or their healthcare delivery systems, product non-use or inappropriate use, and risk of harm. This paper describes our attempts to achieve valid health IT design and avoid the two design errors. We performed iterative, patient-centered design to prototype a mobile application, Power to the Patient (P2P), supporting heart failure self-care management. Our multidisciplinary team of human factors, cardiology, and design experts developed and iteratively refined requirements based on data collection, review, and testing with patient research participants, a patient advisory board, a clinical advisory board, and experts on the team. We describe our process and reflect on working with multiple stakeholders toward the goal of valid health IT design.

A Staged Approach for Facilitating Joint End User, Vendor, and Multi-Disciplinary Subject Matter Expert Input to Health Information Technology Recommendations

Design of health information technology (HIT) that improves patient outcomes is an ongoing process. We propose a methodology that takes a human factors engineering approach to develop systems-engineering-style requirements and design recommendations for both HIT and aspects beyond the scope of the HIT itself (e.g., policies and procedures). Our approach includes: (1) data collection and analysis; (2) preliminary recommendations generation; (3) recommendation review by methodological and domain subject matter experts; (4) revised recommendation review by end users; (5) revised recommendation review by HIT vendors; and (6) final recommendation generation. We illustrate the methodology by presenting a case study focusing on home health care nurses using HIT during the home care admission process.

Multi-Institutional, Large-Scale, International Applied Clinical Informatics Research Through the Clinical Informatics Research Collaborative (CIRCLE).

There is a critical need need for multi-institutional, large-scale, international applied clinical informatics research, given the global, widespread use of commercially-available electronic health records with different designs, capabilities, configurations, and implementation strategies. The Clinical Informatics Research Collaborative (CIRCLE) aims to identify and develop best practices for safe and effective health information technology design, development, implementation, use, and evaluation.

Human Factors and Usability for Health Information Technology: Old and New Challenges.

Summary Objectives : Despite national mandates, incentives, and other programs, the design of health information technology (IT) remains problematic and usability problems continue to be reported. This paper reviews recent literature on human factors and usability of health IT, with a specific focus on research aimed at applying human factors methods and principles to improve the actual design of health IT, its use, and associated patient and clinician outcomes. Methods : We reviewed recent literature on human factors and usability problems of health IT and research on human-centered design of health IT for clinicians and patients. Results : Studies continue to show usability problems of health IT experienced by multiple groups of health care professionals (e.g., physicians and nurses) as well as patients. Recent research shows that usability is influenced by both designers (e.g., IT vendors) and implementers in health care organizations, and that the application of human-centered design practices needs to be further improved and extended. We welcome emerging research on the design of health IT for teams as team-based care is increasingly implemented throughout health care. Conclusions : Progress in the application of human factors methods and principles to the design of health IT is occurring, with important information provided on their actual impact on care processes and patient outcomes. Future research should examine the work of health IT designers and implementers, which would help to develop strategies for further embedding human factors engineering in IT design processes.

Creating synthetic patient data to support the design and evaluation of novel health information technology.

To ensure that new health information technology supports its intended users, researchers and developers need to follow human-centered methods during all stages of the software development lifecycle, including early stage evaluations. These evaluations need to include realistic testing scenarios to ensure that they provide valuable and accurate feedback to system developers. However, obtaining realistic patient data to support these evaluations has many challenges, including the risk of re-identifying anonymized patients as well as the costs associated with connecting test systems with production ready clinical databases. Here we present a novel five-step process to create highly structured and realistic synthetic patient data to support the evaluation and comparison of early to middle stage health information technology prototypes. We applied this method to evaluate and compare three novel health information technology prototypes designed to support clinicians during the identification of high-priority patients when answering the question: "What patient should I see first?" Our novel approach fills an important gap in the evaluation of health information technology and assists designers in creating high-quality software that best supports its end users.