Health Informatics in Low- and Middle-Income Countries Short

Health Informatics in Low- and Middle-Income Countries Short

Health Informatics in Low- and Middle-Income Countries Short Course for Health Information System Professionals Process Improvement, System Design, and Usability People andEvaluation: Technology Lecture A People and Technology, Studies of Technology Learning ObjectivesLecture A

Explain the importance of technology in health Describe the contributions of human-computer interaction (HCI) to the health field Define the concept of system usability Distinguish between human factors and HCI as they apply to usability Explain how cognitive, physical, and organizational ergonomics can be applied to human factors engineering 2

Good Design (Stacie Branch, 2015, CC BY-SA 4.0) 3 Computerized Provider Order Entry Systems (Horsky, Kaufman, Oppenheim, & Patel, 2003) 4

MedlinePlus Seniors Health (Kaufman, 2008) 5 Problematic Interfaces Image retrieved from Wikipedia 6

Modified Patient-Controlled Analgesic Device Interface Study by Lin, Vicente, & Doyle, 2002 (Lin, Isla, Doniz, Harkness, et. al, 2002) 7 Glucose Meters (Kaufman, 2008)

8 Interfaces of Note (CC BY-NC 2.0) 9 Do We Need Such Complexity? (Kaufman, 1998)

10 News Sites Image retrieved from TheGuardian.com 11 Rhapsody (Interactive, 2016)

12 Human Factors and Healthcare Health devices (Kaufman, 2002-2008) Electronic health record systems (Kaufman, 2002-2008)

13 People and Technology 14 Transformative Nature of Technology Technologies have enormous social and cognitive impact Precipitates large-scale social changes

Technological changes have positive and negative consequences 15 Transformative Technologies (Dulaunoy, 2007, CC BY-NC-SA 2.0) (Casonato, 2008, CC BY-NC-SA 2.0) 16

Modern Technologies (CC BY-NC-SA 2.0) 17 Early Medical Technologies (Curious Expeditions, 2008, CC BY-NC-SA 2.0; Emmalouise99, 2007, CC BY-NC-SA 2.0) 18

What is usability? Usability means how useful, usable, and satisfying a system is for the intended users to accomplish goals in the work domain by performing certain sequences of tasks (Zhang & Walji, 2011) Usability has three subcomponents: o Learnability o Efficiency o Error tolerance

(National Center for Cognitive Informatics and Decision Making, n.d.) 19 Usability Principles Visibility of system status Match between the system and the real world User control and freedom Consistency and standards Error prevention

Recognition rather than recall Flexibility and efficiency of use Aesthetic and minimalist design Help users recognize, diagnose, and recover from errors Help and documentation (Nielsen, n.d.)

20 HCI and Human Factors Basic and applied discipline o Study of people using computers to work o People, systems, tasks Ergonomics and human factors o User performance in context of any system o Computer, mechanical, or manual Understanding o Humans in relation to their use of technologies

21 HCI and Health Information Technologies Enormous advances in health information technologies in the last decade o Potential for improved healthcare Clinicians and patients employ health information technologies o Current designs are suboptimal Increasingly, there are more options

22 Why are human factors increasingly important? Diversity of user groups Complexity of systems Increased use of technology Increased costs of human error Social emphasis on well-being and quality of life 23

Human Factors Focus and Goals Focus Goal Human beings and their interactions with products and equipment, tasks, environments Design systems and

system components to match the capabilities and limitations of humans who use them Micro, macro, ambient Optimize working and living conditions 24

Examples of Application Areas Military Highway systems o For example, readability and comprehensibility of signs Automobile design and driver behavior Human-computer systems Healthcare and patient safety Aging and accessibility Nuclear power Workplace layout and furnishings Airline industry

o For example, pilot workload, aircraft design, automation, aircraft maintenance Quality control 25 Nuclear Power Plant Control Room (Lambrev, 2009) 26

Airplane Cockpit (Headly, 2005, CC BY NC-SA 4.0) 27 Human Factors in Medicine

Infusion pumps Anesthesia equipment Medication errors Effects of fatigue on residents performance Judgmental limitations in medical decision making Inadequate infection control Unintended consequences of automation

28 Human Factors and Ergonomics Scientific discipline concerned with understanding interactions: o Among humans o Other elements of a system Profession that applies theory, principles, data, methods to design to optimize: o Human well-being o Overall system performance System can be a technology, device, person, team,

organization, policy, etc. (Carayon, 2007) 29 Human Factors Ergonomics: Three Major Domains Physical ergonomics Cognitive ergonomics Organizational/macro-ergonomics 30

Physical Ergonomics Concerned with physical activity o Topics: Repetitive movements, workplace layout, safety, and health o Application to health: Reducing and preventing injury, designing workstations and work rooms for optimal human performance o Examples: Designing a patient room to facilitate and support patient care Designing medical labels so that they are readable and understandable

31 Organizational Ergonomics Concerned with socio-technical systems o Topics: Communication, teamwork, participatory design, quality management o Application to health: Reducing stress and burnout, improving satisfaction and retention, implementing improvement activities o Examples: Management training in surgery teams Designing work schedules for reduced fatigue

and enhanced performance 32 Cognitive Ergonomics Concerned with mental processes o Topics: Mental workload, decision making, skilled performance, HCI, work stress, o Application to health: Usability, designing training systems, usable interfaces o Examples: Event report systems

Implementing incident analysis system 33 Human Factors Design Implications Reduce the number of competing channels of information Make sources of information as distinct as possible Provide feedback Use redundant cues Work/rest scheduling Training

34 Why It May Matter to You Technology is a potential source of error and can compromise patient safety Position to make a difference in product selection The best technologies have some deficiencies o Better and worse choices 35

People and Technology SummaryLecture A Social and cognitive consequences of new technologies Usability and usability principles HCI and human factors as a discipline Why these disciplines matter in the context of health information technologies NEXT: Patient safety, introduction to design, and usercentered design 36

People and Technology ReferencesLecture A References Bubb, H. (2012). Information ergonomics. In Herczeg, M., & Stein, M. (Eds.), Information ergonomics: A theoretical approach and practical experience in transportation (p. 23). Berlin, Heidelberg: Springer. Horsky, J., Kaufman, D. R., Oppenheim, M. I., & Patel, V. L. (2003). A framework for analyzing the cognitive complexity of computer-assisted clinical ordering. Journal of Biomedical Informatics, 36, 4-22. Kaufman, D. R., Patel, V. L., Hilliman, C., Morin, P. C., Pevzner, J., Weinstock, G. R., Shea, S., & Starren, J. (2003). Usability in the real world: Assessing medical information technologies in patients homes. Journal of Biomedical Informatics, 36, 45-60.

Kaufman, D. R., Pevzner, J., Rodriguez, M., Cimino, J. J., Ebner, S., Fields, L., et al. (2009). Understanding workflow in telehealth video visits: Observations from the IDEATel project. Journal of Biomedical Informatics, 42(4), 581-592. Kaufman, D. R. & Starren, J. B. (2006). A methodological framework for evaluating mobile health devices. In The Proceedings of the American Medical Informatics Annual Fall Symposium (p. 978). Philadelphia, PA: Hanley & Belfus. Lin, L., Isla, R., Doniz, K., Harkness, H., Vicente, K. J., & Doyle, D. J. (1998). Applying human factors to the design of medical equipment: patient-controlled analgesia. Journal of Clinical Monitoring & Computing, 14(4), 253-263. 37 People and Technology

ReferencesLecture A References National Center for Cognitive Informatics and Decision Making in Healthcare. What is usability. Retrieved from https://sbmi.uth.edu/nccd/ehrusability/usability/. Nielsen, J. (1993). Usability engineering. Boston, MA: Academic Press. Norman, D. A. (1986). Cognitive engineering. In D. A. Norman & S. W. Draper (Eds.), User centered system design: New perspectives on human-computer interaction (pp. 31-61). Hillsdale, NJ: Lawrence Erlbaum Associates. Zhang, J. & Walji, M. (2011). TURF: Toward a unified framework of EHR usability. Journal of Biomedical Informatics, 44(6), 1056-1067. http://dx.doi.org/10.1016/j.jbi.2011.08.005 38

People and Technology ReferencesLecture A Images Horsky, J., Kaufman, D.R., Oppenheim, M.I., & Patel, V.L. (2003). A framework for analyzing the cognitive complexity of computer-assisted clinical ordering. Journal of Biomedical Informatics, 36, 4-22. Clockwise from the bottom left-hand corner Kaufman, D. R., & Starren, J. B. (2006). A methodological framework for evaluating mobile health devices. In The Proceedings of the American Medical Informatics Annual Fall Symposium (p. 978). Philadelphia, PA: Hanley & Belfus. Kaufman, D. R., Pevzner, J., Hilliman, C., Weinstock, R. S., Teresi, J., Shea, S., & Starren, J. (2006). Redesigning a telehealth diabetes management program for a digital divide seniors population. Home, Healthcare, Management & Practice, 18, 223-234

Infusion Pumpunpublished work (2002) with Patel, Kubose and Kaufman. Kaufman, D. R., Pevzner, J., Rodriguez, M., Cimino, J. J., Ebner, S., Fields, L., et al. (2009). Understanding workflow in telehealth video visits: Observations from the IDEATel project. Journal of Biomedical Informatics, 42(4), 581-592. Kaufman, D. R., Patel, V. L., Hilliman, C., Morin, P. C., Pevzner, J., Weinstock, G. R., Shea, S., & Starren, J. (2003). Usability in the real world: Assessing medical information technologies in patients homes. Journal of Biomedical Informatics, 36, 45-60. Kaufman, D., & Hripcsak, G. (2008). eClinicalWorks screen. Unpublished usability analysis of eClinicalWorks. 39

People and Technology ReferencesLecture A Images Kaufman, D. (1998). Personal image for a class on usability in the Graduate School of Education at UC Berkeley. Department of Biomedical Informatics, Columbia University Medical Center. Retrieved June 20, 2016, from http://www.theguardian.com/us Interactive, A. (2016). Rhapsody 6 PC Software Guide. Rhapsody Help. Retrieved June 24, 2016, from https://help.rhapsody.com/hc/en-us/articles/212632018-Rhapsody-6-PC-Software-Guide Retrieved June 20, 2016, from http://mlb.mlb.com/mlb/gameday/index.jsp?gid=2016_04_06_seamlb_texmlb_1#game=2016_04_06_ seamlb_texmlb_1,game_state=Live,game_tab=field Clipart. Image Courtesy of Microsoft.

Very old telephone [online image]. (n.d.). Retrieved August 3, 2010, from http://www.flickr.com/photos/adulau/2044441912/ Poster advertisement for an Electro Lux vacuum with a woman using it [online image]. (n.d.). Retrieved August 3, 2010 from http://www.flickr.com/photos/derpunk/2374293386 40 People and Technology ReferencesLecture A Images New technologies such as Blackberry, GPS, iPhone, iPad, and iPods [online images]. (n.d.). Retrieved August 3, 2010, from:

http://www.flickr.com/photos/myuibe/4309248483/sizes/o/#cc_license http://www.flickr.com/photos/cdharrison/338087486/sizes/l/#cc_license http://www.flickr.com/photos/liewcf/4285189817/sizes/l/ http://www.flickr.com/photos/stigster/3761714132/sizes/l/ http://www.flickr.com/photos/williamhook/2830319467/sizes/l/#cc_license Ancient doctor's tools [online image]. (n.d.). Retrieved August 3, 2010, from http://www.flickr.com/photos/curiousexpeditions/2197609542/ Ancient Egyptian stethoscope carved in stone [online image]. (n.d.). Retrieved August 3, 2010, from http://www.flickr.com/photos/emmalouise99/1635483608/ Ancient enemas [online image]. (n.d.). Retrieved August 3, 2010, from http://www.flickr.com/photos/curiousexpeditions/2196820973/in/set-72157603726203746/

Mechanical therapy (hand-drawn picture of a man sitting on a complex machine) [online image]. (n.d.). Retrieved August 3, 2010, from http://www.flickr.com/photos/curiousexpeditions/2196822679/ 41 People and Technology ReferencesLecture A Images Lambrev, Y. (2009). Kozloduy nuclear plant control room [online image]. Retrieved August 20, 2010, from http://it.wikipedia.org/wiki/File:Kozloduy_Nuclear_Power_Plant_-_Control_Room_of_Units_3_and_4.

jpg . [CC-BY-3.0 (http://www.creativecommons.org/licenses/by/3.0)] via Wikimedia Commons Headly, A. (2005). Martin 404 cockpit [online image]. Retrieved September 10, 2010, from http://www.flickr.com/photos/mugland/35440009/ Retrieved on August 3rd, 2010 from http://www.flickr.com/photos/cyberslayer/1437957836/sizes/l/in/photostream/ Horsky, J., Kaufman, D. R., Oppenheim, M. I., & Patel, V. L. (2003). A framework for analyzing the cognitive complexity of computer-assisted clinical ordering. Journal of Biomedical Informatics, 36, 4-22. Horsky, J., Kaufman, D. R., Oppenheim, M. I., & Patel, V.L. (2003). A framework for analyzing the cognitive complexity of computer-assisted clinical ordering. Journal of Biomedical Informatics, 36, 4-22. Retrieved from https://www.nlm.nih.gov/medlineplus/seniorshealth.html

42 People and Technology ReferencesLecture A Images Retrieved August 3, 2010 from http://upload.wikimedia.org/wikipedia/commons/6/66/Butterfly_large.jpg Lin, L., Isla, R., Doniz, K., Harkness, H., Vicente, K. J., & Doyle, D. J. (2002). Applying human factors to the design of medical equipment: patient-controlled analgesia. Journal of Clinical Monitoring & Computing, 14(4), 253-263. Kaufman, D. R. & Starren, J. B. (2006). A methodological framework for evaluating mobile

health devices. In The Proceedings of the American Medical Informatics Annual Fall Symposium (p. 978). Philadelphia, PA: Hanley & Belfus. Candid. (n.d.). All sizes [online image]. Retrieved August 3, 2010, from http://www.flickr.com/photos/fan/39728135/sizes/o/ 43 This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003. This material was updated by The University of Texas Health Center at Houston under Award Number 90WT0006. This presentation was produced with the support of the United

States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government. www.measureevaluation.org

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