The COVID-19 pandemic has disrupted many global industries, none more so than healthcare, and has necessitated the need for health informatics innovations that can bridge time and space to provide timely care. It has also emphasized the need for a system-level informatics infrastructure to support the healthcare management of populations at a macro level, while also providing the necessary support for front line care delivery at a micro level. However, the need for change at a fast pace does not remove the need for an evidence base to support health technologies. This raises fundamental questions about how the informatics tools required can be delivered at pace without compromising the quality and safety of such tools.
This book presents papers from the biennial conference on Context Sensitive Health Informatics, CSHI 2021, held as a virtual event on 15 and 16 November 2021. The theme of the 2021 conference was: The Role of Informatics in Global Pandemics, and this book includes 18 papers on a variety of topics, divided into 4 sections: health information management in the COVID-19 context; implementation of new practices and technologies in healthcare; sociotechnical analysis of task performance and workload in healthcare; and innovations in design and evaluation methods of health technologies.
The book provides an overview of innovative health information systems rooted in robust scientific research on context and health information technology, and will be of interest to all those working in the field of health informatics.
This volume presents the papers from the International Conference on âĂĲContext Sensitive Health InformaticsâĂİ held virtually in November 2021.
Context Sensitive Health Informatics concerns health information technologies and their environments. Environments may be people in various roles, such as citizens, patients, users, designers, and evaluators, but also non-human constructs such as organizations, work practices, guidelines and protocols, buildings and markets.
The conference is endorsed and organized by the International Medical Informatics Association (IMIA) working groups âĂĲHuman Factors Engineering for Healthcare InformaticsâĂİ and âĂĲOrganizational and Social IssuesâĂİ.
The CSHI 2021 conference is sponsored by Lille Academic Hospital, the Federative Research Structure for Health TechnologyâĂİ (SFR-TSM), and the ULR 2694-METRICS research unit. We would like to thank the sponsors for making it possible to organize the conference and publish the proceedings.
We would also like to thank the IMIA for their editing assistance, especially Elaine Huesing and Susan Martin.
We thank the students and researchers who, despite the virtual organization of the conference, submitted their research papers to this conference. We also want to thank the members of the Scientific Program Committee for their efforts in establishing the content of the conference and all the reviewers for providing constructive feedback to the authors. Their excellent work has significantly improved the quality of conference.
Craig Kuziemsky, Christian Nøhr, Romaric Marcilly, Linda Dusseljee-Peute, Xinxin Zhu, Peter L. Elkin
3 - 8
The COVID-19 pandemic has disrupted many global industries and shifted the digital health landscape by stimulating and accelerating the delivery of digital care. It has emphasized the need for a system level informatics implementation that supports the healthcare management of populations at a macro level while also providing the necessary support for front line care delivery at a micro level. From data dashboard to Telemedicine, this crisis has necessitated the need for health informatics transformation that can bridge time and space to provide timely care. However, heath transformation cannot solely rely on Health Information Technology (HIT) for progress, but rather success must be an outcome of system design focus on the contextual complexity of the health system where HIT is used. This conference highlights the important roles context plays for health informatics in global pandemics and aims to answer critical questions in four main areas: 1) health information management in the covid-19 context, 2) implementation of new practices and technologies in healthcare, 3) sociotechnical analysis of task performance and workload in healthcare, and 4) innovations in design and evaluation methods of health technologies. We deem this as a call to action to understand the importance of context while solving the last mile problem in delivering the informatics solutions that are needed to support our public health response.
Law and regulation have not received much attention as part of the context shaping and being shaped by health informatics. Telemedicine, data, devices and software, and electronic health records (EHRs) are examples of how technologies are affected by privacy, intellectual property protections, and other law and regulation.
Helen Monkman, Susan Z. Martin, Simon Minshall, Andre W. Kushniruk, Blake J. Lesselroth
16 - 20
Many organizations created COVID-19 dashboards to communicate epidemiologic statistics or community health capabilities with the public. In this paper we used dashboard heuristics to identify common violations observed in COVID-19 dashboards targeted to citizens. Many of the faults we identified likely stem from failing to include users in the design of these dashboards. We urge health information dashboard designers to implement design principles and test dashboards with representative users to ensure that their tools are satisfying user needs.
Under pandemic conditions, it is important to communicate local infection risks to better enable the general population to adjust their behaviors accordingly. In Japan, our team operates a popular non-government and not-for-profit dashboard project – “Japan LIVE Dashboard” – which allows the public to easily grasp the evolution of the pandemic on the internet. We presented the Dashboard design concept with a generic framework integrating socio-technical theories, disease epidemiology and related contexts, and evidence-based approaches. Through synthesizing multiple types of reliable and real-time local data sources from all prefectures across the country, the Dashboard allows the public access to user-friendly and intuitive disease visualization in real time and has gained an extensive online followership. To date, it has attracted c.30 million visits (98% domestic access) testifying to the reputation it has acquired as a user-friendly portal for understanding the progression of the pandemic. Designed as an open-source solution, the Dashboard can also be adopted by other countries as well as made applicable for other emerging outbreaks in the future. Furthermore, the conceptual design framework may prove applicable into other ehealth scaled for global pandemics.
Helen Monkman, Andre W. Kushniruk, Avi Parush, Blake J. Lesselroth
26 - 30
With the onset of the coronavirus pandemic, clinicians, public officials, and citizens alike struggled to stay abreast of the constant and evolving stream of information about the clinical manifestations of illness, epidemiology of the disease, and the public health response. In this paper, we adapted (i.e., added and modified elements) Beasley and colleagues’ information chaos framework to understand the context of citizens’ experiences with information during the COVID-19 pandemic. We will show how our adapted framework can be used to characterize information associated challenges observed during this time and the possible impact of information chaos on peoples’ cognition and behaviours. Ultimately, we believe that research will benefit by adopting a more holistic perspective using the information chaos framework than strictly studying the independent factors in isolation.
Gunnar Ellingsen, Bente Christensen, Morten Hertzum
33 - 37
Large-scale electronic health record (EHR) suites have the potential to cover a broad range of use needs across various healthcare domains. However, a challenge that must be solved is the distributed governance structure of public healthcare: Regional health authorities regulate hospitals, municipalities are responsible for first-line healthcare services, and general practitioners (GPs) have an independent entrepreneurial role. In such settings, EHR program owners cannot enforce municipalities and GPs to come on board. Thus, we examine what tactics owners of large-scale EHR suite programs apply to persuade municipalities to participate, how strongly these tactics are enforced, and the consequences. Empirically, we focus on the Health Platform program in Central Norway where the goal is to implement the U.S. Epic EHR suite in 2022. Theoretically, the paper is positioned in the socio-technical literature.
Thomas Engelsma, Ahsen Yurt, Monique W. Jaspers, Linda Dusseljee-Peute
38 - 42
To report underlying factors that hinder or advance mHealth implementation and use in Dutch dementia care.
44 dementia experts (healthcare professionals, informal caregivers, dementia case managers, and researchers) completed a questionnaire as part of a wider Delphi study to share their experiences with, thoughts on, and proposals for mHealth use in Dutch dementia care. A SWOT-framework is used to categorize the experiences, thoughts and proposals.
Four strengths, twelve weaknesses, thirteen opportunities and six threats for the current use of mHealth in Dutch dementia care were identified.
Identified weaknesses highlight the importance for a guide for action for everyone involved in design and implementing mHealth for older adults with dementia. It is critical to raise awareness of mHealth’s availability, improve its design, and continue to address the needs of older adults with dementia.
Sidsel Villumsen, Sascha Elsberg, Celine Løvgren, Karina Vinther, Lise Klarholt Busk, Sigrid Vest Arler, Ouafa Rian
43 - 47
Programs supporting the necessary combination of digital, organizational, and cultural transformational change, motivating and engaging the workforce, are scarce. This discussion paper reports on the initial experiences from a competency development program aiming at building capacity within the workforce, leaders, and organization in secondary healthcare to navigate and facilitate digitally transformative healthcare systems. The program aims to support employees and leaders who i) understand digitalization in and of practice, ii) reflect and approach digitalization in a critical and ethical way, iii) are curious and maintain a growth mind-set, iv) engage in development and implementation of digitalization, and v) can convey and communicate digitalization. The insights from the prototype can be useful in further promoting sustainable digitalization within healthcare and supporting leaders in their conduct and management of digital health initiatives.
Clinical pharmacy activities contribute to improve patient safety. Yet, the work system’s characteristics influence how clinical pharmacy activities are performed and conversely clinical pharmacy causes that work system to evolve. This exploratory study aims to identify the different ways in which clinical pharmacy activities are performed in different units of a large academic hospital. Interviews and observations have been performed to identify in each ward the clinical pharmacy activities implemented and how they are carried out.
This study establishes how demanding healthcare work is experienced to be and whether nurses and physicians experience different levels of workload. A meta-analytic review was conducted of 87 studies that reported Task Load Index (TLX) scores for healthcare work. Of these studies, 37 were conducted in real-life settings and 50 in lab settings without real patients. In real-life settings, clinicians experienced a workload with a mean TLX of 49 (on a 0-100 scale). Divided onto staff groups, the mean TLX for nurses was 63, which was significantly higher than the mean of 40 for physicians. Among the six TLX subscales, the main contributors to workload were mental demand, temporal demand, and effort. They were higher than physical demand and frustration. The clinicians experienced their performance – the last subscale – as closer to poor than good in 38% of the studies conducted in real-life settings. The difference between nurses and physicians was consistent across all subscales, except mental demand. Finally, it is methodologically important that TLX scores appeared not to transfer directly from lab to real-life settings. To reduce the risk of errors and burnout, new healthcare procedures and technologies should be evaluated for their impact on workload.
This paper investigates the often neglected area of data work by medical secretaries, specifically in the context of hospitals in Denmark. Since the 1930s medical secretaries have played a steadily more central role in meeting the growing need for health data. With electronic health records (EHRs) and promises of data automation, the profession has been put at risk of redundancy. While there is a considerable base of research on the datafication of health care, the data work emerging from datafication remains undescribed. Hence, we are conducting a socio-technical study of clinical-administrative data work in contemporary Danish public hospitals. In this paper we present early insights of this research, indicating the vital role of medical secretaries’ data work in securing clinical information at the point of care.
This research analysed human–robot cooperation and interaction in the basement of a Danish hospital, where kitchen staff and porters conducted their daily routines in an environment shared with mobile service robots. The robots were installed to ease the everyday routines of kitchen staff and carry out physically demanding tasks, such as transporting heavy cargo between destinations in the hospital basement. The cooperation and interaction were studied through ethnographic inspired fieldwork and the results highlighted how robots affect the real-life environments into which they are gradually moving. The analysis revealed how the great human expectations of robots clashed with reality and identified three key elements that influence human–robot cooperation in hospitals: 1) environmental factors, 2) behavioural factors and 3) factors related to human reliance on robots. We emphasise the importance of considering socio-technical factors when deploying robots to cooperate with humans in hospital environments.
Bethany A. Van Dort, Melissa T Baysari, Mirela Prgomet, Wu Yi Zheng, Magdalena Z Raban, Luciano Dalla-Pozza, Cheryl McCullagh, Johanna Westbrook
72 - 76
Electronic medication management (eMM) systems can have a significant impact on efficiency and safety. There is limited evidence on the effects of eMM implementation on the physical location of work. The objective of this study was to evaluate the impact of eMM and associated hardware implementation on the location of tasks performed by doctors and nurses. 41.5 hours of observation were conducted in the oncology ward of a paediatric hospital. Tasks, locations and resources used were recorded pre and post eMM implementation. Results showed that a wider variety of locations were used to conduct tasks following eMM implementation. Post-eMM, more tasks were performed in the hallway, where medication trolleys with attached laptops were situated, and in patient rooms where additional computers were installed, providing more opportunities for patient/carer and clinician interaction. The findings from this study reveal the impact that computer placement has on the location of work for doctors and nurses, and the importance of planning hardware placement for eMM implementation.
Blake Lesselroth, Hannah Park, Helen Monkman, Shannon Ijams, Ryan Yarnall, Liz Kollaja, J. Lee Luetkemeyer, Syeachia Dennis
79 - 83
The medical literature shows that social determinants of health have a significant impact upon health outcomes. However, health professionals often lack the skills to address these determinants at the systems-level. Therefore, we developed a Design Thinking workshop to teach about health-related social needs and to practice designing person-centered solutions. We piloted the workshop with 53 medical and physician assistant students; 69.8% responded to the post-workshop questionnaire. Nearly 80% of students agreed the workshop helped them understand the effect of context on clinical outcomes and demonstrated how to design patient-centered solutions. However, only 50% of respondents anticipated using the Design Thinking methods in their future practice. We need to identify more effective ways to demonstrate the practical application of Design Thinking to clinical work settings.
Jessica Schiro, Alexandra Degorre, Tony Sanctorum, Thomas Paget, Julien Dejonckheere, Sylvia Pelayo
84 - 88
Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. However, only a few studies have examined the impact of these aerosol boxes on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. In addition, to our knowledge, only a few studies have included in the concerned testbeds elements of the work context, which nevertheless have an impact on the use of the device.
Nanna B. Nielsen, Chaimaa K. Sekkal, Sangavi Yoganathan
89 - 93
In recent years, many people have experienced different problems and challenges in using the national Danish health portal sundhed.dk, as they find it difficult to obtain desired information about their own laboratory test results and treatment plans. Therefore, the aim of this study is to find solutions, to make patients laboratory results easily accessible and understandable for the users. To achieve this aim there will be used two participatory design methods, video observation and questionnaires. The results shows that only 43.5% normally understand their test results, whereas the remaining participants need help to understand their results.
The demographics in Denmark are changing. People’s life expectancy is increasing, which puts a strain on the home care resources. The aim of this article is to get a deeper insight to how a specific medication robot in elders’ homes can be further developed and modified to create more independence. An insight to the end users is created through the use of participatory design methods. The methods illuminate the fact that the medication robots design is gawky, its alarm volume is too low, the robot itself is too big and that it lacks the functionality of being transportable.
Emmanuelle ter Beek, Milan Kos, Mirte Streppel, Linda Dusseljee-Peute, Martijn van Oijen
99 - 106
Due to the COVID-19 pandemic, multidisciplinary team (MDT) meetings have to switch from physical to digital meetings. However, the technology they currently use to facilitate these meetings can sometimes be lacking, therefore many software companies have developed new software to ease our new digital workspace. In this study, we propose a new method, a comparative participatory cognitive walkthrough, which can show mismatches in cognitive models. To test our method, we tested the compatibility of EPIC EMR (EPIC Care) and the NAVIFY Tumor Board for preparing MDT meetings. The identified mismatches are categorized in the HOT-fit model by Yusof et al, a common way to evaluate if a healthcare information system fits with the healthcare professionals and the organization. In total, 16 mismatches were identified. These mismatches were discussed in a feedback session with an implementation manager of the NAVIFY Tumor Board. The proposed method seems to be a fast and cheap method to gain useful insights in how well new software matches with the software currently in use, by comparing the cognitive models in place when performing tasks involved with specific scenarios. The identified aspects can be of use for the development and adaptation of the new software, as well as provide guidelines on which aspects to focus on when training healthcare professionals to use the new software to have a smooth transition of software.
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