eHealth Research Needs to Incorporate Human Factors

The May 2007 issue of American Journal of Preventive Medicine included the article, “eHealth Research from the User’s Perspective” by Bradford W. Hess and Ben Shneiderman.

In essence, the authors call for eHealth research to “…combine best evidence from the user sciences (human factors engineering, human-computer interaction, psychology, and usability) with best evidence in medicine to create transformational improvements in the quality of care that medicine offers” (p. S97).  Moreover, they state:

• “As medical technology advances and the health information environment becomes more complex, health care becomes more vulnerable to error.” (p. S99)
• “…health information technologies will, and must, be part of the solution to guarantee that safeguards are engineered into the environment in which health care takes place.” (p. S99)
• “…combining the best of current medical knowledge with a patient’s own historical data in an age of ‘personalized medicine,’ will be next to impossible without the assistance of health information technology.” (p. S99)

Based on the Institute of Medicine’s (IOM) report “Crossing the Quality Chasm: A New Healthcare System for the 21^st Century,” the authors identify four health system goals (safety, effectiveness, patient-centeredness, and timeliness) and eight types of users (patient, physician, family/friends, microunits of care, community, organizations for care, public health environment, and healthcare context) – resulting in a total of thirty-two “…particular ‘use case scenarios’ that the eHealth-enabled system must support” (p. S100).

Regarding the four “overarching” health systems goals, the authors elaborated on each, including:

Safety

• “A core tenet of the IOM’s prescriptive framework is that safety must be made an inherent attribute of the system.” (p. S100)
• “The principle is to make the healthcare system foolproof by designing the interface between components to be consistent, predictable, and controllable by all of its users.” (p. S100)
• “‘Human-centered’ testing methods applied within the context of “bench-to-bedside” research should be as important to the informatics enterprise as randomized clinical trials are for the introduction of new pharmaceutical agents.” (p. S100)
• “Patients and their families must be engineered into the system as a first line of defense against potential errors, not the last.” (p. S100)

Effectiveness

• “Designing from the user’s perspective takes a different orientation. It embraces the notion that effective decision making is a product of knowledge contained in the mind as well as knowledge stored in the environment. Taking this perspective, the emphasis shifts from personal heroics to creating a system of knowledge to guide evidence-based delivery, a shift that has been shown to yield significant improvements in patient outcomes and reductions in costs.” (p. S101)

Patient-Centeredness

• “All of the tools, conversations, and decisions that take place within a healthcare system must be measured against the benchmark of patient need in order to achieve systemwide objectives of safety and effectiveness.” (p. S101)
• “One aspect of patient-centeredness is customized care. eHealth applications will be part of this effort as they assist in providing the right information, to the right person, at the right time.” (p. S101) [This idea is advocated by Information Therapy - see Center for Information Therapy; Center for Information Therapy Blog; Healthwise; Kemper & Mettler, 2002; Mettler & Kemper, 2003; and Mettler & Kemper, 2005 for more details.]
• “One strategy for accomplishing that goal in eHealth is to adopt the principle of universal design. Under this principle, the structured environment is created to be equally accessible by all users, regardless of experience level or physical ability.” (p. S101)

Timeliness

• “Coordinated eHealth technologies can and should be developed to keep track of the individual needs of patients, and to ensure that all relevant members of the healthcare team, including the patients themselves, are notified in a timely manner.” (p. S102)

References

Kemper, D.W., & Mettler, M. (2002). Information therapy: Prescribed information as a reimbursable medical service. Boise, Idaho: Healthwise, Inc.

Mettler, M. & Kemper, D.W. (2003).  Information therapy: Health education one person at a time.  Health Promotion Practice, 4, 214-217.

Mettler, M. & Kemper, D.W. (2005).  Information therapy: The strategic role of prescribed information in disease self-management.  APLAR Journal of Rheumatology, 8, 69-76.

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