Pew Internet Report Pertaining to Online Health Information Searching Behaviors of Consumers

Last month, the Pew Internet & American Life Project published a report authored by Suzannah Fox and Sydney Jones entitled, “The Social Life of Health Information” (3 MB, .pdf).  The 72-page report is the output from a December 2008 telephone survey of 2,253 US adults asked questions pertaining to “…the social impact of the internet on health care.”  Some of the more interesting findings and comments, include:

• Now, 74% of American adults go online, 57% of American households have broadband connections, and 61% of adults look online for health information.” (p. 2)
• “Half of all online health inquiries (52%) are on behalf of someone other than the person typing in the search terms.” (p. 2)
• “Health consumers are often looking for tailored information, searching for a ‘just-in-time someone-like-me.’” (p. 3)
• “Fully 42% of all adults, or 60% of e-patients, say they or someone they know has been helped by following medical advice or health information found on the internet.” (p. 4)
• “Looking closer at how people use the internet for health care, it is clear that some are going online to connect, in fact, with what we think of as traditional sources: health professionals, friends, and families.” (p. 7)
• “Technology can help to enable the human connection in health care and the internet is turning up the information network’s volume.” (p. 7)
• “American adults continue to turn to traditional sources of health information, even as many of them deepen their engagement with the online world.” (p. 11)
• “…the Center for Studying Health System Change finds that just 41% of patients have the knowledge and confidence required to manage their health in this new world.” (p. 13)
• “While offline conversation about health information may be robust, it seems that the online conversation about health may be lopsided. There are many more readers and listeners than there are writers and creators of online content.” (p. 16)
• “…experts remain vital to the health-search and decision-making process. Americans’ longstanding practices of asking a health professional, a trusted friend, or a wise family member persist as patients pursue good health. These are practices which, in the words of John Seely Brown and Paul Duguid “will not budge” and therefore require designers of any new health care application “to look not ahead, but to look around” in order to see the way forward.” (p. 21)
• “In 2002, 63% of internet users looked online for information about a specific medical problem, and, in 2008, 66% did so.” (p. 24)
• “Currently, 55% of internet users go online to find information on medical treatments and procedure, up from 47% in 2002.” (p. 27)
• “Currently, 45% of online adults look for information about prescription or over-the-counter drugs, up from 34% in 2002.” (p. 41)

Overall, this is an informative report that developers of online health information products and services, among others, should take the opportunity to read.

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Dr. David Blumenthal’s Testimony Regarding HIT

Last month, Dr. David Blumenthal, National Coordinator for Health Information Technology, testified (38 KB, .pdf) before the House Small Business Subcommittee regarding “…the Administration’s health information technology (HIT) activities and specifically how they impact small health care practices” (p. 2)

In his statement, he made the following comment:

“Providers in small health care practices that seek to adopt and meaningfully use HIT face a complex variety of tasks. Those tasks include assessing needs, selecting and negotiating with a system vendor or reseller, and implementing workflow changes to improve clinical performance and, ultimately, outcomes. Past experiences have shown that without robust technical assistance, many EHRs that are purchased are never installed or the providers never obtain meaningful use of the systems.” (p. 5)

First, Dr. Blumenthal rightly acknowledges some of the potential challenges for appropriately implementing HIT.  Second, he identifies a rudimentary process for doing so – something discussed in the article “Assessing Devices from the User’s Perspective” (4 MB, .pdf) and in this post.  Finally, this is another example where human factors and ergonomics professionals can assist the health care community by lending their expertise on designing, assessing, and implementing people-centered systems.

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Paper-Based Workarounds and Electronic Health Records (EHR)

The September 2009 issue of the International Journal of Medical Informatics includes an article entitled “Exploring the Persistence of Paper with the Electronic Health Record.”

According to the authors, “the study objective was to explore and understand human-technology integration factors (e.g., computer usability and human–computer interaction issues) at the EHR level that may be causing employees to rely on paper alternatives” (p. 619).  The authors conducted interviews of twenty employees (physicians, pharmacists, nurse practitioners, registered nurses, health technicians, dietician, administrators, and IT specialists) who use a Computerized Patient Record System (CPRS), a type of electronic health record (EHR), at a Veterans Affairs Medical Center.  The questions focused on three sub-categories, including:

• Cumbersome EHR interface design;
• EHR not well integrated into clinical flow; and
• Visual organization of data in EHR incompatible with clinicians’ mental model.

The responses were divided into 11 categories of reasons why paper-based workarounds were used (p. 621), in descending order of frequency, including:

• Efficiency;
• Knowledge/skill/ease of use;
• Memory;
• Sensorimotor preferences;
• Awareness;
• Task specificity;
• Task complexity;
• Data organization;
• Longitudinal data processes;
• Trust; and
• Security.

Besides providing explanations and examples supporting each of the 11 categories, the authors also raise several important points, including:

• “…workaround strategies may increase efficiency but create new potential paths to medical error. Therefore, a well-designed EHR should support the use of important paper supplementation while minimizing the potential for gaps in EHR documentation” (p. 624)
• “The efficiency finding for paper persistence has two distinct implications. One is that the paper workaround phenomena indicated the EHR was not sufficiently designed and does not efficiently support clinicians’ work and/or is not aligned with clinicians’ natural workflow. Secondly, some paper workarounds replaced important EHR documentation or circumvented critical EHR-designed safety checks. These workarounds may lead to potential gaps in documentation and potential patient safety risks.” (p. 624)
• “Poor ease of use, or usability, of CPRS and related heath IT also led to the use of paper. For example, in the acute dialysis unit, usability issues hindered a new computer process intended to automate patient vitals entry into CPRS, and has delayed future roll-out to the rest of the dialysis service.” (p. 625)
• “…advances in technology such as light weight notebook computers and highly usable personal digital assistants (PDAs) still do not necessarily afford the same level of convenience or integration into clinical workflow as paper and pen.” (p. 625)
• “Paper workarounds were employed when CPRS did not support the specificity or complexity of the clinical task.” (p. 625).
• “…some persistent paper use may also simply be due to a reluctance to change.” (p. 627)

References

Salem, J.J., Russ, A.L., Justice, C.F., Hagg, H., Ebright, P.R., Woodbridge, P.A., & Doebbeling, B.N. (2009).  Exploring the persistence of paper with the electronic health record.  International Journal of Medical Informatics, 79, 618-628.

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Emerging Challenges to the Ergonomics Domain

This weekend I read the article “Emerging Challenges to the Ergonomics Domain” by David Caple.  The author identifies several challenges for the human factors and ergonomics domain, including:

• “The future of ergonomics will depend on how well the domain manages to embrace the challenges of emerging areas requiring scientific research and the success of disseminating the results of the research into practice.” (p. 49)
• “…we now see new ergonomics challenges in microchip controlled processes, such as complex robotic and precision manufacturing systems and new industries, such as nanotechnology.” (p. 49)
• “The increased demands of complex systems from a cognitive perspective and ongoing changes in job design provide the domain with a greater need to take a more holistic approach.” (p. 49)
• “In developing countries, the informal sector involves the largest number of workers. In Indonesia, this sector involves around 70% of workers (Manuaba 2006) and in Turkey it is 50% of workers (Ozan 2007). These workers are in workplaces outside the control of government intervention and are potentially exposed to a wide range of health and safety risks. Strategies to connect with and support these workers will provide future challenges in ergonomics.” (p. 52)
• “The emerging role of women across industry sectors in developed and developing countries raises challenges to ensure that their holistic needs are addressed.” (p. 52)
• “The need for more public visibility is stated as a continuing challenge for the future. Challenges in the future include the need to improve marketing of ergonomics and to enable the public and industry to experience the value of ergonomics.” (p. 53)
• “The future of the ergonomics domain will be as diverse as the understanding of issues in the informal sector in developing countries through to the impacts of information technology on complex work systems in developed countries. The strengths of the multidisciplinary approach that encourages a holistic evaluation of ergonomics issues will enable an expansion of research and application to impact on an increasing range of the human interface with work systems, processes and products.” (p. 52)

While at first glance this list might seem daunting, given the research that’s currently being conducted in these areas and knowing many of the committed practitioners in this discipline, I see this as an enormous opportunity to embrace these challenges with the goal of assisting humankind to achieve improved safety and quality of life.

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HFES Journal To Publish Special Issue on Improving Human-Robot Interaction

Yesterday I received the July 2009 issue (162 KB, .pdf) of the Human Factors and Ergonomics Society Bulletin.  I noticed the Journal of Cognitive Engineering and Decision Making is looking for contributions for a special issue on improving human-robot interaction.  Some of the topics they’re seeking papers on include:

• Sensor interpretation and integration: information visualization; object recognition; motion awareness
• Manipulation: teleoperation and motor control such as during mine removal, USAR, and RSTA
• Navigation: local and global spatial comprehension; robot localization; motion awareness; cognitive maps
• Planning: decision making; task prioritization; contingency planning; dynamic replanning
• Multiple robot operations: operator-to-robot ratio; attention (focused and divided); task switching; situation awareness; adaptive automation
• Team performance: human-human group dynamics; collaboration and coordination; shared situation awareness
• Trust and acceptance: human-robot group dynamics; anthropomorphism; system reliability
• Technological issues: system capabilities and limitations; latency; bandwidth; use of multiple modalities
• Research issues: scaled real-world testbeds versus simulated virtual environments; platform-specific versus platform-general considerations (e.g., UGV vs. UAV); metrics/measures and benchmarks; individual differences

Given that I have an interest in this area, and recently posted on the topic, I’ll be fascinated to read the special issue.

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