In the era of Health 2.0, we see more novel technologies, such as mobile health applications, wearable self-tracking devices, and new communications media, being designed and developed for health consumers. With thesetechnologies, patients can manage theirown health conditions through apps,connect with other patients or healthproviders through online communities,and track a variety of health indicatorsto better understand how behavioralchoices and environmental factors caninfluence their health. Behind suchmobile, connected, and quantified-selfinitiatives are the notions of patient-centeredness and patient empowerment.
Technologies are expected to encourageand facilitate healthy behavior changeand eventually lead to positive healthoutcomes. Moreover, the data recordedthrough these sensing, tracking,and monitoring devices holds greatpotential for helping health providersbecome more aware of their patients’conditions and make more accuratemedical decisions based on thatinformation.
In reality, however, health providers
are often too busy to look at the
information generated in these patient-
centered systems and do not know how
to deal with the novel devices their
patients adopt and bring to visits. These
and other related issues emerged during
the panel discussion we organized
at the 2013 CHI conference [ 1]. The
original goal of this panel was to spark
discussions around the impacts of
health technologies on the interaction
between patients and health providers
and to brainstorm ways to minimize
negative impacts. However, much to
our surprise, the panel triggered a lot
of questions from the audience that
centered on health providers’ daily
practices and how we were able to study
them. The discussions also triggered
many comments. For example, the
audience was surprised to learn that
clinicians were so busy at work that
they would not have time to participate
in research studies or engage in the use
of new patient-centered technologies.
After we described how hecticclinicians’ schedules were and how littletime they had for extra activities intheir daily work, an audience membercommented, “I always assumed thatwhatever we [designers/researchers]built would be a big help for them[physicians]!” This inspired us to writethis article.
WHY CONSIDER HEALTH
The panel discussion revealed
some grey areas between patient-
centered practices and the expected
responsibilities for health providers.
Echoing the assumptions the audience
made about health providers’ work, in
our own research we have heard stories
of patients complaining about their
physicians’ reluctance and even refusal
to check the health data they tracked
and brought to visits. Patients also
complained that their physicians did
not respond to inquiries sent through
communication technologies in a timely
manner. Why would this happen?
When we envisioned these patient-
centered technologies, we believed that
health providers would find it useful
to know about a patient’s everyday
vital signs, symptoms, exercise, diet,
and other kinds of information that
could influence their well-being. We
assumed providers would appreciate
the benefits of having this information
to help them make more informed
decisions. However, comments made
during the panel raised issues such as
that physicians do not, in general, trust
“subjective” data from patients, even
semi-objective data like blood pressure,
as these self-recorded measures are
often collected by non-certified devices
and under uncontrolled circumstances.
Thus, as designers, we may have
misunderstood health providers’
willingness to review the data collected
through such patient-centered devices.
As designers and researchers,
we ask, “Is there anything missing,
neglected, or invisible in the design
process?” Lucy Suchman argued the
importance of making work visible in
information system design since “the
way in which people work is not always
apparent. Too often, assumptions are
The Invisible Workof Health ProvidersYunan Chen, University of California, Irvine, Karen Cheng, University of California, Irvine,
Charlotte Tang, University of Michigan, Flint, Katie A. Siek, Indiana University, Jakob E. Bardram, IT University of Copenhagen
→ The emergence of patient-centered
technologies may lead to unrealistic
expectations of health providers’
willingness and availability to review
detailed patient data.
→ Making health providers’ clinicalwork, goals, and priorities visiblein system design is essential forsuccess.
→ Clinical workflows, positions, andresponsibilities must be revisitedand redesigned to meet the needs ofnew patient-centered technologies.
INTERACTIONS.ACM.ORG 74 INTERACTIONS SEPTEMBER–OCTOBER2014
This forum is dedicated to personal health in all its many facets: decision-making, goal setting, celebration, discovery,
reflection, and coordination, among others. We look at innovations in interactive technologies and how they help address
current critical healthcare challenges. — Gillian R. Hayes, Editor
FORUM HEALTH MATTERS