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FORUM HEALTH MATTERS
previous medical history, interviewingthe patient, performing a physicalexamination, entering orders into theelectronic health record (EHR) system,and writing physician’s notes. Tocomplete these routines in the limitedtime slot is already quite challenging; inmore complicated patient cases, such asthose who have multiple medical issues,extra time is often needed to addressthese problems. Hence, it was notunusual to see doctors complete theirelectronic charting during their lunchbreak and/or after their shift work.
such as physicians, nurses, medicalassistants, social workers, and differenttherapists. Each of these roles hasdifferent medical expertise, workroutines, and time constraints. Giventhe time constraints of physicians, theymay not be the best providers to reviewpatient-generated data and to engagein the use of patient-centered systems.
Imagine a patient arrives with adevice that contains self-tracked dataover the past few months and expectsthe physician to examine the collecteddata. The patient may also invite thephysician to see data from a systemhe has been using in monitoring hisvital signs. How can these unplannedactivities fit into physicians’ alreadypacked or even backlogged schedule?
Rather, it may be more beneficial forother roles, such as medical assistantsand nurses, to review and summarizethe collected data. If the budgetpermits, new positions may even becreated to specifically review andhandle such patient-generated data.
For instance, in a recent study,patients with bipolar disorder wereasked to have their behavioraldata collected by a smartphoneautomatically and by a questionnaire
There is no doubt such technologiesbenefit patients, but the question toconsider here is what we designersand researchers can do to make thesesystems easy to use, not only for theirintended primary users—patients—but also for health providers, whomight be secondary users of thesepatient-centered systems. So how do wesupport these secondary stakeholders?
Should raw data be shared with them?
This quarterly publication is aquarterly journal that publishesrefereed articles addressing issuesof computing as it impacts thelives of people with disabilities.The journal will be of particularinterest to SIGACCESS membersand delegates to its affiliatedconference (i.e., ASSETS), as wellas other international accessibilityconferences.
Should the data be displayed in thesame way to providers as to patientsand family members? How canpatient-generated data be visualized inabstracted and meaningful ways or incustomized formats to meet the needsof different providers? Understandingthe unique time constraints andworkflow challenges of health providerscan help inform the design of patient-centered systems to minimize potentialconflicts between patients who wantto share large amounts of data aboutthemselves and health providers whoare often too time-pressured to lookover the patients’ data.
[ 4]. The objective was to allow clinicalstaff to monitor patients and be ableto react if the patients experiencedsigns of emerging manic or depressiveepisodes. But despite the fact that thesystem was designed with and for theclinical staff [ 5], a subsequent trialrevealed that it was unclear who shouldbe responsible for monitoring thecollected health data, how often, andhow to react to the data. For example,should patients’ data be monitored by apsychiatrist, a general practitioner, or anurse, and should the data be checkedweekly, daily, or every few hours? Mostimportant, what should be done if anemergent depression or manic episodeis detected? Thus, even a seeminglysimple system for semi-automaticdata sampling can have a significantimpact on the organization of treatmentand care, which should be addressedsimultaneously.
Similar issues were found in anotherstudy that examined an online patient
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Second, designers need tounderstand the different roles withinthe healthcare system; this can helpidentify providers who are likelyto embrace new patient-centeredtechnologies. It may be easy to assumethat all providers are the same. Yethealthcare is a highly specialized fieldthat encompasses many specific roles,
to understand the
liability concerns of
health providers and
how this may alter
their willingness to
engage with patient-