portal in an outpatient clinic wherea new work role was established toreview patients’ messages. This newrole ensured all messages were checkedand responded to in a timely mannerwithout imposing an unnecessaryburden on the primary care physicians.
These two examples indicatethat adopting patient-centeredtechnologies in clinical settingsis non-trivial. It is imperative forresearchers to understand how newtechnologies fit into the existing workstructure of the clinical practice, andto evaluate important issues such asthe temporality of patient-generateddata, levels of expertise in interpretingthe data, appropriate workload, andworkflows that make patient-centeredtechnologies usable by and useful tohealth providers. Above all, we shouldnot assume that providing new systemsand new data would automaticallybenefit the work of health providers.
Instead, organizational change in thehealth system may be required if newpatient-centered technologies are tobe utilized and adopted into clinicalpractices.
Third, designers need to understandthe liability concerns of healthproviders and how this may alter theirwillingness to engage with patient-generated data. Clinical work is subjectto a variety of legal regulations andis also governed by licensing boards.
Stepping outside accepted guidelinesor protocols may result in fines, lossof license to practice, or malpracticelawsuits. Data from patient-centeredtechnologies is as yet unregulated bythe law, and best practices have yet tobe established for how to deal with suchdata.
In our experience, such fears canaffect a health provider’s willingnessto review patient-generated data. Inone study, parents of preterm infantswere tasked with recording theirinfant’s diaper usage, weight gain,and appointment attendance througha mobile app [ 6]. Parents were alsoencouraged to track their own moodsand to complete monthly assessmentsof their risk for postpartum depression.
In the design phase of the study, we
found that while the health providers
liked the idea of having access to this
data, they were reluctant to monitor
the data on a regular basis. One concern
providers raised was about overlooking
important data: Would it then put the
infant at risk and make the provider
vulnerable to a malpractice complaint?
Would the transmission of patient-generated data give parents a false senseof security, such that they are no longeras attentive to their child? And finally,the health providers were absolutelyadamant that they did not want toreview the emotional health data of theparents. Though it was generally agreedthat parental well-being could greatlyimpact an infant’s health, the providerswere very clear that the parents werenot their patients and they did not wantthe legal responsibility of monitoringthe parents’ data.
Our CHI panel inadvertently initiatedthe discussion on the design of patient-centered systems and the potentialeffects on health providers. In suchan information-rich and evidence-driven field, designers may assumethat more data will lead to betterhealth practices. However, as we diveinto the participatory Health 2.0era, it is necessary for us to considernot only how to design such systemsfor patients to adopt and use formaking health behavior changes,but also the secondary users whoserole of reviewing, interpreting, andmonitoring patient-generated datais critical to the success of thesetechnologies. As such, the design ofpatient-centered systems is necessaryto make the invisible work of healthproviders more explicit. To do sorequires us to understand and besympathetic to the work practices ofhealth providers, and to explore ways todesign the technology to benefit ratherthan burden them.
1. Chen, Y., Cheng, K.G., Tang, C., Siek,K. A., and Bardram, J. E. Is my doctorlistening to me? Impact of health it systemson patient-provider interaction. CHIExtended Abstracts 2013. 2419–2426
2. Suchman, L. A. Making work visible.Commun. ACM 38, 9 (1995), 56–64.
3. Chen, Y., Ngo, V., Harrison, S., andDuong,V. Unpacking exam-roomcomputing: Negotiating computer-use inpatient-physician interactions. Proc. CHI
4. Frost, M., Doryab, A., Faurholt-Jepsen,M., Kessing, L.V., and Bardram, J.E.Supporting disease insight through dataanalysis: Refinements of the monarca self-assessment system. Proc. UbiComp 2013:133–142.
5. Marcu, G., Bardram, J. E., and Gabrielli,S. A framework for overcoming challengesin designing persuasive monitoring andfeedback systems for mental illness. Proc.PervasiveHealth 2011.
6. Cheng, K.G., Hayes, G.R., Hirano, S.H.,Nagel, M. S., and Baker, D. Challengesof integrating patient-centered datainto clinical workflow for care of high-risk infants. Personal and UbiquitousComputing. In press.
Yunan Chen is an associate professor in theDepartment of Informatics at the Universityof California, Irvine. Her recent projectsexplored the use of EHR systems in variousclinical settings, with a specific focus onclinical documentation and patient-providerinteraction.→
Karen Cheng is a senior research scientistin the Department of Informatics, Universityof California, Irvine, and assistant professorin the Department of Psychiatry, CharlesDrew University of Medicine and Science. Herresearch focuses on mobile systems of healthinterventions and behavior change.→
Charlotte Tang is an assistant professor incomputer science at the University of Michigan,Flint. Her research focuses on human-computer interaction, computer-supportedcooperative work, health informatics,and accessible computing. She currentlyinvestigates the transition from a paper-basedto a digital medical record system in a clinicalpractice.→
Katie A. Siek is an associate professorin the School of Informatics and Computingat Indiana University. Her primary researchinterests are in human-computer interaction,health informatics, and ubiquitous computing.More specifically, she is interested in howsociotechnical interventions affect personalhealth and well-being.→
Jakob E. Bardram is a professor incomputer science at the I T University ofCopenhagen, Denmark. His research focuseson human-computer interaction, computer-supported cooperative work, and ubiquitouscomputing, with a special focus on applicationswithin healthcare. He is currently researchinghow patient-focused mobile technology canhelp mentally ill patients.→
email@example.comSEPTEMBER–OCTOBER 2014 INTERACTIONS 77