“HCI Research in Healthcare: Using Theory from Evidence to Practice”

Download all workshop submissions.

The Wrong Trousers: Misattributing medical device issues to the wrong part of the sociotechnical system - Dominic Furniss, Ann Blandford and Astrid Mayer

HCI does not have well developed theoretical underpinnings to capture how different parts of a sociotechnical system impact medical device design and use. We report an issue that was identified during an ethnographic study of infusion pump use on a haematology ward: the frequency of the alarms caused frustration to staff and patients. Staff understood this to be a device design problem outside their control – a manufacturing issue. It is actually configured this way by the hospital – a device management issue. This misattribution impacts corrective action, and the quality and safety of patient care. We highlight three theoretical areas that could provide leverage for understanding issues such as this.

Theoretical perspectives on the use of social media in the propagation of health messages - Andrew McNeill and Pam Briggs

Influence on social media can be conceptualised as both extensive (relating to quantitative spread) and intensive (qualitative impact). Both of these are important considerations in understanding the dissemination of health messages. We outline several theoretical approaches that offer fruitful ideas for future studies including agenda-setting theory, social norms theory, social representations theory, and theories relating to emotion, framing and recontextualisation. Some of these approaches are novel in social media research and are suggestive for future research directions.

The Use of Theoretical Constructs in Studying Health Information Technologies - Madhu Reddy

Theoretical constructs are the foundational building blocks of theories and are utilized as a way of understanding and explaining phenomena.The use of theory and theoretical constructs to study health information technologies have varied based on research communities, research goals, and types of technology. Within the HCI community, there has been a long history of using theoretical constructs to help us understand the use of technology.

In this position paper, drawing on ourprevious researchin healthcare settings, I would like to discuss the role that theoretical constructs can play in helping us better understand the use of health information technologies. In particular, I am interested in exploring not only how these constructs can help us better understand issues but also how we can use these constructs in designing and implementing health information technologies.

Activity-Centric Configuration Work in Nomadic Computing Steven Houben and Jakob E. Bardram

The work ow in hospitals can be described as nomadic, which means that clinicians roam through the hospital while interacting with a large number of people and information related to di erent patient cases. Over the years, more device types (such as mobile devices, large interactive whiteboard) have been introduced into this work ow to support mobility and coordination. However, most of these devices and systems are intrinsically disconnected from each other, forcing clinicians to manually recon gure them to match the active work setting according to the situation. In this paper, we describe an activity-centric approach to this multi-device con guration problem that is grounded in activity theory.

The Co-production Connection: Community Engagement and Health John M. Carroll

Health can be construed in many ways, for example, as the absence of sickness or as a caused outcome of environmental interactions. Here we focus on personal and collaborative agency in a community context, and construe health as an achievement co-produced by a person and other engaged community members.

On Individuals’ Resilience Strategies: Drawing and Applying Theories George Buchanan and Jonathan Day

Individuals, both in frontline healthcare settings and more generally speaking, frequently deploy a range of resilient strategies and behaviours to maintain performance and mitigate a multitude of potential threats. Our work here describes how theories can be both derived-from and applied-to situated instances of resilience within frontline healthcare settings. We also recognise the value in considering how the concept transcends specific contexts, and the importance and potential significance of establishing such a theory both within, and transferrable across, a range of domains.

In at the deep end: Contextual Inquiry and DiCoT as “flotation aids” for a novice ethnographer  - Erik Berndt, Dominic Furniss and Ann Blandford

Systematic approaches to observation and analysis have the potential to support a junior analyst in making sense of a complex setting. However, the costs and benefits of learning and applying such approaches have rarely been studied explicitly. In this paper, we present an idiographic study in which a single individual systematically learned and applied Contextual Inquiry and DiCoT (a structured approach to analyzing a system in terms of Distributed Cognition) to understand how anesthetists use infusion devices in their work. We present a reflexive account of his experiences. Contextual Inquiry was found to be a valuable tool for understanding this complex system; DiCoT built on that analysis to deliver rich insights into the design of tools and how information is exchanged around the system.

Using Theoretical Frameworks to Tailor Error Prevention Strategies to the Type of Task Being Performed P.L. Trbovich, A. L. Cassano-Piche, S. Pinkney, C. Colvin, M. Fan and A.C. Easty

Numerous studies of errors in health care identify medication-related errors as at or near the top of the list of concerns, both in terms of frequency and severity of impact. Despite the development of automated technologies, such as smart infusion pumps, medication errors are still prevalent and typically occur in more than half of all intravenous (IV) infusions. Incorrect setup, programming and management of IV systems, particularly complex secondary and multi-line infusions, are often caused by knowledge and performance deficits. These deficits are influenced by several factors, one of which is a lack of clinician training on fundamental infusion principles. Thus, to improve patient safety related to administering IV infusions, there is a great need for (a) infusion system design that optimizes capability and ease of use, and (b) an effective means of educating clinicians on the system fundamentals necessary to support critical thinking and decision making when operating IV medication systems. We have undertaken a case study in which we have applied various theoretical frameworks/approaches, to determine the underlying cause of IV medication administration-related errors, and to compare types of errors that were best mitigated through improved device design to those that benefited most from improved user training. Theoretical frameworks/approaches used in our case study include an AcciMap analysis taken from Rasmussen’s Risk Management Framework [1], and Rasmussen’s Skill- Rule-Knowledge conceptual framework for human performance [2].

Integrating Cognitive and Socio- Technical Theoretical Perspectives in Health Informatics - Andre Kushniruk, Elizabeth Borycki, Johanna Kaipio, Marko Nieminen, Christian Nohr and Craig Kuziemsky

The purpose of this presentation is to present our approach to integrating cognitive and socio-technical theoretical perspectives for assessing the impact of health information systems. The objective of this work is to lead to the design of health information user interfaces and systems that better meet the information and workflow needs of health professionals. Previously, health informatics research has typically focused either on the cognitive or the socio-technical aspects of health information systems separately. In this workshop we demonstrate how evaluations of health information systems can be designed that take into account theoretical aspects related to cognition as well as socio-technical aspects, including the impact of systems on workflow. Using a case study, we illustrate use of clinical simulations to bring in and integrate both cognitive and socio-technical theoretical perspectives in evaluating health information technology prior to and after system release.

A Complexity Theory Perspective for Defining the Digital Persona of HIT Usage Craig Kuziemsky Telfer, Andre Kushniruk, Elizabeth Boryck and Christian Nohr

It is common for unintended consequences to arise after implementing health information technology (HIT). These consequences occur because HIT creates a digital chasm between the manner in which people conduct business processes pre and post-HIT. Human Computer Interaction (HCI) issues can provide meaningful insight about the digital persona in which people interact with HIT and how we can better design and evaluate HIT to mitigate the digital chasm. In this paper we use complexity theory to analyze HCI issues from the implementation of a perioperative information system. The insight from our analysis provides insight on how we can design HIT to support the digital persona of end users.

Using A Third-Wave HCI Approach for Researching Mobile Medical Devices - Aisling Ann O’Kane

Theoretical frameworks are often applied and created in the HCI healthcare fieldwork domain, but for less contained non-clinical settings such as medical devices used on the go, there has been little exploration of theories involving user experience. In this paper, I will introduce a project that is focusing on the situated use of mobile medical technologies by people with Type 1 diabetes and the user experience theories that are framing this work. Using user experience frameworks that have developed from the third-wave HCI shift from focusing on technologies used in the workplace to technologies used in everyday life, I present how they might be connected to the evaluation of medical technologies used by laypeople for the self-management of their own health and safety.

ViA – Values in Action within Healthcare - Christiane Moser, Verena Fuchsberger and Manfred Tscheligi

The shift in HCI towards emotions, values, needs etc., (third-wave HCI) reflects a new understanding of interactions between users and technology. We identified a lack of suitable theory, frameworks and concepts, which provide an integrated view on values as well as on usability, user experience and user acceptance [6]. Therefore, we applied the Values in Action (ViA) approach, which aims to support healthcare related Ambient Assisted Living (AAL) projects, in order to develop valuable ICT solutions for older adults, their relatives and formal care giver. It helps to understand what is valued by different users.

Collaborative Reflection: Long-Term Sensemaking in Health Services - Gabriela Marcu, Anind K. Dey,  Sara Kiesler and Madhu C. Reddy

Fieldwork in health service settings has mainly explored collaborative sensemaking as a short-term activity. However, not all providers perform sensemaking in order to make time-critical decisions that could be the difference between life and death. In this paper we present fieldwork that reveals long-term sensemaking. We use the term collaborative reflection to distinguish this type of sensemaking. We discuss how (1) the features of an organization, and (2) the long-term nature of services, affect sensemaking activities and make collaborative reflection a new and unique concept. The goal of this theoretical framework is to inform the design of different classes of systems for different types of sensemaking activities.

Exploring Patient Experience PX Johanna Kaipio, Mari Tyllinen, Marko Nieminen, Andre Kushniruk and Elizabeth Borycki

This paper contributes to the discussion and definition of patient experience (PX). The aim is to promote discussions around the concept and its conceptualization. Our experience is, that in order to support patient-centredness in healthcare and user-centred development of related services and technologies, we need to understand following: What patient experience is about? How can it be defined, researched and measured?

Reassembling the Patient in Nursing Workflow Peter H. Jones

A field investigation may often serve multiple purposes, placing a significant burden on social theory to aid understanding of critical issues, their appropriate resolutions, and to contribute to design decisions. As a theoretical lens for sociotechnical work, activity theory provides an ecologically-validated social theory frame for studying technology mediation and information use for care practices in complex workflow contexts. An activity view studies work behaviors that can inform design decisions for healthcare informatics; to do this we must understand sources of information uses that justify design claims, which involves workflow critique. This paper presents a research program that adopted activity theory in nursing and clinical work studies and critiques the contradiction between workflow and patient-centred care evident in the ethnographic study.

Pace and Temporality in Safety Critical Medical Work: Concepts for Understanding Adaptation Behaviors - Katherine Sellen and Mark Chignell

Drawing on the concepts of temporality and pace to analyze the experience of a new technology for transfusion practice, our analysis articulates the relationship between adoption experiences, task dimensions, and the coping strategies that emerge. We discuss the implications for design of interactive systems in healthcare as well as the theoretical implications for understanding unfolding healthcare practices.

About the Workshop:

Healthcare presents a challenging domain for Human-Computer Interaction (HCI) research. The complexity of work, variability of work practices, richness of, and reliance on information, and continuous collaborative activity, provide opportunities to explore new forms of interaction and to advance theory. Theory has an important place in HCI research in healthcare. However, resources are spread far and wide in different multidisciplinary journals. It is timely for the community to reflect on the classic, modern and contemporary theories they use, to map where strengths and weaknesses lie, and where emerging opportunities are unfolding.

This workshop aims to encourage dialogue and exchange of ideas with examples of current and emerging theory in HCI and healthcare. We aim to produce a journal special issue to map the state of the art in this area. This workshop builds on the successful CHI 2013 workshop: HCI Fieldwork in Healthcare: Creating a Graduate Guidebook. Here we brought together researchers to share experiences and expertise in carrying out healthcare fieldwork in both clinical and non-clinical settings and produced two edited volumes that will both be available by summer 2014.

Please direct any questions to Kate Sellen: ksellen@faculty.ocadu.ca

Abstract:

Theory has an important place in HCI research in healthcare. However, resources on this area are spread far and wide in different multidisciplinary journals. It is timely for the community to reflect on the classic, modern, and contemporary theories they use, to map where strengths and weaknesses lie, and where emerging opportunities are unfolding. This workshop aims to encourage dialogue and exchange of ideas and examples of current and emerging theory in HCI and healthcare to support researchers and practitioners as they address the significant challenges and opportunities of this domain. We aim to produce a journal special issue to map the state of the art in this area.

Motivation:

Healthcare presents a particularly challenging domain for Human-Computer Interaction (HCI) research. The complexity of work, variability of work practices across organizations, richness of, and reliance on information, and continuous collaborative activity [2, 9] provide opportunities to explore new forms of interaction and to advance theory in this domain [11].

This workshop builds on the CHI 2013 workshop: HCI Fieldwork in Healthcare: Creating a Graduate Guidebook [5]. Here we brought together researchers from diverse backgrounds to share experiences and expertise in carrying out healthcare fieldwork in both clinical and non-clinical settings: across hospitals, outpatient care facilities, homecare environments, and on the move when using mobile healthcare technology. This workshop was very successful, receiving 36 submissions, from which 20 delegates were invited to participate. The workshop has resulted in two edited volumes that will be in print by CHI 2014.

The need to address the role of theory in HCI emerged as a prominent theme. Among those issues discussed were the significant barriers to successful design and implementation of Health Information Technologies (HIT) and the unanticipated consequences on the work practices of physicians and nurses that indicate problems in integrating technology solutions with existing work practices [1,3]. In addition, factors related to regulation, organizational culture and political climate in healthcare, also influence technology implementation and adoption in healthcare settings. This is of particular concern to the HCI community carrying out research and working to inform design practice in healthcare since it implies a mismatch between the designs being implemented, the understanding of the domain, and the overall approach.

The complexity and uniqueness of healthcare practices raises a variety of practical questions, related to the clinical setting and the “in the wild” healthcare environment, that may benefit from a theoretical perspective, including questions addressing transition [8], mobility [2], temporality [4], information flow [6], and workflow [12]. Attendees at the CH2013 workshop highlighted the difference in approach between HCI methodology and the research models established in clinical work, and classic, modern and contemporary HCI theory [11]. The focus on fieldwork meant that many modern perspectives were used (e.g. ethnography and distributed cognition), however some contemporary perspectives were also used (e.g. design and value-led approaches).

Participants also suggested that research on the actual impacts of HIT, such as on daily work practices, adaptation behavior, and preventable errors, has the potential to inform the design of more effective health IT systems, as opposed to studying only adoption rates or clinically significant errors. However, without understanding the healthcare context and the ‘how’ and ‘why’ of health practices, positive change may be more difficult to achieve. Hence, the acquisition of such understanding through the application of sound and appropriate theory is necessary. While previous studies provide valuable insights into understanding healthcare practices in targeted settings [9], there has only been limited work that articulates the role of HCI theory in healthcare.

Workshop Focus:

The objective of the workshop is to further develop dialogue about theory between researchers who do HCI research in healthcare, including clinical and non- clinical contexts such as hospitals, outpatient care settings, homecare environments and mobile healthcare technology settings. We are interested in a broad range of approaches and in exploring a variety of theoretical lenses, among them:

  • social interactionism,
  • socio-technical,
  • values in design,
  • activity theory,
  • technology as experience, and
  • distributed and social cognition.

We expect this list to develop from the participants’ submissions and during discussions on the four themes below.

While many theoretical perspectives can inform HCI work on healthcare, equally theoretical perspectives also have the potential to develop from HCI work in healthcare. Much theoretical work on the concept of temporality [10], for example, comes from extensive fieldwork in healthcare settings. More recently HCI has moved away from the dominant themes of synchronous vs. asynchronous communication or collaborative work [9] to questions of supporting complex and unfolding work practices over time [10]. In particular, studies of information transfer between members of healthcare teams, among work organizations, as well as related to mobility issues, have contributed to this change [10].

The workshop will address the following provisional themes:

1. Body of Evidence: Exploring the evidence for the applicability of HCI theory to healthcare.

2. Beyond Health: Discussion of theory originating from healthcare related work that is applicable to the wider HCI community and theories not yet applied to healthcare.

3. In Practice: Moving from theory to the support of design, evaluation, and implementation activities.

4. Future Focus: New ideas emerging from the experience of HCI research in healthcare.

Workshop Goals:

We intend for this workshop to build on the success of the CHI 2013 Fieldwork workshop and benefit HCI researchers and the wider health informatics community by providing a venue for theoretical discussion and the exchange of ideas and experiences. Having identified a number of challenges of conducting fieldwork in healthcare during last year’s workshop, this year we aim to critically examine the appropriateness of classic, modern, and contemporary theoretical approaches to this type of work and build a body of knowledge to guide future work in this area. Our hope is to support bridging the gap between clinical practice and technology design in healthcare such that future technologies will demonstrate a good match to the intended healthcare environments. We aim to produce a journal special issue from the workshop to make these discussions available to other researchers and inform new research, with the ultimate aim of contributing to design, evaluation and implementation practice.

Specifically, we aim to:

  • provide an opportunity for researchers, designers, and practitioners in relevant fields, such as HCI, CSCW, pervasive health, medical informatics, patient safety and general medicine to share and learn from each other’s theoretical approaches,
  • share theoretical insights from research experiences in different settings and the conceptual challenges of particular theoretical lens,
  • discuss both common and uncommon theoretical approaches and explore possible new theoretical directions,
  • brainstorm and map different theoretical approaches to specific challenges in healthcare, e.g. workflow, errors, transitions, trajectories, culture, political climate, etc.,

and develop an outline for a special issue to communicate current theoretical work in healthcare to the wider HCI, health informatics, and general medicine communities.

References:

[1] Ash J. S., Berg M., Coiera, E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. (2004), 11:104-12.

[2] Bardram, J.E., Bossen, C. Mobility Work: The Spatial Dimension of Collaboration at a Hospital. In Proc. CSCW 2005. (2005). 131-160.

[3] Campbell, E. M., Guappone, K. P., Sittig, D. F., Dykstra, R. H., & Ash, J. S. Computerized provider

order entry adoption: implications for clinical workflow. J Gen Intern Med, 24(1), (2009). 21-26.

[4] Chen, Y. Documenting transitional information in EMR. In Proc. CHI2010, (2010). 1787-1796.

[5] Furniss, D, et al. “HCI fieldwork in healthcare: creating a graduate guidebook.” CHI’13 Extended Abstracts on Human Factors in Computing Systems. ACM, 2013.

[6] Karunakaran, A., Hee-Nam, Y., & Reddy, M. (2012). Investigating barriers to electronic medical record use during collaborative information seeking activities. In Proc. SIGHIT 2012, (2012)..

[7] Liu, L.S., Hirano, S.H., Tentori, M., Cheng, K.G., George, S., Park, S.Y., Hayes, G.R. Improving Communication and Social Support for Caregivers of High-Risk Infants through Mobile Technologies. In Proc. CSCW 2011. (2011), 475-484.

[8] Niazkhani, Z. Evaluating the impact of CPOE systems on medical workflow: a mixed method study. Stud Health Technol Inform, 136, (2008). 881-882.

[9] O’Hara, K., Kjeldskov, J., & Paay, J. Blended interaction spaces for distributed team collaboration. ACM Trans. Comput.-Hum. Interact., 18(1), (2011). 1- 28.

[10] Reddy, M. C., Dourish, P., & Pratt, W. Temporality in Medical Work: Time also Matters. Comput. Supported Coop. Work, 15(1), (2006). 29-53.

[11] Rogers, Y. “HCI theory: classical, modern, and contemporary.” Synthesis Lectures on Human-Centered Informatics 5.2 (2012): 1-129.

[12] Tang, C., Carpendale, S. An Observational Study on Information Flow During Nurses’ Shift Change. In Proc. CHI 2007. (2007), 219-228.

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