Connie V. Chan

Redesigning electronic health record systems to support public health

Current electronic health record systems are primarily clinical in focus, designed to provide patient-level data and provider-level decision support. Adapting EHR systems to serve public health needs provides the possibility of enormous advances for public health practice and policy. In this review, we evaluate EHR functionality and map it to the three core functions of public health: assessment, policy development, and assurance. In doing so, we identify and discuss important design, implementation, and methodological issues with current systems. For example, in order to support public healths traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical data elements, and workflow would have to be examined to determine the optimal way of collecting these data. We also argue that redesigning EHR systems to support public health offers benefits not only to the public health system but also to consumers, health-care institutions, and individual providers.

A Framework for Characterizing eHealth Literacy Demands and Barriers

Background Consumer eHealth interventions are of a growing importance in the individual management of health and health behaviors. However, a range of access, resources, and skills barriers prevent health care consumers from fully engaging in and benefiting from the spectrum of eHealth interventions. Consumers may engage in a range of eHealth tasks, such as participating in health discussion forums and entering information into a personal health record. eHealth literacy names a set of skills and knowledge that are essential for productive interactions with technology-based health tools, such as proficiency in information retrieval strategies, and communicating health concepts effectively. Objective We propose a theoretical and methodological framework for characterizing complexity of eHealth tasks, which can be used to diagnose and describe literacy barriers and inform the development of solution strategies. Methods We adapted and integrated two existing theoretical models relevant to the analysis of eHealth literacy into a single framework to systematically categorize and describe task demands and user performance on tasks needed by health care consumers in the information age. The method derived from the framework is applied to (1) code task demands using a cognitive task analysis, and (2) code user performance on tasks. The framework and method are applied to the analysis of a Web-based consumer eHealth task with information-seeking and decision-making demands. We present the results from the in-depth analysis of the task performance of a single user as well as of 20 users on the same task to illustrate both the detailed analysis and the aggregate measures obtained and potential analyses that can be performed using this method. Results The analysis shows that the framework can be used to classify task demands as well as the barriers encountered in user performance of the tasks. Our approach can be used to (1) characterize the challenges confronted by participants in performing the tasks, (2) determine the extent to which application of the framework to the cognitive task analysis can predict and explain the problems encountered by participants, and (3) inform revisions to the framework to increase accuracy of predictions. Conclusions The results of this illustrative application suggest that the framework is useful for characterizing task complexity and for diagnosing and explaining barriers encountered in task completion. The framework and analytic approach can be a potentially powerful generative research platform to inform development of rigorous eHealth examination and design instruments, such as to assess eHealth competence, to design and evaluate consumer eHealth tools, and to develop an eHealth curriculum.

A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries

Health information technologies (HIT) have great potential to advance health care globally. In particular, HIT can provide innovative approaches and methodologies to overcome the range of access and resource barriers specific to developing countries. However, there is a paucity of models and empirical evidence informing the technology selection process in these settings. We propose a framework for selecting patient-oriented technologies in developing countries. The selection guidance process is structured by a set of filters that impose particular constraints and serve to narrow the space of possible decisions. The framework consists of three levels of factors: (1) situational factors, (2) the technology and its relationship with health interventions and with target patients, and (3) empirical evidence. We demonstrate the utility of the framework in the context of mobile phones for behavioral health interventions to reduce risk factors for cardiovascular disease. This framework can be applied to health interventions across health domains to explore how and whether available technologies can support delivery of the associated types of interventions and with the target populations.

Mobile phones as mediators of health behavior change in cardiovascular disease in developing countries.

The global burden of cardiovascular diseases (CVD) is becoming a growing problem in developing countries. Successful self-management of CVD is dependent on a multitude of factors, including social support, communication with health care providers, careful monitoring, and other determinants. The growing market penetration and the communication properties of mobile phones create opportunities for innovation in promoting CVD self-management through support of lifestyle and behavior modification. Mobile phones support various modes of communication and interaction, have fewer adoption barriers, and are more prevalent than other available technologies in developing countries. However, mobile phone interventions are not without many challenges such as mobile infrastructure, electric infrastructure, access to mobile devices, and appropriate user interfaces for interaction. In this paper, we discuss current evidence as well as research opportunities to explore the role of mobile phones in supporting behavior modification in developing countries.

Assessing the need for an online decision-support tool to promote evidence-based practices of psychosocial counseling in HIV care.

Abstract Psychosocial counselors have a vital and challenging role in supporting persons living with HIV/AIDS (PLWH/A) to better manage their disease. However, gaps in training, education, and skills limit the effectiveness of counselors’ efforts. We propose that the use of a decision-support tool for counselors at the point of care can support them in their work as well as help alleviate many training and practice gaps. Decision-support tools aimed at reducing knowledge and practice gaps are used extensively to assist clinical providers at the point of care; however, there is a need for decision-support tools designed specifically for HIV/AIDS counselors. To identify requirements for such a tool, we conducted a needs assessment through interviews of 19 HIV/AIDS clinic counselors who provide 20 or more hours per week of psychosocial support to PLWH/A. The assessment explored their education and training backgrounds, the extent to which evidence-based practices are implemented, and how a decision-support tool can support counselor work practices. Qualitative analysis was organized around seven main categories: counselor characteristics, patient characteristics, barriers, definitions of key concepts, use of guidelines, client assessments, and resources. The resulting coding schemes revealed knowledge and practice gaps among the interviewees, as well as barriers and challenges of counseling. Education and training background of the counseling staff varied widely. When asked to define five key concepts related to HIV counseling, 26–47% of respondents were unable to articulate an adequate definition. Less than half of the interviewees recalled sources of guidelines used in their work and specific models of care introduced during trainings. Interviews identified environmental barriers, language and literacy, patient education, and patient communication as the most prominent challenges to counseling work. The results from this study inform the need for and development of a decision-support tool to support the training and practices of HIV/AIDS counselors.

eHealth Literacy as a Mediator of Health Behaviors

eHealth literacy names a set of core literacies involved in the meaningful and productive use of health technologies. In this chapter, we present an integrative theoretical and methodological cognitive framework for elucidating the nature of these barriers and for fashioning design solutions. The Chan–Kaufman analytic framework differs from other frameworks in that the goals are to develop a diagnostic approach rather than a screening tool. The framework can be used to classify task demands and characterize the barriers encountered in users’ task performance. The methods are illustrated in the context of a health information seeking problem. We then review the research pertaining to the challenges in each of the consumer health domains including information seeking, patient portals, mHealth, social media, and telemedicine. The chapter discusses implications that need to be addressed when developing new health related programs and tools. eHealth tools afford an almost infinite number of new means to achieve health behavior change in the promotion of wellness and in the monitoring and management of chronic illness. The essential question is how do we tune these technologies such that they better address the needs of patients and health consumers at varying levels of eHealth literacy.