Wanda Pratt

Healthcare in the pocket: mapping the space of mobile-phone health interventions.

Mobile phones are becoming an increasingly important platform for the delivery of health interventions. In recent years, researchers have used mobile phones as tools for encouraging physical activity and healthy diets, for symptom monitoring in asthma and heart disease, for sending patients reminders about upcoming appointments, for supporting smoking cessation, and for a range of other health problems. This paper provides an overview of this rapidly growing body of work. We describe the features of mobile phones that make them a particularly promising platform for health interventions, and we identify five basic intervention strategies that have been used in mobile-phone health applications across different health conditions. Finally, we outline the directions for future research that could increase our understanding of functional and design requirements for the development of highly effective mobile-phone health interventions.

How to evaluate technologies for health behavior change in HCI research

New technologies for encouraging physical activity, healthy diet, and other types of health behavior change now frequently appear in the HCI literature. Yet, how such technologies should be evaluated within the context of HCI research remains unclear. In this paper, we argue that the obvious answer to this question - that evaluations should assess whether a technology brought about the intended change in behavior - is too limited. We propose that demonstrating behavior change is often infeasible as well as unnecessary for a meaningful contribution to HCI research, especially when in the early stages of design or when evaluating novel technologies. As an alternative, we suggest that HCI contributions should focus on efficacy evaluations that are tailored to the specific behavior-change intervention strategies (e.g., self-monitoring, conditioning) embodied in the system and studies that help gain a deep understanding of peoples experiences with the technology.

Personal health information management

Integrating personal health information helps people manage their lives and actively participate in their own health care.

Coordinating heterogeneous work: information and representation in medical care

Medical care involves intense collaboration amongst a number of practitioners including physicians, nurses, and pharmacists Their work is concentrated on a single patient, and yet their activities, motivations, and concerns are very different. We explore the use of a shared information system in helping these individuals coordinate their work. In particular, we use the idea of a common information space to explore how the shared information is incorporated into the diverse work practices of an intensive care unit. In addition to physical co-location, we found that providing information in many specialised representations is critical to managing their coordination. Unlike paper records, computer systems offer the ability to decouple information from its representations. This decoupling opens up a rich design space for systems that allow people with different interests, concerns and work practices to work together effectively.

Incorporating ideas from computer-supported cooperative work

Many information systems have failed when deployed into complex health-care settings. We believe that one cause of these failures is the difficulty in systematically accounting for the collaborative and exception-filled nature of medical work. In this methodological review paper, we highlight research from the field of computer-supported cooperative work (CSCW) that could help biomedical informaticists recognize and design around the kinds of challenges that lead to unanticipated breakdowns and eventual abandonment of their systems. The field of CSCW studies how people collaborate with each other and the role that technology plays in this collaboration for a wide variety of organizational settings. Thus, biomedical informaticists could benefit from the lessons learned by CSCW researchers. In this paper, we provide a focused review of CSCW methods and ideas-we review aspects of the field that could be applied to improve the design and deployment of medical information systems. To make our discussion concrete, we use electronic medical record systems as an example medical information system, and present three specific principles from CSCW: accounting for incentive structures, understanding workflow, and incorporating awareness.

Managing the Personal Side of Health: How Patient Expertise Differs from the Expertise of Clinicians

Background When patients need health information to manage their personal health, they turn to both health professionals and other patients. Yet, we know little about how the information exchanged among patients (ie, patient expertise) contrasts with the information offered by health professionals (ie, clinician expertise). Understanding how patients’ experiential expertise contrasts with the medical expertise of health professionals is necessary to inform the design of peer-support tools that meet patients’ needs, particularly with the growing prevalence of largely unguided advice sharing through Internet-based social software. Objective The objective of our study was to enhance our understanding of patient expertise and to inform the design of peer-support tools. We compared the characteristics of patient expertise with that of clinician expertise for breast cancer. Methods Through a comparative content analysis of topics discussed and recommendations offered in Internet message boards and books, we contrasted the topic, form, and style of expertise shared in sources of patient expertise with sources of clinician expertise. Results Patient expertise focused on strategies for coping with day-to-day personal health issues gained through trial and error of the lived experience; thus, it was predominately personal in topic. It offered a wealth of actionable advice that was frequently expressed through the narrative style of personal stories about managing responsibilities and activities associated with family, friends, work, and the home during illness. In contrast, clinician expertise was carried through a prescriptive style and focused on explicit facts and opinions that tied closely to the health care delivery system, biomedical research, and health professionals’ work. These differences were significant between sources of patient expertise and sources of clinician expertise in topic (P < .001), form (P < .001), and style (P < .001). Conclusion Patients offer other patients substantial expertise that differs significantly from the expertise offered by health professionals. Our findings suggest that experienced patients do not necessarily serve as “amateur doctors” who offer more accessible but less comprehensive or detailed medical information. Rather, they offer valuable personal information that clinicians cannot necessarily provide. The characteristics of patient expertise and the resulting design implications that we identified will help informaticians enhance the design of peer-support tools that will help meet patients’ diverse information needs.

Temporality in Medical Work: Time also Matters

CSCW has long been concerned with the distribution of activities in time and in space, but the problems of distributed work have often taken analytic and technical precedence. In this paper, we are interested in the issue of temporality in collaborative work. In particular, we want to examine how the temporal organization of action is experienced by those who are involved in it. To investigate this phenomenon, we conducted a field study of medical workers in a surgical intensive care unit. Through this study, we highlight the temporal organization of the work. In particular, we introduce and describe three temporal features – temporal trajectories, temporal rhythms, and temporal horizons – that emerge from and influence the work of healthcare providers as they attempt to seek, provide, and manage information during the course of their daily work.

Catalyzing social support for breast cancer patients

Social support is a critical, yet underutilized resource when undergoing cancer care. Underutilization occurs in two conditions: (a) when patients fail to seek out information, material assistance, and emotional support from family and friends or (b) when family and friends fail to meet the individualized needs and preferences of patients. Social networks are most effective when kept up to date on the patients status, yet updating everyone takes effort that patients cannot always put in. To improve this situation, we describe the results of our participatory design activities with breast cancer patients. During this process, we uncovered the information a social network needs to stay informed as well as a host of barriers to social support that technology could help break down. Our resulting prototype, built using Facebook Connect, includes explicit features to reduce these barriers and thus, promote the healthy outcomes associated with strong social support.

Patients as actors: The patient's role in detecting, preventing, and recovering from medical errors

PURPOSE Patients have the most to gain from reducing medical errors; yet, little research has been done to investigate the role they could or already do play in detecting and preventing errors in their own health care. The purpose of this study is to examine patients role in detecting, preventing, and recovering from medical errors in outpatient oncology. METHODS In this paper, we use cognitive work analysis and Rasmussens taxonomy of human performance to describe five cases of medical errors that occurred in an outpatient, cancer-care setting. We detail the role of the patient in each case, and analyze each role using constructs from previous studies of human behavior and errors. RESULTS Observational data indicates that patients engage in a range of tasks that identify, prevent, and recover from medical errors in outpatient cancer care. The results of this study point to the importance of considering patients and their work in both the design of patient-care information systems and the structure of clinical-care environments that enable safe and effective health care.

LitLinker: capturing connections across the biomedical literature

The explosive growth in the biomedical literature has made it difficult for researchers to keep up with advancements, even in their own narrow specializations. In addition, this current volume of information has created barriers that prevent researchers from exploring connections to their own work from other parts of the literature. Although potentially useful connections might permeate the literature, they will remain buried without new kinds of tools to help researchers capture new knowledge that bridges gaps across distinct sections of the literature. In this paper, we present LitLinker, a system that incorporates knowledge-based methodologies, natural-language processing techniques, and a data-mining algorithm to mine the biomedical literature for new, potential causal links between biomedical terms. Our results from a well-known text-mining example show that LitLinker can capture these novel, interesting connections in an open-ended fashion, with less manual intervention than in previous systems.