Canadian employers' perspectives on a new framework for health informatics competencies

Competencies are the knowledge, skills, and abilities needed to operate and perform successfully in the workplace. Due to the evolving nature of health informatics, it is important continuously examine and refine competencies in this field. In this study, we administered a questionnaire to Canadian employers (N = 29) of health informatics cooperative education (co-op) students to garner their feedback on competencies within a New Health Informatics Professional Competencies Framework. Overall, the findings supported this new framework. An average of ratings within each of the four competency categories revealed that participants perceived Management Science to be the most important, followed by Information & Computer Science, then Health Science and finally Data Science. Further, at least 20 (69 %) respondents rated nine of the 12 competencies as important. Of the 12 competencies, Biological and Clinical Science was rated the lowest. Findings from this study can potentially be used to inform curricula, career progression, and hiring practices in health informatics. Future work includes refining the questionnaire to assess the competencies more comprehensively and potentially exploring the importance of more transferable skills or general competencies (e.g., communication, problem-solving). Additionally, we want to survey a broader sample of health informatics professionals and integrate recent national and international work on health informatics competencies. Future work is also recommended towards the development of a maturity model for competencies of more experienced health informatics professionals.

Tabular, Annotated, Visual, or Trends + Contextual Information? Preferences for Online Laboratory Results Displays

People are increasingly offered access to their personal health information (e.g., laboratory results, clinical notes, diagnostic imaging results). However, this information is the same as that used by health care providers with clinical expertise and training in medical terminology, which citizens typically do not have. In this study, we examined participants (N = 24) preferences for four different types of displays for online laboratory (lab) results: Tabular, Annotated, Visual, and Trends + Contextual Information. The Friedman test of difference comparing participants' ratings of the four displays was significant, χ2(3)=10.8, P=.013, and the Wilcoxon signed rank pairwise comparison tests revealed that participants rated the visual lab results display significantly more favourably than the traditional display (Z=-2.746, P=.006). These findings indicate that many people prefer lab results displayed using more visual cues and some perceived this format as easier to understand than the other display formats. Given the importance of people accessing, understanding, and using their own health information, it is crucial for displays and systems to provide a better user experience. Displaying data (e.g., lab results) visually is one possible way to improve interpretability of personal health information provided to the public.

Simulating Telemedicine, Medication Reconciliation, and Social Determinants: A Novel Instructional Approach to Health Systems Competencies

While medication reconciliation is necessary to reduce errors, it is often challenging to gather an accurate history in the clinic. Telemedicine offers a relative advantage over clinic and hospital-based interviews by enabling the clinician to inspect the home environment, review pill bottles, and identify social determinants affecting adherence, such as financial instability. To be effective, however, clinicians must be trained in best-practice interview methods and the proper use of telemedicine. There is very little information in the literature describing the best strategies for teaching students or measuring competencies in telemedicine. Therefore, we created an educational module with a telemedicine simulation and an evaluation rubric. We piloted this module with 48 medical and physician assistant students. Most students could complete a virtual interview and gather a medication history. However, only half identified an over-the-counter medication missing from the list. Most students were either entrustable or approaching entrustment in the six telemedicine competencies measured in this simulation. This simulation is valuable for teaching students about medication reconciliation, using telemedicine to close gaps in access to care, and identifying health-related social needs affecting medication adherence.

Citizens' Access to Online Health Information - An International Survey of IMIA Member Countries

Citizens' access to their online health information is pivotal. Therefore, this study examines citizens' access to their online health information across countries and healthcare settings. The study is based on a survey design targeting the 98 IMIA representatives of the national societies. Results indicate that Test results and Medications are the two types of online information that citizens in most cases have access to. Ten countries provide citizens access to all the different types of information included in the study. That relatively few countries provide citizens access to all the included types of online health information underscores the importance of continuous emphasis on accessibility and research within this field.

Teledermatology: Simulating Hybrid Workflows for Telemedicine Education

Given the importance of telemedicine in improving healthcare access for underserved patients, professional students need experience using virtual clinical workflows. We developed an educational workshop with (1) readings, (2) a knowledge assessment test, (3) dermatology and teledermatology lectures, (5) a telemedicine simulation with a standardized patient, and (6) a debriefing session. The simulation included a "hybrid" workflow with live videoconferencing and store-and-forward image review. We measured student performance using three American Association of Medical Colleges (AAMC) Telemedicine Competencies for medical education. Ninety-eight medical and physician assistant students completed this workshop between 2021 and 2022, and 80% were entrustable or approaching entrustment in each competency. Some students struggled with data collection and technology use. Our results suggest that this workshop offers a practical and generalizable way to teach about multiple virtual workflows and strengthen students' telemedicine competencies.

Interpreting Laboratory Results with Complementary Health Information: A Human Factors Perspective

The desire to access personal and high-quality health information electronically is increasing, not only in Canada, but globally. With the advent of the COVID - 19 pandemic the desire and demand for telemedicine and timely access to personal health data such as online laboratory (lab) results has increased substantially. This study examines citizens' perspectives of being provided with high-quality information about a specific lab test (i.e., potassium) in the same display as a trend graph. Therefore, the objective of this study is to test how participants managed this additional information about the context of the test, understood, and applied it. The researchers analyzed the responses of semi-structured interviews with Canadian participants (N=24) using conventional content analysis. This paper examined four themes related to providing complementary information concurrently with lab results in the same display: 1) Benefits of Collocated Information, 2) Information Overload, 3) Misinterpretation, 4) Confusion. This study provided examples of some of the difficulties that the participants faced accessing their lab values online, while navigating and discerning complimentary high-quality health information available in their patient portal.

Assessing Telemedicine Competencies: Developing and Validating Learner Measures for Simulation-Based Telemedicine Training

In 2021, the Association of American Medical Colleges published Telehealth Competencies Across the Learning Continuum, a roadmap for designing telemedicine curricula and evaluating learners. While this document advances educators' shared understanding of telemedicine's core content and performance expectations, it does not include turn-key-ready evaluation instruments. At the University of Oklahoma School of Community Medicine, we developed a year-long telemedicine curriculum for third-year medical and second-year physician assistant students. We used the AAMC framework to create program objectives and instructional simulations. We designed and piloted an assessment rubric for eight AAMC competencies to accompany the simulations. In this monograph, we describe the rubric development, scores for students participating in simulations, and results comparing inter-rater reliability between faculty and standardized patient evaluators. Our preliminary work suggests that our rubric provides a practical method for evaluating learners by faculty during telemedicine simulations. We also identified opportunities for additional reliability and validity testing.

Identifying Failure Modes in Telemedicine: An Instructional Needs Assessment

Technology failures in telehealth are common, and clinicians need the skills to diagnose and manage them at the point of care. However, there are issues beyond technology failures mediating the effective use of telehealth. We must teach best-practice procedures for conducting telemedicine visits and include in instructional simulations commonly encountered failure modes so students can build their skills. To this end, we recruited medical students to conduct a Healthcare Failure Modes and Effects Analysis (HFMEA) to predict failures in telemedicine, their potential causes, and the consequences to develop and teach prevention strategies. Sixteen students observed telehealth appointments independently. Based on their observations, we identified four categories of failures in telemedicine: technical issues, patient safety, communication, and social and structural determinants. We proposed a normalized workflow that included management and prevention strategies. Our findings can inform the creation of new curricula.

Differential Perceptions of What Constitutes a Medical Error Associated with Electronic Medical Records

Perceptions of errors associated with healthcare information technology (HIT) often depend on the context and position of the viewer. HIT vendors posit very different causes of errors than clinicians, implementation teams, or IT staff. Even within the same hospital, members of departments and services often implicate other departments. Organizations may attribute errors to external care partners that refer patients, such as nursing homes or outside clinics. Also, the various clinical roles within an organization (e.g., physicians, nurses, pharmacists) can conceptualize errors and their root causes differently. Overarching all these perceptual factors, the definitions, mechanisms, and incidence of HIT-related errors are remarkably conflictual. There is neither a universal standard for defining or counting these errors. This paper attempts to enumerate and clarify the issues related to differential perceptions of medical errors associated with HIT. It then suggests solutions.

Applying Logic to the Healthcare Journey

Cross-disciplinary approaches to remediate complex healthcare service delivery issues may have merit. This study aims to establish the potential benefits of applying service design and evaluative research concepts in healthcare. Specifically, this study aims to demonstrate how a Customer Journey Map and a Logic Model could be used in unison to identify and remedy service delivery gaps to reduce barriers to care. This study provides systems thinking approach to solving operational issues in healthcare.

Humanizing Big Data and Detailing Social Determinants of Health via Information Visualizations

The pandemic has had devastating impacts on humanity and the global healthcare sector. An analysis into the social determinants of health, in particular racial and ethnic disparities may explain why certain population groups have been disproportionately affected by COVID-19. The objective of this study is to humanize and personify numerical data. Additionally, COVID-19 population data will be stratified via three data visualization tools (i.e., a persona, a journey map, Sankey diagram) to create a Visualized Combined Experience (VCE) Diagram to illustrate the micro, and macro, perspectives of marginalized individuals across the continuum of care.

Automation vs. Innovation: Unexplored Strategies to Improve Virtual Care

While there is a global desire to increase digital health capacity, digital health should transform health services delivery rather than simply automate - or worse - replicate existing practices. Failing to capitalize on this transformative potential misses an opportunity to engage patients and other users to provide a more person-centered experience. However, digital transformation done recklessly can disrupt workflow, alienate users, and jeopardize patient safety, as we have observed with implementation of many digital health tools. This paper uses a telemedicine example to provide insight into how digital health innovation can be a meaningful enabler of health system transformation. Examining different ways to leverage digital health technologies is crucial to best capitalize on their potential.

Consumers' Needs for Laboratory Results Portals: Questionnaire Study

BACKGROUND

Over the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment.

OBJECTIVE

We aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety.

METHODS

A web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed.

RESULTS

Participants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention.

CONCLUSIONS

There are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety.

Exploring Patient Journey Mapping and the Learning Health System: Scoping Review

BACKGROUND

Journey maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies may exist between journey maps and the concept of a learning health system (LHS). The overarching goal of an LHS is to use health care data to inform clinical practice and improve service delivery processes and patient outcomes.

OBJECTIVE

The purpose of this review was to assess the literature and establish a relationship between journey mapping techniques and LHSs. Specifically, in this study, we explored the current state of the literature to answer the following research questions: (1) Is there a relationship between journey mapping techniques and an LHS in the literature? (2) Is there a way to integrate the data from journey mapping activities into an LHS? (3) How can the data gleaned from journey map activities be used to inform an LHS?

METHODS

A scoping review was conducted by querying the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost). Two researchers applied the inclusion criteria and assessed all articles by title and abstract in the first screen, using Covidence. Following this, a full-text review of included articles was done, with relevant data extracted, tabulated, and assessed thematically.

RESULTS

The initial search yielded 694 studies. Of those, 179 duplicates were removed. Following this, 515 articles were assessed during the first screening phase, and 412 were excluded, as they did not meet the inclusion criteria. Next, 103 articles were read in full, and 95 were excluded, resulting in a final sample of 8 articles that satisfied the inclusion criteria. The article sample can be subsumed into 2 overarching themes: (1) the need to evolve service delivery models in health care, and (2) the potential value of using patient journey data in an LHS.

CONCLUSIONS

This scoping review demonstrated the gap in knowledge regarding integrating the data from journey mapping activities into an LHS. Our findings highlighted the importance of using the data from patient experiences to enrich an LHS and provide holistic care. To satisfy this gap, the authors intend to continue this investigation to establish the relationship between journey mapping and the concept of LHSs. This scoping review will serve as phase 1 of an investigative series. Phase 2 will entail the creation of a holistic framework to guide and streamline data integration from journey mapping activities into an LHS. Lastly, phase 3 will provide a proof of concept to demonstrate how patient journey mapping activities could be integrated into an LHS.

Updating professional competencies in health informatics: A scoping review and consultation with subject matter experts

INTRODUCTION

The discipline of health informatics emerged to address the need for uniquely skilled professionals to design, develop, implement, and evaluate health information technology. Core competencies are an essential pre-requisite for establishing a professional discipline such as health informatics. In 2012, Digital Health Canada released a framework (DHC Framework) for Canadian health informatics competencies. Multiple perspectives on health informatics competencies have evolved to reflect global and unique country contexts. In this paper, we will describe a two-phase study in which we ultimately developed a new framework for health informatics competencies.

METHODS

In Phase 1, we conducted a scoping review of to identify health informatics competencies from research articles and grey literature from professional associations. Of 1038 articles identified in the search, ultimately 38 met our inclusion criteria and were subject to in-depth analysis. We summarized our findings from this phase into a preliminary framework of health informatics competencies and then in Phase 2, we shared these findings with subject matter experts (SMEs; N = 5) to garner their feedback. The SMEs were all instructors in health informatics in Canada and held various roles (director, professor, advisor, and co-operative education coordinator). We used their insights into the current and forecasted Canadian health informatics landscape to iteratively develop a new framework until we achieved consensus amongst the subject matter experts.

RESULTS

In Phase 1, all competencies of the DHC Framework were supported by the literature. However, we also identified two emergent competencies: Human Factors and Data Science. In Phase 2, consultations with SMEs guided the introduction of one new competency category and seven new competencies. One competency was renamed and two were removed from the DHC Framework. Additionally, we added new terms that encompass the framework and labelled the core of the framework Health Informatics Professionalism.

DISCUSSION

We found that the DHC Framework did not capture all necessary competencies required by health informatics professionals. Based on the literature and consultations with SMEs, we extended the DHC Framework to better reflect the current Canadian context and propose a new Health Informatics Core Competencies Framework. The new framework can be used to inform Canadian health informatics programs to ensure graduates are equipped for careers in health informatics. Future work includes validating the new framework with Canadian health informatics employers to assess whether this new framework adequately reflects their needs, and more detail may be required to define specific skills necessary in each competency.

Towards the Adoption of Novel Visualizations in Public Health

Visualizations form an important part of public health informatics (PHI) communications. Visualizing data facilitates discussion, aids understanding, makes patterns apparent, promotes analysis, and fosters recall. How rare are novel visualizations in the PHI literature? In Phase 1, we used a rapid review methodology to test the commonness of the Sankey diagram in the PHI theory literature via an automated text search for key terms. In Phase 2, we prototype an uncommon chart type. A total of 27 relvant papers were searched and a computer-generated Sankey diagram was prototyped. PHI professionals have access to visualization tools emerging from social media and niche systems. PHI literature underutilizes uncommon visualizations requiring programming expertise. The authors advocate for: multi-disciplinary teamwork, technical education, the use of open visualization tools, and further adoption of visualization for public health professionals.

An Evaluation Guide and Decision Support Tool for Journey Maps in Healthcare and Beyond

The journey map concept evolved out of the service design field and is still relatively new in the healthcare landscape [1]. Journey maps are visualizations that effectively highlight organizational issues and allow stakeholder groups to be depicted by interest or function for a comparative visual analysis [2]. There are five journey map approaches: 1) Mental (Cognitive) Model Map, 2) Customer Journey Map, 3) Experience Map, 4) Service Blueprint Map, 5) Spatial Map. The objective of this article is three-fold: 1) quantify and delineate the journey mapping visualization techniques utilized from the phase 1 scoping review [2], 2) create a Journey Map Evaluation Guide, 3) create a Journey Map Decision Support Tool to facilitate a standardized method for journey map selection. For those less familiar with journey mapping, this framework can serve as a decision-making tool to facilitate the most effective choice among the different journey mapping visualization approaches. The tools presented in this study can provide a mechanism to standardize the assessment, classification and utilization of journey maps in the healthcare sector and industries abound.

Contextualizing Online Laboratory (lab) Results and Mapping the Patient Journey

The 21st century has brought forth unprecedented technological advances, such as the advent of portable digital devices [1]. This trend has also permeated the health care sector, with the introduction of digital health services, like providing citizens with access to their online laboratory (lab) results. This qualitative study will illustrate the patient journey, namely participant 16 (P16), to address the research question: what phases does a person go through when accessing their lab results online? The findings revealed that lab results were accessed from two types of devices a tablet (e.g., portable computer) when at home and a mobile phone when away from home. We also found that interpretation of results can be a challenge and it was unclear if P16 was able to understand her lab results. To illustrate the complexity of interpreting and accessing online lab results, the authors created a Customer Journey Map to contextualize the experiences of P16. The journey map depicts a combination of factors such as: eHealth literacy, limited access to providers, difficulty interpreting lab test results. Additionally, recommendations for online lab portal functionality enhancements were discovered through the mapping exercise. This study demonstrated that along with providing citizens with access to digital health technologies and services, considerations to eHealth literacy, the digital divide and health equity are paramount. As evidenced by the visualization, journey maps hold promise to serve as efficient tools to build empathy and identify the unique needs and perspectives of citizens.

The Utilization of Health Informatics Interventions in the COVID-19 Pandemic: A Scoping Review

On March 11, 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the highly infectious virus that causes coronavirus disease (COVID-19), was characterized by the World Health Organization (WHO) as a global pandemic [1,2]. Due to its highly contagious nature, COVID-19 has catalyzed the introduction of non-pharmaceutical interventions such as social distancing and quarantine measures [6]. Thus, the pandemic has shifted society to become reliant on healthcare technologies. The objective of this scoping review is to establish what health informatics interventions have been applied, validated and tested globally during the COVID-19 pandemic. The findings demonstrated a range of 12 types of health informatics interventions with various global applications and use. As evidenced by the intervention heterogeneity, the necessity to adopt a global cohesive strategy to improve human safety through the utilization of smart, efficient, and communicable technologies is vital.

Hidden in Plain Sight: Overlooked Results and Other Errors in Evaluating Online Laboratory Results

People are increasingly accessing their own laboratory (lab) results online. However, Canadians may be expected to use different systems to access their results, depending upon where they are tested (e.g., community lab vs. hospital), and these results may be displayed differently. This study examined the extent to which participants without medical expertise (N = 25) made errors identifying lab results (i.e., missing or mis-identifying abnormal results) in a mock report. Six participants overlooked each of the flagged values, 20 participants missed an abnormal result that was not flagged, and 2 participants mis-identified a normal value as out of range. We describe potential causes of these errors and the implications for the design of consumer-facing lab results.

Pre- and Post-Redesign Usability Assessment of a Telemedicine Interface Based on Subjective Metrics

Usability problems in the interaction between patients and telemedicine platforms has been recognized as a deterrent in the public's acceptance and use of this alternative healthcare delivery method. Therefore, evaluating the usability of telemedicine provider websites, with a focus on potential patients' first interaction with telemedicine, is a critical research inquiry. To this end, a novel survey was developed to conduct an unmoderated remote usability test (URUT) of the Teladoc website. Teladoc is one of the largest providers of Direct-to-Consumer (DTC) telemedicine. The Teladoc Website Usability Survey (TWUS) instrument collected both objective task completion success metrics and subjective user feedback. A codebook was developed to categorize design features and user interface aspects that affected usability. The TWUS and codebook demonstrated value in identifying usability problems with the Teladoc interface and can be applied in other telemedicine or Health Information Technology (HIT) usability studies. Identifying and addressing usability issues is an important approach to increase the widespread acceptance and adoption of these healthcare delivery technologies.

Overcoming Challenges to Inclusive User-based Testing of Health Information Technology with Vulnerable Older Adults: Recommendations from a Human Factors Engineering Expert Inquiry

OBJECTIVES

Involving representative users in usability testing of health information technology (HIT) is central to user-centered design. However, (vulnerable) older adults as representative users have unique requirements. Aging processes may affect physical capabilities and cognitive skills, which can hamper testing with this demographic and may require special attention and revised protocols. This study was performed to provide expert-based recommendations for HIT user-testing with (vulnerable) older adults to support inclusive HIT design and evaluation.

METHODS

First, we conducted a structured workshop with ten experts in HIT implementation and research, recruited through purposeful sampling, to generate insights into how characteristics of older adults may influence user-testing. Next, five Human Factor researchers experienced in HIT user-testing with (vulnerable) older adults validated the results and provided additional textual insights to gain consensus on the most important recommendations. A thematic analysis was performed on the resulting inquiries. Applied codes were based on the User-Centered Design framework.

RESULTS

The analysis resulted in nine recommendations for user-testing of HIT with older adults, divided into three main themes: (1) empathetic approach and trust-building, (2) new requirements for testing and study design, and (3) adjustments to usability evaluation methods. For each theme a checklist of relevant items to follow-up on the recommendation is provided.

CONCLUSIONS

The recommendations generated through expert inquiry contribute to more effective usability testing of HIT with older adults. This provides an important step towards improved accessibility of HIT amongst older adults through inclusive user-centered design.

Using Simulations to Train Medical Students for Unanticipated Technology Failures in Telemedicine

Simulations offer a safe environment for health professional training and the opportunity to predictably and consistently introduce events or variables that may be rare or dangerous in a live setting. Exposing trainees to unanticipated events during simulations can improve their ability to adapt and improvise. The COVID-19 pandemic accelerated the adoption of telehealth worldwide and highlighted the need for better training in health professional schools. In the United States, the Association of American Medical Colleges (AAMC) published new telehealth competency standards in 2021. The AAMC stated that health care providers should be aware of the risks of technology failures, capable of troubleshooting them, and lead systems interventions to improve safety. However, the AAMC does not provide guidance on the specific failures or solutions. In this study, we developed a set of technology failures that can be simulated in a telehealth curriculum. We incorporated one technology failure into a simulated telehealth encounter and gathered students' (N = 53) feedback on the exercise. Students' feedback was overwhelmingly positive. They agreed that integrating technology failures into telehealth simulations provides important practice managing these events during clinical encounters. While telehealth is an important healthcare delivery modality that can improve access-to-care, it is imperative to train medical students to navigate technology failures so that can adeptly manage these issues in clinical practice.

Why Do People Use Online Lab Results and What Do They Look For: A Qualitative Study

Laboratory (lab) test results are increasingly available online for patient review. However, there is a dearth of research with respect to users' information needs, goals, and information processing strategies. In this exploratory qualitative study, we interviewed a sample of (N = 25) online lab results users to understand their objectives and search targets. We transcribed their responses and used affinity diagramming to identify themes in their responses. Our analysis identified six reasons why people look at their online lab results (i.e., health status, reassurance, health education, speed, self-management, and patient safety) and two themes about what people look for (i.e., abnormal and normal values, trends). Knowing what drives users and what information they are looking for can inform the design of online lab reporting, improve usefulness, and better satisfy user needs.

Improving Shared Decision-Making Using Cognitive Effort-Optimization

Diabetes Prevention Programs (DPPs) can prevent or delay type 2 diabetes (T2D). However, the participation rates in DPPs have been limited. Many individuals at risk of developing diabetes have difficulties making healthy choices because of the cognitive effort required to understand the risks, the role of biomarkers, the consequences of inaction and the actions required to delay or avoid development of T2D. We report on the design and development of a prototype digital tool that decreases cognitive effort for people at risk of developing T2D using the effort-optimized intervention framework.