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van der Mee FAM, Schaper F, Jansen J, Bons JAP, Meex SJR, Cals JWL. Enhancing Patient Understanding of Laboratory Test Results: Systematic Review of Presentation Formats and Their Impact on Perception, Decision, Action, and Memory. J Med Internet Res 2024; 26:e53993. [PMID: 39133906 PMCID: PMC11347896 DOI: 10.2196/53993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/07/2024] [Accepted: 05/27/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients' processing of the information. OBJECTIVE This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory. METHODS The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool. RESULTS A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants' perception. Additionally, horizontal line bars significantly decreased participants' tendency to search for information or to contact their physician, compared with numerical values with reference ranges. CONCLUSIONS In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants' cognitive perception and perception of communication while decreasing participants' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients' information processing.
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Affiliation(s)
- Frederieke A M van der Mee
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Fleur Schaper
- Department of Clinical Chemistry, Reinier Medical Diagnostic Center, Delft, Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jesse Jansen
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Judith A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Steven J R Meex
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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He Z, Bhasuran B, Jin Q, Tian S, Hanna K, Shavor C, Arguello LG, Murray P, Lu Z. Quality of Answers of Generative Large Language Models Versus Peer Users for Interpreting Laboratory Test Results for Lay Patients: Evaluation Study. J Med Internet Res 2024; 26:e56655. [PMID: 38630520 PMCID: PMC11063893 DOI: 10.2196/56655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/17/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Although patients have easy access to their electronic health records and laboratory test result data through patient portals, laboratory test results are often confusing and hard to understand. Many patients turn to web-based forums or question-and-answer (Q&A) sites to seek advice from their peers. The quality of answers from social Q&A sites on health-related questions varies significantly, and not all responses are accurate or reliable. Large language models (LLMs) such as ChatGPT have opened a promising avenue for patients to have their questions answered. OBJECTIVE We aimed to assess the feasibility of using LLMs to generate relevant, accurate, helpful, and unharmful responses to laboratory test-related questions asked by patients and identify potential issues that can be mitigated using augmentation approaches. METHODS We collected laboratory test result-related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, we generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. We assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics, including Recall-Oriented Understudy for Gisting Evaluation, Bilingual Evaluation Understudy, Metric for Evaluation of Translation With Explicit Ordering, and Bidirectional Encoder Representations from Transformers Score. We used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. We performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects. RESULTS Regarding the similarity of the responses from 4 LLMs; the GPT-4 output was used as the reference answer, the responses from GPT-3.5 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest and, thus, as the least similar to GPT-4-generated answers. The results of the win rate and medical expert evaluation both showed that GPT-4's responses achieved better scores than all the other LLM responses and human responses on all 4 aspects (relevance, correctness, helpfulness, and safety). LLM responses occasionally also suffered from lack of interpretation in one's medical context, incorrect statements, and lack of references. CONCLUSIONS By evaluating LLMs in generating responses to patients' laboratory test result-related questions, we found that, compared to other 4 LLMs and human answers from a Q&A website, GPT-4's responses were more accurate, helpful, relevant, and safer. There were cases in which GPT-4 responses were inaccurate and not individualized. We identified a number of ways to improve the quality of LLM responses, including prompt engineering, prompt augmentation, retrieval-augmented generation, and response evaluation.
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Affiliation(s)
- Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States
| | - Balu Bhasuran
- School of Information, Florida State University, Tallahassee, FL, United States
| | - Qiao Jin
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Shubo Tian
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Karim Hanna
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Cindy Shavor
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | | | - Patrick Murray
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
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Reston RE, Caskey FJ, Hole B, Udayaraj U, Weinman J. CareKnowDo-A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e33147. [PMID: 37995117 DOI: 10.2196/33147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 07/05/2022] [Accepted: 01/03/2023] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. OBJECTIVE The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). METHODS A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51%) integrated with PV or standard care (PV alone: 30/61, 49%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. RESULTS Of the 1392 patients screened in local kidney clinics, 269 (19.32%) met the basic inclusion criteria; the first 22.7% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). CONCLUSIONS A tailored digital and nurse call-based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. TRIAL REGISTRATION NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/.
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Affiliation(s)
| | - Fergus J Caskey
- University of Bristol, Bristol, United Kingdom
- North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Barnaby Hole
- University of Bristol, Bristol, United Kingdom
- North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Udaya Udayaraj
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
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Lazaro G. When Positive is Negative: Health Literacy Barriers to Patient Access to Clinical Laboratory Test Results. J Appl Lab Med 2023; 8:1133-1147. [PMID: 37681277 PMCID: PMC10756206 DOI: 10.1093/jalm/jfad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/09/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Health literacy is a multidimensional set of skills (e.g., narrative, numeracy, digital, medication) that patients need to access and understand health information timely and accurately to make evidence-based informed decisions. CONTENT Multiple barriers prevent patients from effectively interacting with health information. The most salient barriers are poor overall health literacy skills and linguistic proficiency in English. As patients prefer direct access to laboratory test results, especially those of routine tests, contextualization and provider-directed interpretation of results are required to foster shared decision-making to address their healthcare issues and improve health outcomes. SUMMARY The use of systematic approaches that account for poor health literacy skills and include culturally and linguistically appropriate planning and availability of resources is warranted at individual and population health levels (e.g., human-centered design of patient portals).
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Affiliation(s)
- Gerardo Lazaro
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, United States
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5
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Petrovskaya O, Karpman A, Schilling J, Singh S, Wegren L, Caine V, Kusi-Appiah E, Geen W. Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review. J Med Internet Res 2023; 25:e43765. [PMID: 37856174 PMCID: PMC10623227 DOI: 10.2196/43765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.
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Affiliation(s)
| | - Albina Karpman
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | | | - Simran Singh
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Larissa Wegren
- South Health Campus, Women's Health, Calgary, AB, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Willow Geen
- School of Nursing, University of Victoria, Victoria, BC, Canada
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6
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Monkman H, Griffith J, MacDonald L, Lesselroth B. Consumers' Needs for Laboratory Results Portals: Questionnaire Study. JMIR Hum Factors 2023; 10:e42843. [PMID: 37307049 DOI: 10.2196/42843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/25/2023] [Accepted: 04/13/2023] [Indexed: 06/13/2023] Open
Abstract
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.
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Affiliation(s)
- Helen Monkman
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Janessa Griffith
- Health Information Management, Douglas College, Coquitlam, BC, Canada
- Work Wellness Institute, Vancouver, BC, Canada
| | - Leah MacDonald
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Blake Lesselroth
- Department of Medical Informatics, School of Community Medicine, University of Oklahoma Tulsa, Tulsa, OK, United States
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7
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Wang T, Voss JG. Information Overload in Patient Education: A Wilsonian Concept Analysis. Nurs Sci Q 2022; 35:341-349. [PMID: 35762054 DOI: 10.1177/08943184221092451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors of this concept analysis seek to clarify the concept of information overload within the context of patient education in healthcare. A modified six-step Wilsonian concept analysis method with a review of qualified manuscripts from PubMed, PsycInfo, CINAHL, and MEDLINE from 2000 to 2018 was conducted. Information overload occurs when an individual acknowledges that information received is beyond his or her information-absorbing threshold. The causes include quantity and quality of the information and information delivery structures. Information overload is associated with higher levels of stress and poor self-care performance. It is significant for healthcare providers to recognize patients' feelings of information overload.
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Affiliation(s)
- Tongyao Wang
- Post-Doctoral Fellow, School of Nursing, University of Hong Kong, Hong Kong, China; Student, Frances Payne Bolton School of Nurisng, Case Western Reserve University, Cleveland, OH, USA
| | - Joachim G Voss
- Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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8
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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Arnold MH. Teasing out Artificial Intelligence in Medicine: An Ethical Critique of Artificial Intelligence and Machine Learning in Medicine. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:121-139. [PMID: 33415596 PMCID: PMC7790358 DOI: 10.1007/s11673-020-10080-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 12/23/2020] [Indexed: 05/05/2023]
Abstract
The rapid adoption and implementation of artificial intelligence in medicine creates an ontologically distinct situation from prior care models. There are both potential advantages and disadvantages with such technology in advancing the interests of patients, with resultant ontological and epistemic concerns for physicians and patients relating to the instatiation of AI as a dependent, semi- or fully-autonomous agent in the encounter. The concept of libertarian paternalism potentially exercised by AI (and those who control it) has created challenges to conventional assessments of patient and physician autonomy. The unclear legal relationship between AI and its users cannot be settled presently, an progress in AI and its implementation in patient care will necessitate an iterative discourse to preserve humanitarian concerns in future models of care. This paper proposes that physicians should neither uncritically accept nor unreasonably resist developments in AI but must actively engage and contribute to the discourse, since AI will affect their roles and the nature of their work. One's moral imaginative capacity must be engaged in the questions of beneficence, autonomy, and justice of AI and whether its integration in healthcare has the potential to augment or interfere with the ends of medical practice.
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Affiliation(s)
- Mark Henderson Arnold
- School of Rural Health (Dubbo/Orange), Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, Australia.
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10
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Freise L, Neves AL, Flott K, Harrison P, Kelly J, Darzi A, Mayer EK. Assessment of Patients' Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey. JMIR Form Res 2021; 5:e19074. [PMID: 33635277 PMCID: PMC7954650 DOI: 10.2196/19074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/01/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care.
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Affiliation(s)
- Lisa Freise
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.,Center for Health Technology and Services Research / Department of Community Medicine, Health Information and Decision (CINTESIS/MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Paul Harrison
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John Kelly
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Erik K Mayer
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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11
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Sharma V, Piscoran O, Summers A, Woywodt A, van der Veer SN, Ainsworth J, Augustine T. The use of health information technology in renal transplantation: A systematic review. Transplant Rev (Orlando) 2021; 35:100607. [PMID: 33607425 DOI: 10.1016/j.trre.2021.100607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Renal transplantation is a complex, multi-disciplinary and cross-center service. Clinical pathways naturally traverse specialty and organizational boundaries as patients transition from chronic kidney disease to renal failure and ultimately transplantation. Health information technology (IT) has the potential to support transplant care by improving access to data, information sharing and communication. This novel review aimed to identify and characterize health IT solutions in renal transplantation, and where possible evaluate any intended benefits. A systematic literature review was conducted of studies covering any part of the clinical pathway, with end-users being clinical staff or patients. Interventions were characterized and evaluated for achieved benefits using the World Health Organization (WHO) Classification of Digital Health Interventions and the mixed methods assessment tool (MMAT) was used to determine the quality of experimental studies. Of 4498 articles, 12 descriptive and 6 experimental studies met the inclusion criteria. Median MMAT percentage score of experimental studies was 64 (i.q.r. 57 to 74.8). The most frequent functionality of technology involved overcoming communication roadblocks and improving access to data. Intended benefits included improving information management and supporting workflow, however only one study reported evaluated results. Six patient-facing applications that primarily addressed adherence-to-treatment were identified, five of which were evaluated for intended benefits, showing overall positive results. Overall, despite transplantation being well suited to health IT interventions, this review demonstrates a scarcity of literature in this field. A small number of clinician- and patient-facing IT solutions have been reported, albeit mostly in non-experimental studies. Due to this lack of formal evaluation, the effectiveness of solutions remains unclear. High-quality evaluative studies are required to develop effective IT solutions that improve clinical care.
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Affiliation(s)
- Videha Sharma
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK.
| | - Oana Piscoran
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Angela Summers
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
| | - Alexander Woywodt
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Nephrology, Royal Preston Hospital, Preston, Lancashire, PR2 9HT, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - Titus Augustine
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
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12
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Struikman B, Bol N, Goedhart A, van Weert JCM, Talboom-Kamp E, van Delft S, Brabers AEM, van Dijk L. Features of a Patient Portal for Blood Test Results and Patient Health Engagement: Web-Based Pre-Post Experiment. J Med Internet Res 2020; 22:e15798. [PMID: 32706704 PMCID: PMC7399951 DOI: 10.2196/15798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/15/2020] [Accepted: 03/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of patient portals for presenting health-related patient data, such as blood test results, is becoming increasingly important in health practices. Patient portals have the potential to enhance patient health engagement, but content might be misinterpreted. OBJECTIVE This study aimed to discover whether the way of presenting blood test outcomes in an electronic patient portal is associated with patient health engagement and whether this varies across different blood test outcomes. METHODS A 2x3 between-subjects experiment was conducted among members of the Nivel Dutch Health Care Consumer Panel. All participants read a scenario in which they were asked to imagine themselves receiving blood test results. These results differed in terms of the presented blood values (ie, normal vs partially abnormal vs all abnormal) as well as in terms of whether the results were accompanied with explanatory text and visualization. Patient health engagement was measured both before (T0) and after (T1) participants were exposed to their fictive blood test results. RESULTS A total 487 of 900 invited members responded (response rate 54%), of whom 50.3% (245/487) were female. The average age of the participants was 52.82 years (SD 15.41 years). Patient health engagement saw either a significant decrease or a nonsignificant difference in the experimental groups after viewing the blood test results. The mean difference was smaller in the groups that received blood test results with additional text and visualization (meanT0 5.33, SE 0.08; meanT1 5.14, SE 0.09; mean difference 0.19, SE 0.08, P=.02) compared with groups that received blood test results without explanatory text and visualization (meanT0 5.19, SE 0.08; meanT1 4.55, SE 0.09; mean difference 0.64, SE 0.08, P<.001). Adding text and visualization, in particular, reduced the decline in patient health engagement in participants who received normal results or mixed results (ie, combination of normal and abnormal results). CONCLUSIONS Adding text and visualization features can attenuate the decrease in patient health engagement in participants who receive outcomes of a blood test via a patient portal, particularly when blood test results are (partly) normal. This suggests that explanatory text and visualization can be reassuring. Future research is warranted to determine whether these results can be generalized to a patient population who receive their actual blood test results.
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Affiliation(s)
- Bas Struikman
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | | | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Esther Talboom-Kamp
- Saltro, Diagnostics Center for Health Care, Utrecht, Netherlands.,Department National eHealth Living Lab, Leiden University, Leiden, Netherlands
| | - Sanne van Delft
- Saltro, Diagnostics Center for Health Care, Utrecht, Netherlands
| | - Anne E M Brabers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Liset van Dijk
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands
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13
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Talboom-Kamp E, Tossaint-Schoenmakers R, Goedhart A, Versluis A, Kasteleyn M. Patients' Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study Using the eHealth Impact Questionnaire. JMIR Form Res 2020; 4:e17060. [PMID: 32024632 PMCID: PMC7081138 DOI: 10.2196/17060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Communicating laboratory test results online has several advantages for patients, such as improving clinical efficiency and accessibility, thereby helping patients to take an active role in managing their health. OBJECTIVE This study aimed to investigate the experiences and self-efficacy of patients using an online patient portal that communicates laboratory test results. METHODS We used the online-administered eHealth Impact Questionnaire to explore patients' attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire. The subscale Information and Presentation assessed the usability of the patient portal and the subscale Motivation and Confidence to Act assessed self-efficacy to determine whether patients were motivated to act on the presented information. We used a cutoff score of 65 or greater to determine whether the portal was rated positively. RESULTS The questionnaire was completed by 354 of 13,907 patients who viewed their laboratory results in the patient portal, with a response rate of 2.55%. The mean Information and Presentation score was 67.70 (SD 13.12) and the mean Motivation and Confidence to Act score was 63.59 (SD 16.22). We found a positive, significant correlation between the 2 subscales (r345=.77, P<.001). CONCLUSIONS Patients participating in the study rated the usability of the portal positively. However, the portal only slightly helped patients to take an active role in managing their own health. The low response rate precludes generalization of the results. Future research should examine avenues to further increase patients' self-efficacy and study whether portal acceptability differs in subgroups. Patient portals conveying laboratory test results in understandable language seem usable and potentially provide a viable way to help patients take a more active role in managing their own health.
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Affiliation(s)
- Esther Talboom-Kamp
- Saltro Diagnostic Centre, Utrecht, Netherlands
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Utrecht, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Anke Versluis
- Saltro Diagnostic Centre, Utrecht, Netherlands
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Marise Kasteleyn
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
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14
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van Kuppenveld SI, van Os-Medendorp H, Tiemessen NA, van Delden JJ. Real-Time Access to Electronic Health Record via a Patient Portal: Is it Harmful? A Retrospective Observational Study. J Med Internet Res 2020; 22:e13622. [PMID: 32044753 PMCID: PMC7055752 DOI: 10.2196/13622] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/18/2019] [Accepted: 10/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The rapid implementation of patient portals, through which patients can view their electronic health record, creates possibilities for information exchange and communication between patients and health care professionals. However, real-time disclosure of test results and clinical reports poses a source of concern. OBJECTIVE This study aimed to examine negative experiences resulting from real-time disclosure of medical information through a patient portal. METHODS Data were collected over a 2-year period in 4 datasets consisting of incidents reported by health care professionals, complaints of patients, patient issues at a portal helpdesk, and a survey among health care professionals. Incidents, complaints, issues, and answers on the survey were counted and analyzed through an iterative process of coding. RESULTS Within the chosen time frame of 2 years, on average, 7978 patients per month logged into the portal at least once. The amount of negative incidents and complaints was limited. A total of 6 incidents, 4 complaints, and 2506 issues at the helpdesk concerning the patient portal were reported, of which only 2, 1, and 3 cases of these respective databases concerned real-time disclosure of medical information through the patient portal. Moreover, 32 out of 216 health care professionals reported patients that had negative experiences with real-time disclosure. Most negative consequences concerned confused and anxious patients when confronted with unexpected or incomprehensible results. CONCLUSIONS Real-time access through a patient portal did not substantially result in negative consequences. The negative consequences that did occur can be mitigated by adequate preparation and instruction of patients concerning the various functionalities of the patient portal, real-time disclosure of test results in particular, and can also be managed through educating health care professionals about the patient portal and making adjustments in the daily practice of health care professionals.
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Affiliation(s)
| | - Harmieke van Os-Medendorp
- University Medical Center Utrecht, Department of Dermatology and Allergology, Utrecht, Netherlands.,Saxion University of Applied Sciences, School of Health, Deventer/Enschede, Netherlands
| | - Nicole Am Tiemessen
- University Medical Center Utrecht, Department Information Technology, Utrecht, Netherlands
| | - Johannes Jm van Delden
- University Medical Center Utrecht, Department of Medical Humanities, Julius Center, Utrecht, Netherlands
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15
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Warren LR, Harrison M, Arora S, Darzi A. Working with patients and the public to design an electronic health record interface: a qualitative mixed-methods study. BMC Med Inform Decis Mak 2019; 19:250. [PMID: 31795998 PMCID: PMC6889299 DOI: 10.1186/s12911-019-0993-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Enabling patients to be active users of their own medical records may promote the delivery of safe, efficient care across settings. Patients are rarely involved in designing digital health record systems which may make them unsuitable for patient use. We aimed to develop an evidence-based electronic health record (EHR) interface and participatory design process by involving patients and the public. METHODS Participants were recruited to multi-step workshops involving individual and group design activities. A mixture of quantitative and qualitative questionnaires and observational methods were used to collect participant perspectives on interface design and feedback on the workshop design process. RESULTS 48 recruited participants identified several design principles and components of a patient-centred electronic medical record interface. Most participants indicated that an interactive timeline would be an appropriate way to depict a medical history. Several key principles and design components, including the use of specific colours and shapes for clinical events, were identified. Participants found the workshop design process utilised to be useful, interesting, enjoyable and beneficial to their understanding of the challenges of information exchange in healthcare. CONCLUSION Patients and the public should be involved in EHR interface design if these systems are to be suitable for use by patient-users. Workshops, as used in this study, can provide an engaging format for patient design input. Design principles and components highlighted in this study should be considered when patient-facing EHR design interfaces are being developed.
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Affiliation(s)
- Leigh R Warren
- Department of Surgery and Cancer, Patient Safety Translational Research Centre, St Mary's Hospital Campus, Imperial College London, London, W21NY, UK.
| | - Matthew Harrison
- Helix Centre, St Mary's Campus, Imperial College London, London, W21NY, UK
| | - Sonal Arora
- Department of Surgery and Cancer, Patient Safety Translational Research Centre, St Mary's Hospital Campus, Imperial College London, London, W21NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Patient Safety Translational Research Centre, St Mary's Hospital Campus, Imperial College London, London, W21NY, UK
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16
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Hazara AM, Durrans K, Bhandari S. The role of patient portals in enhancing self-care in patients with renal conditions. Clin Kidney J 2019; 13:1-7. [PMID: 32082547 PMCID: PMC7025346 DOI: 10.1093/ckj/sfz154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022] Open
Abstract
Web-based portals enable patients to access their electronic health records, including test results and clinical documents, from anywhere with Internet access. Some portals also serve as a means of two-way communication between patients and healthcare professionals and provide a platform for the recording of patient-entered data such as home blood pressure readings. Such systems are designed to encourage patient participation in the management of their condition, and ultimately to increase patient empowerment and self-management, which are associated with improved clinical outcomes. As an example of portal use in patients with renal conditions, we discuss the PatientView portal, which is offered free of cost to patients under the care of renal physicians in the UK. We present an account of its various features and briefly describe the user experience. Previous studies examining the impact of this portal on patient care have been very positive; it appears to be popular among users and overall levels of satisfaction with the service are high. As the use of patient portals increases, we discuss barriers to the more widespread use of portals. We offer suggestions on how the care of patients with renal conditions can be enhanced in the future by further developing the existing features, learning from experiences of other patient portals and providing better integration of portal use into the current model of care.
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Affiliation(s)
- Adil M Hazara
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, University of Hull, Hull, UK
| | - Katherine Durrans
- Department of Nutrition and Dietetics, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, University of Hull, Hull, UK
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17
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Turchioe MR, Myers A, Isaac S, Baik D, Grossman LV, Ancker JS, Creber RM. A Systematic Review of Patient-Facing Visualizations of Personal Health Data. Appl Clin Inform 2019; 10:751-770. [PMID: 31597182 DOI: 10.1055/s-0039-1697592] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES As personal health data are being returned to patients with increasing frequency and volume, visualizations are garnering excitement for their potential to facilitate patient interpretation. Evaluating these visualizations is important to ensure that patients are able to understand and, when appropriate, act upon health data in a safe and effective manner. The objective of this systematic review was to review and evaluate the state of the science of patient-facing visualizations of personal health data. METHODS We searched five scholarly databases (PubMed, Embase, Scopus, ACM Digital Library [Association for Computing Machinery Digital Library], and IEEE Computational Index [Institute of Electrical and Electronics Engineers Computational Index]) through December 1, 2018 for relevant articles. We included English-language articles that developed or tested one or more patient-facing visualizations for personal health data. Three reviewers independently assessed quality of included articles using the Mixed methods Appraisal Tool. Characteristics of included articles and visualizations were extracted and synthesized. RESULTS In 39 articles included in the review, there was heterogeneity in the sample sizes and methods for evaluation but not sample demographics. Few articles measured health literacy, numeracy, or graph literacy. Line graphs were the most common visualization, especially for longitudinal data, but number lines were used more frequently in included articles over past 5 years. Article findings suggested more patients understand the number lines and bar graphs compared with line graphs, and that color is effective at communicating risk, improving comprehension, and increasing confidence in interpretation. CONCLUSION In this review, we summarize types and components of patient-facing visualizations and methodologies for development and evaluation in the reviewed articles. We also identify recommendations for future work relating to collecting and reporting data, examining clinically actionable boundaries for diverse data types, and leveraging data science. This work will be critically important as patient access of their personal health data through portals and mobile devices continues to rise.
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Affiliation(s)
- Meghan Reading Turchioe
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Annie Myers
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Samuel Isaac
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Dawon Baik
- Columbia University School of Nursing, New York, New York, United States
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Ruth Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
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18
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Qureshi N, Mehrotra A, Rudin RS, Fischer SH. Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users. Appl Clin Inform 2019; 10:175-179. [PMID: 30866000 DOI: 10.1055/s-0039-1679960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES More patients are receiving their test results via patient portals. Given test results are written using medical jargon, there has been concern that patients may misinterpret these results. Using sample colonoscopy and Pap smear results, our objective was to assess how frequently people can identify the correct diagnosis and when a patient should follow up with a provider. METHODS We used Mechanical Turk-a crowdsourcing tool run by Amazon that enables easy and fast gathering of users to perform tasks like answering questions or identifying objects-to survey individuals who were shown six sample test results (three colonoscopy, three Pap smear) ranging in complexity. For each case, respondents answered multiple choice questions on the correct diagnosis and recommended return time. RESULTS Among the three colonoscopy cases (n = 642) and three Pap smear cases (n = 642), 63% (95% confidence interval [CI]: 60-67%) and 53% (95% CI: 49-57%) of the respondents chose the correct diagnosis, respectively. For the most complex colonoscopy and Pap smear cases, only 29% (95% CI: 23-35%) and 9% (95% CI: 5-13%) chose the correct diagnosis. CONCLUSION People frequently misinterpret colonoscopy and Pap smear test results. Greater emphasis needs to be placed on assisting patients in interpretation.
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Affiliation(s)
- Nabeel Qureshi
- RAND Corporation, Santa Monica, California, United States
| | - Ateev Mehrotra
- RAND Corporation, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
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19
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Ali EE, Chan SSL, Poh HY, Susanto YA, Suganya T, Leow JL, Pang CK, Chew L, Yap KYL. Design Considerations in the Development of App-Based Oral Anticancer Medication Management Systems: a Qualitative Evaluation of Pharmacists' and Patients' Perspectives. J Med Syst 2019; 43:63. [PMID: 30726518 DOI: 10.1007/s10916-019-1168-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/15/2019] [Indexed: 12/23/2022]
Abstract
Smartphone apps can potentially help in enhancing oral anticancer medication (OAM) adherence. Patient adoption and efficacy of such apps depends on inclusion of user-centred and evidence-based features. The objective of this study was to identify important design considerations from the perspectives of patients taking OAMs, caregivers and oncology pharmacists. The study employed a qualitative study design. Data were collected using in-depth interviews with patients (n = 15), caregivers (n = 3) and pharmacists (n = 16). Interviews were audio-recorded, transcribed verbatim and inductive thematic analysis approach was used in data analysis. Monitoring medication-related problems, medication information, replacement of or integration with current systems and accessibility of app content on devices other than smartphones were the key themes identified in the analysis. Flexible input methods for monitored data, glanceability of monitored reports/information, near real-time adherence enhancing and symptom management interventions and customisable reminder options were design considerations identified under the monitoring medication-related problems theme. Participants suggested the provision of focused and easily understandable medication information with a potential for personalisation. Integration of app-based adherence systems with patients' electronic medical records with added mechanisms for alerts in the dispensing system was also suggested as a key design requirement to improve quality of patient care and facilitate adoption by clinicians. Finally, smartphones were the most favoured platform with optional accessibility of app content on other devices. In conclusion, important design considerations were identified through a user-centred design approach. The findings will help developers and clinicians in the design of new app-based systems and evaluation of existing ones.
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Affiliation(s)
- Eskinder Eshetu Ali
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Sharlene Si Ling Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Huan Yu Poh
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Yosua Amadeus Susanto
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Thendral Suganya
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Jo Lene Leow
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Chee Khiang Pang
- Department of Electrical and Computer Engineering, Faculty of Engineering, National University of Singapore, Block E4, Level 5, 4 Engineering Drive 3, Singapore, 117583, Singapore
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore
| | - Lita Chew
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Kevin Yi-Lwern Yap
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Victoria, Australia.
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Shankar P, Anderson N. Advances in Sharing Multi-sourced Health Data on Decision Support Science 2016-2017. Yearb Med Inform 2018; 27:16-24. [PMID: 30157504 PMCID: PMC6115214 DOI: 10.1055/s-0038-1641215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Clinical decision support science is expanding to include integration from broader and more varied data sources, diverse platforms and delivery modalities, and is responding to emerging regulatory guidelines and increased interest from industry. OBJECTIVE Evaluate key advances and challenges of accessing, sharing, and managing data from multiple sources for development and implementation of Clinical Decision Support (CDS) systems in 2016-2017. METHODS Assessment of literature and scientific conference proceedings, current and pending policy development, and review of commercial applications nationally and internationally. RESULTS CDS research is approaching multiple landmark points driven by commercialization interests, emerging regulatory policy, and increased public awareness. However, the availability of patient-related "Big Data" sources from genomics and mobile health, expanded privacy considerations, applications of service-based computational techniques and tools, the emergence of "app" ecosystems, and evolving patient-centric approaches reflect the distributed, complex, and uneven maturity of the CDS landscape. Nonetheless, the field of CDS is yet to mature. The lack of standards and CDS-specific policies from regulatory bodies that address the privacy and safety concerns of data and knowledge sharing to support CDS development may continue to slow down the broad CDS adoption within and across institutions. CONCLUSION Partnerships with Electronic Health Record and commercial CDS vendors, policy makers, standards development agencies, clinicians, and patients are needed to see CDS deployed in the evolving learning health system.
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Affiliation(s)
- Prabhu Shankar
- Division of Health Informatics, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Nick Anderson
- Division of Health Informatics, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
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