MyHealthPlace

Abdulrahman Jabour Jim McLaughlin

Maryam Zolnoori

● Patient education leads to the successful treatment of medical conditions and diseases.

● Reliable health information is obscured by a plethora of content and a variety of sources.

● The typical learning process is self-directed, has a general focus

● Learning lacks planning or structure

● Relevance and reliability of sources can vary

Application Domain - The Problem

● Patients with recent diagnosis will likely have ongoing questions about their disease

● They may rely on the advice of the physician, or may seek a second opinion

● They may desire to find others with the disease to learn more

● Often patients turn to the internet but cannot always expect reliable information

Application Domain - The Patient

● Patients may jump to extreme examples of their disease

● They may favor an ineffective treatment option

● They may select and trust disreputable sources for clinical information

● They may mistakenly confuse their diagnosis with a disease that has similar symptoms

Application Domain - Pitfalls

Places and spaces where patients where patients will get information about their disease:- Doctor/specialist’s office or clinic

- Hospitals

- Libraries

- Internet (through various devices)

- Friends and family

- Their physician or disease specialist

- The privacy of their home

Field Setting - Locations

Investigate and uncover:

- Sources of information selected and why

- Flow of information from:

- initial search

- information gathering

- consolidation of content

Field Setting - Expectations

Patients were allowed to choose the space and place that is most comfortable to them for the contextual interview

- Private home

- School library

- School classroom

Each was asked to bring and use whatever tools they felt would help them better understand their diagnosis

Field Setting - Environment

Field Setting - Objectives

● How they intend to learn and their process

● Whom they will ask and why

● What other sources they use and why

● The filters for all sources of information

● What structure they apply to their process of understanding

● Their steps toward education and understanding

● The successes they accomplish and the obstacles they encounter

Field Observations - Methodologies

We observed three recently diagnosed patients as they explored the education options available, these contextual inquiry methodologies were applied:

● Observation ● Partnership (expert/apprentice)● Think aloud protocol● Field notes were captured

Field Observations - Methodologies

Field observations were conducted with sensitivity to the highly personal nature of disease, users were advised to share only what they were comfortable sharing.

One participant agreed to have one photograph captured

Three diagnoses and the symptoms that prompted medical attention (as reported by interviewees):

● Eye infection (pink eye or conjunctivitis)○ Redness, swelling, watering of the eyes

● Hypothyroidism (underactive thyroid)○ Fatigue, hair loss, pale skin

● Crohn’s disease○ Abdominal pain, diarrhea

Field Observations - Cases

Field Observations - Limitations

Since the team could not be present during the initial diagnosis, the patient was asked to walk through their experience and learnings and continue the process for our purpose of the contextual inquiry.

In one instance, the patient demonstrated a similar approach to research a different yet similar disease to the original diagnosis.

Since each patient was researching new material, an authentic observation of the work process was captured.

Consolidated Flow Model

Consolidated Models - Flow

● Difficult to retain information at time of diagnosis (cognitive load)

● Challenge to capture then remember questions for next visit

● Delay to receive lab results creates anxiety

● Family advice may interfere with medical protocol

● Sponsored internet may be misleading

Consolidated Sequence Model

Consolidated Models - Sequence

Activities and breakdowns● Learn about diagnosis - anxiety interferes with learning

● Compare symptoms- internet has ad supported and possibly misleading content.

● Understand medications- technical; doctor or pharmacist may be unreachable

● Explore treatment options - must capture and remember questions for next visit

● Consider second opinion - internet, first doctor, family? -- bias may exist with each

Consolidated Models - Artifact

● Prescriptions, lab results and clinic discharge papers

● Most of the workflow at a personal computer

● Some users/patients will keep notes as they conduct research

● Some users will print out pdfs found on the internet

● The team found little relevance of the artifact model

Consolidated Physical Model

Consolidated Models - Physical

1. User-InternetUnlimited access, always on, variable quality, not personalized

2. User-PhysicianHigh quality, low quantity, low accessibility

3. User-Family/FriendsHigh trust, uncertain quality, high sympathy

4. User-Library (dead tree)Seldom used, inconvenient, not easy to share

5. User-LifestyleExercise participation varies, nutrition choices self determined

Consolidated Cultural Model

Consolidated Models - Cultural

● Physician is key influencer

● Internet serves as source to confirm or deny facts

● Family and friends are key sources of support

● Online communities can provide connections that are specific to disease

Primary sources of information:

- Physician/specialist

- Web

- Friends Family

- Support groups

Interactions were organized into two main channels of communication:

- Internet - Non internet

Interpretation - Affinity Diagram

Both have equal significance for user

- Internet holds majority of content users selected, also most misinformation

Conclusion: a digital solution can be designed to mediate across both domains

- also provide reliable and accurate content

Interpretation - Affinity Diagram

Interpretation - Themes

● User/Patient places trust with physician or specialist and prefers open communication channels

● User/patient will affirm/confirm diagnosis, treatment plan, medications via web

● Support from friends and family is important but is not first level source for advice (mostly sounding board)

● Disease support groups are considered at a later time

Vision

● Reliable sources for patient education

● Electronic communication between physician and patient to reinforce interactions

● Initiate access and delivery of information at diagnosis to close any gaps where misinformation may enter education process

● Structure to anticipate user process to seek information and deliver it where it is expected

Primary Requirements

● Facilitate reliable and flexible search within and external to system

● Safe accessibility to medical history and appointments, medications

● Secure connectivity to physician’s office, clinic or hospital providing treatment

● Reliable and customizable information about diagnosis, treatment, symptoms, causes

● Ability to share information with friends, family, guardian, care provider

Design

● Web based to be accessible by:

- Physician/specialist/nurse at office/clinic

- User/patient

- Guardian or designated caretaker

● Easy and familiar interface that allows clickable configuration to easily change and compare information

● Uncluttered presentation of information

Consolidated Vision

● Web-based for access by all stakeholders:physicians, patients, guardians, friends and family

● Customizable interface to give control of interface and content to the patient

● Enrollment initiated by doctor’s office for accuracy of information

● Enrollment at time of diagnosis to provide best chance to meet knowledge gaps

Consolidated Vision Model

User Environment Design Model

Interactive Prototype - Profile Settings Page, Personal Information

Interactive Prototype - Medical History Page, Test Results

Interactive Prototype - Patient Education Page, Symptoms Comparison

Interactive Prototype - Patient Education Page, Treatment Options

Use Scenarios - Part I

Scenario I:

- Day of Initial diagnosis

- Nurse emailed MyHealth Place link

- At home, select link and explore the site

Tasks:

- Locate and review diagnosis

- Review information about disease, symptoms

- Ask about the next appointment

Use Scenarios - Part II

Scenario II:

- 3 weeks later, visited doctor 2 days ago

- Received tests and prescription

- At home, open MyHealth Place

Tasks:

- Locate and review test results

- Review information about meds, side-effects

- Locate resources doctor mentioned at visit

Summary of Feedback

1) “I like that the fact that the site would be facilitated by my doctor, I can trust him”

“Its good to compare the various levels of information, it helps me learn the terms I don’t understand”

“The Web pages are easy to use”

“I would like my doctor to use this”

2) I like this application. And now I can easily see my health history and get some information, without going to different websites and wasting my time.

Summary of Feedback

3). If this application provides a section for evaluating chief complaints, it would be a great help. For example, if I have a problem in my eyes, I could select eyes and application can provide me with different diagnosis and description of diseases, causes and possible treatments.

4) After providing a solution for chief complaints, if application could help with me to find the nearest Doctors or hospital with type of insurance they accept and estimated cost, it will be great.

Summary of Feedback

5) It will be great, if application could connect to my insurance company and I could get information related to my bills, and other insurance related to my insurance coverage.

6) It was great, if application can provide me with alternative solutions for reducing my medical costs.

7) It is great, if software can provide me with some solution for alternative medicine such as herbal treatment for my disease. And I could see opinion of other patients and effects of herbal treatment on their disease.