Virtually Priceless Thoughts

I received a package this week. Inside was the textbook:
Human, Social, and Organizational Aspects of Health Information Systems.

Turning to page 23, as I read the title to Chapter 2, I cannot help but grin. “A Bio-Psycho-Social Review of Usbility Methods and their Applications in Healthcare”

My first book chapter.

Very exciting for me to see – I even had the opportunity to draw my own figures. All in all, it came together fairly well for a first chapter. Writing has never been natural for me (as my dear mother – an English professor – will sigh about), but it did come together.

The key to the chapter is that usability has many forms and can work at many levels. Like medicine, a reductionist view is powerful but not sufficient. We do much better today if we understand the biology of a disease, the personal impact of the illness, and the impact it has on the social network around a patient. For healthcare information systems (e.g. Electronic Health Records), it is the same. First we need to understand the bio (mechanical) aspects of systems – where the computers are, how big buttons are, etc. Next, the design impacts how a user (e.g. RN, MD) makes decisions and need to consider and observe the psychological (cognitive) impacts of design. Finally, medicine is a team sport. At the smallest, the team is the patient:provider pair, and increasingly the team is getting larger including people over time and over distance. Information systems need to support the group work – for improved effectiveness. If we design and test at all three levels, our systems will be more usable and more functional. The chapter is a review of some tools and work at each of the three levels.

So that was my contribution. And the rest book has a great collection of authors. I have had the opportunity to learn and work with several of them over the past several years. I am also honoured that I had a chance to help establish an 18-month primary care informatics fellowship a few years through UBC (thank you Peter!) that supported several BC family doctors learn more about informatics, that grew in collaboration with CIHR’s fellowship to include a primary care stream. Several of the fellows are are contributing authors.

Finally a quick thank you to the editors, Drs. Kushniruk and Borycki for inviting me to contribute a chapter to this book and for not making any snide comments on why “psycho” ended up the title of my chapter.

I love this idea – tying together smoking cessation and social networking. It reminds me of the awe when I saw the marrying of videogames and maintaining good glucose control in glucoboy.

Qwitter, from tobacco free Florida, leverages the existing Twitter network to link people together and to monitor your own progress towards quitting smoking. Check out Qwitter. There is also a quick (qwick?) video on the site (although the connection does seem to be slow) that outlines how it works.

I had the luxury of spending a couple of years as a Visiting Worker for the National Research Council in Canada. I was working in their eHealth Group with Dr. Harrop. These were exciting times where some amazing ground work was done on Personal Health Records and how to use it integrate health behaviour change into people’s lives. Really, Qwitter is a very simple, targeted Personal Health Record that provides two of the key foundations of success for sustained change in behaviour that Dr. Harrop liked to quote:

1. Engagement in a person’s own health information – by using Qwitter, you will log your smoking habits and can watch them change over time. That is a key base to change, is to understand baseline and to receive feedback.
2. Community Support – by posting and inviting friends and family to participate through the Twitter Network, you are sharing your journey with them and they can support you in your process.

As I was writing this post, into my RSS feed came a great post on Zen Habits about health and balance where the guest poster talked about how he used his blog to publicly lose weight. He said it very well:

How am I healthier you ask? It’s simple really. I blogged. I read. People read. I felt accountable for my weight loss and health. We formed a community. I felt inspired. They felt inspired. I lost weight. I got healthier. I blogged some more. Repeat. It’s a no-brainer really.

The whole Qwitter site is public (you can, of course make up a great alias so nobody can figure out who you are, but everything you post is online. This is good to share publicly your thoughts and actions.

The Qwitter site also provides you with feedback in the form of graphs (see right).

Seems like a great idea, but I found it hard to find many people who had logged in and used it for more than a few days. I wonder if it would be more powerful if Qwitter is more integrated with community support locally. Perhaps providers and local programs could leverage a tool like this? I think this might be something to bring up with a couple of my patients.

This past winter I discovered a relatively new little application called Flying Logic. It’s designed – specifically – to represent decision graphs. Gone is the tweaking with placement of boxes and shapes of arrows and you’re left with the ability (requirement) to focus on how to model the logic of your problem / solution / system. It’s based heavily on the Theory of Constraints and there is information on the web site describing how to use the tool using that paradigm. Basically the idea is that systems are finite. Some systems are more finite than they need to be because there are bottlenecks (constraints) that can be worked on and elevated / removed, making the system more efficient and productive.

One built-in model, the Prerequisite Tree, I find particularly useful (see diagram). Basically it provides a simple structure to document your goals and then map out the things you need to overcome to achieve those goals. Finally you document milestones that, if achieved, mean that what needs to be overcome is completed.

If you want to find out more about Flying Logic, it is best to see it in action and there are a couple of good videos on the site that are worth looking at.

Interestingly, the pro version allows you to create your own classes (the other versions can accept templates, but not create new ones). I have found that feature helpful in arranging thoughts, arguments, etc. in relation to my thesis. The diagram below (click for a bigger picture) was a draft to organize my thoughts in framing various potential research questions on diagrammatic reasoning.

I set up some research elements, based on a framework published by Weber and Wand, attached my questions to those elements and then built down my methods. Finally I mapped out phases for the research and “promoted” some questions to key questions as they were summations of several others.

In the end, we are focusing on the question “In what ways do physicians reason differently about EMR requirements when using conceptual diagrams as compared to textual requirements?” thanks, in part, to Flying Logic Pro.

Of course, we have gone through some more iterations since I sketched this out, but it gives people an idea of a more complex map.