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Researchers should investigate the use of case-based vignettes requiring providers to make decisions using PGHD. These types of studies would allow for an examination of the features and functionalities needed for optimal decision making or improved patient outcomes.
We recommend further exploration of preferences for PGHD displays using other chronic diseases, such as congestive heart failure or cancer, to determine the generalizability of results for longitudinal, chronic-care activities. Future work should also include multiple members of the care team, participants of different ages, and those serving diverse patient populations.
Providers treating patients with pediatric asthma expressed preferences for the features and content used in PGHD displays such as color, trendlines, and environmental data. Although providers felt the visualizations served as a useful summary, they also expressed a need for greater detail, additional data sources, and visual integration with relevant EHR data. Therefore, future research should examine interactive PGHD displays integrated into EHRs and evaluated within the context of clinical workflows to promote team-based care and shared decision making using PGHD.
Participatory design approaches are beneficial in the design of data displays. Correct Answer: The correct answer is option d. Assessing information needs. Prior to introducing new data into clinical workflows, it is important to assess information needs and how the data will contribute to clinical decision making. Although creating vignettes and designing displays are steps, they are not the first steps. Recruiting providers is only important if there is research being conducted.
Correct Answer: The correct answer is option b. Inhaler use, medications, and environmental data correspond with display content, not features. Overview, zoom, and details on demand refer to visualization principles; and usability, usefulness, and intent to use were constructs measured in the questionnaire.
Content is solely the responsibility of the authors and does not necessarily represent the official views of Jonas Philanthropies. Conflict of Interest None declared. Appl Clin Inform. Published online Jul Victoria L.
Tiase , 1, 2 Sarah E. Wawrzynski , 1 Katherine A. Cummins 1. Sarah E. Katherine A. Mollie R. Author information Article notes Copyright and License information Disclaimer. Address for correspondence Victoria L. Received Apr 17; Accepted Jun Copyright The Author s. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit.
Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
Keywords: analysis, design, data visualization, self-management, mHealth, smartphone. Background and Significance Pediatric asthma, an airway disease characterized by wheezing and chest tightness, is the most common chronic disease in children. Objective The purpose of this study was to investigate provider preferences for the graphical display of pediatric-asthma PGHD to support decisions and information needs in the outpatient setting.
Methods We conducted the study in two phases. Open in a separate window. Development of Vignettes and Displays Vignette Development We developed vignettes to anchor the participatory design approach and formative evaluation.
Table 1 Vignette descriptions, decisions, and types of patient-generated health data. She has a BMI at the 90th percentile, but active. She reports few symptoms during the winter, but in the spring, when her allergies are severe, she takes an Albuterol inhaler before outdoor activities. She had one exacerbation about 5 months ago but has had no symptoms in the past month.
She has not needed recent urgent care or prednisone therapy. Upon examination, no wheezing is noted. Her mother is helping her track symptoms using a smartphone app, and every month she uses the app to calculate her ACT score. Her most recent score was In addition, the app collects outdoor air quality, and local pollen counts.
Identify level of symptom control. Assess extent of exposure to risk factors. Symptoms, Asthma Control Test Exposures, symptoms, environmental factors air-quality index, pollen count 2 A year-old boy with a long history of asthma arrives for his follow-up visit at an NYC clinic. He complains of daily wheezing and episodes of nighttime coughing. He reports missed school days, is frustrated by schoolwork, and cannot keep up on the basketball court with his friends.
He tries to remember to use his Flovent daily and Albuterol inhaler before exercise. No other health issues are noted. You have been unable to identify any specific triggers. He carries his smartphone with him everywhere, and for the last 6 months, has been using a smart inhaler connected to a mobile health application to collect all medication doses.
In addition, he uses the app to document symptoms and exposures on a weekly basis. Determine adjustments to the medication regimen. Identify exposure to risk factors. Symptoms, inhaler use Exposures, symptoms. Display Development Consistent with Gestalt theory and visualization principles, 23 24 we chose to focus on graphical displays for the information. Table 2 Design of display features. Participatory Design of Displays In the early development stages, participatory design methods are well suited for obtaining feedback, exploring user needs, and generating knowledge.
Participant Recruitment We recruited study participants from two academic medical centers with multiple outpatient clinic locations—one in Salt Lake City and the other in New York City. Procedures We elicited feedback on the prototype displays through a series of individual design sessions with semi-structured interviews. Appendix A Interview guide. Cycle Question Prompts 1 Is this what you expected to see? Why not? Does this display provide the information needed? What features are most helpful?
Is there anything else you would prefer to see? Are there additional changes or edits that would be helpful? Anything else you would like to add regarding PGHD and pediatric asthma? What else? Abbreviation: PGHD, patient-generated health data. Data Analysis Data analysis consisted of calculating the mean scores for each questionnaire item for each display in each cycle. Results We conducted two individual design sessions with six participants for a total of 12 interviews.
Overall, I am satisfied with how easy it is to use this display. I was able to complete the tasks and scenarios quickly using this display. I felt comfortable using this display. It was easy to learn to use this display. It was easy to find the information I needed. The information was effective in helping me complete the tasks and scenarios. The organization of information on the display was clear.
This display has all the functions and capabilities I expect it to have. Overall, I am satisfied with this display. If this display were made available to me, I would incorporate it into my practice.
Analysis of Interview Data Using the qualitative data, we made iterative changes to each display between cycles. Table 4 Interview excerpts for display features and content. Display features Display content Display 1 I like that it's a visual graph.
Almost like a run chart or a dotted line that's connected so that you can see the shape of the increase or decrease. You don't have to read actual numbers.
So I like that. The red dots are going up as air-quality index goes down. That's a very helpful thing to know because I'm not usually familiar with the local air-quality index or pollen count so this is really helpful to see it all in one place. It's nice to have the bars. It's nice that the shading on the bar is alternated.
So it's easy to see As air quality improves his ACT score goes up and the symptoms better as pollen count goes down. So this is cool, this is super good. The way it's all displayed is nice and crisp and clean and easy to interpret which is nice, which I like. Looks good and it makes sense. I really love the first graph with the ACT. I really like the color-coding 'cause we don't see it too often, and of course the proper labeling. Display 2 I think that trend is good.
It's good to have a longer-picture understanding. Interested in knowing if you are compliant with controller med. I think that's a valuable piece of information to have there.
It's nice to have the controller and rescue side by side. Appendix B Display modification requests. Discussion To our knowledge, this is the first study to design and conduct a formative evaluation of PGHD displays for providers using participatory design methods. Limitations The participants included in this study represent a sample of physicians from urban academic medical centers and may not be representative of all providers.
Recommendations for Future Research Future iterations of interactive PGHD displays for pediatric asthma should continue to involve participatory design.
Conclusion Providers treating patients with pediatric asthma expressed preferences for the features and content used in PGHD displays such as color, trendlines, and environmental data. Clinical Relevance Statement Participatory design approaches are beneficial in the design of data displays. Acknowledgements V. Funding Statement Funding None. References 1. Serebrisky D, Wiznia A.
Pediatric asthma: a global epidemic. Ann Glob Health. Increased prevalence of allergic asthma from to and further to results from three population surveys. Clin Exp Allergy. Fuhlbrigge A L. Challenges in childhood asthma mortality persist despite advances in care.
J Allergy Clin Immunol Pract. App chronic disease checklist: protocol to evaluate mobile apps for chronic disease self-management. Making sense of mobile health data: an open architecture to improve individual- and population-level health.
J Med Internet Res. Fox S, Rainie L. Pediatric asthma: an unmet need for more effective, focused treatments. Pediatr Allergy Immunol. Understanding the potential role of mobile phone-based monitoring on asthma self-management: qualitative study.
From smartphone to EHR: a case report on integrating patient-generated health data. NPJ Digit Med. Saripalle R K. Leveraging FHIR to integrate activity data with electronic health record. Health Technol Berl ; 10 01 — Patient-generated health data management and quality challenges in remote patient monitoring. Critical care information display approaches and design frameworks: a systematic review and meta-analysis.
J Biomed Inform X. Adler-Milstein J, Nong P. Early experiences with patient generated health data: health system and patient perspectives. J Am Med Inform Assoc. Patient generated health data use in clinical practice: a systematic review.
Nurs Outlook. Converging and diverging needs between patients and providers who are collecting and using patient-generated health data: an integrative review. Electronic patient-generated health data to facilitate disease prevention and health promotion: scoping review.
Patient-generated health data and electronic health record integration: a scoping review. Vignette methodologies for studying clinicians' decision-making: validity, utility, and application in ICD field studies.
Int J Clin Health Psychol. Kim J. Scenarios in information seeking and information retrieval research: a methodological application and discussion. Libr Inf Sci Res. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality.
Patient-generated health data in pediatric asthma: exploratory study of providers' information needs. Gordon I E. Theories of Visual Perception. A century of Gestalt psychology in visual perception: I. Psychol Bull. Ratwani R. Electronic health records and improved patient care: opportunities for applied psychology. Curr Dir Psychol Sci. Interactive visual displays for interpreting the results of clinical trials: formative evaluation with case vignettes. Software prototyping: a case report of refining user requirements for a health information exchange dashboard.
Core components for a clinically integrated mHealth app for asthma symptom monitoring. Shneiderman B. The eyes have it: a task by data type taxonomy for information visualizations. Tufte E R. Cheshire, CT: Graphics Press; The visual display of quantitative information. Proximity compatibility and information display: effects of color, space, and object display on information integration.
Hum Factors. Visualization of Time-Oriented Data. Extracting insights from electronic health records: case studies, a visual analytics process model, and design recommendations. J Med Syst. Envisioning information. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. Visualizing time-oriented data—a systematic view.
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