Persistent inequitable design and implementation of patient portals for users at the margins.
Persistent inequitable design and implementation of patient portals for users at the margins.
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DOI：
10.1093/jamia/ocaa273
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发表时间：
2021-02-15
期刊：
影响因子：
--
通讯作者：
Dedding C
中科院分区：
文献类型：
--
作者：
Goedhart NS;Zuiderent-Jerak T;Woudstra J;Broerse JEW;Betten AW;Dedding C
Diane Forsythe和其他女权主义学者早就指出了系统构建者的默认假设如何导致某些用户从设计过程中被系统地删除。尽管这种现象在健康信息学文献中已经存在了几十年，但最近的研究表明，患者门户网站和电子患者健康记录如何继续再现西方社会的健康不平等。为了更好地了解这种不平等和主流设计的学术意识之间的差异，这项研究揭开了（概念）的假设和设计师和其他负责在荷兰的门户网站实施的做法，以及如何公民生活在脆弱的情况下，包括在这个过程中。我们进行了半结构化访谈（n = 24）和问卷调查（n = 14）与门户网站设计师，卫生专业人员和政策顾问。在日常设计实践中，公平被视为“管道末端”问题。受访者认为医疗保健专业人员而不是患者是他们的主要用户。如果设计中包括患者，这通常会使患者处于特权地位。在设计过程中没有优先考虑生活在弱势环境中的公民的需求。开发人员通过参考创新扩散的创新理论方法来使他们的重点合法化。虽然女权主义学者已经发展了重要的理解，从门户网站设计中排除生活在弱势环境中的公民，其他学术努力深刻地塑造了门户网站开发的日常实践。Diane Forsythe可能会将这种差异视为一种挑战，通过寻找将这些见解转化为主流系统设计的方法。
Diane Forsythe and other feminist scholars have long shown how system builders’ tacit assumptions lead to the systematic erasure of certain users from the design process. In spite of this phenomena being known in the health informatics literature for decades, recent research shows how patient portals and electronic patients health records continue to reproduce health inequalities in Western societies. To better understand this discrepancy between scholarly awareness of such inequities and mainstream design, this study unravels the (conceptual) assumptions and practices of designers and others responsible for portal implementation in the Netherlands and how citizens living in vulnerable circumstances are included in this process. We conducted semistructured interviews (n = 24) and questionnaires (n = 14) with portal designers, health professionals, and policy advisors. In daily design practices, equity is seen as an “end-of-the-pipeline” concern. Respondents identify health care professionals rather than patients as their main users. If patients are included in the design, this generally entails patients in privileged positions. The needs of citizens living in vulnerable circumstances are not prioritized in design processes. Developers legitimize their focus with reference to the innovation-theoretical approach of the Diffusion of Innovations. Although feminist scholars have developed important understandings of the exclusion of citizens living in vulnerable circumstances from portal design, other academic efforts have profoundly shaped daily practices of portal development. Diane Forsythe would likely have taken up this discrepancy as a challenge by finding ways to translate these insights into mainstream systems design.
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影响因子：
5.6
作者：
Friedman, B;Nissenbaum, H
通讯作者：
Nissenbaum, H
DOI：
10.1093/jamia/ocz024
发表时间：
2019-08-01
影响因子：
6.4
作者：
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通讯作者：
Midboe, Amanda M.
影响因子：
1.2
作者：
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通讯作者：
Abma, Tineke A.
影响因子：
1.3
作者：
Bacigalupe, Gonzalo;Askari, Sabrina F.
通讯作者：
Askari, Sabrina F.
影响因子：
5
作者：
Courtois, Cedric;Verdegem, Pieter
通讯作者：
Verdegem, Pieter