Technical infrastructure implications of the patient work framework.
Technical infrastructure implications of the patient work framework.
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患者工作框架的技术基础设施影响。
DOI：
10.1093/jamia/ocu031
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Veinot,TiffanyC
中科院分区：
文献类型：
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作者：
Valdez,RupaS;Holden,RichardJ;Novak,LaurieL;Veinot,TiffanyC
在他们对我们的原始论文“通过患者工作框架转换消费者健康信息学：将患者连接到上下文”的回应中，Marceglia及其同事提出了一种架构，该架构将患者工作框架集成到连接消费者健康信息学（CHI）应用程序和专业健康信息系统（作者指定为健康信息技术（IT）生态系统）的高阶框架中。1我们这封信的目的有三个。首先，我们详细介绍了如何扩大理解病人的工作框架已经在概念上涵盖了更大的背景下，CHI的使用必须发生。第二，我们断言，有意义的应用病人的工作角度产生的影响，不仅与专业的健康信息系统的整合，但也与更大的信息基础设施内的社区。第三，我们建议修改Marceglia和同事的架构，明确表示CHI应用程序和专业健康信息系统之间的“共享空间”，这个空间包含协作工作和协作信息。我们最初的病人工作框架旨在通过理解人们、他们的日常环境和他们的日常活动来作为CHI设计的基础。因此，我们将讨论的范围限制在患者的家庭和社区环境中。然而，我们同意Marceglia及其同事的观点，即需要更深入地了解患者工作的宏观结构。这种理解是必要的，不仅为指定的设计结果的约束，但也产生创造性的设计方案。更大的宏观结构包含在构成患者工作框架核心的人因工程和社会科学理论中;因此，它们已经在概念上嵌入。2-4这些宏观结构不仅包括更大的技术基础设施（包括但不限于Marceglia及其同事指定的健康IT生态系统），还包括经济，监管和政策环境。例如，对保险政策的认识可能会导致设计者为CHI应用程序被覆盖的实体的未来做规划。然而，为社会经济地位较低和医疗保险计划不那么慷慨的人设计的应用程序的设计者可能需要寻求低成本的替代方案。为使用较旧硬件或操作系统的人群设计同样需要理解和解决技术挑战，例如mHealth应用程序和基于短消息服务（SMS）的替代方案的向后兼容性。在概念设计阶段，我们以用户为中心的设计过程的第二步，整合这些更广泛的背景知识是特别突出的。虽然我们同意，病人的工作框架可以产生有价值的见解连接CHI应用程序与专业的健康信息系统，我们断言，它的技术影响，事实上，更广泛。作为一个研究框架，患者工作还阐明了与更广泛概念化的健康IT生态系统（包括患者家庭和社区的信息基础设施）相关的许多领域。为了说明这一点，我们提供了一些基于对这个更大的健康IT生态系统的认识的设计替代方案示例。在“物理环境”类别中，社区步行能力得分和安全信息，沿着患者健康和社交网络数据，可以为整合治疗性身体活动的策略的开发提供信息。
In their response to our original paper,“Transforming Consumer Health Informatics through a Patient Work Framework: Connecting Patients to Context,” Marceglia and colleagues propose an architecture that integrates the patient work framework into a higher-order framework linking consumer health informatics (CHI) applications and professional health information systems (designated by the authors as the health-Information Technology (IT) ecosystem). 1 The purpose of our letter is threefold. First, we detail how an expanded understanding of the patient work framework already conceptually encompasses the larger contexts in which CHI use must occur. Second, we assert that meaningful application of the patient work perspective yields implications not only for integration with professional health information systems but also with the larger information infrastructures within the community. Third, we propose modifications to Marceglia and colleagues’ architecture to explicitly represent a “shared space” between CHI applications and professional health information systems; this space contains collaborative work and collaborative informatics. Our original patient work framework was intended to serve as a foundation for CHI design by enabling the understanding of people, their daily contexts, and their daily activities. As such, we limited the scope of our discussion to the immediate home and community environments of the patient. We agree, however, with Marceglia and colleagues that a deeper understanding of the macrostructures encompassing patient work is required. This understanding is necessary not only for specifying constraints on the design outcome, but also for generating creative design alternatives. Larger macrostructures are included in the human factor engineering and social science theories that form the core of the patient work framework; consequently, they are already conceptually embedded. 2–4 These macrostructures include not only the larger technological infrastructure (including, but not limited to, the health-IT ecosystem specified by Marceglia and colleagues), but also the economic, regulatory, and policy landscapes. For example, awareness of insurance policies may lead designers to plan for a future in which CHI applications are covered entities.However, designers of applications for people with low socioeconomic status and less generous health insurance plans may need to pursue low-cost alternatives. Designing for populations that use older hardware or operating systems will similarly require technological challenges to be understood and addressed, such as the backward compatibility of mHealth applications and Short Message Service (SMS)-based alternatives. In the phase of conceptual design, the second step in our user-centered design process, integrating knowledge of these broader contexts is particularly salient. Although we agree that the patient work framework can produce valuable insights into connecting CHI applications with professional health information systems, we assert that its technical implications are, in fact, much broader. As an investigational framework, patient work also illuminates numerous areas of connection to a more broadly conceptualized health-IT ecosystem that includes the information infrastructures of patients’ homes and communities. To illustrate, we offer a few examples of design alternatives that build upon a recognition of this larger health-IT ecosystem. In the category “physical environment,” neighborhood walkability scores and safety information, along with patient health and social network data, may inform the development of strategies for integrating therapeutic physical activity …