Fairness in Classifying and Grouping Health Equity Information.

This paper explores the balance between fairness and performance in machine learning classification, predicting the likelihood of a patient receiving anti-microbial treatment using structured data in community nursing wound care electronic health records. The data includes two important predictors (gender and language) of the social determinants of health, which we used to evaluate the fairness of the classifiers. At the same time, the impact of various groupings of language codes on classifiers' performance and fairness is analyzed. Most common statistical learning-based classifiers are evaluated. The findings indicate that while K-Nearest Neighbors offers the best fairness metrics among different grouping settings, the performance of all classifiers is generally consistent across different language code groupings. Also, grouping more variables tends to improve the fairness metrics over all classifiers while maintaining their performance.

Technology-Related Safety Event Analysis in Community Clinical Informatics: A Case Study.

This case study presents a process that was iteratively developed for clinical informaticians to identify, analyse, and respond to safety events related to health information technologies (HIT) in community care settings (This research was supported by the CIHR Health Systems Impact Fellowship Program. We would also like to thank Vancouver Coastal Health for their valuable contributions.). The goal was to build capacity within a clinical informatics team to integrate patient safety into their work and to help them recognize and respond to HIT-related safety events. The technology-related safety event analysis process that was ultimately developed included three key components: 1) an internal workflow to analyse voluntarily reported HIT-related safety events using a sociotechnical model, 2) safety huddles to amplify learnings from reviewed events, and 3) a cumulative analysis of all events over time to identify and respond to patterns. A systematic approach to quickly identify and understand HIT safety concerns enables informatics teams to proactively reduce risks and prevent harm.

Integrating Justice, Equity, Diversity, Inclusion & Indigeneity into an Informatics Curriculum.

In this case study, we present the inclusion of justice, equity, diversity, inclusion, and Indigeneity (JEDI-I) principles into a graduate certificate in clinical informatics. We specifically focus on two assignments that were created for the program: 1) journal club, 2) usability evaluation. We found that there was limited description of JEDI-I principles in journal club articles. New criteria for authentic resource evaluation were somewhat met in the usability evaluation of a sexual health website. Incorporating JEDI-I principles into the assignments supported fulsome conversations about end-user of technology in healthcare. Identifying examples of including JEDI-I would strengthen students' experiences in clinical informatics programs.

Nurse Involvement in Health Information Technology Design for Computerized Nursing Practice: A Scoping Review.

This scoping review assesses evidence regarding nurse involvement in health information technology (health IT) design, focusing on the method(s), frequency, capacity, and levels of involvement. The JBI methodology for scoping reviews was used to search seven multidisciplinary databases, yielding 2948 articles. After screening, 98 articles were included for data abstraction. Textual data summary is ongoing. Preliminary findings highlight that nurses are often involved in the late stages of health IT design, with less frequency in the early and pre-programming design phases. Most studies used a user-centered design approach to elicit nurses' views about health IT tools after the tools had been developed, with nearly half being point of care nurses. Increasing nurse involvement in health IT design may help to improve nurses' perceptions of health IT that nurses use.

Development and Testing of an Instrument to Measure the Impact of EHR Use on Quality of Care.

There is an increased adoption of electronic health records (EHR) motivated by many purported benefits, yet limited research has explored their impact on quality of care. We developed and tested a multidimensional measure of quality of care in relation to EHR use. 234 nurses completed a cross-sectional survey. The score of the quality of care construct reached 0.92. Four subdimensions were identified: technology impact on nursing practice, learning and improvement capability, transition accountability, and fault responsibility. The instrument has potential to advance our understanding of the impact of EHR use on quality of care.

Interpretive Description in Computerized Ontology Development: Rigour.

This poster presents the use of Interpretive Description in ontology development. The methods selected attended to the need for quality and rigour.

Technology-Related Safety Events in Primary and Community Care Settings: A Scoping Review.

This scoping review assesses the current knowledge on technology-related safety events in primary and community care settings, focusing on patient safety and harm. Utilizing Arksey and O'Malley's methodological framework, a comprehensive literature search was conducted across various databases, yielding 17 relevant articles. The review highlighted predominant safety event issues, such as technology limitations, incorrect data, and software malfunctions, and identified essential risk mitigation strategies. Consultation with healthcare leaders reinforced these findings and revealed additional organizational challenges, emphasizing the need for continuous monitoring, reporting, and analyzing of HIT-related safety concerns. The findings suggest that while safety events in non-acute settings share similarities with those in acute care, they require specific attention and further research.

Speech Recognition Technology for Nursing Charting: A Literature Review.

This literature review explores the impact of Speech Recognition Technology (SRT) on nursing documentation within electronic health records (EHR). A search across PubMed, CINAHL, and Google Scholar identified 156 studies, with seven meeting the inclusion criteria. These studies investigated the impact of SRT on documentation time, accuracy, and user satisfaction. Findings suggest SRT, particularly when integrated with artificial intelligence can speed up documentation by up to 15%. However, challenges remain in its implementation in real-world clinical settings and existing EHR workflows. Future studies should focus on developing SRT systems that process conversational nursing assessments and integrate into current EHRs.

Association Between EHR Compatibility and Nurses' Emotional Exhaustion.

In this study we explored the relationship between nurses' emotional exhaustion and three EHR compatibility subdimensions (nurses' preferred work style, existing clinical practice, and values). We found higher emotional exhaustion with lower EHR compatibility for both preferred work style and existing clinical practice, but no relationship between emotional exhaustion and nurses' values. Efforts to improve EHR compatibility are recommended to mitigate nurses' burnout.

Integration of Equity, Diversity, Inclusivity, and Indigeneity Principles into Usability Heuristic Evaluations.

Cognitive walkthrough is a form of usability testing that considers the perspective of the end users to identify issues related to user experience and web design. This project aims to enhance traditional heuristic evaluation methods with consideration of equity, diversity, inclusivity, and indigeneity (EDI-I) principles. The authors provide suggestions that align with modern informatics advancements, aiming for inclusive design systems and the elimination of systemic barriers.

A Tailored Self-Management App to Support Older Adults with Cancer and Multi-Morbidities: Development and Usability Testing.

Cancer self-management interventions improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multi-morbidities. Despite growing evidence of digital health tools in cancer care, many such tools have not been co-designed with older adults to ensure that they are tailored to their specific needs. The objective of the study was to design a self-and symptom-management app to support older adults with cancer and multi-morbidities. Utilizing a user-centered design thinking framework, we recruited 2 caregivers and 18 older adults with lived experiences of cancer to design a medium-fidelity app prototype. Participants highlighted the importance of tracking functions to make sense of the information about their symptoms, clear displays, and reminders to mitigate concerns related to polypharmacy. This app will create a 'home base' for symprtom management and support for older adults with cancer and multi-morbidities.

Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing.

BACKGROUND: Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. OBJECTIVE: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. METHODS: This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. RESULTS: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. CONCLUSIONS: This app has the potential to support the complex health care needs of older adults with cancer, creating a "home base" for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation.

Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study.

BACKGROUND: Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). OBJECTIVE: This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work. METHODS: We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. RESULTS: A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. CONCLUSIONS: As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work.

Nursing Informatics' Contribution to One Health.

OBJECTIVES: To summarise contemporary knowledge in nursing informatics related to education, practice, governance and research in advancing One Health. METHODS: This descriptive study combined a theoretical and an empirical approach. Published literature on recent advancements and areas of interest in nursing informatics was explored. In addition, empirical data from International Medical Informatics Association (IMIA) Nursing Informatics (NI) society reports were extracted and categorised into key areas regarding needs, established activities, issues under development and items not current. RESULTS: A total of 1,772 references were identified through bibliographic database searches. After screening and assessment for eligibility, 146 articles were included in the review. Three topics were identified for each key area: 1) education: "building basic nursing informatics competence", "interdisciplinary and interprofessional competence" and "supporting educators competence"; 2) practice: "digital nursing and patient care", "evidence for timely issues in practice" and "patient-centred safe care"; 3) governance: "information systems in healthcare", "standardised documentation in clinical context" and "concepts and interoperability", and 4) research: "informatics literacy and competence", "leadership and management", and "electronic documentation of care". 17 reports from society members were included. The data showed overlap with the literature, but also highlighted needs for further work, including more strategies, methods and competence in nursing informatics to support One Health. CONCLUSIONS: Considering the results of this study, from the literature nursing informatics would appear to have a significant contribution to make to One Health across settings. Future work is needed for international guidelines on roles and policies as well as knowledge sharing.

Characterization of Safety Events Involving Technology in Primary and Community Care.

BACKGROUND: The adoption of technology in health care settings is often touted as an opportunity to improve patient safety. While some adverse events can be reduced by health information technologies, technology has also been implicated in or attributed to safety events. To date, most studies on this topic have focused on acute care settings. OBJECTIVES: To describe voluntarily reported safety events that involved health information technology in community and primary care settings in a large Canadian health care organization. METHODS: Two years of safety events involving health information technology (2016-2018) were extracted from an online voluntary safety event reporting system. Events from primary and community care settings were categorized according to clinical setting, type of event, and level of harm. The Sittig and Singh sociotechnical system model was then used to identify the most prominent sociotechnical dimensions of each event. RESULTS: Of 104 reported events, most (n = 85, 82%) indicated the event resulted in no harm. Public health had the highest number of reports (n = 45, 43%), whereas home health had the fewest (n = 7, 7%). Of the 182 sociotechnical concepts identified, many events (n = 61, 59%) mapped to more than one dimension. Personnel (n = 48, 46%), Workflow and Communication (n = 37, 36%), and Content (n = 30, 29%) were the most common. Personnel and Content together was the most common combination of dimensions. CONCLUSION: Most reported events featured both technical and social dimensions, suggesting that the nature of these events is multifaceted. Leveraging existing safety event reporting systems to screen for safety events involving health information technology, and applying a sociotechnical analytic framework can aid health organizations in identifying, responding to, and learning from reported events.

Co-design of a digital app "WhatMatters" to support person-centred care: A critical reflection.

BACKGROUND: People with dementia often do not receive optimal person-centred care (PCC) in care settings. Family members can play a vital role as care partners to support the person with dementia with their psychosocial needs. Participatory research that includes the perspectives of those with lived experience is essential for developing high-quality dementia care and practices. OBJECTIVE: Throughout 2021-2022, a mobile app, called WhatMatters, was co-developed to provide easy-to-access and personalised support for people with dementia in hospitals and long-term care homes, with input from patients/residents, family partners and healthcare staff. This article discusses and critically reflects on the experiences of patients/residents, family partners, and healthcare staff involved in the co-design process. METHODS: For the app development, we applied a participatory co-design approach, guided by a User Experience (UX) model. The process involved co-design workshops and user testing sessions with users (patients/residents, family partners, healthcare staff) to co-develop the WhatMatters prototype. We also conducted focus groups and one on one interviews with staff and caregiver participants to explore their experiences. Our research team, which also included patient partners, took part in regular team meetings during the app's development, where we discussed and reflected on the co-design process. Reflexive thematic analysis was performed to identify themes that represent the challenges and rewarding experiences of the users involved in the co-design process, which guided our overall reflective process. FINDINGS: Our reflective analysis identified five themes (1) clarifying the co-design process, (2) ensuring inclusive collaborations of various users, and (3) supporting expression of emotion in a virtual environment, (4) feeling a sense of achievement and (5) feeling valued. IMPLICATIONS: WhatMatters offers potential for providing personally relevant and engaging resources in dementia care. Including the voices of relevant users is crucial to ensure meaningful benefits for patients/residents. We offer insights and lessons learned about the co-design process, and explore the challenges of involving people with lived experiences of dementia in co-design work, particularly during the pandemic.

Differing Effects of Implementation Leadership Characteristics on Nurses' Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study.

BACKGROUND: Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically. OBJECTIVE: This study aimed to examine the effects of first-level leaders' implementation leadership characteristics on nurses' intention to use and actual use of mHealth technologies in practice while controlling for nurses' individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies. METHODS: A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use. RESULTS: The implementation leadership characteristics of first-level leaders influenced nurses' intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47% of the variance in nurses' intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses' demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership × age interaction term (ß=.22; P=.001) and in the final model that included the implementation leadership × age interaction term (ß=-.53; P=.03). The final model explained 40% of the variance in nurses' actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies. CONCLUSIONS: Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses' use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice.

Defining destigmatizing design guidelines for use in sexual health-related digital technologies: A Delphi study.

OBJECTIVE: Stigma has been recognized as a significant issue in sexual health, yet no specific guidelines exist to support digital health development teams in creating stigma-alleviating sexual health digital platforms. The purpose of this study was to develop a set of design guidelines that would serve as a reference point for addressing stigma during the design of sexual health-related digital platforms. MATERIALS AND METHODS: We conducted a 3-round Delphi study among 14 researchers in stigma and sexual health. A preliminary list of 28 design guidelines was generated from a literature review. Participants appraised and critiqued the clarity and usefulness of the preliminary list and provided comments for each item and for the overall group of items at each round. At each round, a content validity index and an interquartile range were calculated to determine the level of consensus regarding the clarity and usefulness of each guideline. Items were retained if there was high consensus or were dropped if there was no consensus after the three rounds. RESULTS: Nineteen design guidelines achieved consensus. Most of them were content-related guidelines and sought to address the emotional concerns of patients that could potentially aggravate stigma. The findings also reflected modern stigma management strategies of making stigma a societal attribute by challenging, exposing, and normalizing stigma attributes via web platforms. CONCLUSION: To address stigma via digital platforms, developers should not just concentrate on technical solutions but seriously consider content-related and emotional design components that are likely to result in stigma.

Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study.

BACKGROUND: Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences. OBJECTIVE: The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers' experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers' willingness to share their stories with broader audiences as a method for knowledge translation. METHODS: This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach. RESULTS: A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants' experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website. CONCLUSIONS: Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention.

Application of Two-Eyed Seeing in Adolescent Mental Health to Bridge Design Thinking and Indigenous Collective Storytelling.

BACKGROUND: eMental health apps are increasingly being considered for use in health care with growing recognition of the importance of considering end-user preferences in their design and implementation. The key to the success of using apps with Indigenous youth is tailoring the design and content to include Indigenous perspectives. In this study we used a Two-Eyed Seeing perspective to integrate Indigenous and human computer interaction methodologies to identify end-user preferences for a tablet-based mental health screening app used in a primary care clinic serving Indigenous youth. OBJECTIVE: The research objectives used a Two-Eyed Seeing approach to (i) collectively create stories about Indigenous youth lived experiences accessing integrated primary care for their mental health concerns; and (ii) engage Indigenous youth in Design Circles to determine their usability preferences for digital mental health screening tools. METHOD: Eight adolescents (n = 4 young women; n = 3 young men; and n = 1 Two Spirit) between 20 to 24 years old who self-identified as Indigenous participated. Indigenous youth joined Design Circles to co-create a story about accessing mental health care and their needs and preferences for an eMental Health app. RESULTS: Findings highlighted the importance of collective Indigenous storytelling about accessing integrated primary care for mental health needs. Participants created three persona stories about their challenges accessing mental health care and the role of social support. Participants sorted their usability design preferences for an eMental Health app to be inclusive of Indigenous knowledges. CONCLUSIONS: A Two-Eyed Seeing perspective was useful to incorporate a design thinking approach as collective storytelling among Indigenous youth. This research may inform and shape the design of eMental health apps used in health clinics to better engage Indigenous youth.