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Yearb Med Inform 2016; 25(01): 113-119
DOI: 10.15265/IY-2016-031
IMIA and Schattauer GmbH
Georg Thieme Verlag KG Stuttgart

Impact of Patient-centered eHealth Applications on Patient Outcomes: A Review on the Mediating Influence of Human Factor Issues

G.A. Wildenbos
1   Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), The Netherlands
,
L.W. Peute
1   Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), The Netherlands
,
M.W.M. Jaspers
1   Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), The Netherlands
› Author Affiliations
Further Information

Publication History

10 November 2016

Publication Date:
06 March 2018 (online)

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Summary

Objectives: To examine the evidence of the impact of patient-centered eHealth applications on patient care and to analyze if and how reported human factor issues mediated the outcomes.

Methods: We searched PubMed (2014-2015) for studies evaluating the impact of patient-centered eHealth applications on patient care (behavior change, self-efficacy, and patient health-related outcomes). The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model was used as a guidance framework to identify the reported human factors possibly impacting the effectiveness of an eHealth intervention.

Results: Of the 348 potentially relevant papers, 10 papers were included for data analysis. None of the 10 papers reported a negative impact of the eHealth intervention. Seven papers involved a randomized controlled trial (RCT) study. Six of these RCTs reported a positive impact of the eHealth intervention on patient care. All 10 papers reported on human factor issues possibly mediating effects of patient-centered eHealth. Human factors involved patient characteristics, perceived social support, and (type of) interaction between patient and provider.

Conclusion: While the amount of patient-centered eHealth interventions increases, many questions remain as to whether and to what extent human factors mediate their use and impact. Future research should adopt a formal theory-driven approach towards human factors when investigating those factors’ influence on the effectiveness of these interventions. Insights could then be used to better tailor the content and design of eHealth solutions according to patient user profiles, so as to enhance eHealth interventions impact on patient behavior, self-efficacy, and health-related outcomes.

Keywords

eHealth - health-related outcome - behavior change - self-efficacy - patients - impact
 

  • References

  • 1 Bell B, Thornton K. From promise to reality achieving the value of an EHR.. Healthc Financ Manage 2011; Feb 65 (Suppl. 02) 50-6.
    PubMedGoogle Scholar
  • 2 Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results.. Health Aff (Millwood) 2011; Mar 30 (Suppl. 03) 464-71.
    CrossrefPubMedGoogle Scholar
  • 3 Chaudhry B Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care.. Ann Intern Med 2006; 144: 742-52.
    CrossrefPubMedGoogle Scholar
  • 4 Kumar S, Bauer K. The business case for implementing electronic health records in primary care settings in the United States.. Journal of Revenue and Pricing Management 2011; 10 (Suppl. 02) 119-31.
    CrossrefPubMedGoogle Scholar
  • 5 McCullough JS, Casey M, Moscovice I, Prasad S. The Effect of Health Information Technology on Quality in U.S. Hospitals.. Health Aff (Millwood) 2010; 29 (Suppl. 04) 647-54.
    CrossrefPubMedGoogle Scholar
  • 6 Ash JS, Berg M, Coiera E. Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors.. J Am Med Inform Assoc 2004; 11 (Suppl. 02) 104-12.
    PubMedGoogle Scholar
  • 7 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry.. J Am Med Inform Assoc 2007; 14 (Suppl. 04) 415-23.
    CrossrefPubMedGoogle Scholar
  • 8 Bowman S. Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications.. Perspect Health Inf Manag 2013; Oct 1 10: 1c.
    PubMedGoogle Scholar
  • 9 Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of Unintended Consequences Related to Computerized Provider Order Entry.. J Am Med Inform Assoc 2006; 13 (Suppl. 05) 547-56.
    CrossrefPubMedGoogle Scholar
  • 10 Gephart S, Carrington JM, Finley B. A Systematic Review of Nurses’ Experiences With Unintended Consequences When Using the Electronic Health Record.. Nurs Adm Q 2015; xOct-Dec; 39 (Suppl. 04) 345-56.
    CrossrefPubMedGoogle Scholar
  • 11 Peute LW, Aarts J, Bakker PJ, Jaspers MW. Anatomy of a failure: a sociotechnical evaluation of a laboratory physician order entry system implementation.. Int J Med Inform 2010; Apr 79 (Suppl. 04) e58-70.
    CrossrefPubMedGoogle Scholar
  • 12 Bloomrosen M, Starren J, Lorenzi NM, Ash JS, Patel VL, Shortliffe EH. Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting.. J Am Med Inform Assoc 2011; Jan-Feb 18 (Suppl. 01) 82-90.
    CrossrefPubMedGoogle Scholar
  • 13 Carayon P, Xie A, Kianfar S. Human factors and ergonomics as a patient safety practice.. BMJ Qual Saf 2014; Mar 23 (Suppl. 03) 196-205.
    CrossrefPubMedGoogle Scholar
  • 14 Harrison MI, Koppel R, Bar-Lev S. Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis.. J Am Med Inform Assoc 2007; 14 (Suppl. 05) 542-9.
    CrossrefPubMedGoogle Scholar
  • 15 Khajouei R, Jaspers MW. The impact of CPOE medication systems’ design aspects on usability, workflow and medication orders: a systematic review.. Methods Inf Med 2010; 49 (Suppl. 01) 3-19.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors.. JAMA 2005; Mar 9 293 (Suppl. 10) 1197-203.
    CrossrefPubMedGoogle Scholar
  • 17 Kushniruk A, Borycki E, Kuwata S, Kannry J. Predicting Changes in Workflow Resulting from Healthcare Information Systems: Ensuring the Safety of Healthcare.. Healthc Q 2006; 9 Spec No: 114-8.
    CrossrefPubMedGoogle Scholar
  • 18 Patel VL, Kannampallil TG. Human factors and health information technology: current challenges and future directions.. Yearb Med Inform 2014; Aug 15 9 (Suppl. 01) 58-66.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Peute LW, Jaspers MW. The significance of a usability evaluation of an emerging laboratory order entry system.. Int J Med Inform 2007; FebMar 76 2-3 157-68.
    CrossrefPubMedGoogle Scholar
  • 20 Singh H, Sittig DF. Measuring and improving patient safety through health information technology: The Health IT Safety Framework.. BMJ Qual Saf 2016; Apr 25 (Suppl. 04) 226-32.
    CrossrefPubMedGoogle Scholar
  • 21 Baysari MT, Westbrook JL. Mobile Applications for Patient-Centered Care Coordination: a Review of Human Factors Methods Applied to their Design, Development and Evaluation.. Yearb Med Inform 2015; 10: 47-54.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Peute LW. Human factors methods in health information systems.. Design and evaluation. The Road to Success? 2013
    PubMedGoogle Scholar
  • 23 Andersen B, Fagerhaug T, Beltz M. Root Cause Analysis and Improvement in the Healthcare Sector: A Step-by-step Guide.. ASQ Quality Press; 2009
    PubMedGoogle Scholar
  • 24 Ahern DK, Woods SS, Lightowler MC, Finley SW, Houston TK. Promise of and Potential for Patient-Facing Technologies to Enable Meaningful Use.. Am J Prev Med 2011; 40 (Suppl. 02) S162-S172.
    CrossrefPubMedGoogle Scholar
  • 25 Kayser L, Kushniruk A, Osborne RH, Norgaard O, Turner P. Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users’ Needs.. JMIR Hum Factors 2015; 2 (Suppl. 01) e9.
    CrossrefPubMedGoogle Scholar
  • 26 Das A, Faxvaag A. What influences Patient Participation in an Online Forum on Weight Loss Surgery? A Qualitative Case Study.. Interact J Med Res 2014; 3 (Suppl. 01) e4.
    CrossrefPubMedGoogle Scholar
  • 27 Schrader G, Bidargaddi N, Harris M, Newman L, Lynn S, Peterson L. et al. An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study.. JMIR Res Protoc 2014; 3 (Suppl. 02) e27.
    CrossrefPubMedGoogle Scholar
  • 28 Schutte JL, McCue M, Parmanto B, Handen B. Usability and Reliability of a Remote Administered Adult Autism Assessment, the Autism Diagnostic Observation Schedule (ADOS), Module 4., Tele-medicine and e-Health,. March 2015
    PubMedGoogle Scholar
  • 29 Sun N, Rau PP. The acceptance of personal health devices among patients with chronic conditions.. Int J Med Inform 2015; 84: 288-97.
    CrossrefPubMedGoogle Scholar
  • 30 Baumeister H, Nowoczin L, Lin J, Seifferth H, Seufert J, Laubner K. et al. Impact of an acceptance facilitating intervention on diabetes patients’ acceptance of Internet-based interventions for depression: a randomized controlled trial.. Diabetes Res Clin Pract 2014; Jul 105 (Suppl. 01) 30-9.
    CrossrefPubMedGoogle Scholar
  • 31 Stroetman KA, Jones T, Dobrev A, Stroetmann VN. eHealth is Worth it.. The economic benefits of implemented eHealth solutions at ten European sites. Commissioned by the European commission, September 2006. Last download, June 25, 2016. Available at: http://ehealth-impact.org/download/documents/ehealthimpactsept2006.pdf.
    PubMedGoogle Scholar
  • 32 Car J, Black A, Anandan C, Cresswell K, Pagliari C, McKinstry B, Procter R. et al. Impact of eHealth on the Quality & Safety of Healthcare.. March 2008. Last download, June 25, 2016. Available at: https://www1.imperial.ac.uk/resources/32956FFCBD76-47B7-94D2-FFAC56979B74.
    PubMedGoogle Scholar
  • 33 Piette JD, Lun KC, Moura LA, Fraser HSF, Mechael PN, Powell J. et al. Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?. Bull World Health Organ 2012; May 1 90 (Suppl. 05) 365-72.
    CrossrefPubMedGoogle Scholar
  • 34 Comstock J. Patient-Centered healthcare is broadly supported, but has many meanings [Online].. Available: http://mobihealthnews.com/48757/patient-centered-healthcare-is-broadly-supported-but-has-many-meanings [Accessed: 18-01-2016].
    PubMedGoogle Scholar
  • 35 Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok A. et al. SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients Ergonomics.. 2013 56:11 1669-86.
    PubMedGoogle Scholar
  • 36 Allam A, Kostova Z, Nakamato K, Schulz PJ. The effect of Social Support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis Patients: Randomized Controlled Trial. J Med Internet Res 2015; Jan 17 (Suppl. 01) e14.
    CrossrefPubMedGoogle Scholar
  • 37 Berry DL, Blonquist TM, Patel RA, Halpenny B, McReynolds J. Exposure to a Patient-Centered, Web-Based Intervention for Managing Cancer Symptom and Quality of Life Issues: Impact on Symptom Distress.. J Med Internet Res 2015; Jun 17 (Suppl. 06) e136.
    CrossrefPubMedGoogle Scholar
  • 38 Borosund E, Cvancarova M, Moore MS, Ekstedt M, Ruland MC. Comparing Effects in Regular Practice of E-communication and Web-Based Self-Management Support Among Breast Cancer Patients: Preliminary Results of a Randomized Controlled Trial.. J Med Internet Res 2014; Dec 16 (Suppl. 12) e295.
    CrossrefPubMedGoogle Scholar
  • 39 Fiks AG, Mayne SL, Karavite DJ, Suh A, O‘Hara R, Localio AR. et al. Parent-Reported Outcomes of a Shared Decision-Making Portal in Asthma: a practice-based RCT.. Pediatrics 2015; Apr 135 (Suppl. 04) e965-73.
    CrossrefPubMedGoogle Scholar
  • 40 Ralston JD, Cook AJ, Anderson ML, Catz SL, Fishman PA, Carlson J. et.al. Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control. A mediation analysis.. Appl Clin Inform 2014; Mar 12 5 (Suppl. 01) 232-48.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Safran Naimark J, Madar Z, Shahar DR. The Impact of a Web-Based App (eBalance) in Promoting Healthy Lifestyles: Randomized Controlled Trial.. J Med Internet Res 2015; Mar 17 (Suppl. 03) e56.
    CrossrefPubMedGoogle Scholar
  • 42 Volker D, Zijlstra-Vlasveld MC, Anema JR, Beekman A, Brouwers EP, Emons WH. et al. Effectiveness of a Blended Web-Based Intervention on Returm to Work for Sick-Listed Employees With Common Mental Disorders: Results of a Cluster Randomized Controlled Trial.. J Med Internet Res 2015; May 17 (Suppl. 05) e116.
    CrossrefPubMedGoogle Scholar
  • 43 MacNab M, Lee SH, McCloughan L, Hanley J, McKinstry B, Pinnock H. Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project.. BMC Health Serv Res 2015; Oct 26 15: 485.
    CrossrefPubMedGoogle Scholar
  • 44 Gomez-Zuniga B, Pousada M, Hernandez MM, Colberg S, Gabarron E, Armayones M. Case Report: The Online Big Blue Test for Promoting Exercise: Health, Self-Efficacy, and Social Support.. Telemed J E Health 2015; Oct 21 (Suppl. 10) 852-9. .
    CrossrefPubMedGoogle Scholar
  • 45 Sepah SC, Jiang L, Peters AL. Long-Term Outcomes of a Web-Based Diabetes Prevention Program:2-Year Results of a Single-Arm Longitudinal Study.. J Med Internet Res 2015; Apr 17 (Suppl. 04) e92.
    CrossrefPubMedGoogle Scholar