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We incorporated suggestions for display improvements that included legends and the use of color to indicate control levels. Although the ACT score has a particular color scheme, not all participants were familiar with the displayed colors as expected; however, participants indicated that the use of red coloring to indicate a control problem and green to indicate good control is standard practice. Once we made modifications to the display features for the second cycle, and display content became more relevant, participants found it easier to interpret the relationships in the data.

This finding indicates an interrelation of display content and display features. Given the importance of data interpretation, a deeper exploration of display content and features within the context of decision making is essential for future research.

In general, participants requested more content and more detail in each display. This was not surprising, given the tradeoff between having all data in one place and the limitation of one display being able to show all possibly relevant data. There might be a role for more features, like filtering and details on demand, in the current design of EHRs to address this tradeoff.

An exploration of display use over time may also influence design features. Because we did not perform a task analysis as part of this study, it is unknown whether more content and more details are needed to support the vignette decisions. In most cases, the requested data types would not be available from the asthma apps that we explored.

But we expected the request for PGHD related to the patient’s daily activities, given their importance in chronic disease management. With the promise of health-monitoring sensors, it is reasonable to expect that clinicians will soon have access to these PGHD. Application developers should explore gaps in required PGHD types for potential inclusion in asthma mHealth apps as these technologies mature.

Although most of the participants lacked knowledge on the numeric representation of a positive or negative air-pollen count, there was interest in seeing details related to the air-quality index and pollen counts.

This finding demonstrates a growing concern for the association between asthma and outdoor environmental factors, in addition to clinician continuing education. It may be helpful to include geolocation data within pediatric asthma mHealth apps to estimate the amount of time spent in green spaces or near cut grass.

As more mobile data capabilities enter the health care market, future work should explore the collection of other types of environmental PGHD to support asthma treatment planning. One participant was interested in learning more about smart inhalers, including the mechanisms used for medication compliance. There was also an interest in understanding the expense associated with device acquisition, especially for patients who need them most.

Support for providers should include an assessment of readiness to answer questions from patients and families, along with information about available PGHD, the methods for collection, and the medical evidence used to create the app features. Although this study examined preferences for PGHD visualizations in isolation, clinicians likely need more information to make treatment decisions.

Many historical data already reside in the EHR or in health records from other specialists, and patients do not always have the ability to share with other providers. The participants included in this study represent a sample of physicians from urban academic medical centers and may not be representative of all providers.

However, we recruited from two regions of the country and reached saturation of responses. Another limitation is that the preferences reflect the views of only one provider type. Although we invited both physicians and nurse practitioners, only physicians participated. We used a methodological approach which assumed that all clinicians consider PGHD to be a reliable information source, whether direct from devices or entered by patients.

Although we did not assess the level of trust, we believe that participants with interest in PGHD self-selected to participate, which served to support the participatory nature of the study. Future iterations of interactive PGHD displays for pediatric asthma should continue to involve participatory design. Interactive capabilities would allow for an examination of visualization principles such as zoom and filter and, subsequently, details on demand.

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. If you plan on displaying 49 participants per screen, either change the size of your screen or move to full screen if each 49 thumbnails will be populated.

Zoom is used to display up to 49 participants to one screen: Register in to the Zoom browser. By clicking Videos on the Settings page, you can display the video settings.

Choose Display up to 49 participants per screen from Gallery View as an option. Ensure that you have enabled this option under Settings if you are not able to see all 49 participants. In this case, there needs to be minimum system requirements for this feature to operate properly. The settings can be accessed by clicking on your user icon in the top-right corner. Would there be a need for more participants ers can join the meeting?

In all plans, you can have as many participants as you like by default up to with the Large Meeting optional supplement. There are how many meetings meeting license? There is an unlimited number of meetings available to any licensed user. On the View page, click on Speaker or Gallery.

As an example, if your screen shows 49 thumbnails per display, you will probably have to change your size or turn off your monitor to ensure the 50 thumbnails are visible. Meetings that begin but do not have other participants are considered to begin after a time when there are none.

Confirm that meeting begins with the meeting host. When it does, go to a meeting ID that appears at the top of a Zoom window for example, and compare that meeting ID to yours, if it has already been created.


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