Andre Kushniruk

University of Victoria | UVIC · School of Health Information Science

Background: Journey maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies m...

Background Hospital@home is a model of healthcare, where healthcare professionals actively treat patients in their homes for conditions that may otherwise require hospitalization. Similar models of care have been implemented in jurisdictions around the world over the past few years. However, there are new developments in health informatics includin...

Health technology quality and safety is an important issue for health informatics (i.e. digital health) professionals. Health technologies have been used to (1) collect data that can be analyzed to improve the quality and safety of healthcare activities and (2) re-engineer and/or automate error-prone processes. Health technologies are also able to...

Introduction: The discipline of health informatics emerged to address the need for uniquely skilled professionals to design, develop, implement, and evaluate health information technology. Core competencies are an essential pre-requisite for establishing a professional discipline such as health informatics. In 2012, Digital Health Canada released...

A range of human factors issues are recognized as critical to the success of projects involving Health Information Technology (HIT). Problems related to the usability of HIT have come to the fore, with continued reports of systems that are non-intuitive and difficult to use and that may even pose safety risks. In this article, we consider a number...

Evaluating conversational agents (CA) that are supposed to be applied in healthcare and ensuring their quality is essential to avoid patient harm. However, most researchers only study usability and use the CA in clinical trials before conducting such careful evaluation. In previous work, consensus on metrics for evaluating healthcare CA have been f...

BACKGROUND Journey maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies may...

Background The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has publish...

HealthHealth care is being transformed by the increased use of information technologyInformation technology at all healthcare systemHealth care system levels. It has included advances in supporting decisionDecision-making and processing informationInformation related to healthHealth for professionalsProfessional, patientsPatients, and societySociet...

The authors of the Integrated ScienceIntegrated science:MultidisciplinarityMultidisciplinarityandInterdisciplinarityInterdisciplinarityinHealthHealth were asked how you would see the future of your field 30 years later. This chapter presents the authors’ views on this subject in 2050. The Al-Samah danceDance. In the above poem, Hushang Ebtehaj says...

There is a need to determine the relative similarity and differences in safety issues across specific types of software and medical devices in order to develop standardized solutions that can be used across these technologies. Over the past several years, health informatics researchers have identified differing types of technology-induced errors or...

The 21st century has brought forth unprecedented technological advances, such as the advent of portable digital devices [1]. This trend has also permeated the health care sector, with the introduction of digital health services, like providing citizens with access to their online laboratory (lab) results. This qualitative study will illustrate the...

The objective of this research was to develop a reproducible method of integrating human patterns of qualitative coding with machine learning. The application of qualitative codes from the technology-induced error and safety literatures to the analysis of incident reports was done successfully, helping to identify the factors that lead to an error...

On March 11, 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the highly infectious virus that causes coronavirus disease (COVID-19), was characterized by the World Health Organization (WHO) as a global pandemic [1,2]. Due to its highly contagious nature, COVID-19 has catalyzed the introduction of non-pharmaceutical intervent...

The journey map concept evolved out of the service design field and is still relatively new in the healthcare landscape [1]. Journey maps are visualizations that effectively highlight organizational issues and allow stakeholder groups to be depicted by interest or function for a comparative visual analysis [2]. There are five journey map approaches...

Visualizations form an important part of public health informatics (PHI) communications. Visualizing data facilitates discussion, aids understanding, makes patterns apparent, promotes analysis, and fosters recall. How rare are novel visualizations in the PHI literature? In Phase 1, we used a rapid review methodology to test the commonness of the Sa...

In many ways health technology safety has improved significantly over the past few decades. Yet, we still have examples of incidents where safety of health technology systems of care have led to possible and actual safety incidents. In this paper we examine the complexity of errors in an increasingly complex and digitized system of care. Although s...

Introduction Patients with head and neck cancer (HNC) may be offered a choice of treatments which can cause undue stress and anxiety when comprehending the options and making a decision congruent with personal values and health goals. Methods Informed by a scoping review on electronic decision aids (DAs) for patients with HNC and feedback from the...

Information technologies have the potential to increase the safety of healthcare and advance safety science. However, it is now well known that health information systems may also inadvertently introduce new forms of error known as technology-induced error. Such errors may be difficult to detect as they may only appear under conditions of system us...

Dementia and other related diseases causing symptoms of mild cognitive impairment are being increasingly diagnosed. These diseases are placing a significant strain on the healthcare system. Robotic technology research has also been increasing, specifically in the field of healthcare and assisted living. This scoping review explores the research at...

The objective of this study was to describe and assess the quality of the direct-to-consumer medical teleconsultation landscape in three Canadian provinces. An environmental scan of primary care teleconsultation platforms was conducted in January 2022 to identify medical teleconsultation platforms in Quebec (Qc), Ontario, and British Columbia (BC)....

Personal Health Records (PHRs) are poised to improve patient safety, however the mechanism(s) in which they improve safety is not clear. To this end, we conducted a scoping review with the following objectives: 1) explore the extent of the evidence that PHRs improve patient safety, 2) determine where PHR research has been done per International Med...

A significant number of problems in emergency care are caused by a lack of provider access to pre-existing patient information at the point of care. Medical Emergency Datasets (MEDs) are brief summarizations of an individual’s medical history, providing vital patient information to emergency medical providers. The German MED was validated by German...

The pandemic has accelerated the move to virtual care. This has included remote monitoring and implementation of technologies that allow for patient care at home and assisted living for ageing in place. Technologies are available to help consumers to maintain their health and wellness. However, challenges associated with implementing virtual care r...

Evaluation criteria for health information systems (HIS) and health information technologies (HIT) is broad, diverse and lacks a gold standard approach that could be leveraged, to evaluate clinical systems at various stages of their system development life cycle (SDLC). Without generalizable tools such as frameworks or models, comparative analysis...

In this paper we describe a review of the literature and the development of an initial maturity model for the research literature in the area of technology-induced errors and health technology safety. The capability maturity model provides a way forward for organizations to formalize their health technology safety processes and also compare their e...

While there has been a rapid growth of digital health apps to support chronic diseases, clear standards on how to best evaluate the quality of these evolving tools are absent. This scoping review aims to synthesize the emerging field of mobile health app quality assessment by reviewing criteria used by previous studies to assess the quality of mobi...

The objective of this scoping review is to evaluate the range and nature of electronic decision-support tools that have been researched and/or trialled for patients with head and neck cancer (HNC), and to explore the implication on patient safety through improving risk communication. A scoping review was conducted by: (1) identifying the research q...

Virtual care extends beyond the walls of healthcare organizations to provide care at a distance. Although virtual care cannot be regarded as a solution for all health-related inquiries, it provides another care delivery channel for specific patient populations with appointments that do not require in-person physical examinations or procedures. A sc...

In this book chapter we outline some of the emerging issues and considerations that will need to be considered by policy makers, clinicians, healthcare administrators, health technology developers, and implementers, when considering AI’s use in the coming years. In addition to this, the authors propose a new framework for researching and evaluating...

PMID: 34129083 PMCID: PMC8204071 DOI: 10.1007/s00520-021-06285-8

Background and Aims: Trust in digital health is a significant challenge. We are developing a digital solution, TRUSTSPHERE (TS),that will address this trust gap to enable easier adoption of digital health. Our test use case is children living with type 1 diabetes (T1D), and our aim is that TS serves as a digital identity layer that will empower pat...

In this paper, we describe techniques for predictive modeling of human-computer interaction (HCI) and discuss how they could be used in the development and evaluation of user interfaces for digital health systems such as electronic health record systems. Predictive HCI modeling has the potential to improve the generalizability of usability evaluati...

Background As a major public health crisis, the novel coronavirus disease 2019 (COVID-19) pandemic demonstrates the urgent need for safe, effective, and evidence-based implementations of digital health. The urgency stems from the frequent tendency to focus attention on seemingly high promising digital health interventions despite being poorly valid...

Background: The ambient assisted living (AAL) market is rapidly becoming fundamental to the delivery of health and social care services for the elderly. Worldwide many different steps have been taken to increase the engagement of older adults with these technologies. Much of this work has focused on the development of novel digital services that in...

Objectives: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patien...

(1) Background: To facilitate optimal prescription medication benefits and safety, it is important that people are informed about their prescription medications. As we shift towards using the digital medium to communicate medication information, it is important to address the needs and preferences of different user groups so that they are more like...

Background Electronic health resources are becoming prevalent. However, consumer medication information (CMI) is still predominantly text based. Incorporating multimedia into CMI (eg, images, narration) may improve consumers’ memory of the information as well as their perceptions and preferences of these materials. Objective This study examined whe...

BACKGROUND Navigational complexity can present formidable challenges for electronic health record (EHR) users. The fragmented design of conventional EHRs can contribute to increased cognitive load for clinician users and poor fit-to-task. First, the ‘keyhole effect’ describes the phenomenon in which due to the large volume of information and limite...

UNSTRUCTURED In this paper, we describe techniques for predictive modeling of human-computer interaction (HCI) and discuss how they could be used in the development and evaluation of user interfaces for digital health systems such as electronic health record systems. Predictive HCI modeling has the potential to improve the generalizability of usabi...

User experience (UX) theories, models, and frameworks (TMFs) help scope user-centered design activities, aid in the selection of constructs and measures, and contextualize findings within a larger knowledge base. However, the fragmentation of literature across disciplines and the inconsistent use of TMFs makes integrating concepts and selecting UX...

BACKGROUND The complexity of healthcare data and workflows presents challenges to the study of usability in electronic health records (EHR). Display fragmentation refers to the distribution of relevant data across different screens, requiring complex navigation for the user’s workflow. Task and data source fragmentation also contributes to cognitiv...

Background The complexity of health care data and workflow presents challenges to the study of usability in electronic health records (EHRs). Display fragmentation refers to the distribution of relevant data across different screens or otherwise far apart, requiring complex navigation for the user’s workflow. Task and information fragmentation also...

Reflection plays an important role in medical students’ ability to develop diagnostic competence through practice with clinical cases. However, it is not easy for students to develop expert-like performance through self-reflection alone; conversely, seeking feedback from experts constantly in practice is impractical. This study investigates the des...

The purpose of this article is to examine the extent and nature of the published electronic medical record (EMR) downtime, downtime mitigation and downtime planning research in healthcare. The article will also summarize some of the major themes and recommendations found in published research focused on downtime and healthcare. In this study, data...

BACKGROUND While the basic intent of all nursing documentation is to be representative of what the nurse does with and for the patient, each nursing professional association has identified and legislated documentation standards. Despite these standards, several challenges exist leading to documentation burden and ultimately the introduction of elec...

BACKGROUND Evidence-based health policy (EBHP) development is critical to the judicious use of public funds. EBHPs increase transparency, accountability, effectiveness and efficiency of policies. Encouraging collaboration between researchers/knowledge producers (KPs) and policy-makers (PMs) is important, because both communities have distinct profe...

Background Evidence-based health policy (EBHP) development is critical to the judicious use of public funds. EBHPs increase transparency, accountability, effectiveness, and efficiency of policies. Encouraging collaboration between researchers or knowledge producers and policy makers is important because both communities have distinct professional c...

Objective: This study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR. Design: A QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based...

Eye-tracking has long been used to assess usability for the public web. Recently, it is used to assess user behavior with electronic health records (EHRs). We conducted a scoping review of studies involving eye-tracking for usability of EHRs to determine the current state. Three main themes emerged: studies of usual use of systems, development of n...

Electronic prescribing, defined as the electronic generation and transmission of a medication order for community-dwelling patients, is presented as an essential technology to improve medication use. The objective of this study was to evaluate a nationwide e-prescribing system in Quebec, Canada. A mixed-method study was conducted from July 2017 unt...

First Nations and other health leaders are looking to Electronic Health Records (EHRs) to improve the quality of health information, efficiency of health services, and health outcomes for Indigenous people in Canada. This study used qualitative and quantitative methods to identify the success factors in an EHR implementation at a First Nations heal...

The International Medical Informatics Association (IMIA), a non-governmental, not-for-profit, global organization promoting health and biomedical informatics, is committed to the right of communities/populations and individuals to science, comprised of three separate constituent rights: 1) the right to participate in science, 2) the right to benefi...

PURPOSE: This review will identify dominant themes, common to published articles that discuss downtime planning in a clinical setting. These common themes will represent key considerations for healthcare organizations’ comprehensive downtime plans. METHOD: A scoping study was performed using search results from PubMed, CINAHL and Medline. The 4 art...

Introduction: Self-management of chronic diseases using mobile health (mHealth) systems and applications is becoming common. Current evaluation methods such as formal usability testing can be very costly and time-consuming; others may be more efficient but lack a user focus. We propose an enhanced cognitive walkthrough (CW) method, the user-center...

In recent years the usability of health information systems has come to the fore as a major issue, with many reported examples of problems with the usability of systems such as electronic health records and other health information technologies (HIT). In response a range of usability engineering methods have emerged to help in the design and evalua...

The objective of the work described in this paper was to develop a coding scheme focused on socio-technical issues and considerations for the analysis of video data collected in usability studies of health information systems. The usability and safety of health information systems such as electronic health records, decision support and patient faci...

This paper identifies issues relating to academic health record systems and outlines a project currently underway to develop an open source educational clinical information system to better support interprofessional health education.

BACKGROUND Technology is increasingly embedded into the full spectrum of health care. This movement has benefited from the application of software development practices such as usability testing and agile development processes. These practices are frequently applied in both commercial or operational and academic settings. However, the relative impo...

Objectives: A qualitative evaluation of the perceived impact of a new evidence-informed electronic basal bolus insulin therapy order set on clinical workflow and practice, and exploration of potential barriers and facilitators to electronic basal bolus insulin order set uptake and use in acute care facilities for various acute care team members....

Effective learning through problem solving is difficult to realize as problem solving often involves complex processes that are inaccessible to novices. It is important to make the complex process visible to novices and provide them with necessary support throughout the tasks. This study proposes a computer-based learning environment that allows le...

Anticoagulation therapy with Warfarin is used for specific cardiovascular diseases to control the ability of blood clotting. Traditional ways of self-management therapy are based on paper forms and procedures. This paper presents an evaluation of the smartphone application Warfarin Guide, a computer-assisted decision-support system used to help pat...

The modernization of healthcare through the introduction of health information technology (HIT) has decreased the number of medical errors associated with specific healthcare processes such as medication ordering, dispensing, and administration. Alternatively, with the introduction of new HIT, there has emerged a new type of medical error—the techn...

Health information technology promises to modernize and streamline healthcare and to connect up different users and stakeholders in the e-health market. Systems such as electronic health records, decision support systems and personal health records are promising and are becoming widely deployed worldwide. However, in addition to successes there hav...

Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research publishe...

Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research publishe...

Big Data Analytics (BDA) is important to utilize data from hospital systems to reduce healthcare costs. BDA enable queries of large volumes of patient data in an interactively dynamic way for healthcare. The study objective was high performance establishment of interactive BDA platform of hospital system. A Hadoop/MapReduce framework was establishe...

At the University of Victoria Health Services clinic from May 2015 to September 2016, psychiatrists saw a number of young adult students with type 1 diabetes presenting with serious major depression and anxiety, and poor blood glucose monitoring. Clinic staff found that psychotherapy not only addressed mental health concerns but gave patients an op...

With the emergence of personal health record (PHR) platforms becoming more widely available, this research focused on the development of privacy heuristics to assess PHRs regarding privacy. Existing sets of heuristics are typically not application specific and do not address patient-centric privacy as a main concern prior to undergoing PHR procurem...

In recent years there has been considerable discussion around the need for certification and regulation of healthcare information technology (IT). In particular, the usability of the products being developed needs to be evaluated. This has included the application of standards designed to ensure the process of system development is user-centered an...

Health information technologies (HIT) promised to streamline and modernize healthcare processes. However, a growing body of research has indicated that if such technologies are not designed, implemented or maintained properly this may lead to an increased incidence of new types of errors which the authors have referred to as "technology-induced err...

With limited problem-solving capability and practical experience, novices have difficulties developing expert-like performance. It is important to make the complex problem-solving process visible to learners and provide them with necessary help throughout the process. This study explores the design and effects of a model-based learning approach imp...

Many researchers assume that there is a relationship between health literacy and eHealth literacy, yet it is not clear whether the literature supports this assumption. The purpose of this study was to determine if there was a relationship between health and eHealth literacy. To this end, participants' (n = 36) scores on the Newest Vital Sign (NVS,...

Persistent problems with healthcare IT that is unusable and unsafe have been reported worldwide. In this paper we present our vision for deploying usability engineering in healthcare in a more substantive way in order to improve the current situation. The argument will be made that stronger and more substantial efforts need to be made to bring mult...

The usability and safety of health information systems have become major issues in the design and implementation of useful healthcare IT. In this paper we describe a multi-phased multi-method approach to integrating usability engineering methods into system testing to ensure both usability and safety of healthcare IT upon widespread deployment. The...

Current methods for monitoring harm caused by health information technology (HIT) are minimal, even if there are known risks associated with the use of HIT. Monitoring is predominantly based on voluntary reporting using generic patient safety adverse events reporting systems. Another important means for monitoring technology-induced errors is a hea...