Elizabeth M Borycki

University of Victoria | UVIC

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 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 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...

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...

Business Intelligence (BI) dashboards are interactive data visualization displays identifying key patient quality and safety trends and metrics. Yet, it remains unclear whether dashboards are impacting clinical care for desired organizational outcomes. In this paper we summarize the positive and negative impacts of dashboards on safety and quality...

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...

Paper-based prescriptions have been used for several decades by many healthcare practitioners. The literature suggests that several challenges are associated with handwritten prescriptions that might impact patients’ safety and medication errors. Electronic prescribing (e-prescribing) has been developed to phase out handwritten and computer-generat...

Optimization of interdisciplinary team-based care is an important strategy to improve home health care for older adults. An electronic, shared care plan was designed with aim to support shifts toward greater client and family involvement and interdisciplinary team functioning. Content for the home health collaborative care plan (HHCCP) was determin...

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...

The objective of this scoping review is to develop a model to understand the factors that influence clinical downtimes or clinical activities in a healthcare organization. To report on the results of searches preformed using seven bibliographic databases, using the logical search criteria of (downtime AND (EMR OR Electronic Medical Record OR EHR OR...

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...

Dementia and other related diseases are becoming increasingly diagnosed and are placing a serious strain on the healthcare system. Robotic technology research is currently underway to provide the much needed support to patients, caregivers, and health providers. This includes examining the ethical implications of robots use in healthcare. This scop...

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...

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...

There is considerable interest and excitement around the application of artificial intelligence (AI) in healthcare. Indeed, there have been a range of successful systems employing methods from AI such as artificial neural nets, machine learning, natural language processing and deep learning approaches to diagnosis and treatment. As the number of AI...

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...

This book offers a comprehensive yet concise overview of the challenges and opportunities presented by the use of artificial intelligence in healthcare. It does so by approaching the topic from multiple perspectives, e.g. the nursing, consumer, medical practitioner, healthcare manager, and data analyst perspective. It covers human factors research,...

(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...

Opioid-related harm has become a major public health crisis around the world. There is a paucity of literature that examines the state of mHealth technologies in relation to the prevention and management of opioid-related harm. The purpose of this research is to examine the current state of knowledge with respect to mHealth technologies focused on...

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: Patient engagement strategies in health service delivery have become more common in recent years. However, many healthcare organizations are challenged in identifying the best methods to engage patients in health information technology (IT) initiatives. Engaging with important stakeholders to identify effective opportunities can inform...

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...

Background Significant chronic disease challenges exist among older adults. However, most older adults want to remain at home even if their health conditions challenge their ability to live independently. Yet publicly funded home care resources are scarce, private home care is expensive, and family/friend caregivers have limited capacity. Many olde...

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 Research in the area of health technology safety has demonstrated that technology may both improve patient safety, and introduce new types of technology-induced errors. There is a need to develop a safety science literature to develop an evidence-based, research base on which to continually develop safe new technologies and improve the s...

Research in the area of health technology safety has demonstrated that technology may both improve patient safety and introduce new types of technology-induced errors. Thus, there is a need to publish safety science literature to develop an evidence-based research base, on which we can continually develop new, safe technologies and improve patient...

Background: Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use,...

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...

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...

BACKGROUND Electronic health resources are becoming prevalent. However, Consumer Medication Information (CMI) is still predominantly text based. Incorporating multimedia into CMI (e.g., images, narration) may improve consumers’ memory of the information as well as their perceptions and preferences of these materials. OBJECTIVE This study examined...

There has been an acknowledged need for the integration of health technologies such as the electronic health record system (EHR) into health professional education. At the University of Victoria we have been experimenting with different models, architectures and applications of educational EHRs in the context of training health informatics, medical...

Given the prevalence of prescription medication use, it is important that consumers are aware of the benefits and risks of taking their prescribed medications. One approach to informing consumers in North America is to provide them with Consumer Medication Information (CMI), the paper leaflets given to consumers when they fill a prescription for th...

The usability of healthcare information technology has become a major issue in health informatics. There have been many reports of systems that have been deemed unusable by end users such as clinicians and a growing body of usability studies have been reported in the literature. The issue of how to fruitfully analyze and code usability study data i...

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...

BACKGROUND Many healthcare organizations around the world have implemented health information technologies in an effort to enhance health service efficiency, effectiveness and safety. Studies have demonstrated that promising outcomes of health information technology initiatives can be obtained when patients and family members effectively participat...

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...

Oncology, telehealth nursing practice is growing. There has been an increased use of telehealth systems to support patients living with cancer in the community. In this study we explore the impact of integrating electronic symptom management guidelines (eSMGs) and electronic health records (EHRs) upon oncology, telehealth nursing practice. Ten nurs...

Big data, in the form of ever increasing amounts of healthcare data, promises to revolutionize and transform healthcare. Large amounts of personal health data, fitness data, genomic data and epidemiological data are being generated at an unprecedented rate and this trend will only continue. While advances are being made in the automated collection...

The advent of big data promises to revolutionize healthcare and lead to improved and streamlined healthcare processes and improved outcomes. Driving the move to big data in healthcare is the concomitant deployment of health information technologies worldwide. These systems have been shown to improve safety of healthcare by providing automated advic...

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...

Medical Emergency Datasets (MEDs) are brief summarizations of an individual's medical history, providing vital patient information to emergency medical providers. A recent German study [1] evaluated whether MEDs are useful to local emergency physicians and paramedics, and which health data were relevant to their medical management. To validate of t...

Telenursing triage and advice services are continuing to expand both nationally and internationally. A primary role of telehealth nursing triage is to channel patients or clients towards appropriate levels of care, thereby reducing healthcare costs and freeing up resources. Purpose: The objective of this research is to: (a) present an overview of...

Smart Homes may improve the care received by the elderly and those with disabilities that prevent them from conveniently accessing care from providers. This paper examines the structures and mechanisms of Smart Homes, explores the advantages and disadvantages for patients receiving care from the comfort of their own homes and describes a model that...

Health care organizations are investing in system solutions that can be leveraged across the continuum of care (i.e. electronic medical records (EMR's); electronic health records (EHR's); health information exchanges (HIE's) and patient portals. The importance of these systems and how they have evolved over the past 30 years has been well researche...

Opioid-related harm is a major public health concern in Canada and abroad. There is a growing market of mobile apps that focus on preventing and managing opioid-related harm. The use of mobile health technologies is a promising intervention that can assist with addressing the problem. The aim of this paper is to examine the current state of the mob...

Objective: Understand the cognitive processes of telenurses' decision making with the use of health information systems (HIS), specifically Clinical Decision Support Systems (CDSS). In addition, identify the factors that influence how telenurses use CDSS. Methods: Eight telenurses were recruited to manage two call scenarios in a clinical simulat...

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.

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...

Background and purpose: Clinician research competencies influence research use for evidence-based practice (EBP). We aimed to develop, refine, and psychometrically assess the Research Competencies Assessment Instrument for Nurses (RCAIN) to measure registered nurse research competencies (i.e., knowledge, skills, attitudes) focused on EBP-related d...

Background Electronic health records (EHRs) are transforming the way health care is delivered. They are central to improving the quality of patient care and have been attributed to making health care more accessible, reliable, and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unant...

Background: Wait times for psychiatric consultations are long, leaving many patients suffering and untreated. This was found to be a concern for students presenting with mental health issues to University Health Services at the University of Victoria, where the average wait time for a psychiatric consultation in 2013 was 43 days. In an effort to re...

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....

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...

Background Electronic prescribing (e-prescribing) is a potentially important intervention that can be used to reduce errors. It provides many potential benefits over handwritten medication prescriptions, including standardization, legibility, audit trails, and decision support. Electronic health record (EHR) and e-prescribing systems may greatly en...