Insuring full benefit of consumer health informatics innovations requires integrating the technology into nursing practice, yet many valuable innovations are developed in research projects and never reach full integration. To avoid this outcome, a team of researchers partnered with a home care agency’s staff and patients and their corporate parent’s Information Systems and Research group to create a Technology-Enhanced Practice (TEP) designed to enhance care of home bound patients and their family care givers. The technology core of TEP, the HeartCare2 web site, was built in a collaborative process and deployed within the existing patient portal of the clinical partner. This paper describes the innovation and the experience of bringing it into full operation.

Sixty percent of the US population manages at least one chronic illness. For these patients, personal health information management (PHIM) is an integral part of daily life, and largely occurs within the home. However, the way in which the home supports PHIM has not been systematically investigated. The present study examined how members of the diabetic population use features of the home environment to support PHIM. Participants (N = 60) explored a simulated home environment, the VR CAVE, and identified the most useful features for performing three examples of PHIM tasks. The computer was perceived as the most useful feature for PHIM. However, perceived usefulness of features varied based on the PHIM task performed and the rooms in which features appeared. We conclude that a detailed study of the affordances of features is necessary to ease the burden of managing chronic illness, particularly diabetes mellitus, in the sociotechnical system of the home.

Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N=20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM.Practitioner Summary:We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

Much of patient care takes places in patients' homes, but we do know very little about how patients deal with their health and chronic illness condition(s) while at home and how the physical environment can have an impact on their care. In this study, we focus on patients' management of their personal health information management (PHIM) in the home. To enable repeated assessment of a set of constant stimuli, we have scanned 20 different households that we subsequently rendered for viewing in a 3-D virtual cave (VR) CAVE. Study participants identified features in the virtual home models that they considered useful for PHIM. Using the VR CAVE has many advantages. It enables all participants to experience the same stimulus in precisely the same condition, and it allows for standardization of the study procedures. However, we know relatively little about the impact the VR CAVE experience has on workload and simulation sickness, and if these interfere with task performance. In this study, we examine the relationship between time spent in the CAVE (duration), the number of frames rendered per second (framerate), the experienced workload and simulation sickness symptoms. Results show that performing tasks in the CAVE required some effort, particularly mental workload. Only a few participants reported minor simulation sickness symptoms, such as dizziness, headache or eyestrain. Apart from a correlation between duration and workload, we did not find a significant relation between exposure, framerates, workload, and simulation sickness.

Managing one's own healthcare has been progressively changing from occurring at hospitals and healthcare facilities to one's own day to day living environment. Due to this change, studying how people care for themselves becomes more challenging as visiting people in their living environments is intrusive and often logistically challenging. LiDAR scanning technology allows for highly detailed capture and generation of 3D models. With proper rendering software, virtual reality (VR) technology enables the display of LiDAR models in a manner that provides immersion and presence of feeling like one is situated in a scanned model. This document describes the combination of using LiDAR and VR technology to enable the study of health in the home. A research project involving the study of how home context affects diabetic patients' ability to manage their health information in the home is presented as an example. The document finishes by discussing other potential health care applications that could use similar methodologies as those introduced to improve health in the home for additional chronically ill populations.

Growing evidence indicates that transitioning patients are often unprepared for the self-management role they must assume when they return home. Over the past twenty five years, LiDAR scanning has emerged as a fascinating technology that allows for the rapid acquisition of three dimensional data of real world environments while new virtual reality (VR) technology allows users to experience simulated environments. However, combining these two technologies can be difficult as previous approaches to interactively rendering large point clouds have generally created a trade-off between interactivity and quality. For instance, many techniques used in commercially available software have utilized methods to sub-sample data during interaction, only showing a high-quality render when the viewpoint is kept static. Unfortunately, for displays in which viewpoints are rarely static, such as virtual reality systems, these methods are not useful. This paper presents a novel approach to the problem of quality-interactivity trade-off through a progressive feedback-driven rendering algorithm. This technique uses reprojections of past views to accelerate the reconstruction of the current view and can be used to extend existing point cloud viewing algorithms. The presented method is tested against previous methods, demonstrating marked improvements in both rendering quality and interactivity. This algorithm and rendering application could serve as a tool to enable virtual rehabilitation within 3D models of one's own home from a remote location.

Consumer health information technologies would benefit from a clearer understanding of the unique personal health information management (PHIM) practices of chronically ill people. There is growing evidence that context shapes health information management behaviors, but awareness of the places within which people conduct specific healthrelated tasks is lacking. We posit that better understanding of the home context could lead to improved design of information technologies tailored to the needs and context for home use. We report here on the current status of a project that focuses on the visualization of homes and the use of virtual models, as an illustration of how researchers can work with citizen participants to collect novel and personal data. The 5-phase vizHOME project (AHRQ R01HS022548), is designed to systematically determine how household context shapes PHIM in the home through in-depth explorations of 1) PHIM strategies employed by people who report having diabetes and 2) the context of their homes. The five subprojects of vizHOME have used virtual reality technologies (LiDAR, the CAVE) for data collection by lay participants, requiring visualization and naming of 3D data to generate a new instrument for more data collection. The more we engage with the data of the home, the more data teaches us about the home and the more customized technological solutions can be to the person who lives there.

It is now well recognized that patients play an important and active role in self-care and disease management, and many of these activities happen in their homes. Information technologies to support such care might be better used if they were designed taking into account the physical context of the home and the health information management needs of the residents. We conducted home-based interviews of 20 adults including an extensive analysis of their personal health information management (PHIM) tasks. Here we present these task descriptions, locations of their performance, and distribution across space and time. Implications for the informatics community include accommodating the distributed nature of tasks in the design of consumer technologies.

This paper introduces the SafeHome Simulator system, a set of immersive Virtual Reality Training tools and display systems to train patients in safe discharge procedures in captured environments of their actual houses. The aim is to lower patient readmission by significantly improving discharge planning and training. The SafeHOME Simulator is a project currently under review.

The physical spaces within which the work of health occurs - the home, the intensive care unit, the emergency room, even the bedroom - influence the manner in which behaviors unfold, and may contribute to efficacy and effectiveness of health interventions. Yet the study of such complex workspaces is difficult. Health care environments are complex, chaotic workspaces that do not lend themselves to the typical assessment approaches used in other industrial settings. This paper provides two methodological advances for studying internal health care environments: a strategy to capture salient aspects of the physical environment and a suite of approaches to visualize and analyze that physical environment. We used a Faro™ laser scanner to obtain point cloud data sets of the internal aspects of home environments. The point cloud enables precise measurement, including the location of physical boundaries and object perimeters, color, and light, in an interior space that can be translated later for visualization on a variety of platforms. The work was motivated by vizHOME, a multi-year program to intensively examine the home context of personal health information management in a way that minimizes repeated, intrusive, and potentially disruptive in vivo assessments. Thus, we illustrate how to capture, process, display, and analyze point clouds using the home as a specific example of a health care environment. Our work presages a time when emerging technologies facilitate inexpensive capture and efficient management of point cloud data, thus enabling visual and analytical tools for enhanced discharge planning, new insights for designers of consumer-facing clinical informatics solutions, and a robust approach to context-based studies of health-related work environments.

Effective personal health information management (PHIM), including symptom monitoring, medication management and clinical care coordination, facilitates self-care, ensures appropriate use of health services, and improves health outcomes. Computer tools can assist with PHIM, but these solutions are often created with little attention to where they will be used. The visibility of a calendar for reminding one of a weekly blood test or the proximity of a Bluetooth-enabled glucometer to the computer that stores the readings can enable or interfere with PHIM. Designers must understand where PHIM occurs to make optimally effective solutions. Yet bringing designers and engineers into the private, personal spaces and allowing repeated, systematic study of home contexts is not only burdensome to the home dweller, but also infeasible due to the ever-changing nature of homes. The purpose of this project is to systematically determine how household context shapes personal health information management. Using Venkatesh’s (1996) model of the five environments of health to explicate the environmental context in the SEIPS work system model, we will (1) undertake an extensive study of 20 households addressing the social, physical, psychological, technical and health services context of PHIM, including creating detailed photographic, video, and 3D reconstructions of these households in a virtual reality CAVE; (2) through recursive immersive exploration in the CAVE, enumerate the features of these households that shape PHIM; (3) enlist 20 people self-identified with diabetes in a requirements validation activity in the CAVE; (4) engage 60 people with diabetes in an experimental evaluation of these indicators and (5) use all of these results to develop and evaluate, in a field assessment of 200 households, an Assessment of the Context of Home Environments inventory. The reference set of 20 virtual homes will be distributed through Creative Commons for repeated studies by designers. We will also make available the Assessment of the Context of Home Environments (ACHE) protocol for rapid assessments of the home context. This interdisciplinary project brings together nurses, engineers, computer scientists, and health services researchers to explicate how the home context shapes health information needs and can be used to guide the design of consumer health information management solutions. As health care migrates from the institution to the home, and engagement of everyone in healthy practices is necessary to avoid disease or mitigate its consequences, systematic understanding of how homes will foster the integration of technologies into the every-day lives of people that ensure that homes not only become spaces for health but tools that draw people towards optimal well-being.

Creating technological solutions that support health everywhere requires understanding the context of health and the vernacular of those engaged in it within that context. Within the formal healthcare system, institutional environments dominate and perspectives of biomedical science and the health professions govern the characterization of disease, illness and related terminology. In the everyday living context, the myriad viewpoints of the person prevail within informal, highly personal environments. The words used to characterize concern the manner in which symptoms are interpreted, and even the language employed arises from one’s lived experience. In this paper, based in our work with Project HealthDesign grantee teams, we advocate for an expanded notion of the contexts of health, extending beyond hospitals and clinics to homes, workplaces and communities. We also introduce a new vernacular, observations of daily living (ODLs), a novel type of patient-generated health data that Project HealthDesign participants revealed to us. ODLs reflect feelings, thoughts, behaviors, exposures and actions; they serve as cues to healthy action and indicators of personal health states. We conclude with recommendations to the PUC community to leverage in designing tools useful for the personal, everyday context experience of health.

The rapid migration of health care from the institution to the home presents a plethora of consumer health technology options.. The fit of these technologies to the users' actual task performance and environment remains to be explored. In the vizHOME study, we set out to conduct in-depth analyses of health information management tasks conducted by individuals residing in 20 homes in the Midwestern United States who self-reported with diabetes. This paper will explore early results from five of the 13 assessments we have performed to-date. Early observations are described and implications for informatics are posited.

Advancements in the health information technology that brought personal health records to individuals have opened the door to new insights concerning the cues people use to monitor health in their everyday lives. In order to evaluate the impact of capturing, storing, and integrating these observations of daily living (ODLs) into the clinical care process, Project HealthDesign selected five teams to create and analyze mobile health applications with ODLs in mind. These teams targeted underserved, minority populations with at least two chronic conditions. Using third-party platforms for storage, the teams were expected to bring the ODLs into the clinical workflow through the EHR. ODLs were successfully captured, interpreted and displayed; however technical and policy barriers challenge their integration outside of the mobile application. This paper serves as a preliminary, program-level report distinct from the publication of evaluation results from individual teams.

Keeping individuals aware of their own health is a global challenge in health care. Observations of Daily Living (ODLs), cues to health that are derived from and personally meaningful to an individual, provide a detailed picture of one's experience of health. Project HealthDesign, an 8-year initiative of the Robert Wood Johnson Foundation, is investigating ODLs and devising innovative ways of tracking them through personal health record deployment in diverse communities and health care settings. Nursing informatics knowledge base and skills, applied to the ODL challenge can accelerate their identification, capture, and interpretation, thus empowering individuals toward meaningful action and facilitating more robust information exchange between individuals and their health care providers.

OBJECTIVE This 3 year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home care nursing model referred to as technology enhanced practice (TEP)METHODS Nurses using TEP augmented the usual care with a web based resource (HeartCareII) that provided patients with self management information self monitoring tools and messaging servicesRESULTS Patients exposed to TEP demonstrated better quality of life and self management of chronic heart disease during the first 4 weeks and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital Both groups demonstrated the same long term symptom management and achievements in health statusCONCLUSION This project provides new evidence that the purposeful creation of patient tailored web resources within a hospital portal is possible that nurses have difficulty with modifying their practice routines even with a highly tailored web resource and that the benefits of this intervention are more discern able in the early postdischarge stages of care (Heart Lung (R) 2010 39 S34-S46)