Background: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service. Objectives: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends. Methods: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] Conclusions: We surmise that the field – as it stands today – may be characterized by the global definitions suggested by Eysenbach and Eng.

This paper presents the results of an evaluation of an automated teller machine (ATM) that provides the facility for depositing bunches of bank notes and cheques without the need to use an envelope. Results are presented and discussed with measures of performance and self-reported ratings being given. Conclusions are drawn as to the usability of the deposit features, along with discussion as to how the height of the interface can best accommodate the widest population of users and the challenges of designing products with a complex feature set for use in a public, walk-up-and-use environment.

This paper presents an evaluation of biometric fingerprint technology installed on an automated teller machine. 100 people took part in a user trial, with 22% of participants being over 65 years old. Results indicate that the technology is suitable for use in a self-service terminal, and demonstrate the importance of the enrolment stage in the success of such a device. However, the results also show that even under optimal conditions, with a carefully controlled enrolment, some users may be unable to provide a sufficiently high-contrast image, and therefore there should always be a fallback authentication device to make the self-service terminal accessible to all.

Eye-tracking is a valuable tool for usability research. Studies into the effect of age on eye-movement behavior tend to indicate a propensity for slower viewing and longer times spent examining information. This pattern is usually attributed to the general physiological and cognitive slow-down associated with normal aging. In this paper, however, across three different tasks based on computer and internet use (free-viewing, visual search, and browser interaction), we show that among older adults (n=18, age range: 70-93) computer experience appears to be a highly important factor in eye-movement behavior. We argue that as a consequence of the experimental environment used in modern eye-tracking studies, characteristics such as familiarity and experience with computers should be taken into account before conclusions are drawn about the raw effects of age.

A course on computers was run for computer beginners aged over 55. An iterative and flexible approach aimed to ensure that students' anxieties and difficulties were addressed as the course proceeded. Several layers of difficulty were encountered, ranging from initial difficulties understanding Windows systems and the working of the mouse to more fundamental and long-term problems such as repeatedly forgetting to move the focus before typing or failing to recognize onscreen objects and understand their behaviours. Inclusive design approaches should benefit from detailed recording of barriers to use, but the diversity of the user population will also necessitate flexibility to ensure inclusivity.

Toilets and toilet habits are perceived as a taboo subject that people may be reluctant or embarrassed to talk openly about. In the past, appropriately designed Computer Based Interviews have been shown to encourage more honest answers to sensitive questions than other forms of interview, and can be more interesting and engaging that filling out a paper questionnaire. This chapter presents Dundee University's role within the Friendly Restroom project which was primarily to provide Computer Based Interviews and other computer-based requirements gathering tools to be used to elicit toileting requirements of elderly people. Dundee University also investigated the feasibility of using Virtual Reality technologies, such as 3D environments and 360 degree panoramas, to support this information and requirements gathering.

Although “User-Centred”, “Participatory”, and other similar design approaches have proved to be very valuable for mainstream design, their principles are more difficult to apply successfully when the user group contains, or is composed of, older and/or disabled users. In the field of design for older and disabled people, the “Universal Design”, “Inclusive Design” and “Design for All” movements have encouraged designers to extend their design briefs to include older and disabled people. The downside of these approaches is that they can tend to encourage designers to follow a traditional design path to produce a prototype design, and only then investigate how to modify their interfaces and systems to cope with older and/or disabled users. This can lead to an inefficient design process and sometimes an inappropriate design, which may be “accessible” to people with disabilities, but in practice unusable. This paper reviews the concept that the authors have called “User-Sensitive Inclusive Design”, which suggests a different approach to designing for marginalised groups of people. Rather than suggesting that designers rely on standards and guidelines, it is suggested that designers need to develop a real empathy with their user groups. A number of ways to achieve this are recommended, including the use of ethnography and techniques derived from professional theatre both for requirements gathering and for improving designers’ empathy for marginalised groups of users, such as older and disabled people.

RATIONALE, AIMS AND OBJECTIVESIn this study, the aim was to investigate if an electronic prescribing system designed specifically to reduce errors would lead to fewer errors in prescribing medicines in a secondary care setting.METHODThe electronic system was compared with paper prescription charts on 16 intensive care patients to assess any change in the number of prescribing errors.RESULTSThe overall level of compliance with nationally accepted standards was significantly higher with the electronic system (91.67%) compared with the paper system (46.73%). Electronically generated prescriptions were found to contain significantly fewer deviations (28 in 329 prescriptions, 8.5%) than the written prescriptions (208 in 408 prescriptions, 51%).CONCLUSIONTaking an interdisciplinary approach to work on the creation of a system designed to minimize the risk of error has resulted in a favoured system that significantly reduces the number of errors made.

In this paper, we describe the User Centre at the University of Dundee which provides a space for older people and technology to come together for the benefit of new learning opportunities, social interaction and research.

We were very pleased to see the paper by Shapira, Barak and Gal (2007) in which they examine the effects of a computer and Internet training course on the well-being of a group of older adults. This area is a very important one and needs high-quality and well-controlled research. However, we disagree with their statement that ‘the conclusions of our research contradict the assertion of a recent comprehensive review by Dickinson and Gregor (2006) who found no consistent and validated effects of computer use by older people on well-being’. In our 2006 review, we examined the published literature on well-being, computers and older adults and concluded that the research did not support the claim that computer use itself improved well-being in older people. The conclusion of Shapira et al. that computer use does improve well-being in older adults cannot, therefore, be said to contradict our conclusions, which referred only to literature available in the public domain in 2005. Our claim was that the literature which then existed failed to demonstrate a positive effect on well-being. One flaw in much of the literature, as we saw it, was the difficulty of teasing apart the effects of computer use and the effects of training and increased social interaction that a course in computer use was associated with. Of the papers available in the literature at the time of our survey only Billipp (2001) sought to distinguish between use and training by comparing frail older adults trained to use computers with those who were simply given access to them. Her results indicated that computer use itself had no effect on well-being. The complexity of computer systems and their inappropriateness for older people arguably makes it necessary to have training and support if users are to learn about computers and benefit from their potential. In our review we suggested a similar approach to that used by Shapira et al., arguing that in order to test the effects of computer use, rather than the effects of training, researchers might ‘compare computer use with a similar activity which necessitated a comparable level of training . . .’. Although such a study is a positive step and it is encouraging to see such research being done, we remain to be convinced that it is the final word in this area. The high drop-out level in the intervention group suggests that those struggling with the computer course may simply have removed themselves from the research. The authors themselves recognise this, suggesting that ‘using computers in old age does not suit everyone’ but arguing in the rest of the paper that ‘computer and internet use seems to contribute to older adults’ wellbeing and sense of empowerment’. While participants in the study by Shapira et al. clearly had a great deal of support learning to use computers, with trained instructors and volunteers for an hour once or twice a week, the control group appear to have had less support. For example, no mention is made of volunteers helping control group participants. The fact that the control activities were familiar and, as the authors point out, those which older adults might be expected to enjoy is also perhaps a significant issue. We assume that these courses were often available in the settings used, as courses such as these often are. We would argue that the parsimonious explanation of the results in this case could be that novel activities with generous provision of training and support led to the measured improvements. We emphasise again that our assertion is not that computer use does not improve well-being in older adults, but simply that the existing research cannot be said to clearly demonstrate such a relationship. We appeal to researchers to be cautious in assuming that computer and internet use are necessarily a positive thing in the lives of older people and to examine the available evidence with caution.

Electronic devices such as personal digital assistants have been used successfully as aids for people with memory problems. However, limitations of Currently available technology can create difficulties in the day-to-day use of such devices, particularly for memory impaired and older users. These limitations are discussed in terms of both the software and hardware issues, and are set into the context of challenges raised in the current study, which is to design a new interactive memory aid. It is concluded that a specific, customisable software interface is needed to meet the dynamic requirements of the user groups. This would also go some way to compensate for the hardware limitations until available technology becomes more usable.

In October 2005, the IBM Human Ability and Accessibility Center and T.J. Watson Research Center hosted a symposium on “cognitive and learning difficulties and how they affect access to IT systems”. The central premise of the symposium was the recognition that cognitive and learning difficulties have a profound impact on a person’s ability to interact with information technology (IT) systems, but that little support is currently being offered by those systems. By bringing together internationally renowned experts from a variety of different, but complementary, research fields, the symposium aimed to provide a complete overview of the issues related to this topic. This paper summarises the discussions and findings of the symposium.

OBJECTIVE:To develop and pilot two computer-based decision aids to assist women with decision-making about mode of delivery after a previous caesarean section (CS), which could then be evaluated in a randomized-controlled trial.BACKGROUND:Women with a previous CS are faced with a decision between repeat elective CS and vaginal birth after caesarean. Research has shown that women may benefit from access to comprehensive information about the risks and benefits of the delivery options.DESIGN:A qualitative pilot study of two novel decision aids, an information program and a decision analysis program, which were developed by a multidisciplinary research team.PARTICIPANTS AND SETTING:15 women who had recently given birth and had previously had a CS and 11 pregnant women with a previous CS, recruited from two UK hospitals. Women were interviewed and observed using the decision aids.RESULTS:Participants found both decision aids useful and informative. Most liked the computer-based format. Participants found the utility assessment of the decision analysis program acceptable although some had difficulty completing the tasks required. Following the pilot study improvements were made to expand the program content, the decision analysis program was accompanied by a training session and a website version of the information program was developed to allow repeat access.CONCLUSIONS:This pilot study was an essential step in the design of the decision aids and in establishing their acceptability and feasibility. In general, participating women viewed the decision aids as a welcome addition to routine antenatal care. A randomized trial has been conducted to establish the effectiveness and cost-effectiveness of the decision aids.

Imine Abdessamad Johan Aberg Gregory Abowd Johnny Accot Mark Ackerman Brian Amento Elske Ammenwerth Susan Anderson Mark Apperley Caroline Appert Shlomo Argamon Holly Arrow Chieko Asakawa Helen Ashman Daniel Avrahami Chris Baber Jeremy Bailenson Brian Bailey Ravin Balakrishnan Jakob Bardram Armando Baretto Len Bass Remi Bastide Patrick Baudisch Russell Beale Michel Beaudouin-Lafon Shirley Becker Benjamin Bederson James “Bo” Begole Genevieve Bell Victoria Bellotti Jan Benway Olav Bertelsen Tim Bickmore Mark Billinghurst Ann Bisantz Staffan Björk John Black Jeanette Blomberg Mark Blythe Susanne Bodker Cathy Bodine Jan Borchers Katy Borner Alan Borning Nathan Bos Paolo Bottoni Niels Bouvin Doug Bowman Michael Boyle Gary Bradski Morten Breinbjerg Harry Brignull Christina Brodersen Barry Brown A J Brush Margaret Burnett Andrew Burton-Jones Kirsten Butcher Markus Bylund Michael Byrne Xiang Cao Ole Caprani Sheelagh Carpendale Michelle Cart Justine Cassell Antonio Cerone Annmarie ChadwickDias Matthew Chalmers Alex Chaparro Neil Charness Fang Chen Ed Chi Andy Cockburn Gilbert Cockton Phil Cohen Stephane Conversy Jon Cook Steve Cornett Anna Cox Lorrie Cranor Martha Crosby Edward Cutrell Sara Czaja Mary Czerwinski Liwei Dai Antonella DeAngeli Andrew Dearden Clarisse De Souza Heather Desurvire Anind Dey Wayne Dick Chris DiGiano Ellen Yi-Luen Do Paul Dourish Nicolas Ducheneaut Andrew Duchowski Catherine Dwyer Keith Edwards Darin Ellis Pier Luigi Emiliani Ida Engholm Tom Erickson Eva Eriksson Peter Fairweather Daniel Fällman Weiguo Fan

People with cognitive difficulties, including memory, sequencing and attentional difficulties, face barriers to the use of conventionally designed information systems. This paper explores some of the reasons for these barriers in terms of the expectations normally placed on the user’s cognitive abilities and background knowledge. In the paper, the design and evaluation of three information systems are reported. These systems go some way towards overcoming cognitive barriers, allowing access to the advantages of computers for people with dyslexia, and for older users with no background in computer use who were able to access both email and the World Wide Web through specially designed interfaces.

Background: The prevalence of mild hypoglycemia is difficult to document, particularly, in young people with diabetes. The usual method is to ask for subject recall using written 'diaries'.Objective: In 2004, we investigated if new technology could be used to ascertain an accurate prevalence of mild hypoglycemia, particularly self-treated. We compared the use of 'text messaging' and computer-based interviewing with the standard diary method.Participants: Thirty-seven participants, aged 7-18 yr, with type 1 diabetes (T1D) for > 1-yr duration.Method: Open comparison of three systems to collect the data on frequency of hypos (all severity): diary, mobile phone and computer-based interview (CBI), with qualitative analysis of patient feedback.Results: One hundred thirty-two hypos were found over 705 recorded days. All were graded mild or moderate and none severe. Calculated frequency was 5.2 hypos per month: 13.6% subjects had no recorded episode, 36.4% had 1-4, 31.8% 5-9 and 18.2% > 10. Mean blood glucose level at the onset of hypoglycemia was 3.0 mmol/L (1.0-5.2). Response rate of occurrence of hypoglycemic episode recorded by three systems is as follows - diary: 24 (65%) of the 37 subjects reported episodes, mobile: 18 (95%) of 19 subjects and CBI: 16 (89%) of 18 subjects. Sixty-five percent of subjects preferred the mobile and 54% of subjects preferred CBI compared with the diary. Fifty-five percent and 30.8% of subjects found the mobile and the CBI, respectively, easiest to fit into their everyday life.Conclusions: Mobile phone text messaging and CBI are alternatives to written diaries as methods of data collection. Each has its own strengths and weaknesses, but both have the advantage of daily reminders, rapid response and quick data analysis. Using this technology, it was found that the frequency of hypoglycemia was higher (> 3 times) than that previously recognized.