This article, titled “Human Factors and Organizational Issues in Health Informatics: Review of Recent Developments and Advances,” was authored by Andre Kushniruk and David Kaufman.
The objective of the paper is to provide a comprehensive review of key articles published in 2022 and 2023 focusing on human factors and organizational issues within health informatics. It highlights prominent trends that have emerged from the literature during this period.
The methodology involved a balanced approach between breadth and depth, consistent with previous reviews. The authors conducted a series of searches using PubMed, Web of Science, and Google Scholar for articles published in 2022 and 2023. They also reviewed specific journals such as the Journal of the American Medical Informatics Association, Applied Clinical Informatics, JMIR Human Factors, and the International Journal of Medical Informatics. Search strategies included keyword searches, MeSH terms, filters, and a “pearl-growing strategy” (citation mining). Articles were selectively included if they aligned with themes focusing on information technologies and organizational factors, prioritizing original empirical studies, but also including reviews, position papers, theoretical frameworks, book chapters, and technical reports. The authors noted the vast volume of literature, with a search for “human factors” yielding 65,710 results and “human factors” combined with “health informatics” yielding 1,605 results, indicating the challenge of exhaustive coverage.
The results section of the paper reveals several significant trends and advances:
- Expanded Scope of Applications: The range of applications designed and analyzed using human factors approaches has rapidly expanded, including an increased number of articles on topics such as Artificial Intelligence (AI) in healthcare, patient-centered design, usability of mobile health (mHealth), organizational issues, and system safety. This includes studies of applications for both patients and health providers, utilizing qualitative and quantitative approaches for user requirements, user-centered system design, and human factors analysis and evaluation.
- Diverse Technologies: There has been a rapid increase in the number of applications applying AI in healthcare, a major trend expected to continue. Studies have focused on barriers and facilitators to AI adoption, as well as ethical and legal concerns. The user experience (UX) with these advanced technologies, including generative AI and Large Language Models (LLMs), has gained considerable interest. Other diverse technologies reported include personal health and medical devices like smartphones, smartwatches, wearable devices, and the Internet of Things (IoT), with concerns regarding their usability, safety, ethics, and legality. The paper also noted an increase in studies on virtual reality and augmented reality applications for patient education, procedure planning, and complex healthcare simulations.
- Advances in Methods: There has been progress in methods for assessing healthcare systems and their fit with users and organizations, ranging from laboratory and simulation settings to real-world and remote evaluation using naturalistic approaches. Methodologies reported include user-centered design, participatory design, and mixed methods approaches, with an increased focus on agile approaches. Validated scales such as SUS, TAM, and UTAUT continue to be widely applied for measuring user perceptions.
- Focus on Patient-Facing Technologies: A growing number of studies have concentrated on the design, development, and evaluation of novel technologies for patients and lay people. This includes research on remote interaction between patients and providers, such as “hospital at home” and remote patient monitoring, and the feasibility of wearable technologies and mHealth applications in real-world settings. e-Health literacy has also become an increased focus, with technologies aiming to enable patients to effectively use personal health apps and patient portals.
- Electronic Health Records (EHRs): While the range of technologies has expanded, several studies continue to focus on clinician interaction with EHRs, particularly regarding usability and the persistence of human factors concerns. Issues like diagnostic error related to EHR use have been explored.
- Safety and Technology-Induced Error: Integral to usability is the study of system and device safety. While technology often improves safety, a growing number of publications have examined how it might inadvertently decrease safety and lead to error, especially under real-world conditions of stress and urgency. Approaches to mitigate technology-induced error, such as sequential application of complementary methods (e.g., usability inspection, testing, naturalistic evaluation), are being developed.
- System-Centered and Organizational Approaches: The paper emphasizes a broader systems-centered perspective, drawing on frameworks like the Systems Engineering Initiative for Patient Safety (SEIPS) and the NASSS (Nonadoption, Abandonment, Scale-up, Spread, and Sustainability) framework. These frameworks help understand how diverse organizational factors (micro-, meso-, and macro-level) impact the implementation and usage of health information technology. NASSS has been used to identify barriers and facilitators for technologies like digital twins and wearable health monitors. SEIPS has been applied to analyze teamwork, environmental cleaning, opioid prescribing, and early warning systems, as well as for patient-centered studies on medication management and inhalation therapy adherence.
- Patient Safety Culture and Burnout: Patient safety culture has become a focal point for promoting institutional changes. Studies have refined the safety culture construct, exploring factors like communication, psychological safety, and organizational culture. Global perspectives highlight the need for non-punitive cultures to encourage error reporting. Furthermore, the relationship between teamwork, patient safety culture, and healthcare professional burnout has been extensively studied, with findings indicating that effective teamwork and supportive leadership can reduce burnout rates.
In conclusion, human factors and organizational systems research is a dynamic field that continues to expand in scope and global reach. The success of health information systems and informatics depends on continued research and practical application of findings in human factors. While significant advances have been made, challenges remain, including standardizing approaches and instruments, improving scholarly communication, and facilitating the translation of research findings into practical applications, especially for commercial vendor-based systems. There is a continued need for healthcare decision-makers to better understand human factors issues, and for the development of truly user-centric applications that effectively support user needs in varied healthcare contexts.
Reference: Kushniruk, A., & Kaufman, D. (2024). Human Factors and Organizational Issues in Health Informatics: Review of Recent Developments and Advances. Yearbook of Medical Informatics, 33(01), 196-209.
