A Bio-Psycho-Social Review of Usability Methods and their Applications in Healthcare

Introduction

The field of human computer interaction (HCI) is a fast growing field of research in computer science. It is interested in understanding how we use devices and how the usability of those devices can be improved. HCI sits between several disciplines including computer science, psychology, cognitive science, sociology, and anthropology. Although a young field, it offers a wealth of understanding into the use of systems. It provides a relatively rich collection of quantitative and qualitative models and methods that have been applied to the design and evaluation of information systems (IS) in many domains (Carroll, 2003)^. Despite the advances in HCI to guide design and evaluate systems, their published impact in health information systems has been limited in scope—systems are still designed, evaluated, and selected without often formally considering issues of usability, cognitive load and fit. There is a need to better understand where models from HCI can assist in the design and adoption of clinical information systems in health care.

In medicine, a biomedical, reductionist view has been the prevailing perspective through the 20^th century. It has led to a great number of advances in medical science: from Pasteur’s experiments in microbiology that led to the popularization of the germ theory at the end of the 19th century (Ewald, 2004) through to the mapping of the human genome at the beginning of the twenty-first (Venter, Adams, Myers et al., 2001), the science of medicine has seen an explosion in information, in diagnostic options, and in the treatment of diseases. During this time, prominence and understanding of illness, the patient’s experience of the disease, decreased. In 1977, George Engel proposed a new conceptual model for illness: The bio-psycho-social model. His approach expanded the biomedical model to include both the psychological and the social impacts of a disease. It was meant to aid in better understanding and management of a patient rather than simply treating a disease (Engel, 1977). In this model, Engel stresses that the reductionist biomedical model, while it is powerful and has moved our understanding of disease forward, is not sufficient to describe the impact of illness to a patient and their surroundings. Indeed, an illness typically has a biologic component, but it also has a psychological impact on the patient as well as a social impact on those around the patient.

In this chapter, we will review applications of HCI in health information systems development and evaluation and will propose a model that aligns with Engel’s bio-psycho-social model.