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The User Centered Design of HealthPAL - an audio personal health library of clinic visit recordings for patients and their caregivers (Preprint)


 BACKGROUND
 Providing digital recordings of clinic visits to patients has emerged as a new strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (e.g., medications, tests and imaging) and linkages to trustworthy online resources, curated in an audio-based personal health library (PHL). In this paper, we describe the user-centered design of such a PHL; HealthPAL.
 
 
 OBJECTIVE
 The objective of this paper is to report on the user centered development of HealthPAL, an audio-personal health library.
 
 
 METHODS
 Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded usability design sessions from 2016 to 2019. We recruited participants from a range of community settings to represent patient and caregiver perspectives. We began with a de-identified, standardized primary care visit recording that participants would listen to before completing a series of tasks e.g., find in the recording where a medication was discussed, followed by a debriefing interview. Findings from each round informed the agile software development process. In the first round, we used paper-prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds which were focused on functionality and use. In the final round, we recorded patient participants’ own primary care clinic visits for use in the sessions. Task completion and critical incidents were recorded in each round, and the System Usability Scale (SUS) was completed by participants using the digital prototype in later rounds.
 
 
 RESULTS
 We completed five rounds of usability sessions with 40 participants, 60% female, with a median age of 68 (23 to 89 years). Feedback from sessions resulted in color coding and highlighting of information tags, more prominent play/pause button, clearer structure to move between one’s own recordings and recordings of others one has access to, the addition of tag filtering and descriptions, 10 second forward/rewind controls, and a help link and search bar. Perceived usability increased each round, with a median SUS of 78.2 (range 20 to 100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and about participants having the computer-based skills necessary to access recordings.
 
 
 CONCLUSIONS
 To our knowledge, HealthPAL is the first patient-centered application designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans.
