Technostress is one of many factors holding our healthcare system back. This presentation contains the results of research performed in healthcare settings and proposes a new approach to reducing the technostress induced by the electronic healthcare systems.

1. Reducing Stress in Health Care:
Evidence From Using an Integration Design Model
Rob Keefer, PhD
Lisa Douglas, PhD

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Big Idea
Technostress is real and can be reduced
using an integration design model.

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Technostress is Real

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Technostress in Healthcare
1 Widera, E., Chang, A., & Chen, H. (2010). Presenteeism: A public health hazard. Journal of General Internal Medicine,
25(11), 1244-1247.
2 Smith, M., Carayon, P., Sanders, K., Lim, S., & Legrande, D. (1992). Employee stress and health complaints in jobs with
and without electronic performance monitoring. Applied Ergonomics, 23(1), 17-27.
3 Al-Abri, R. (2007). Managing change in healthcare. Oman Medical Journal, 22(3), 9-10.
4 Friedberg, M., et al. (2013). Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care,
Health Systems, and Health Policy. RAND Corporation Research Report. ISBN 978-0-8330-8220-6
Person-Technology Fit Model*
3 potential sources of stress designed into a system:
Intrusive (presenteeism1 and anonymity2)
Dynamic (pace of change3)
Usability (usefulness, complexity, and reliability4)
*Ayyagari, R., Grover, V., & Russell, P. (2011).

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Integration Design Model

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Classic Model
Typical questions in user research:
Traditional Interaction Questions Additional Synergistic Questions
What is the user trying to accomplish?
Why is this important?
Are the user goals able to be categorized
into themes? (i.e. collaboration)
What does the user need to know to
accomplish the goal? Why?
What is the user’s reasoning process to
solve this problem?
How does the user feel while performing a
task?
What near-real time information does the
user want to know?
What is the machine trying to
accomplish? Why is this important?
Are the machine goals able to be
categorized into themes? (i.e. tracking)
What does the machine need to know to
accomplish the goal? Why?
What is the algorithm, or machine’s
reasoning process, to solve this problem?
What information does the machine need
to monitor and radiate appropriately?
Does the system promote the desired
emotions of the user?
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Research Users

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Integration Design Model
Researchers Users
Developers
A Synergistic Approach

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Integration Design Model
Let’s add a set of questions to our research:
Traditional Interaction Questions Additional Synergistic Questions
What is the user trying to accomplish? Why
is this important?
Are the user goals able to be categorized
into themes? (i.e. collaboration)
What does the user need to know to
accomplish the goal? Why?
What is the user’s reasoning process to
solve this problem?
How does the user feel while performing a
task?
What near-real time information does the
user want to know?
What is the machine trying to
accomplish? Why is this important?
Are the machine goals able to be
categorized into themes? (i.e. tracking)
What does the machine need to know to
accomplish the goal? Why?
What is the algorithm, or machine’s
reasoning process, to solve this problem?
What information does the machine need
to monitor and radiate appropriately?
Does the system promote the desired
emotions of the user?
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Results

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Methodology
57 Participants:
Registered Nurse: 55
Physician: 1
Hospital Tech: 1
Evaluation Method:
No. Research Projects: 9
SUS: 5-point Likert Scale
Subjective: 1-10 continuum

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Existing Systems

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Existing Systems
NOTE:
Interact with up to 10 disparate
systems to complete tasks
44.5

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Initial Releases

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Initial Releases
NOTE:
Focus on consolidating systems,
increasing efficiency, reducing
cognitive workload

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Following Releases
NOTE:
Support for Multitasking
Summarization of Information

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Continued Success
NOTE:
Further Experimentation
Continued Learning

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Final Releases
NOTE:
Last Known Sighting
Medication Review Support

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Results
NOTE:
Unpaired t-test:
t = 6.0504, p < 0.001
MD=18.90 (in Conf Interval)
M1 M2

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Conclusion
Technostress is real and can be reduced
using an integration design model.

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Further Research
A recent study*suggests that perception of usability (SUS)
and mental workload may be independent, not fully
overlapping, constructs. Further research will introduce
mental workload scores (NASA Task Load Index).
*Longo, L. (2017). Subjective Usability, Mental Workload Assessments and Their Impact on Objective
Human Performance. In: Bernhaupt R., Dalvi G., Joshi A., K. Balkrishan D., O'Neill J., Winckler M.
(eds) Human-Computer Interaction - INTERACT 2017. INTERACT 2017. Lecture Notes in Computer
Science, vol 10514. Springer. 202 - 223
We plan to gather more data to support and refine the
integration design model seeking to incorporate trust and
shared values.

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Questions
Rob Keefer, PhD
rob.Keefer@pomiet.com
@rbkeefer

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Usability Testing Results
Study Focus N SUS Score 1-10 Rating
Current System 10 44.5 -
Dashboard 6 69 -
Homepage 6 72 -
Multitasking 6 88 8.6
Progress Notes 5 89 9.4
Header Info 6 84 9.2
Last Known Sight 6 91 8.4
Assessments 7 - 9.3
Med. Review 6 95 9.4
Alerts 4 - 10
Mean 5.7 84 91.9