2010 saas national conference and niatx annual summit trust in technology enid montague, phd...

2010SAAS National Conference and NIATx

Annual Summit

Trust in Technology

Enid Montague, PhD Assistant Professor

Anna Julia Cooper FellowDirector: HCI lab

Industrial and Systems EngineeringUniversity of Wisconsin-Madison

enidmontague.com

Outline

• Why are we implementing new technologies?• Patient trust in care provider• Patient attitudes about technologies• Provider attitudes about technologies• Tips and considerations• Interactive activity

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Why are we using EMRs?

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Physician shortage

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Nursing shortage

Year Supply Demand Shortage Percent

2000 1,890,700 2,001,500 -110,800 -6%

2005 1,942,500 2,161,300 -218,800 -10%

2010 1,941,200 2,347,000 -405,800 -17%

2015 1,886,100 2,569,800 -683,700 -27%

2020 1,808,000 2,824,900 -1,016,900 -36%

Source: Data from the Bureau of Health Professions. (2004)

US Supply versus Demand Projections for FTE Registered Nurses

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Growth in medical technology industry

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Growth in medical technology invention.

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What is trust?

• Trust is a person’s belief that a person or object will not fail them.

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Trust is a popular topic in relation to the provision of health.

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Trust is a fundamental aspect of all relationships.

– Human- human• e.g. worker- worker, parent- child, doctor- patient,

– Human-organization• e.g. worker- company, patient- hospital

– Human- social institution• e.g. citizens- government, patient- health systems

– Human-technology• e.g. user- website, user- device, human- computer

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Trust triad model

Montague, E., Winchester, W.W. Kleiner, B.M. (in press). Trust in medical technology by patients and health care providers in obstetric work systems. Behaviour & Information Technology.

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Client- Provider Trust

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Patient trust in care provider predicts… • Quality variables such as:

– sustained enrollment in health plans– patient satisfaction– utilization of preventive services – adherence to medical advice – malpractice litigation – health status – health service seeking behaviours

• Organizational and economic factors such as: – decreases in the possibility of a patient

leaving a care provider’s practice– withdrawing from a health plan.

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As trust declines…• The cost of providing care may increase. • Patients and care providers may engage in self-protection

– patients withhold information or avoid seeking care from sources they determine are untrustworthy and care providers practice defensive medicine.

• “People are increasingly unwilling to take risks, demand greater protection against the possibility of betrayal, and increasingly insist on costly sanctioning mechanisms to defend their interests” (p 13) (Tyler & Kramer, 1996).

• Distrust can also act as a barrier to the formation of interpersonal relationships• Distrust can “provoke feelings of anxiety and insecurity, causing people to feel

uncomfortable and ill at ease and to expend energy on monitoring the behavior and possible motives of others” (p 1) (Fuller, 1996).

• When patients feel unsafe, energy that could be devoted to healing is expended on self-preservation.

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Ideal environments for interpersonal communication

-Full view of the body-Full view of facial expressions-No limitations on making eye contact-Channels are free to focus on listening and responding

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How does technology change interpersonal relationships?

• Nonverbal cues are important for interpersonal communication and trust in clinical encounters– Difficulty using multiple channels (i.e listening, while

typing)– Time utilizing technologies might affect total visit time– Difficulty noticing the expressions of others– Difficulty showing appropriate expressions – Mistakes may cause stress and frustration– Time for social touch– Eye contact

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Shared computer use can make interpersonal communication difficult.

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Typical sets ups that involve technologies can bring new communication challenges.

Image source: Mayo SPARC

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Patient trust in technology

Previous Experiences/ Attitudes

Previous Experiences/ Attitudes

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The goal is appropriate trust in technology.

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Using technologies to make decisions in the absence of additional information

Using technologies in ways they were not designed for

Using technologies to enhance human capabilities, while continuing to use medical knowledge

Refusing to use technologies that could enhance the provision of care and quality of work

Using technologies in lieu of medical care i.e. Google as a first or second opinion

Using technologies in a way they were not designed for

Using technologies appropriately to enhance health and care

Refusing to use technologies that could enhance the health and the care provision process

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Patient attitudes about technologies

• Concern over information security• Lack of knowledge about technology (technology literacy)

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Uncertainty about the health record can contribute to distrusting attitudes.

• Have you ever looked at your medical record?(52%) No, I have never looked at my medical record(39%) Yes, it was accurate(16%) Yes, it was inaccurate or incomplete

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Beliefs can affect behaviors

• Do you believe the information in your medical record is kept secure?(70%) Yes(28%) No

• Have you ever avoided telling your doctor something about your health, because you did not want the information to appear in your medical record?(76%) No (20%) Yes

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Which of the following would you not want to appear in your medical record?

• (43%) Number of sexual partners• (43%) Previous incarcerations• (26%) HIV/AIDS status • (24%) Sexually transmitted diseases• (22%) History of substance abuse• (20%) Prior use of illegal drugs• (20%) History of mental illness• ( 9%) Family history of genetic illness

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There are different attitudes about information sharing with partners, friends, family.

• How many people would you like to have access to your medical record? and why?

Mixed results– Some said virtually everyone (doctors, nurses,

clinic staff, spouse, child, parent, emergency contact)

– Others said virtually no one (only doctor seeing them and only limited access to information involving the purpose of the visit)

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Distrust in health system can affect attitudes about technologies.

• Studies have shown that certain populations are more distrusting of health care systems and providers– Racial/ethnic minorities (African American,

Hispanic American, Arab American)– Substance abusers– Those suffering from mental illness– Chronically homeless– Those with socially stigmatizing illnesses and

diseases

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Differences can exist across age groups.

• Privacy literacy– Teens are aware of information privacy and

information sharing.• “I don’t know if the doctor is going to turn the screen off when they leave the room”• “I don’t know who else can see or access the

information they put it in the computer” • “I don’t know if my parents can see it” • “I don’t know what they are writing about me”

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Differences can exist across age groups.

• Older clients might be more concerned about technology etiquette.• “I don’t think its polite when my doctor types while I’m

trying to talk to him”• “Its bad enough that my kids text message during dinner,

now I have to watch my doctor text during my check-ups”• “It took me two hours to get here, I only have 30 minutes

for the visit and they spent 10 minutes of my time trying to get the computer to work!”

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Provider attitudes about technologies

• Provider distrust in technology can contribute to patient distrust in technology and the provider.

• Provider self-confidence can contribute to appropriate trust in the technology.

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New technologies can be stressful for some care providers.

Techno-stress– “The negative psychological link between people and the introduction

of new technologies. “– Not unique to health care; educators have similar experiences

Causes of technostress– the quick pace of technological change– lack of proper training– increased workload as result of new technology– lack of standardization within technologies– the reliability of hardware and software– Poor usability–

• Choose usable software that matches your organizations work flow is important!

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Provider trust in technology

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Things to consider.• Design of work stations

– Consider where and how you will introduce work stations into your practice

– Don’t be afraid to role play and try different set ups• User friendly solutions

– Develop a personal and organizational plan for addressing technology problems during client encounters.

• Flexible work flow- – Be able to treat each client as an individual

• You may not be able to type your notes during each visit• Communicate with clients about their ideas about

computer technologies– Develop a working plan together

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Practical tips and considerations

• For the client– Be prepared to provide information about who has access to

their information and how it is kept confidential• For the clinician

– Consider the effects on your interpersonal relationships when choosing a system

• Training and be flexible… everyone may different• Allow for adequate time in visits to accompany additional

times or technology usage• Effective implementation plan• Match self trust/ self confidence with start times• Establish etiquette• Communicate etiquette with other workers and clients

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Role-playing activity1. Spend a few minutes reading about the character assigned to you.2. With a partner you will each perform as the character assigned to you in

a simulated intake process with a new client for about 10 minutes. 3. After the role-playing scenario, individually spend a few minutes writing

down what worked well and what were obstacles in building rapport and trust with your partner from your perspective?

– Please write down at least 5 observations for each question.4. You and your partner will spend a few minutes discussing the role-play

scenario: – Compare perspectives of the experience – Brainstorm about solutions and things that should be considered

when implementing new computer systems into the clinician-client relationship. • Be sure to think about different types of people, tasks, and

organizations. 5. We will discuss as a group.

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Thank you!

• For more information please,– See the NIAtx website– Or visit my website www.enidmontague.com

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