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Journal of Biomedical Informatics 38 (2005) 1–3

Guest Editorial

Human-centered computing in health information systemsPart 1: Analysis and design

A large number of health information system projectsfail. Most of these failures are not due to flawed technol-ogy, but rather due to the lack of systematic consider-ations of human and other non-technology issues inthe design and implementation processes [1–8]. In otherwords, designing and implementing a health informa-tion system is not so much an IT project as a humanproject about human-centered computing such asusability, workflow, organizational change, medical er-ror, and process reengineering. In other industries suchas aviation, nuclear power plants, automobiles, and con-sumer software and electronics, human-centered designis a routine practice. In healthcare, however, the cultureis still to train people to adapt to poorly designed tech-nology, rather than to design technology to fit people�scharacteristics. Human-centered methods and tech-niques specifically developed for healthcare domainsare necessary for the successful development of healthinformation systems that increase efficiency and produc-tivity, increase ease of use and ease of learning, increaseuser adoption, retention, and satisfaction, and decreasemedical errors, decrease development time and cost,and decrease support and training cost.

Human-centered computing covers more than tradi-tional usability engineering, human–computer interac-tion, and human factors, which are primarilyconcerned with user interfaces [9–11]. As described inZhang et al. [12], human-centered computing is basedon four types of analyses: user, functional, representa-tional, and task analyses. User analysis is the processof identifying the characteristics of existing and poten-tial users, such as expertise, knowledge, skills, educationlevels, cognitive capacities and limitations, perceptualvariations, ages, cultural background, personalities,times available for learning and training, etc. User anal-ysis can help us design systems that have the rightknowledge and information structures that match thoseof the users. Functional analysis is the process of identi-fying a system�s abstract structures that are independent

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doi:10.1016/j.jbi.2004.12.002

of implementations. Its product is the ontology of a gi-ven work domain. This ontology is an explicit, abstract,implementation-independent description of the workdomain. It includes (a) objects and their attributes, (b)resources and their types, (c) relations among entitiesand constraints on relations, (d) operations on singleor multiple objects, transformations, relations, and con-straints, and (e) workflow structures [13]. Representa-tional analysis is the process of identifying anappropriate information display format for a given taskperformed by a specific type of users such that the inter-action between users and systems is in a direct interac-tion mode [14,15]. With direct interaction interfaces,users can directly, completely, and efficiently engage inthe primary tasks they intend to perform, not the house-keeping interface tasks that are barriers between usersand systems. Traditional user interface design is mostlyat the level of representational analysis. Task analysis isthe process of identifying the procedures and actions tobe carried out and the information to be processed toachieve task goals by using specific representations[16–18]. For the same task goal, different representationscan lead to very different sets of task steps that requiredifferent types of information. Task analysis can gener-ate estimates of relative task difficulties and complexitiesand help understand the workflows of tasks.

Human-centered computing is also a process that in-cludes work domain analysis, design, and evaluation asthree major steps. To develop a human-centered productfor a work domain, we first need to understand the natureof the work. After the work domain analysis, we need todesign and implement the product. Then the producthas to be evaluated using human-centered criteria.

Two special issues are produced to bring together ori-ginal research and methodology papers that focus onhuman-centered computing in health information sys-tems. Part 1, the current issue, focuses on the domainanalysis and design aspects of human-centered comput-ing. Part 2 will focus on the evaluation aspect. Health

2 Guest Editorial / Journal of Biomedical Informatics 38 (2005) 1–3

information systems in these two special issues include,but are not limited to, electronic health records (EHR),decision support systems, medical devices, telemedicinesystems, PDAs, communication systems, public healthinformation systems, cognitive artifacts, and others.

The following is an introduction to the papers in part1—analysis and design.

The first paper by Rinkus et al. [19] is a direct reflec-tion of the human-centered computing defined above. Itapplies the four types of analyses and a more elaborateProduct Design Lifecycle in the analysis, design, andevaluation of a knowledge management system for a dis-tributed work environment that is composed of multipleteams of people distributed across space and time andinteracting with multiple types of artifacts (both ad-vanced computing devices and traditional artifacts).The domain is the Biomedical Engineer and Flight Sur-geon Console in the Mission Control Center at NASAJohnson Space Center. The authors analyzed this com-plex system, identified its problems, generated systemsrequirements, and provided specifications of a replace-ment prototype for effective organizational memoryand knowledge management. They demonstrated thevalue provided by their human-centered approach anddescribed the unique properties, structures, and pro-cesses discovered using this methodology and how theycontributed in the design of the prototype. This paperinvolves all four types of analyses of users, functions,representations, and tasks.

The next two papers focus on functional analysis.The paper by Nemeth et al. [20] introduces an emergingparadigm called cognitive work analysis [21] and itsapplications in the design of healthcare IT. There is littleevidence that the use of IT will have sustainable positiveeffects in improving patient safety, despite that much ofgovernment funding has been directed to support theproduction of such new IT systems. In their opinion,to get the desired effects of new IT in healthcare, it isessential to understand the cognitive work performedby the practitioners. They used two examples, infusionpumps and operating room schedules, to demonstratethe procedures and outcomes of cognitive work analysis.Nemeth et al. also introduced the distributed cognitionframework [22,23] and the properties of cognitive arti-facts [24], which are the focus of the next paper by Xiao[25]. According to Xiao, healthcare is delivered in thecontext of a highly structured physical environment,with much effort on physical and spatial arrangementand re-arrangement of workers, patients, and materials.This article reviewed field studies in healthcare and otherdomains on the role of artifacts in collaborative workand demonstrated how artifacts are used and exploitedto facilitate collaborative work in the scheduling ofoperating rooms. The author suggests that new technol-ogy should support the functions provided by physicalartifacts that are replaced or disrupted by new technol-

ogy and that new technology needs to be sensitive tothe distributed nature of cognitive work by healthcareworkers.

The next two papers focus on task analysis. Malhotraet al. [26] conducted semi-structured interviews ofhealthcare providers, biomedical engineers, and admin-istrators who were involved with various degrees in theuse, maintenance, or purchasing of infusion pumps.The interviews were centered on three scenarios of med-ical errors with infusion pumps and the participantswere asked to assess, rank, and explain the medical er-rors. The results from this study were used to developa patient-centered methodology for designing medicaldevices. The paper by Rose et al. [27] describes a studythat used task analysis and focus group to discoverusability problems of an EHR module and to generateredesigns that eliminate the discovered usability prob-lems. Usability is a major factor for the successful adop-tion of any EHR systems. This paper is one of very fewpublished studies that explicitly examine the usabilityproblems of EHR.

The next paper by Samaras and Horst [28] focuses ondesign life cycles. The primary objective is to reconsiderhuman-centered design of health information systemsfrom a systems engineering perspective. Systems engi-neering is a structured, systematic approach to system riskreduction over the full lifetime of the system (from cradleto grave). It is particularly important for new productdevelopment of complex systems. The authors reviewedvarious models of design life cycles and analyzed twomedical error cases involving radiation overdoses. Fromthese results the authors argue that the various modelsof design life cycles in usability engineering are subset ofthe classical systems engineering method and thus intro-ducing the core components of systems engineering backto design life cycles will increase the reliability, compli-ance, and safety of health information systems.

The last paper by Johnson et al. [29] is the methodol-ogy review paper for this special issue. Numerous healthinformation systems are designed without considerationof user-centered design guidelines. This often results inuser dissatisfaction and abandonment. To salvage thesystems that are designed without usability consider-ations, the authors combined different methods fromthe area of computer science, cognitive science, psychol-ogy, and human–computer interaction to formulate aframework for guiding the redesign process. Theauthors first provided a review of the different methodsinvolved in the design process and presented a lifecycleof their own redesign approach. The authors then ap-plied the new method to the redesign of a software appli-cation that tracks genetic history of patient families,compared the new design with the old one, and demon-strated the improvement of usability of the new design.

This is the first of the two special issues. It focuses onthe domain analysis and product design aspects of hu-

Guest Editorial / Journal of Biomedical Informatics 38 (2005) 1–3 3

man-centered computing. The next issue will be dedi-cated to papers centered on the evaluation aspect of hu-man-centered computing.

Acknowledgments

I thank all the reviewers for their comprehensive re-views. Without their hard work and professional recom-mendations it would be an impossible task for me tocompile this special issue. Their constructive criticismsalso greatly helped the authors in their revisions. Iwould also like to give special thanks to Vimla Patelfor her encouragement and support in producing bothof these Special Issues.

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Jiajie ZhangGuest Editor

School of Health Information Sciences

University of Texas Health Science Center at Houston

Houston, TX, USA

E-mail address: jiajie.zhang@uth.tmc.edu

Available online 7 January 2005