Computing has become an essential field of study, with programming as its core component. However, pedagogical aspects of teaching programming remain under-explored and poorly understood. The selection of a student's first programming language has sparked considerable debate within the community, often referred to as a “culture war”, and presents curricular challenges that extend to subsequent language choices. This research full paper investigates the transitions between different programming languages and measures students' learning experiences as they progress through a single language. We utilize Mindshift Learning Theory (MLT) to examine the transfer of knowledge across programming languages as students go through courses in a pre-requisite chain in our curriculum. Our study focuses on three aspects: novelty (encountering new, unique concepts), change (differently applying previously exposed topics), and carryover (directly transferring concepts to new contexts). Our methodology includes an online survey of current and past students transitioning through these courses. We aim to understand how perceived transitions impact mastery and confidence in programming languages. We designed the survey questions, identified target classes, and implemented incentive mechanisms to ensure a statistically significant response rate. Our results are partially aligned with earlier findings in the literature, which correlated carryover, changed, and novel concepts with knowledge scores of object oriented (OO) developers, despite a totally different demographic. Namely, our student participants transitioning to C/C++ (procedural programming) and OO C++ mostly have high, moderate, and low knowledge scores on the programming concepts they perceive as carryover, novel, and changed respectively. On the other hand, those transitioning to OO Java have higher scores for the changed concepts.

Informal caregivers, such as family members and friends, are important for maintaining the health and wellness of the elderly and the chronically ill. However, the complexity of informal caregiving has been under-studied in prior research. In this study, we attempt to answer two main questions – what makes the coordination of patient care so difficult among multiple informal caregivers, and what are the challenges that should be considered in designing technologies to facilitate informal care coordination? To answer these questions, we conducted a qualitative interview study with 15 individuals with caregiving experience. The findings of the study identified the main challenges faced by caregivers in maintaining awareness, coordinating handoffs among informal caregivers, and easing tensions among caregivers and patients. These findings revealed considerations unique for informal caregiver coordination, and helped inform the design of technologies to support the care coordination.

We conducted a field study in a nephrology practice that performs multiple functions in a variety of distributed settings. The task of physician scheduling was done manually on paper by a single scheduler. Our study revealed challenges persistently encountered while using a plethora of fragmented, transient paper artifacts. Any changes made to existing schedules often impact other physicians' schedules, clinical functions, patients, and the practice operation. Finally, we highlight several issues for consideration in the design of a digital scheduling module for meeting the specific needs of distributed multi-function, multi-setting medical practices. These issues include increasing the level of transparency in the scheduling process, providing light-weight customization of schedules, and actively engaging patients in their health care and management.

In today’s society, most people are both consumers of information technology and of health care. Virtually every person has consumed health care and will consume more as one ages. Moreover, 84% of US households own a computer, 1 and 64% of adults own a smartphone. 2 We carry pocket-sized devices that connect us to people around the world and vast stores of information. With these technologies, we manage our lives from mundane activities like reading, checking the weather, making to-do lists, and buying books and clothes, to more complex tasks such as learning, managing finances, shopping for houses, and maintaining ties with friends and family around the world. With such diverse and powerful technologies at our fingertips and myriad societal-level health care challenges in cost, quality, and outcome, it is tantalizing to imagine all of the ways that health information technologies (health IT) can be used to enhance people’s health and societies’ health care delivery. Patient-centered care respects and responds to individual differences in patient preferences, needs, and values. 3 To respond to such differences and achieve patient-centered care, patients and health care professionals must engage in constant communication. In recent years, researchers have examined a number of ostensibly patient-oriented technologies that could enhance such communication, including patient portals, personal health records (PHRs), and mobile health (mHealth) applications. Furthermore, it is not difficult to conceptualize pathways through which such information systems might improve communication between patients and clinicians, create more patient-centered care, and help achieve the triple aim of better experiences of care, better population health, and lower health care costs. 3 Yet, practically, these enticing tools and outcomes are far from reality. There is scant evidence that patients frequently or effectively access and use information systems that engage them and improve patient-centered care delivery. For example, patients generally have positive attitudes toward using patient portals, but studies have not shown portals to have positive impacts on patient empowerment, 4,5 health outcomes, or costs. 6,7 Also, racial and ethnic differences may impede widespread portal adoption and use, 6 and this threatens to compound already-existing disparities in health care access and communication. Another often-studied system type, the PHR, has been shown to infrequently contain patient-oriented features, which is also likely to limit patient-clinician communication. 6 Next, as smartphone adoption has increased, mHealth technologies have emerged as another set of tools that may enhance patient-clinician communication. Yet despite the existence of many applications, including hundreds for cancer alone, 8 we lack strong research evidence on how to design and use mHealth applications to consistently achieve patient-centered care. 3 Finally, the study of patient-facing systems to improve patient-centered care cannot be disentangled from the study of electronic health records (EHRs). EHRs are nearing ubiquity in the US health care system, meaning that patient engagement, communication, and attainment of patient-centered care is also inexorably tied to the design and use of EHRs. This special focus issue follows from the 2014 annual Workshop on Interactive Systems in Healthcare (WISH). The WISH workshop aims to promote deeper and more profound connections among the biomedical informatics, human-computer interaction, medical sociology, and anthropology communities. WISH 2014 focused on the challenge that information systems often fall short in adequately engaging patients and ensuring that clinical decisions are patient-centered. This may be attributed to a disconnect between system designers’ understanding of clinical work and care processes, a lack of clear protocols defining how patient-engaged technologies should be adopted and used, or an insufficient understanding of people’s information needs, preferences, and values. Therefore, the articles in this special focus issue reflect discipline-spanning research teams, methodologies, and perspectives while highlighting new approaches to designing, developing, and evaluating interactive information systems to support patient-centered care and patient engagement. We have organized the articles in this special focus issue into four themes: health IT for patient-centered heath care delivery and management, patient–provider interactions mediated by health IT, pervasive and mobile technologies to promote patient engagement, and designing for underserved patient populations. The first theme includes studies that focus on improving EHR and PHR effectiveness and patient-centered care outcome. The studies range from designing a scaffolding system to existing EHR, customizing a commercial EHR system, identifying strategies of using EHR during patient consultation, re-examining the role of EHR in primary clinical workflows, and designing an experiment to determine the PHR impact on patient engagement. For instance, to improve patient engagement and EHR effectiveness, researchers implemented a scaffolding system to include patient-reported outcomes integrated into the existing EHR and identified both facilitators (e.g., high degree of process automation, good interface usability, capability of targeting the right patients at the right time) and barriers (e.g., uncertain clinical benefits and constraints on time, workflows, and efforts). 9 Similarly, researchers from Texas Children’s Hospital customized a commercial EHR to include the design of a new work element for a cross-functional team to prioritize the outcome measurement in EHR optimization, which significantly improved the outcome status tracking and number of patients involved. 10 Moreover, researchers continue to investigate workflow issues 11 and the tensions of using EHR while interacting with patients face to face 12 in primary care settings, which helps inform commercial vendors about how to improve the design of EHR for accommodating the dynamic needs of frontline clinicians. Furthermore, an observational study on the use of PHR indicated significant improvement in the HbA1c levels of the active and super user groups while no other health outcomes improved. There was also no statistically significant improvement observed in patient engagement during the study. While the research context is limited in coronary artery disease patients, we hope this study could shed light on the current debates of PHR usefulness and effectiveness, and invite additional efforts in examining the effectiveness of patient-centered systems, including patient portals, on improving patient engagement and health outcomes. The second theme focuses on the design of health IT to improve the quality of patient–provider interaction. Studies included the development of a web-based toolkit to improve patient education and involvement in the care plan during hospitalization, 13 the design of a dashboard to facilitate data collection and efficient use of patient-reported outcomes, 14 and design recommendations for a web-based tool to satisfy the caregivers’ information needs in the context of inpatient pediatric hematopoietic stem cell transplant. 15 As there is a paucity of research in designing IT tools to support patients and caregivers in an inpatient setting, we hope that these studies will provide readers with valuable insights and practical design experiences for approaching the problem, including ways to engage patients, caregivers, and providers in the iterative user-centered design process. The third theme involves the use of pervasive and mobile technologies to promote patient engagement, such as. 16 Many mHealth technologies were found to be useful for patients to manage their care and improve health outcomes. However, certain patient factors must be considered when designing mHealth technologies, as they play a pivotal role in patient engagement. For example, patient factors like ethnicity, health literacy, and age were found to impact the use of mHealth applications for managing medication adherence 17 and service members’ background characteristics were reported to impact their engagement with an mHealth application for managing their post-trauma issues. 18 On the other hand, one size does not fit all. It is therefore important to customize mHealth tools for patients with special needs to ensure patient engagement. For instance, an mHealth tool designed for diabetic patients from economically disadvantaged communities and ethnic minorities was found to help patients self-monitor and reflect, 19 and a PHR application customized for post-cardiothoracic surgery patients was useful to support their medication management and tracking in a hospital setting. 20 The last theme that we identified is centered around designing for underserved patient populations, e.g. 21 It is well-known in the health informatics community that studying underserved patient populations is challenging. Thus, most previous research focused on a single case study. While a single case study offers valuable knowledge, cross-case analysis of diverse case studies offers exceptionally important insights to the success factors, barriers, and common patterns identified across multiple cases. 22 In addition, research targeted at underserved populations offers lessons particularly instrumental in the design of health IT to meet the specific needs of individual underserved populations. For example, a large-scale national program succeeded in promoting health and well-being in older adults using a suite of accessible computing, 23 a longitudinal participatory design approach supported the design of mHealth applications for overcoming perinatal depression of women from vulnerable populations after their pregnancies, 24 and the use of daily questionnaires helped to identify the association between service members’ background characteristics and their engagement with an mHealth application for managing their post-trauma issues/conditions. 18 In conclusion, researchers in this growing, vibrant health informatics community have been diligently exploring a range of relevant topics in the design, implementation, and evaluation of interactive, patient-centered health IT systems for enhancing patient engagement, as evidenced in the sample research included in this special focus issue. While challenges remain and future work abounds, we believe that our effort has led us a step closer to achieving a high level of health care quality and outcomes.

We conducted a field study in a non-profit resource-scarce primary care clinic to investigate its current paper-based practices. The goal is to inform the design and deployment of an impending Electronic Medical Record (EMR) system at the clinic. The clinic serves a local vulnerable, low-income population who are insured through local community health plans. We identified problems encountered by the providers in their use of the current paper-based system. We also found that providers customized their work practices so that they can serve the underserved population better. Based on the tacit knowledge that they acquired in the workplace over time, they adapted their patient care to align with the patients' prescribed health benefits. In this way, the patients were able to receive timely and proper medical care. We also propose technological recommendations for the impending EMR system to address the problems with current practices and to support the adapted practices specifically customized for the low socioeconomic patients.

Non-profit organizations (NPOs) are often resource-restricted and rely on volunteers to function. As such, their human infrastructure - the social system supporting work - is different from conventional organizations, and technologies that function in a traditional organization with a stable workforce may not work in NPOs. Through an investigation of the deployment of an Electronic Health Record (EHR) system in a safety-net free clinic serving underprivileged populations, we report how the EHR disrupted the human infrastructure - namely, the work typically enacted by volunteers. Specifically, there was a mismatch between the technological and human infrastructures leading to diminished volunteer roles, an increased workload for paid employees, and a negative impact on the quality of patient care. In turn, employees acted to reconcile the disrupted human infrastructure by creating new work roles for volunteers, re-establishing the quality of patient care, and developing workarounds for volunteers to resume their volunteer work. Finally we discuss how the commercial EHR system failed to support the fluid volunteer-based human infrastructure of the free clinic.

We conducted an observational study in an emergency department (ED) to acquire an in-depth understanding of the activities and processes involved in the ED patient outflow and the challenges encountered in the outflow coordination with heterogeneous and autonomous stakeholders within and across organisations. We identified that inefficient patient outflow not only led to overcrowding in the ED because patients could not be admitted to the ED, but it also affected the operation of other inpatient units and that of external organisations. Moreover, the overcrowding issue was found to be contingent on how efficiently the multiple, concurrent, and intertwined patient outflow work was coordinated. The patient outflow coordination work was primarily non-clinical, and invisible in the current information system. Therefore, we propose to make the non-clinical coordination outflow work visible and be supported in the information system as efficient outflow is crucial to the efficiency of the overall patient flow.

Interruptions in the home pose a threat to the validity of self-administered computerised cognitive testing. We report the findings of a laboratory experiment investigating the effects of increased interruption workload demand on older adults' computerised cognitive test performance. Related work has reported interruptions having a range of inhibitory and facilitatory effects on primary task performance. Cognitive ageing literature suggests that increased interruption workload demand should have greater detrimental effects on older adults' performance, when compared to younger adults. With 36 participants from 3 age groups (20-54, 55-69, 70+), we found divergent effects of increased interruption demand on two primary tasks. Results suggest that older and younger adults experience interruptions differently, but at no age is test performance compromised by demanding interruptions. This finding is reassuring with respect to the success of a self-administered computerised cognitive assessment test, and is likely to be useful for other applications used by older adults.

We conducted an observational study to investigate nurses' communication behaviors in an Emergency Department (ED). Our observations reveal unique collaboration practices exercised by ED staff, which we term as "loosely formed team collaboration." Specifically, ED patient care teams are dynamically and quickly assembled upon patient arrival, wherein team members engage in interdependent and complex care activities. The responsible care team then disassembles when a patient leaves the ED. The coordination mechanism required for these work practices challenges nurses' communication processes, often increasing breakdown susceptibility. Our analysis of the ED nurses' communication behaviors and use of communication channels highlights the importance of maintaining team awareness and supporting role-based communication. This points to the need for explicit efforts to coordinate tasks and informative interruptions. These findings call for the design of future communication technologies to meet the needs of loosely formed collaborative environments to provide team-based communication, lightweight feedback, and information transparency.

This article presents a framework of 6 distinct yet interrelated factors for describing information flow that arose from a combination of field studies in a hospital ward and a review of literature. These studies investigated the dynamics of nurses' information flow, focusing on shift change. The InfoFlow Framework's 6 interrelated factors that affect the information flow are information, personnel, artifacts, spatiality, temporality, and communication mode. The framework is presented as a tool for evaluating new health care technologies. The 6 factors and their interrelationships are described first. Next, this structure is applied as a tool to aid in the analysis of the data generated in a study that assesses technology in use. Then the use of the framework is illustrated by structuring it as a set of questions that can be used as a guide for other researchers to generate coherent descriptions of the information flow and to evaluate technology deployments. Finally, there is a discussion of areas where the InfoFlow framework may be applied to allow an evaluation of the extent to which the framework may be generalized to other settings.

Hospital work coordination and collaboration often requires mobility for acquiring proper information and resources. In turn, the spatial distribution and the mobility of clinicians can curtail the opportunities for effective communications making collaboration difficult. In this situation, a mobile hands-free voice communication system, Vocera, was introduced to enhance communication. It supports quick and impromptu conversations among coworkers for work coordination and collaboration anytime and anywhere. We study this deployment and present our findings concerning the impact of this communication system on the information flow. Our information flow framework's communication strategies help contrast the information processes before and after the deployment of Vocera.

This paper reports the findings from two field studies that reveal paper-based artifacts being heavily relied upon in medical shift work despite the deployment of a mobile technology in a local hospital ward. We present the information flow in terms of common and personal information spaces and identify three important functions of these personal artifacts in the actual work practices. Artifacts serve as a bedside information source for patient care delivery, an opportune notepad and an information basis for reporting and handover. We thus recommend a system employing digital pens and paper so that nurses can retain the manual practice of constructing their personal artifacts, flexibly use them in the actual work and easily formalize the informal information recorded therein. We also discuss the benefits and challenges of our proposed technology.

Since health care teams are often distributed across time and location, information sharing is crucial for effective patient care. Studying the use of a mobile information technology in a local hospital ward at two months and eleven months after its deployment identifies both short- and long-term phenomena and reveals a mismatch between the intentions behind the deployed mobile technology and the nurses' current work practices. We contrast the new mobile technology with the paper artifacts that were previously relied upon in nursing work. Finally, in light of these findings, we suggest design directions for future technology to support the nursing shift work.

We present an observational study that was conducted to guide the design and development of technologies to support information flow during nurses' shift change in a hospital ward. Our goal is to find out how the complex information sharing processes during nurses' brief shift change unfold in a hospital setting. Our study shows the multitude of information media that nurses access during the parallel processes of information assembly and disassembly: digital, paper-based, displayed and verbal media. An initial analysis reveals how the common information spaces, where information media are positioned and accessible by all participants, are actively used and how they interact with the personal information spaces ephemerally constructed by the participants. Several types of information are consistently transposed from the common information spaces to the personal information space including: demographics, historical data, reminders and to-dos, alerts, prompts, scheduling and reporting information. Information types are often enhanced with a variety of visual cues to help nurses carry out their tasks.