Educational inequalities in disadvantaged areas have long been a global concern. While Information and Communication Technologies (ICTs) have shown great potential in addressing this issue, the unique challenges in disadvantaged areas often hinder the practical effectiveness of such technologies. This paper examines live-streaming-based dual-teacher classes (LSDC) through a qualitative study in disadvantaged regions of China. Our findings indicate that, although LSDC offers students in these regions access to high-quality educational resources, its practical implementation is fraught with challenges. Specifically, we foreground the pivotal role of local teachers in mitigating these challenges. Through a series of situated efforts, local teachers contextualize high-quality lectures to the local classroom environment, ensuring the expected educational outcomes. Based on our findings, we argue that greater recognition and support for the situational practices of local teachers is essential for fostering a more equitable, sustainable, and scalable technology-driven educational model in disadvantaged areas.

More than 350 million people worldwide suffer from depression. Major depressive disorder has a hugely negative impact on psychological well-being, work, and family life. Yet culture may shape how depressed patients interpret their symptoms, choose treatments, and behave. This paper reports a case study, including participant observations and interviews, of the Chinese online depression community, SunForum. Our findings reveal that Chinese cultural beliefs (e.g., the power of inner self-control) and Chinese beliefs about traditional medicine (e.g., the integrated body-mind relationship) significantly affect patients' understandings of depression, illness management, and social interactions. These beliefs create problems of understanding depression in society - including family members, friends, co-workers, and others - and present various challenges for depressed patients who can become marginalized, suffer discrimination, and lose their jobs. We draw implications for how Chinese society as a whole may respond to the misunderstanding of mental illness and the raising of public awareness. We also propose specific social media design to support depressed patients as they seek online information and social support.

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.

China has overtaken India and the U.S. as host to the largest diabetic population in the world. Many problems exist in the Chinese healthcare system and very small number of diabetes patients receives treatment. Our paper reports on a case study through the lens of an online diabetes patient community, Sweet Home. We conducted participant observations, text analysis, and interviews, to understand the health management of patients at Sweet Home. Our findings reveal that patients' understanding of diabetes, their choice of treatments, their routine management, and their interactions with others (in the physical world) and among themselves (in the online world) are influenced by many factors: belief in traditional Chinese versus western medicine, cultural and social norms regarding social eating and drinking, conflicts over self-images, and responses to comments and pressures of coworkers. That is, social context may significantly affect patients' behaviors and each individual patient's actions may also help reshape the social context. We draw out implications for how our society as a whole may respond to these issues, from the perspective of public health, education, and information technology design.

The patient portal is a relatively new healthcare information technology that enables patients more convenient access to their healthcare information and allows them to send messages to their doctors. Our study examines the themes discussed in these messages and the different ways in which patients communicate with their providers via a portal employed in a large medical center. We also explore the differences between the patient portal and more traditional communication media, and investigated the advantages and potential problems of the portal system. Our findings show a wide variety of topics discussed in the communication messages (such as medication, appointments, laboratory tests, etc.) and how patients provide information, consult with their providers, and express psychosocial and emotional needs. We argue that the patient portal improves the accuracy of communication and could facilitate illness management for patients, especially over a longer term. However, messaging through the patient portal is not popular among patients and the simultaneous use of multiple communication media may create information gaps. More research is needed to better elucidate barriers to the use of patient portals and the optimal methods of communication and information integration given different contexts.

The patient Problem List (PL) is a mandated documentation component of electronic health records supporting the longitudinal summarization of patient information in addition to facilitating the coordination of care by multidisciplinary medical teams. In this paper, we report an ethnographic study that examined the institutionalization of the PL. Specifically, we explored: (1) how different groups (primary care providers, inpatient hospitalists, specialists, and emergency doctors) perceived the purposes of the PL differently; (2) how these deviated perceptions might affect their use of the PL; and (3) how the technical design of the PL facilitated or hindered the clinical practices of these groups. We found significant ambiguity regarding the definition, benefits, and use of the PL across different groups. We also found that certain groups (e.g. primary care providers) had developed effective cooperative strategies regarding the use of the PL; however, suboptimal usage was common among other user types, which could have a profound impact on quality of care and safety. Based on these findings, we provide suggestions to improve the design of the PL, particularly on strengthening its support on longitudinal and cooperative clinical practices.

We conducted an ethnographically based study at a large teaching hospital to examine clinician workarounds engendered by the adoption of a Computerized Prescribe Order Entry (CPOE) system. Specifically, we investigated how adoption of computerized systems may alter medical practice, order management in particular, as manifested through the working-around behavior developed by doctors and nurses to accommodate the changes in their day-to-day work environment. In this paper, we focus on clinicians' workarounds, including those workarounds that gradually disappeared and those that have become routinized. Further, we extend the CSCW concept of boundary object (to "assemblage") in order to understand the workarounds created with CPOE system use and the changing nature of clinical practices that are increasingly computerized.

Unpredictable yet frequently occurring exception situations pervade clinical care. Handling them properly often requires aberrant actions temporarily departing from normal practice. In this study, the authors investigated several exception-handling procedures provided in an electronic health records system for facilitating clinical documentation, which the authors refer to as 'data entry exit strategies.' Through a longitudinal analysis of computer-recorded usage data, the authors found that (1) utilization of the exit strategies was not affected by postimplementation system maturity or patient visit volume, suggesting clinicians' needs to 'exit' unwanted situations are persistent; and (2) clinician type and gender are strong predictors of exit-strategy usage. Drilldown analyses further revealed that the exit strategies were judiciously used and enabled actions that would be otherwise difficult or impossible. However, many data entries recorded via them could have been 'properly' documented, yet were not, and a considerable proportion containing temporary or incomplete information was never subsequently amended. These findings may have significant implications for the design of safer and more user-friendly point-of-care information systems for healthcare.

We conducted a field-based study at a large teaching hospital to examine doctors' use and documentation of patient care information, with a special focus on a patient's psychosocial information. We were particularly interested in the gaps between the medical work and any representations of the patient. The paper describes how doctors record this information for immediate and long-term use. We found that doctors documented a considerable amount of psychosocial information in their electronic health records (EHR) system. Yet, we also observed that such information was recorded selectively, and a medicalized view-point is a key contributing factor. Our study shows how missing or problematic representations of a patient affect work activities and patient care. We accordingly suggest that EHR systems could be made more usable and useful in the long run, by supporting both representations of medical processes and of patients.

We conducted a field-based study examining informal nursing information. We examined the use of this information before and after the adoption of a CPOE (Computerized Provider Order Entry) system in an inpatient unit of a large teaching hospital. Before CPOE adoption, nurses used paper working documents to detail psycho-social information about patients; after the CPOE adoption, they did not use paper or digital notes as was planned. The paper describes this process and analyses how several interlocked reasons contributed to the loss of this information in written form. We found that a change in physical location, sufficient convenience, visibility of the information, and permanency of information account for some, but not all, of the outcome. As well, we found that computerization of the nursing data led to a shift in the politics of the information itself - the nurses no longer had a cohesive agreement about the kinds of data to enter into the system. The findings address the requirements of healthcare computerization to support both formal and informal work practices, respecting the nature of nursing work and the politics of information inherent in complex medical work.

Video connections can establish a media space in which games may be played, just as people play games while collocated. Experiments with participants playing the game 'Mafia' indicate that people in a video condition have similar levels of satisfaction, fun, and frustration, to those that play while collocated. This finding holds for both those with prior experience using video systems and those without, suggesting it is not merely a "novelty effect." Results differ about whether there exist differences in focus of attention, suspicion/trust, and pointing for people playing the game while using a video system. Implications for both fun and work uses of video are suggested.