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Patient Journey Maps are an emerging concept that visually map each interactive touchpoint that the patient experiences as they navigate the care continuum. The purpose of this article is to: 1) Identify the ways that patient journey mapping has been used to identify efficiencies and inefficiencies in the healthcare process from a patient perspective, 2) Identify the type of approaches that have been documented to visually identify the patient journey, 3) Identify how information tools can be taken into account to improve gaps identified by patient journey mapping; and 4) Detail what patient journey visualization and mapping tools currently exist (and are used) in research and healthcare practice. A scoping review literature exploration, following the Arksey and O’Malley Framework (2005) was conducted in the PubMed database, with a focus on English publications only, using the search terms “patient journey map.” Two researchers iteratively assessed the articles based on inclusion and exclusion criteria; 30 articles were included in the study. A thematic analysis was conducted and the findings were tabulated in the data extraction table. The patient journey map has considerable promise but continues to be an underutilized resource in industry - further research and standardization is required to increase adoption in the healthcare setting.

While there has been a rapid growth of digital health apps to support chronic diseases, clear standards on how to best evaluate the quality of these evolving tools are absent. This scoping review aims to synthesize the emerging field of mobile health app quality assessment by reviewing criteria used by previous studies to assess the quality of mobile apps for chronic disease management. A literature review was conducted in September 2017 for published studies that use a set of quality criteria to directly evaluate two or more patient-facing apps supporting promote chronic disease management. This resulted in 8182 citations which were reviewed by research team members, resulting in 65 articles for inclusion. An inductive coding schema to synthesize the quality criteria utilized by included articles was developed, with 40 unique quality criteria identified. Of the 43 (66%) articles that reported resources used to support criteria selection, 19 (29%) used clinical guidelines, and 10 (15%) used behavior change theory. The most commonly used criteria included the presence of user engagement or behavior change functions (97%, n  = 63) and technical features of the app such as customizability (20%, n  = 13, while Usability was assessed by 24 studies (36.9%). This study highlights the significant variation in quality criteria employed for the assessment of mobile health apps. Future methods for app evaluation will benefit from approaches that leverage the best evidence regarding the clinical impact and behavior change mechanisms while more directly reflecting patient needs when evaluating the quality of apps.

The objective of this scoping review is to evaluate the range and nature of electronic decision-support tools that have been researched and/or trialled for patients with head and neck cancer (HNC), and to explore the implication on patient safety through improving risk communication. A scoping review was conducted by: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) collecting data and data items; (5) and reporting on results. Six databases, reference lists and grey literature from Google and Google Scholar were searched, including articles in English from January 2010 to January 2021. Articles discussing electronic decision aids (DAs) for oncology patients were searched then sorted by specificity for HNC. This returned 4217 articles for oncology but only 167 for HNC. Twelve articles met the inclusion criteria and were incorporated in the analysis. Five DAs have been created with varying design characteristics but four consistent themes: appreciation for DAs, usefulness of visuals, impact on reducing decisional conflict and anxiety while increasing knowledge, satisfaction, and shared decision-making, and the variability of patient information needs. Findings demonstrate the paucity of developed and/or trialled electronic DAs for patients with HNC and confirms their value and need for further research and development in this area.

Patient journey mapping represents a new way of reasoning about continuity of care, reducing wait times and improving patient safety. Patient journey mapping allows users such as health professionals, patients and policy makers to identify technologies that can be used to support patient care. Patient journey maps allow one to visualize a patient’s journey and at the same time understand, where gaps in patient care exist. In this paper we discuss a novel approach to patient journey mapping for supporting reasoning and decision making about how technological tools could be integrated into a patient’s health journey. The approach allows for reasoning surrounding technologies in the patent’s digital ecosystem.

Technologies such as electronic health records (EHRs), embedded clinical decision support systems (CDSS) and computerized physician order entry (CPOE) systems are at the forefront of healthcare’s technological revolution. These health information technologies (HIT) pose great promise to improve patient safety, reduce medication errors and increase operational efficiencies in healthcare organizations. However, despite the perceived benefits that these complex technologies offer, their associated risks must not be overlooked or disregarded (Borycki et al., 2012). The objective of this article is to answer the following questions: 1) What is the nature of errors caused by technology (i.e., technology-induced errors) and alert fatigue in healthcare? 2) Is there a relationship between alert fatigue and technology-induced errors? 3) Do organizational strategies exist to address these problems and enhance patient safety? 4) Do technological recommendations exist to improve the current issues surrounding safety? To answer these questions a scoping review following the Arksey and O’Malley (2005) framework was conducted using the CINAHL®, Web of Science®, IEEE Xplore® and PubMed® databases. The search focused on English publications only, using the search terms “Alert Fatigue” and “Technology Errors.” Articles were iteratively assessed based on the inclusion and exclusion criteria, resulting in an inclusion of 36 articles in the final scoping review. Following this, a thematic analysis was conducted and the findings placed in a data extraction table. The results indicated that while HIT present a significant opportunity to streamline processes and reduce medication errors, there is a critical need to assess them from a patient safety and quality lens. Lastly, a novel conceptual tool was created, the Flow of Cognitive Processing Model. The model provides an iterative perspective and an insightful view into the cognitive realms of healthcare professionals in their interactions with HIT. By illustrating the complexities of healthcare providers from a humanistic lens, the model could guide HIT design, acquisitions and implementations to reduce alert fatigue and mitigate the introduction of technology-induced errors.

Technology and device safety has emerged as an important area of research across many disciplines. In this issue of Knowledge Management and e-Learning there is as exploration of some of the key issues and considerations surrounding safety. The issue has a range of papers that can be organized into several themes around safety including the design of systems, their implementation, user perceptions, emerging roles and education. A number of methods and approaches are described that can improve safety. Such research is critical to advancing the evidence base and knowledge in safety science and is an essential aspect of foundational and iterative improvement of technology safety over time.

Journey mapping methods have a number of practical uses. One of the most promising applications in the area of healthcare is to apply patient journey mapping to identify a patient’s pathway through their healthcare journey. Nowhere is this more important than in the area of cancer care. With lengthy wait times in many countries and the complexity of care paths that cancer patients travel, there is ample opportunity to identify both gaps in care as well as opportunities to improve care processes. In this article the authors discuss a case study of a patient journey involving multiple care organizations, several health professionals and care in both Canada and the United States. By applying patient journey mapping a simplified version of such complexity can be presented in a visual and succinct way, allowing health professionals and managers of healthcare organizations to identify where inefficiencies in care and patient safety issues occur. Furthermore, this mapping can form the basis for optimizing care processes and holds considerable promise for patient-centred healthcare. Implications of using patient journey mapping for improving cancer care and healthcare more generally are discussed.

Patients with head and neck cancer (HNC) carry a clinically significant symptom burden, have alterations in function (eg, impaired ability to chew, swallow, and talk), and decrease in quality of life. Furthermore, treatment impacts social activities and interactions as patients report reduced sexuality and shoulder the highest rates of depression across cancer types. Patients suffer undue anxiety because they find the treatment incomprehensible, which is partially a function of limited, understandable information. Patients' perceptions of having obtained adequate information prior to and during treatment are predictive of positive outcomes. Providing patient-centered decision support and utilizing visual images may increase understanding of treatment options and associated risks to improve satisfaction with their decision and consultation, while reducing decisional conflict. This study aims to gather requirements from survivors of HNC on the utility of key visual components to be used in the design of an electronic decision aid (eDA) to assist with decision-making on treatment options. Informed by a scoping review on eDAs for patients with HNC, screens and visualizations for an eDA were created and then presented to 12 survivors of HNC for feedback on their utility, features, and further requirements. The semistructured interviews were video-recorded and thematically analyzed to inform co-design recommendations. A total of 9 themes were organized into 2 categories. The first category, eDAs and decision support, included 3 themes: familiarity with DAs, support of concept, and versatility of the prototype. The second category, evaluation of mock-up, contained 6 themes: reaction to the screens and visualizations, favorite features, complexity, preference for customizability, presentation device, and suggestions for improvement. All participants felt an eDA, used in the presence of their oncologist, would support a more thorough and transparent explanation of treatment or augment the quality of education received. Participants liked the simple design of the mock-ups they were shown but, ultimately, desired customizability to adapt the eDA to their individual information needs. This research highlights the value of user-centered design, rooted in acceptability and utility, in medical health informatics, recognizing cancer survivors as the ultimate knowledge holders. This research highlights the value of incorporating visuals into technology-based innovations to engage all patients in treatment decisions.

In this paper, the authors describe a method for exploring the feasibility of using Natural Language Processing (NLP) and Machine Learning (ML) techniques to analyze patient safety incident database reports for themes. We developed a novel thematic analysis strategy to automatically detect keywords and latent themes that describe HIT-related patient safety incidents. The strategy was applied to patient safety reports to test the approach. The efforts by the automated strategy were compared to the efforts by analysts who manually reviewed and identified key words, topics, and themes for the same reports. The computer-based error themes were also compared to the human-determined themes for crosschecking. The manual thematic analysis took about 150 hours to complete on the patient safety reports. The semi-automated approach took only 10% of that time. 95% of the themes extracted from the automated method were aligned with the themes from the manual process. The findings underscore the utility of NLP and ML in identifying thematic patterns embedded in large numbers of unstructured data. The NLP-ML method therefore represents a valuable addition to the tools of detecting and understanding HIT-related errors.

Patient journey mapping represents a visual approach to documenting and analysing the experiences and stories of patients as they move through healthcare systems. Journey maps can also diagrammatically illustrate how patients interact with other stakeholders, systems and organizations throughout their journey. In this special issue a variety of innovative and scientific approaches to mapping the patient journey are described. The methods range from development of journey maps based on observation and interviews, to developing maps based on results of evidence-based literature reviews as well as from case studies. The outputs of the mapping may include an improved understanding of patient experiences, issues and problems encountered as well as the identification of opportunities for improving the healthcare process, patient experience and health outcomes. In this issue a range of health-related applications are described in order to illustrate the potential of the approach for improving complex domains such as healthcare.