Scenarios

Introduction

On this page are some example scenarios that can use different Personal Preferences Approaches in a healthcare platform. Not all scenarios are mutually exclusive, they may build onto or compliment one another for interoperability in a wider ecosystem.

These scenarios demonstrate the use of values, principles, and guidelines from the Guide for Reducing Barriers to Virtual Healthcare:

Values: Working and engaging in a complex, evolving, and interconnected system
Guideline principles: Contextualization can individualize healthcare experiences
Guidelines:
- Enhancing intake process to personalize service delivery
- Improving service by storing and sharing complimentary information
- Encourage self-documentation and personal data logging

Scenario 1: No Personal Preferences

A healthcare platform that does not allow for any expression of personal preferences. In this case there are no adjustments individuals can make to configure the system to meet their own needs and preferences.

Pros

Can initially be quicker to design and implement.

Cons

No ability to personalize the user experience.
Individuals will have to adapt themselves to the system or not be able to make use of some/all features.
Retrofitting new features to support future requirements may be more time consuming and expensive.
System does not facilitate sharing any personal preferences between the patient's and healthcare systems.

Other

Individuals might be able to bring their own customizations through system preferences (i.e. OS or browser settings).
Assistive technology can bridge some of these gaps.
- there are a limited number of affordable or free options.
- dependent on device and software used to access the healthcare platform.
- requires some design/intention for best interoperability.

Patient Example

You find the contrast of the text on your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around for a way to adjust the contrast or text size to help, but are unable to find any way to do that. Finally you go into your computer's settings and modify the contrast settings until the text is easier to read. However, this has affected the rest of your applications, and you'll need to revert the change afterwards.

Practitioner Example

You find it difficult to read through the various lab results as a table of data, each time you bring up a patient's records you have to manually switch to the data view. You look for a way to make this the standard presentation, but there doesn't appear to be a way to do this.

Scenario 2: Personal Preferences for a Single Platform

A healthcare platform that allows for some personal preferences; however, those preferences only apply to itself. The individual does not have the ability to import preferences from other applications or systems, or export their preferences to be used elsewhere. This means that when moving between healthcare platforms they will need to re-specify their preferences.

Pros

Individuals are able to customize the system.
Facilitates sharing of personal preferences between the patient and the practitioner on a single system.

Cons

Individuals need to specify their preferences for each healthcare platform they interact with.

Patient Example

You find the contrast of the text in your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around the interface for a way to adjust the contrast or text size and notice an option for doing just that. You make some adjustments until you find settings that allow you to comfortably read the content.

Your doctor refers you to a specialist; however, you run into the same issue again on the specialist's site and begin the process of adjusting the settings all over again.

Practitioner Example

You find it difficult to read through the various lab results as a table of data, each time you bring up a patient's records you have to manually switch to the data view. You look for a way to make this the standard presentation, and fortunately you find that you can save this preferences. Now each time you open a patient's lab results you see a graph of the results and can easily compare them across time.

Scenario 3: Personal Preferences for a Single Platform: Export/Import

A healthcare platform that allows for some personal preferences. Preferences can be imported or exported in some data format (e.g. JSON).

Pros

Individuals are able to customize the system.
Individuals can share preferences across healthcare platforms.
Enables different practitioners on different systems to be able to customize delivery of care for this individual using a manual import / export process.

Cons

Individuals need to manually manage exporting from one system and importing to another.
Individuals need to manually manage the synchronization of preferences across platforms as they make updates.
- e.g. export and import for subsequent changes, or make the change in each system separately.
Requires that each healthcare platform support import and export features.
Requires that each healthcare platform support a common data format, or provide different options for import and export.
- Individuals may be required to manually convert between data formats.

Patient Example

You find the contrast of the text in your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around the interface for a way to adjust the contrast or text size and notice an option for doing just that. You make some adjustments until you find settings that allow you to comfortably read the content.

Your doctor refers you to a specialist; however, you run into the same issue again on the specialist's site. Fortunately while you were setting your preferences on your doctor's site you noticed that you could export them. Your specialist's site allows you to import preferences, so you take a couple of minutes to transfer them over.

Practitioner Example

You find it difficult to read through the various lab results as a table of data, each time you bring up a patient's records you have to manually switch to the data view. You look for a way to make this the standard presentation, and fortunately you find that you can save this preferences. Now each time you open a patient's lab results you see a graph of the results and can easily compare them across time. Unfortunately your clinic is moving to a new healthcare platform that also defaults to the raw data view. You were able to export your preferences before the switch over, and imported them in when you start using the new system.

Scenario 4: Centralized Preferences Server

A healthcare platform that allows for centralized storage of some personal preferences.

Pros

Individuals are able to customize the system.
Individuals can share preferences across healthcare platforms.
Synchronization of preferences can be automated through the centralized Preferences Server.
Enables different practitioners on different systems to be able to customize delivery of care for an individual.

Cons

Individuals will need to grant permission to each healthcare platform to access their shared records.
Individuals will need to have an account with the centralized Preferences server (or Single Sign-on authority used by the Preferences Server).
Requires healthcare platforms to integrate with the centralized Preferences Server.

Patient Example

You find the contrast of the text in your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around the interface for a way to adjust the contrast or text size and notice an option for doing just that. You make some adjustments until you find settings that allow you to comfortably read the content.

Your doctor refers you to a specialist; however, you run into the same issue again on the specialist's site. Fortunately while you were setting your preferences on your doctor's site you noticed that you could create an account and save them for future use. Your specialist's site allows you to connect to the same service. You log in and all of your settings are applied.

Practitioner Example

You find it difficult to read through the various lab results as a table of data, each time you bring up a patient's records you have to manually switch to the data view. You look for a way to make this the standard presentation, and fortunately you find that you can save this preferences. Now each time you open a patient's lab results you see a graph of the results and can easily compare them across time. Unfortunately your clinic is moving to a new healthcare platform that also defaults to the raw data view. In the previous system you saved your preferences to a Preferences Server and are able to connect this one to it as well. Once you've again established the connection, your preferences are applied as you like them.

Scenario 5: Centralized Preferences Server: Connecting Disparate Systems

A healthcare platform that allows for some personal preferences. Preferences can be synchronized via a centralized server (like the Preferences Server) and shared with other systems the individual has connected it to.

Pros

Individuals are able to customize the system.
Individuals can share preferences across healthcare platforms and other systems connected to the Preferences Server.
Synchronization of preferences can be automated through the centralized Preferences Server.
Enables different practitioners on different systems to be able to customize delivery of care for an individual.

Cons

Individuals will need to grant permission to each system to access their shared records.
Individuals will need to have an account with the centralized Preferences server (or Single Sign-on authority used by the Preferences Server).
Requires all connected systems to integrate with the centralized Preferences Server.

Patient Example

You find the contrast of the text in your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around the interface for a way to adjust the contrast or text size and notice, that you can connect to the same Preference Server used by your company's intranet. You're able to pull in your preferences from there, including: the contrast, text size, and time's you've blocked your calendar from accepting appointments. You make an additional change to the font style used. Later when you connect to your company's intranet you accept the font style change and use it there as well.

Practitioner Example

You find it difficult to read through the various lab results as a table of data, each time you bring up a patient's records you have to manually switch to the data view. You look for a way to make this the standard presentation, and fortunately you find that you can save this preferences. Now each time you open a patient's lab results you see a graph of the results and can easily compare them across time. You were able to save your preferences to a Preferences Server for future use.

You log into a government website to review current data on infection and vaccination rates. You notice that you can connect to the same Preferences Server that your healthcare platform uses. After connecting to the Preferences Server, the data is displayed using graphics, making it easier for you to track current trends as soon as you login.

Scenario 6: Centralized Preferences Server - Contextual Application

A healthcare platform that allows for centralized storage of some personal preferences. Preferences can be synchronized via a centralized server (like the Preferences Server), and selected/modified based on the application context.

Pros

Individuals are able to customize the system.
Individuals can share preferences across healthcare platforms and other systems.
Synchronization of preferences can be automated through the centralized Preferences Server.
Applying preferences can be contextualized to the specific application being used.
Enables different practitioners on different systems to be able to customize delivery of care for an individual.

Cons

Individuals will need to give permission to each healthcare platform to access their shared records.
Individuals will need to have an account with the centralized Preferences server (or Single Sign-on authority used by the Preferences Server).
Requires all connected systems to integrate with the centralized Preferences Server.
Increases complexity for individuals to manage preferences across systems.

Patient Example

You find the contrast of the text in your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around the interface for a way to adjust the contrast or text size and notice an option for doing just that. You make some adjustments until you find settings that allow you to comfortably read the content.

Your doctor refers you to a specialist. On the specialist's site, you notice that you can connect to the same Preferences Server and retrieve your previously set preferences. However, the contrast on the specialist's site is already quite legible and you prefer not to use any specific contrast settings. You only include the text size preference initially set on your doctor's site, but do not enable the contrast preference.

Practitioner Example

You find it difficult to read through the various lab results as a table of data, each time you bring up a patient's records you have to manually switch to the data view. You look for a way to make this the standard presentation, and fortunately you find that you can save this preferences. Now each time you open a patient's lab results you see a graph of the results and can easily compare them across time. You were able to save your preferences to a Preferences Server for future use.

You started teaching a course and are logging into the institution's Learning Management System (LMS) to review your students' grades. You notice that you can connect to the same Preferences Server. However, in this case you do prefer to see the data in tabular format, so you do not enable that preference setting for the LMS.

Scenario 7: Personal Preferences Included with Health Record

A healthcare platform that allows for some personal preferences. Preferences can be stored within the patient's healthcare record. The HL7 Fast Healthcare Interoperability Resources, Release 4 (FHIR, R4) provides an interoperable specification for health information storage and exchange. It defines how to record information about the patient. This already includes some communication preferences and includes optional extensions (e.g communication preferences, interpreter required, disability, and etc.). The FHIR spec recognizes that there may be additional information needed that hasn't been included in the spec. The spec allows for extensibility to account for these additional requirements.

The FHIR spec and pre-defined extensions include some support for preferences; mostly around communication/language. It is likely that personal preferences will primarily need to be included using the extensibility features, in order to allow for the full breadth of personal preferences that should be offered. However, without an agreed upon common set of requirements, it may make interoperability more difficult.

In addition to patient records, the FHIR spec also accounts for practitioners. Which could be used to specify the practitioners preferences for virtual healthcare platforms in addition to matching patients with practitioners (e.g. on the basis of preferred language or other cultural sensitivities). Similar considerations can be made for other administrative records covered by FHIR, such as location.

Pros

Individuals are able to customize the system.
Individuals can share preferences across healthcare platforms.
Synchronization of preferences can be automated through the healthcare record.
Possible to use SMART, an API to access health records, to integrate with a broader ecosystem of applications.
Enables different practitioners on different systems to be able to customize delivery of care for an individual.

Cons

Not all jurisdictions include all of the extensions in their implementation guidelines.
Including preferences under the Disability extension could lead to unwanted inferences from the system or healthcare practitioners.
- Healthcare practitioners misinterpreting personal preferences as medical symptoms/conditions.
- Healthcare platforms using medical conditions to infer what personal preferences to apply to a system, without consulting the patient.
- etc.
Requires that the various healthcare platforms understand and interact with the extensions, in particular those added via the more free form extensibility portion.
- Requires an agreed upon extension definition(s) and/or an ability to translate between or understand multiple definitions.
Requires connecting to your healthcare record before settings can be transferred.

Patient Example

You find the contrast of the text in your family doctor's virtual healthcare platform too low, so it is difficult for you to read the content. You are able to make out most of the text, but it is causing a lot of strain and fatigue.

You look around the interface for a way to adjust the contrast or text size and notice an option for doing just that. You make some adjustments until you find settings that allow you to comfortably read the content.

Your doctor refers you to a specialist; however, you run into the same issue again on the specialist's site. After setting up your account, via your doctor's referral, your preferences are automatically applied.

Scenario 8: Preference Synthesis Through Introspection

A system that allows one to analyze their own data and synthesize preferences that can be shared to personalize other systems to one's own needs and preferences. This may take the form of a journalling tool.

Pros

Individuals are able to explore, aggregate, and analyze information about themselves.
Individuals are empowered to synthesize those personal inferences into preferences to configure other systems with.
Individuals are able to connect with third parties (individuals, services, etc.) to analyze data as needed.

Cons

Breadth of data may make inferring relationships complicated.
Need to know how to translate inferences into preferences.
Using third parties to help with analysis may be a privacy concern.

Patient Example

In your journal, you log your medication schedule noting which prescriptions are taken, in what doses and at what times. You also start a mood tracker. After a few days you notice a co-relation between the time you take your medication and feeling more irritable. Your mood tracker seems to indicate that you feel better a few hours after taking your medication. You make a note to bring this up with your doctor at your next appointment.

Using this information you generate a preference to block meetings during the three hour window after you take your medication. You save this preference to the connected Preferences Server, which is also connected to your doctor's healthcare platform and your company's office suite. Now anyone trying to book a meeting with you, will see that you aren't available at that time. When you go to make a follow up appointment with your doctor, you see that the scheduling system has flagged your blocked times and suggests alternative time slots. You're also able to connect to your journalling tool, to pull in your analyzed data to send to your doctor.

Practitioner Example

In your journal, you've been tracking your eye strain and fatigue. From the data you've pulled in from your healthcare platform you notice that this corresponds to longer hours spent in video appointments.

Using this information, you generate a preferences to set your scheduling system to prefer phone calls. You create a preference to adjust your hours to allow for a couple of breaks in the middle of the day so that you can rest for a few minutes between blocks of appointments. These are saved to the connected Preferences Server, and automatically updated for future bookings in the healthcare platform.