HIT Human Factors Award Winner Looks to Bright Future

In an industry dominated by billion-dollar deals and the launch of teraflop-scale analytics platforms, a $1,000 prize won by a graduate student may not appear to offer particularly salient lessons, but don't tell that to Spencer Kohn.

Kohn, who with colleague Cheng Guo recently won the Human Factors and Ergonomics Society's (HFES) "Mobile Health Applications for Consumers" student design competition with an app that allows patient-controlled medical record sharing, said current snafus in interoperability and data portability are likely transitory problems, and that, in the trenches, anyway, clinicians and patients are quite simpatico on how the flow of health information could be facilitated with technology such as his.

The app, called Hermes after the Olympian messenger who moved with ease between mortal and divine worlds, allows users to select a healthcare provider and choose which personal health information can be accessed by that provider.  The HFES called the application "intuitive and simple to use," citing sharing settings that can be created in moments with little information required from the user.

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"Hermes enhances privacy and eases the process of transferring electronic health records for both patients and providers," HFES judges said in announcing the prize, and Kohn, currently a graduate student in George Mason University's human factors and applied cognition program, said he does not feel like a voice in the wilderness – on the contrary, he said the human factors component of health IT is a vital element that is currently underdeveloped but fully appreciated.

"I don't feel like I'm pushing against a wall," Kohn said. "There are massive companies dominating the field, but the people I talk to at these conferences, the people I email back and forth, are entirely supportive of this. It's giving patients control over their own health information, taking that right away from doctors – or that ability away from doctors. Believe it or not, doctors are OK with that, most the ones I spoke with."

Kohn's sentiments are backed by the research supporting Hermes. Published in the Journal of General Internal Medicine and led by Kohn's former mentor at Clemson University, Kelly Caine,  the research convincingly demonstrated  patients surveyed for the project unanimously wanted control over who got access to their medical records, how long that access should be granted, and how much of that information should be available.

Kohn said he and Guo addressed two essential problems with data sharing: ease of use/efficiency in getting records to a pertinent provider, and granularity of privacy control.

"The way things are predominantly set up now, sharing of EHRs is pretty much binary," he said. "You either share the entire thing or you don't. Theoretically, there is a way around that, but I personally  have yet to see that successfully achieved. So we designed this app."

The Hermes prototype, which relies on cloud-based records, offers standard presets with different levels of privacy control: All, Most, Some, and None, loosely based on one of Caine's previous studies of patient privacy preferences. Choosing All grants the recipient access to the entire EHR; Most shares everything except potentially sensitive categories such as drug and alcohol use; Some shares only demographics, current health, and medications; and None gives users with greater privacy needs the option to not divulge any of their health information while still allowing their provider to enter new information into their existing record. These options are visually associated by proximity and similar colors, avoiding marking or coloring that would indicate any as the ‘right’ or ‘wrong’ option. In user testing, participants tended to prefer the All preset over the other three options.

Kohn is under no illusion that his prize-winning technology will be ready for real-world deployment any time soon. It is strictly a research platform, but one he says is aligned with the emerging healthcare economy that necessitates consumer convenience and a sense of partnership with providers – Kohn said patients' sense of frustration at communications breakdowns, the sense of wasting time filling out paper forms at every new provider's office, and being left in the dark on exactly what's in their records will necessitate a more equitable approach.

"Consumers have always been a little bit fed up in some of these areas, and now for the first time, they are beginning to have alternatives," he said. "It's a burgeoning field. There is a flood of new consumer technology and provider technology and so much of it is being developed faster than the human factors research behind it.  There are different ways to do these things. There are a lot of great companies, and a lot of great providers who are doing an amazing job of adapting their systems but equally, some of them aren't. Workarounds hurt doctors, and hurt patients, and it's unfortunate that needs to happen, but I think we're finally at a point where healthcare is beginning to catch up. It's not there yet."