AMIA2014 Workflow Paper (Monday) Engineering for reliability in at-home chronic disease management

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[CW: Great table! > Table 2. Summary of reliability system design strategies used by participants to enhance self-care reminders.]

3:30PM Sunday

“Prospective Memory as a Basis for Task Planning and Recall

Remembering to perform all the tasks expected for proper self-management requires effective recall of what has already happened and a continuous scan of what needs to happen in the near future. The process of remembering is frequently framed as either of two types: (1) retrospective memory that is concerned with the retrieval of past memories of people, events, and words, or (2) prospective memory that is concerned with remembering to perform a planned action or intention in the future11. The latter process includes short-term intentions—such as daily intake of a medication—as well as delayed actions—such as going to an annual checkup appointment—that could occur weeks or months in the future. Outlined in Figure 1, the process for realizing a delayed intention begins with encoding the future action, retaining the intention, and then retrieving the intention at the appropriate time to complete the action. This can occur through either an explicit reminder system or through spontaneous retrieval. Actions such as remembering to take medication at breakfast often rely on spontaneous retrieval of the intention that is triggered through environmental and physiological cues linked to daily routines. However, intermittent actions further out in time often involve a more explicit signaling cue—such as creating an alarm on a phone—to retrieve and execute the action at the right time12. In the case of an individual managing a chronic condition, the capacity to reliably shape and direct future behavior is critical to successfully managing the disease. The role of both explicit and implicit reminder systems within this memory process is the focus of this paper.
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Designing for Human Error

Importantly for systems-thinking, our study highlights the variety of ways that failures can occur in remembering to perform self-care management activities. Therefore, the design of reminder systems to support self-management should account for errors by making it easier to detect, evaluate, and respond to failures when they do occur.”

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