The macroergonomics perspective on patient work emphasizes that work performed by patients and their informal caregivers is performed in a work system that has multiple elements (people, tasks, technologies, and physical, social and organizational environment). Patient work is done at multiple system levels of direct care level, organizational level and policy level. Various macroergonomic models of patient work have been developed that can be used to describe and
evaluate the broad sociotechnical system in which patient work occurs. These models can be used to improve the design and implementation of sociotechnical interventions such as patient portal and decision support technologies. Because patient work occurs over time and space, we recommend the approach of mapping the patient journey, which can be applied to improve thepatient work system and outcomes, including outcomes of importance to patients, e.g. their
experience with health care delivery organizations.@en

We used a sociotechnical systems approach-which conceptualizes a system of interacting people, technologies, and tasks, to identify individual differences in personal health information management (PHIM) that can inform the design of patient-friendly environments, tools, and technologies. We conducted a secondary thematic analysis of data collected as part of a parent project, vizHOME. The goal of vizHOME was to improve health and health outcomes through identifying key features in the environment that will inform the design of consumer health information technology HIT. We analyzed interview data collected from 20 individuals with diabetes. We found seven dimensions of PHIM: (1) level of privacy preferred for PHIM; (2) amount of engagement in PHIM; (3) extent of guidance preferred for PHIM; (4) level of documentation preferred for PHIM; (5) degree of physical distribution of PHIM; (6) amount of flexibility in PHIM routine; and (7) use of external cues to manage PHIM. Our results suggest that each dimension exists as a continuum, which are anchored from low to high. Exploring the interaction between PHIM and the sociotechnical system in which PHIM is performed revealed key dimensions of PHIM as well as individual differences in those PHIM dimensions. Identification of individual differences in PHIM can support the creation of human-centered design considerations for tailored environments, products, processes, and technologies that support PHIM. Future research will seek to validate PHIM dimensions in a larger population and develop a PHIM-typing measure to identify PHIM types toward tailoring processes, products, and to individual needs in context.

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