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Enormous advances in information technology have permeated essentially all facets
of life. Although these technologies are transforming the workplace as well as
leisure time, formidable challenges remain in fostering tools that enhance
productivity, are sensitive to work practices, and are intuitive to learn and to use
effectively. Informatics is a discipline concerned with applied and basic science of
information, the practices involved in information processing, and the engineering
of information systems.
Cognitive Informatics (CI), a term that has been adopted and applied particularly
in the fields of biomedicine and health care, is the multidisciplinary study of cogni­
tion, information and computational sciences. It investigates all facets of computer
applications in biomedicine and health care, including system design and computer-­
mediated intelligent action. The basic scientific discipline of CI is strongly grounded
in methods and theories derived from cognitive science. The discipline provides a
framework for the analysis and modeling of complex human performance in tech­
nology-­mediated settings and contributes to the design and development of better
information systems for biomedicine and health care.
Despite the significant growth of this discipline, there have been few systematic
published volumes for reference or instruction intended for working professionals,
scientists or graduate students in cognitive science and biomedical informatics,
beyond those published in this series. Although information technologies are now in
widespread use globally for promoting increased self-reliance in patients, there is
often a disparity between the scientific and technological knowledge underlying
healthcare practices and the lay beliefs, mental models, and cognitive representa­
tions of illness and disease. The topics covered in this book series address the key
research gaps in biomedical informatics related to the applicability of theories,
models, and evaluation frameworks of HCI and human factors as they apply to clini­
cians as well as to the lay public.
Andre W. Kushniruk • David R. Kaufman
Thomas G. Kannampallil • Vimla L. Patel
Editors

Human Computer
Interaction in Healthcare
The Role of Cognition

Second Edition
Editors
Andre W. Kushniruk David R. Kaufman
School of Health Information Science Health Informatics Program, School of
University of Victoria Health Professions
Victoria, BC, Canada SUNY Downstate Health Sciences
University
Thomas G. Kannampallil New York, NY, USA
Department of Anesthesiology
Washington University School of Medicine Vimla L. Patel
St Louis, MO, USA Center for Cognitive Studies in Medicine
and Public Health
New York Academy of Medicine
New York, NY, USA

ISSN 2662-7280     ISSN 2662-7299 (electronic)

Cognitive Informatics in Biomedicine and Healthcare
ISBN 978-3-031-69946-7    ISBN 978-3-031-69947-4 (eBook)
https://doi.org/10.1007/978-3-031-69947-4

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William (Bill) J Clancey
His prescient use of cognitive models to
enhance our understanding of human
cognition and to develop better tools for
student learning in medicine have greatly
influenced our research on medical
cognition.
James (Jim) J Cimino
His keen insight into the importance of the
user experience, and his efforts to promote
cognitive research in clinical practice, have
affected the way clinical systems are
perceived and used.
Foreword

When I was first introduced to computing (in university, not on my parents’ laps the
way it happens today), the notion of interface design was pretty much irrelevant.
Initially (1966), I wrote my programs on paper and then translated them onto punch
cards that were run through mainframe computers in batch mode. A direct human
interface with the computer did not actually occur. Within a few years, I was able to
type code into minicomputers using teletype machines—all uppercase, noisy, and
certainly not mobile. The results of a program then came back as scrolling text on
paper produced by the same teletype. And, a few years after that, we had moved on
to the use of video display terminals although the screens still displayed only ASCII
characters, and efforts to draw pictures were achieved solely by using keyboard
characters aligned above or adjacent to others to suggest an image of some sort.
I moved in the early 1970s to what would soon become known as Silicon Valley,
and there (as a Stanford medical student and computer science graduate student) I
was exposed to remarkably inventive activities at Stanford Research Institute (now
known simply as SRI International). Developed in their Artificial Intelligence
Center, “Shakey the robot” was demonstrating whole new ways to interact with
computing devices (this computer-on-wheels had “sensory” inputs, could solve
problems, and then would perform their solution by moving in a room with a plat­
form and pushing objects up or down ramps as required)1. A few years earlier, SRI
scientist Doug Engelbart had developed a new way to interact with characters and
activities on a display screen utilizing a manual device that rolled on a desktop and
used a button to make selections—a creation that he wistfully called a “mouse”
because of the wire “tail” that emerged from it to connect to the display device2. But
most of us were still using keyboards for all our work, depending on paper printouts
to review our programs and their results (initially produced on large line-printers,
next on portable thermal-paper devices, and then on early laser printers).

1
http://en.wikipedia.org/wiki/Shakey_the_robot. Accessed 30 Apr 2023.
2
http://www.dougengelbart.org/firsts/mouse.html. Accessed 30 Apr 2023.

vii
viii Foreword

Nearby SRI was Xerox’s Palo Alto Research Center, known simply as Xerox
PARC, and we at Stanford had close interactions with many of the creative develop­
ers there. By 1973 we had been exposed to their work on the Xerox Alto, the first
computer to use a desktop metaphor and incorporating a mouse pointing device of
the sort that Engelbart had invented at SRI.3 And, by the end of that decade, two
other key innovations were unveiled: (1) the introduction of commercial microcom­
puters (notably the Apple II, first presented to the public in April 19774, and the first
IBM PC, which did not appear until four years later5), and (2) the introduction of
local area networking (LANs) in the form of Ethernet technology, developed by
Bob Metcalfe at Xerox PARC and then spun off into a company called 3Com
in 1979.6
But even at the end of that decade, most of us were still using character-based
devices without graphical capabilities, and our access to networks was limited to the
wide-area technology of the ARPANET7. I do not remember any discussions of
interface design or human-computer interaction during most of the 1970s, although
pertinent notions were beginning to develop, mostly at Xerox PARC in light of their
Alto experience. Everything changed in the following decade. Xerox did introduce
commercial products based on its Alto work (an office document-management sys­
tem known as the Star8, and a set of machines that were designed to support work
coded in the Lisp programming language9), but their innovations had led to expen­
sive special-purpose machines and failed to succeed in the marketplace [1]. The
1983 introduction of the Apple Lisa10 (a personal computer with a graphical user
interface, icons, and mouse pointing device), followed a year later by a less expen­
sive and commercially successful successor, the Apple Macintosh11, changed com­
puting (and human-computer interaction) in key ways. Before long the notion of a
computer “desktop” became standard, with icons, files, folders, and images. It was
in this context that it became clear that programmers needed to understand their
intended users and to design systems that would be intuitive, usable, and well
matched with the user’s needs and assumptions.
I have summarized this history here because I fear that we too often forget that
our remarkable advances in computing and communications happened gradually,
with key early insights and inventions that led incrementally to the interconnected
world of ubiquitous computing that we expect and accept today. The same is true of
our knowledge of human–computer interaction, which began as a subject of study

3
http://en.wikipedia.org/wiki/Xerox_Alto. Accessed 30 Apr 2023.
4
http://en.wikipedia.org/wiki/History_of_Apple_Inc.#Apple_II. Accessed 30 Apr 2023.
5
http://www-03.ibm.com/ibm/history/exhibits/pc25/pc25_birth.html. Accessed 30 Apr 2023.
6
https://history-computer.com/ethernet/. Accessed 30 Apr 2023.
7
http://en.wikipedia.org/wiki/ARPANET. Accessed 30 Apr 2023.
8
http://en.wikipedia.org/wiki/Xerox_Star. Accessed 30 Apr 2023.
9
http://en.wikipedia.org/wiki/Lisp_machine. Accessed 30 Apr 2023.
10
http://oldcomputers.net/lisa.html. Accessed 30 Apr 2023.
11
http://apple-history.com/128k. Accessed 30 Apr 2023.
Foreword ix

(as I have stressed) decades after we first began to work with early computing
devices. Most of us began with highly intuitive notions of how a computer should
interact with its users, and there were no courses or principled books to guide us. It
was largely with the introduction of graphical user interfaces that notions of right
and wrong ways to build interfaces began to emerge.
I was accordingly impressed, in 1980, when I encountered the first of Ben
Shneiderman’s books on psychological issues and human factors in the design of
computer systems [2]. This initial volume focused more on programming styles,
team organization, and personality factors, but I was intrigued and inspired by the
psychological emphasis and the notion that cognition was a crucial consideration in
the design and construction of computing systems. It was his landmark book on user
interface design, which appeared in its first edition in 1986, that ultimately per­
suaded me that there was an important set of scientific issues to be explored and that
building the interface to a computer system should be based on theory and estab­
lished principles rather than intuition. Now in its sixth edition, that book continues
to be a classic volume for those interested in how to achieve effective human-­
computer interaction through principled interface design [3]. Shneiderman has fur­
ther built on this landmark volume with his recent important and influential book on
human-centered artificial intelligence [4].
As a physician and computer scientist who has watched biomedical informatics
evolve from an exploratory discipline to a more mature field that feeds into a vibrant
health information technology industry, I can identify poor human engineering as a
key barrier to the successful fielding of computer systems for health care and bio­
medicine. Physicians and other health professionals, who too often despise or reject
the systems they are asked to use, will almost always focus on problems with the
interface design and performance: “confusing,” “inefficient,” “slow,” “difficult to
learn,” “annoying,” “condescending,” “unusable,” and many more similar character­
izations. With the introduction of electronic health records (EHRs) in recent
decades—ones that have interfaces that too often generate similar outcries from
physicians and other clinical users—we have seen common human-interface limita­
tions emerge as complaints associated with the notion of clinician “burnout.” I
accordingly applaud efforts to focus on human-computer interaction and usability
in the design and implementation of clinical systems and would like to see com­
mercial developers embrace these concepts more aggressively in their design and
introduction of systems for clinical use.
The best of intentions, and great cleverness in information and knowledge manage­
ment, will come to naught if the systems that provide clinical functionalities are con­
structed without deep insight into the cognitive issues that affect the intended users.
The growing field of cognitive informatics, with its focus on health and biomedicine
as demonstrated in the current updated volume, is accordingly a crucial element in the
evolution and success of the informatics field [5]. As this book makes clear, there are
core principles and theories that need to be understood, and a set of methods for
exploring the cognitive processes of both users and system developers, that will deter­
mine the utility and success of the systems that are built for use in healthcare settings,
thereby demonstrating the importance of these cognitive principles. Their importance
x Foreword

cannot be overstated, and it will be crucially important for students of biomedical

informatics to learn these skills and insights and to bring them to bear in future work.
I applaud the efforts of Drs. Kushniruk, Kaufman, Kannampallil, and Patel, and all the
chapter authors, for compiling a second edition of their important and influential book
on this topic. I commend this updated edition to all those who want to assure that the
systems they build, and the interactive environments that they promote, will reflect the
rigor and dedication to human-computer interaction principles, including cognitive
informatics, that will ultimately enhance both the user’s experience and the quality
and safety of the care that we offer to patients.

References
1. Smith DK, Alexander RC. Fumbling the future: how Xerox invented, then
ignored, the first personal computer. iUniverse; 1999. ISBN-13: 978-1583482667.
2. Shneiderman B. Software psychology: human factors in computer and informa­
tion systems. Winthrop Publishers; 1980. ISBN-13: 978-0876268162.
3. Shneiderman B, Plaisant C, Cohen M, et al. Designing the user interface: strate­
gies for effective human-computer interaction. London: Pearson; 2016. ISBN-13:
978-0134380384.
4. Shneiderman B. Human-centered AI. Oxford University Press; 2022. ISBN-13:
978-0192845290.
5. Shortliffe EH. Reflections on the role of cognitive science in biomedical infor­
matics (Chapter 23). In: Patel VL, Kaufman D, Cohen T, editors. Cognitive
informatics in health and biomedicine: case studies on critical care, complexity
and errors. London: Springer; 2013. p. 467–75. ISBN-13: 978-1447154891.

Chair Emeritus and Adjunct Professor, Edward H. Shortliffe

Department of Biomedical Informatics
Columbia University,
New York, NY, USA
May 2023
Preface

One might ask why cognitive scientists have prepared a book that deals with a
topic—human-computer interaction (HCI)—that has typically been the purview of
computer scientists. Computer science is of course well represented in this volume,
but the orientation of the discussion is distinctly cognitive. Some background may
be helpful in explaining how this cognitive focus has emerged as we consider the
realities of human-computer interaction within the context of medicine and
health care.
As my team and I embarked on investigations into the nature of cognitive com­
plexity and error in medicine, I became aware that the work would need to consider
the pervasive roles of computers and other technology in high intensity settings such
as emergency departments and intensive care units. However, given my major focus
on the role of cognition, I did not fully anticipate the central role that technology
would begin to play in our discussions and, in turn, in our studies. Our 6-year jour­
ney into these multi-site, team-based investigations quickly showed us that technol­
ogy could either overwhelm or be taken for granted by clinical teams, occasionally
exacerbating typical errors or leading to new ones. However, it also became clear
that technology could play a major role in error mitigation if human cognition and
its interaction with the socio-cultural environment were seriously considered in the
context of system design and use. Furthermore, it was evident that advances in tech­
nology could support data collection and analyses, as well as the modeling of human
behavior, to help us to make better predictions regarding the use and impact of
patient-oriented decision tools, and, in turn, the outcomes of care. In addition, new
sensor-based methods allowed us to track healthcare providers in naturalistic prac­
tice settings, observing unobtrusively how they worked in the context of clinical
workflow. We leveraged these methods to capture real-world data in a more precise
way (at one- or two-second intervals), and then used visualization methods to dis­
play and support the analysis in our laboratory, studying the subjects’ two-­
dimensional movement patterns within the clinical units.
During this time, we also saw a dramatic change in patient behavior, wherein
patients increasingly came to the emergency room, or to see their personal physi­
cians, bringing pieces of paper with information that they had gathered from the

xi
xii Preface

Internet. Similarly, an increase in the use of social media to seek and share health
information became apparent. We accordingly asked whether health information
technology could help to mitigate errors by providing cognitive support to both
healthcare providers and patients, in part by facilitating the delivery of information
and computer-supported care without generating unintended negative consequences,
even in the patients’ homes. There were other questions about the effect of technol­
ogy in shaping human behavior, especially in terms of how information is orga­
nized, retrieved, and used safely, which influenced our thoughts throughout the
process.
Then, during the next few years, I became actively involved in teaching a course
on Human-Computer Interaction and Human Factors in Health Care, offered to
both biomedical informatics and computer science graduate students. We soon
found that there were no books that covered this field in a coherent, systematic way,
especially ones that offered a cognitive perspective that resonated with our view of
the field. Most also offered no special insights or examples drawn from the health­
care environment. I co-taught the class with my colleague, David R. Kaufman, an
educational and cognitive psychologist interested in both HCI and medical applica­
tions. We had no choice but to use papers from a diverse collection of journals and
books, each of which generally covered HCI from a single perspective: biomedical
informatics, psychology, computer science, engineering, or cognitive anthropology.
I increasingly viewed HCI as having a major cognitive component, not solely as a
technical topic. I accordingly reached out to my colleague, Thomas Kannampallil,
who has a background in both computer science and cognition, as a logical person
to work with me on a first edition of an HCI resource that would take a cognitive
perspective while also elucidating the technical components of the field. We then
extended our invitation to David R. Kaufman, who agreed to join us as a third co-­
editor. The resulting first edition has served as a useful resource for researchers
seeking to understand the cognitive issues that arise when designing interfaces for
medical and healthcare applications. It has also facilitated new types of courses
developed to educate those who are designing or building systems that reflect cogni­
tive considerations in the construction of medical applications.
Now, for the book’s second edition, we have sought a pair of fresh eyes to evalu­
ate the current field. I could not think of a more suitable person to lead this second
edition than André W. Kushniruk. André, with a background in both psychology and
computer science, has special expertise in HCI in healthcare and biomedicine. The
next step was to review the topics covered in the first edition, identifying updates or
additional issues that needed to be included in the new volume. Next, we invited the
original chapter authors to update the current chapters and invited new authors to
address the topics in additional chapters. Then, as we edited the revised chapters, we
focused on cognitive themes and particularly asked how these technologies and
methods influence and respond to the human mind and how they facilitate the effec­
tive completion of the tasks to be addressed by users.
We were delighted that the chapter authors enthusiastically agreed to participate
in the book’s second edition, seeing the need for such an updated volume. The
resulting book highlights the current state of the art in HCI. It offers subject reviews,
Preface xiii

drawing from the current research in HCI and providing a graduate-level volume
suitable for use in an introductory HCI course for biomedical informatics, cognitive
science, computer science, or social science students. The volume is particularly
pertinent for biomedical informatics students because most of the examples are
drawn from medicine and health. Still, our classroom experience has shown us that
medical examples can offer concrete motivation for students in computer science or
other fields, even if they may not have a long-term professional interest to work in
the healthcare arena.
This work would not have been possible without dedicated support and collegial
brainstorming with my colleagues and co-editors, André, Thomas, and David. We
spent many hours communicating and providing timely input to the authors. All
chapters were reviewed by one of the editors and one additional reviewer. We are
grateful for the input in the first edition of the book by our research center’s advisory
board members (Bill Clancey, Alan Lesgold, Randy Miller, Michael Shabot, and
Ted Shortliffe), who shaped our thoughts regarding the developing volume while
offering advice and guidance regarding the role of technology in mitigating errors
as well as in providing cognitive support. I am indebted to John Bruer, former presi­
dent of the James S. McDonnell Foundation, who influenced much of my thinking
about cognition and education. His vision, commitment, and support of this field—
especially with an emphasis on biomedicine and health care—provided the founda­
tion that allowed us to create this book on HCI and cognition.

New York, NY, USA Vimla L. Patel

June 2023
Contents

Part I Foundations
1  Multi-Disciplinary Science of Human Computer Interaction
A
in Biomedical Informatics ����������������������������������������������������������������������    3
Vimla L. Patel, Thomas G. Kannampallil, and David R. Kaufman
2 
Cognition and Human Computer Interaction in Healthcare��������������   11
David R. Kaufman, Thomas G. Kannampallil, and Vimla L. Patel
3 
Theoretical Foundations for Health Communication Research
and Practice����������������������������������������������������������������������������������������������   37
Daniel G. Morrow and Karen Dunn Lopez
4 
Applications and Challenges of Human Computer Interaction
and AI Interfaces for Health Care����������������������������������������������������������   63
Meghan R. Hutch and Yuan Luo

Part II Approaches to Evaluation

5 
Evaluation of Health Information Technology: Methods,
Frameworks and Challenges������������������������������������������������������������������   93
Thomas G. Kannampallil and Joanna Abraham
6 
Computational Ethnography: Automated and Unobtrusive
Means for Collecting Data In Situ for Human–Computer
Interaction Evaluation Studies �������������������������������������������������������������� 121
Kai Zheng, David A. Hanauer, Nadir Weibel, and Zia Agha
7 
Analyzing Video-Based Human-Computer Interaction Data
in Healthcare Using a Cognitive-Socio-Technical Framework������������ 151
Andre W. Kushniruk and Elizabeth M. Borycki
8  Cognitive Approach to Understanding and Mitigating
A
a Pernicious Infodemic���������������������������������������������������������������������������� 181
David R. Kaufman and Tonya N. Taylor

xv
xvi Contents

9 
Visual Analytics: Leveraging Cognitive Principles to Accelerate
Biomedical Discoveries���������������������������������������������������������������������������� 209
Suresh K. Bhavnani

Part III Design
10 
User-Centered Design and Evaluation of Health Information
Systems: A Rapid Usability Engineering Approach ���������������������������� 235
Andre W. Kushniruk, Helen Monkman, Elizabeth M. Borycki,
and Joseph Kannry
11 
Human Factors and Design for Supporting Healthcare Teams���������� 263
Charlotte Tang, Yan Xiao, Yunan Chen, and Paul N. Gorman
12 
Designing and Deploying Mobile Health Interventions����������������������� 291
Meghan Reading Turchioe, Albert M. Lai, and Katie A. Siek

Part IV Applications
13 
Human-Computer Interaction in Medical Devices������������������������������ 319
Todd R. Johnson, Harold Thimbleby, Peter Killoran,
and Franck Diaz-Garelli
14 
Applying HCI Principles in Designing Usable Systems
for Dentistry��������������������������������������������������������������������������������������������� 345
Elsbeth Kalenderian and Muhammad F. Walji
15 
The Unintended Consequences of the Technology
in Clinical Settings ���������������������������������������������������������������������������������� 371
Amy Franklin and Jeritt Thayer
16 
The Role of Human Computer Interaction in Consumer
Health Applications: Current State, Challenges and Future �������������� 391
Holly B. Jimison and Misha Pavel
17 
Intelligent Decision Support in Personal Health: Personalized
Health Coaching in Type 2 Diabetes������������������������������������������������������ 413
Lena Mamykina, Elliot Mitchell, Pooja Desai, and David Albers

Part V Future Directions

18 
Looking Forward: The Role of Human Computer Interaction
and Cognition in Healthcare ������������������������������������������������������������������ 441
Andre W. Kushniruk, David R. Kaufman, Thomas G. Kannampallil,
and Vimla L. Patel

Index������������������������������������������������������������������������������������������������������������������ 455
About the Editors

Andre W. Kushniruk, PhD, FACMI is the Director and Professor in the School
of Health Information Science at the University of Victoria. He holds undergraduate
degrees in Psychology and Biology, an MSc in Computer Science from McMaster
University, and a PhD in Cognitive Psychology from McGill University. An elected
member of the International Academy of Health Sciences Informatics, the Canadian
Academy of Health Sciences, he is a Fellow of the American College of Medical
Informatics. He conducts research in several areas, including evaluation of the
effects of technology, human-computer interaction in health care, and usability
engineering. Dr. Kushniruk’s research focuses on developing new methods for eval­
uating information technology and conducting video analysis of computer users. He
is currently extending this research to remote studies of e-health applications, vir­
tual healthcare, and advanced information technologies, including electronic health
record systems. He has been a key researcher on several national and international
collaborative projects and has held academic positions at several Canadian universi­
ties. Besides his research with the publication of over 200 scholarly peer-reviewed
articles and as a co-editor of several books in health informatics, Dr. Kushniruk has
mentored numerous students and is actively involved with teaching, bridging aca­
demia to industry.

Thomas G. Kannampallil, PhD, FAMIA is an Associate Professor in the Wash­

ington University School of Medicine’s (WUSM) Department of Anesthesiology
and the Institute for Informatics. He also holds joint appointments in the Depart­
ment of Computer Science and Engineering, and the Division of Biology and Bio­
medical Sciences. He is the Associate Chief Research Information Officer (CRIO)
at WUSM. His research interests lie at the intersection of computer science, cogni­
tive science, and clinical informatics, focusing on developing and evaluating intel­
ligent computational tools for improving clinical decision-making and patient
safety. More recently, Dr. Kannampallil’s research has focused on developing artifi­
cial intelligence (AI)-based tools for improving postoperative and mental health
outcomes. He is currently the Associate Editor for the Journal of Biomedical Infor-
matics and serves on ONC and PCORI technical expert panels on health informa­

xvii
xviii About the Editors

tion technology. He was elected as a Fellow of the American Medical Informatics

Association (FAMIA) in 2021. His research is supported by funding from the
Agency for Healthcare Research and Quality (AHRQ), National Institute of Aging
and National Library of Medicine.

David R. Kaufman, PhD, FACMI is an Associate Professor in Health Informat­

ics at SUNY Downstate Health Sciences University. Previously, he was an Associ­
ate Professor of Biomedical informatics and the Director of the Graduate Training
Program at Arizona State University (ASU). With an undergraduate degree in psy­
chology, he received his masters and doctorate in educational psychology, both
from McGill University. In 2017, he was elected a Fellow of the American College
of Medical Informatics. Dr. Kaufman worked in human-computer interaction (HCI)
and human factors for about 25 years. He has extensive experience conducting cog­
nitive research concerning informatics initiatives and evaluating various health
information technologies (HIT) developed for clinicians, patients, and health con­
sumers. Since 1994, his involvement in HCI projects on the evaluation of electronic
health records, computer-provider order entry systems, and a large-­scale telemedi­
cine system for patients with diabetes has transitioned to a recent NIH-funded tele­
health clinical trial for stroke disparity patients. Dr. Kaufman was the principal
investigator on a Mayo Clinic-ASU ROOT project, which characterized the EHR
workflows during the transition to another EHR. He is currently leading an AHRQ-
funded effort to characterize pandemic workflow at a Brooklyn safety-net hospital,
with the objective to fashion technology-mediated solutions that will enhance data
collection, aggregation, synthesis, and visualization to support decision-making.

Vimla L. Patel, PhD, DSc, FACMI is the Director and Senior Research Scientist
at the Center for Cognitive Studies in Medicine and Public Health at the New York
Academy of Medicine. She has adjunct professorial appointments at Columbia Uni­
versity, Arizona State University, and Weill Cornell Medical College in New York.
Trained as a cognitive and educational psychologist at McGill University, Dr. Patel
served as a Professor of Medicine and Psychology. She has expertise in using cogni­
tive methods to capture and analyze data to model clinical decision-making and
explore ways to augment human intelligence. Her recent research addresses the
nature of complexity in the healthcare environment and the use of appropriate meth­
ods of investigation for health information technology intervention and patient
safety. She is an elected fellow of the Royal Society of Canada (Academy of Social
Sciences), the American College of Medical Informatics, and the New York Acad­
emy of Medicine. An elected founding member of the International Academy of
Health Sciences Informatics, she is the past Associate Editor of the Journal of Bio-
medical Informatics and on the editorial board of the Journal of Intelligence-Based
Medicine and Healthcare. She is an editor or co-editor of eight books and the series
editor of the Springer book series in Cognitive Informatics in Biomedicine and
Healthcare.
 Part I
Foundations