Modern healthcare relies on a connected, integrated and sophisticated backbone of health information technology (HIT). Clinicians rely on HIT (e.g., electronic health records, EHRs) to deliver safe patient care. As has been extensively documented in recent research literature, HIT use is fraught with numerous challenges, some of which compromise patient safety (Koppel et al. 2005; Horsky et al. 2005; IOM 2011). Usability and more specifically, workflow, data integration and data presentation are among the principal pain points identified by clinicians in a recent HIMSS survey (2010). These issues are the subject of a growing body of applied research in human-computer interaction (HCI) and allied disciplines.

HCI is an interdisciplinary science at the intersection of social and behavioral sciences, and computer and information technology. Drawing from the fields of psychology, computer and social sciences, HCI is concerned with understanding how people interact with devices and systems, and how to make these interactions more useful and usable (Carroll 2003).

HCI research was originally spurred by the advent of personal computers in the early 1980s. HCI developed as an applied science, drawing heavily on software psychology, to enhance the design and evaluation of human-computer interfaces (Shneiderman 1992). With early work rooted in modeling human performance and efficiency of using interfaces (Card et al. 1983), HCI has been transformed by developments in technology and software. HCI also became both a focal area of inquiry and application for cognitive science, and a fertile test bed for evaluating cognitive theories.

With advances in computing and technology, HCI research has greatly expanded, spawning several research genres: computer supported cooperative work (CSCW), mobile and ubiquitous computing (UbiComp), and intelligent user interfaces (IUI). While early work on HCI drew heavily on theories and empirical research in cognitive psychology (e.g., research on memory, perception and motor skills), and human factors to explain and improve human interactions with machines, the advent of personal computers transformed the field. Grudin (2012) provides a comprehensive history and development of HCI. The transformation and development of HCI as a field had a profound impact in healthcare as it did in other professional sectors. An extended history is beyond the scope of this chapter. However, we provide a brief synopsis as an entry-point to discuss HCI in the context of healthcare.

HCI research in healthcare has paralleled the theoretical and methodological developments in the field beginning with cognitive evaluations of electronic medical records in the mid-1990s (Kushniruk et al. 1996), extending to a focus on distributed health information systems (Horsky et al. 2003; Hazlehurst et al. 2007) and analysis of unintended sociotechnical consequences of computerized provider order entry systems (Koppel et al. 2005). HCI work in biomedicine extends across clinical and consumer health informatics, addressing a range of user populations including providers, biomedical scientists and patients. While the implications of HCI principles for the design of HIT are acknowledged, the adoption of the tools and techniques among clinicians, informatics researchers and developers of HIT are limited. There is a general consensus that HIT has not realized its potential as a tool that facilitates clinical decision-making, coordination of care, and improvement of patient safety (Middleton et al. 2013; IOM 2011; Schumacher and Lowry 2010). For interested readers, a recent chapter by Patel and Kaufman (2014) provides a detailed discussion on the relationship between HCI and biomedical informatics.

Theories and methods in HCI continue to evolve to better meet the needs of evaluating systems. For example, classical cognitive or symbolic information processing theory viewed mental representations as mediating all activity (Card et al. 1983). Although methods and theories emerging from the classical cognitive approach continue to be useful and productive, they are limited in their characterization of interactivity or of team/group activities. In more contemporary theories of HCI, such as distributed cognition, cognition is viewed as the process of coordinating internal (mental states) and external representations. The scope has broadened to include external mediators of cognition including artifacts and is also seen as stretched across social agents (e.g., a clinical care team). The socio-technical approach has further expanded the focus of HCI research to include a range of social and organizational factors that influence the productive use and acceptance of technology (Berg 1999).

The scope of HCI in biomedicine and healthcare is currently very broad encompassing thousands of journal articles across medical disciplines and consumer health domains. Although the 14 chapters in this volume cover considerable terrain, it would not be possible to cover the full range of research and application of HCI in biomedicine and healthcare. In general, there is a strong focus in this volume on issues in clinical informatics. The chapters by Jimison and colleagues on consumer health informatics (Chap. 12), and by Lai and Siek (Chap. 13) on mobile health are notable exceptions.

Human factors and HCI are sister disciplines and share many of the same methods and foci. Although they remain distinct disciplines, the boundaries of research have become increasingly blurred, often using similar theories and methods (Patel and Kannampallil 2014). In addition, patient safety and clinical workflow are focal topics in applied human factors in healthcare. However, we elected not to specifically cover human factors research because of its immense scope. The handbook edited by Carayon and colleagues (2012) provides excellent coverage (in the 50+ chapters) of this important field. Pervasive computing in healthcare is a burgeoning cutting-edge field of growing importance (Orwat et al. 2008), but is only briefly addressed in a couple of chapters. Similarly, HCI and global health informatics is an important emerging field of research (Chan and Kaufman 2010), but is not dealt with in this volume. Finally, our focus is predominantly on evaluation of HIT in the modern healthcare environment rather than the design (or design approaches) for HIT. Although the chapters in this volume embrace a range of theoretical perspectives, it should be noted that this is part of the Cognitive Informatics series and the frameworks are somewhat skewed toward the cognitive rather than the social perspectives. The omissions in this text leave room for future volumes that will encompass some of these other fields.

The objective of this book is to provide a pedagogical description of HCI within the context of healthcare settings and HIT. Although there is a growing awareness of the importance of HCI in biomedical informatics, there is limited training at the graduate level in HCI for biomedical informatics (BMI) students. An informal review of the curriculum of graduate programs led us to the conclusion that fewer than 25 % of the US-based BMI programs had any course in HCI or related topics. Part of the reason for this, we believe, is the relative inaccessibility of advanced level graduate materials for students. While there are considerable original materials in the form of journal and conference articles, these are idiosyncratic in their coverage of issues and demand greater understanding of cognitive and informatics-related issues. Our purpose with this book is to provide an aggregated source of a collection of HCI topics that are relevant to BMI students and researchers. The role of HCI in the biomedical informatics curriculum is reflected in the presence of HCI-related courses in some academic graduate programs and in the growing number of research programs. Most courses are taught with a combination of research papers, general HCI textbooks with minimal focus on HIT, and instructor prepared material. Within this scope, we have identified a set of topics – both from a classical HCI perspective and others from an applied HCI in BMI focus. These chapters, as we acknowledged above, do not provide comprehensive coverage of all HCI topics. However, the selected topics represent a mix of topics that coalesces the past with the future of HCI.