Optimizing digital health informatics interventions through unobtrusive quantitative process evaluations

Wouter T. Gude*, Sabine N. Van Der Veer, Nicolette F. De Keizer, Enrico Coiera, Niels Peek

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

11 Citations (Scopus)
13 Downloads (Pure)


Health informatics interventions such as clinical decision support (CDS) and audit and feedback (A&F) are variably effective at improving care because the underlying mechanisms through which these interventions bring about change are poorly understood. This limits our possibilities to design better interventions. Process evaluations can be used to improve this understanding by assessing fidelity and quality of implementation, clarifying causal mechanisms, and identifying contextual factors associated with variation in outcomes. Coiera describes the intervention process as a series of stages extending from interactions to outcomes: the "information value chain". However, past process evaluations often did not assess the relationships between those stages. In this paper we argue that the chain can be measured quantitatively and unobtrusively in digital interventions thanks to the availability of electronic data that are a by-product of their use. This provides novel possibilities to study the mechanisms of informatics interventions in detail and inform essential design choices to optimize their efficacy.

Original languageEnglish
Title of host publicationExploring complexity in health
Subtitle of host publicationan interdisciplinary systems approach
EditorsAlexander Hörbst, Werner Hackl, Nicolette de Keizer, Hans-Ulrich Prokosch, Mira Hercigonja-Szekeres, Simon de Lusignan
Place of PublicationAmsterdam
PublisherIOS Press
Number of pages5
ISBN (Electronic)9781614996781
ISBN (Print)9781614996774
Publication statusPublished - 2016
EventMedical Informatics Europe (MIE) Conference at Conference on Health - Exploring Complexity (HEC) - An Interdisciplinary Systems Approach - Munich, Germany
Duration: 28 Aug 20162 Sep 2016

Publication series

NameStudies in Health Technology and Informatics
PublisherIOS PRESS
ISSN (Print)0926-9630


ConferenceMedical Informatics Europe (MIE) Conference at Conference on Health - Exploring Complexity (HEC) - An Interdisciplinary Systems Approach

Bibliographical note

Copyright the Publisher 2016. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • Medical Audit
  • Clinical Decision Support Systems
  • Process Evaluation

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