Anesthesia Mobile

Anesthesia Mobile Benjamin Dueñas Figueroa Summer work in collaboration with Innovamedica R&D - Mexico City.

Masters of Interaction Design - UMEÅ Institute of Design Umeå University.

Mexico DF. Mexico, 2008

Index Summary 1.Introduction

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2.Research

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2.1 Interaction Design & Anesthesia

2.2 Sterile Environment

2.3 Automated & Robotic

2.4 Voice Recognition Interaction

2.5 Keyboard

2.6 GUI

2.7 Field Work

2.7.1 Surgery Programming

2.7.2 Mobile Phones

2.7.3 Patient Intubation

2.7.4 Surgery Planning

2.7.5 Monitor Changes

3.4 Concept

3.3.2 Paper Prototyping

3.3.3 The Anesthesia Mobile Concept

3.3.4 The Mobile Without the mobile

3.3.5 Participatory Design

3.3.6 Designed Scenario

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4.References

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3.Conceptualization

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3.1 Brainstorming Session

3.1.2 Selected Ideas

3.1.3 Ideas for further development

3.2 Group Brainstorming

3.2.1 Ideas from group brainstorming

3.3 Mobile Concepts

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Summary In this project is presented an initial research about interaction design linked with Anesthesia and Monitoring of a patient in the Operating Room, a number of ideas are being explored in order to seek for new solutions, applications or services for the anesthesiologist to better organize and make a more efficient and reliable the working environment.

New technologies can be applied into the operating room, as tools, not only to avoid human errors but also to help anesthesiologists to increase their concentration on their work.

A mobile network concept is proposed as a one of the strongest ideas to follow and to develop, but still there are some points to cover on this development to refine the idea and come up with the complete and defined system.

Nevertheless, this framework can be used for further development on this field, where many efforts are being done to design the Operating Room of the future and where new interactions with new, applications, systems and services urge to be designed.

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Acknowledgments I would like to thank all the people in Innovamedica for his support, specially to those who helped me and who participated on the activities of this project, this is a great learning for me.

Emilio Sacristán Marcus Dantus Javier Pinzón Juan Carlos Avilez Francisco Molina Ursina Díaz Eduardo Morelos María Acero Ivan Rangel Yasmín García Andrés Moron Alfonso Rodríguez Alejandra Silva Miroslava Rodríguez Viridiana Rodríguez Hanako Arámbula Silvia Juárez Victor Valencia Bogar Patiño Alejandro Bolaños Omar Mendizabal Antonio Hernández

Innovamédica Innovamédica Innovamédica Innovamédica Instituto Nacional de Cardiología Ignacio Chávez Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica Innovamédica

Armando Hurtado special thanks, who acted in the participatory design session.

Professional Actor.

1.Introduction The initial research of this project was done as a summer work of the MA of Interaction Design in the UmeĂĽ Institue of Design - UmeĂĽ University within the Mexican company of Medical R&D Innovamedica in Mexico City.

Innovamedica is currently developing some new concepts on anesthesia and they looked at this project as an opportunity to be linked with interaction design.

The aim of this initial research is to provide a link between Interaction Design and the Anesthesia project looking for new services and systems for the people who are involved with the anesthesia procedure and with the patient monitoring in the Operating Room.

The result of this work is not intended to replace the current equipment in the hospitals, but to enhance the capabilities of it and reinforce the hospital network, by better organizing and communicating the spaces with the people.

Computer Assisted Surgery I started looking at some articles of the interactive elements involved with the work in the operating room, focused on those that were related with anesthesia, and I found that there are many efforts focused on improving and finding new ways of better interacting with computers inside the operating room, specially the development of more appropriate hardware to use the computers.

Computer Assisted Surgery (CAS) is one of the topics that are being develop with great emphasis seeking a more natural and proactive relation between the surgeon and the computer.

CAS refers to any computer system inside the Operating Room helping with a surgery, and enhancing the reliability to take important decisions.

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2.Research 2.1 Interaction Design & Operating Room.

Sterile pen of the Stealth Station from Medtronic

Considering the complexity that the medical field requires, and specially the one dedicated to anesthesia and patient monitoring, certainly a large amount of interactions between human-human or human-machine is making more and more interesting this field, to explore for better applications and solutions.

Directions on interaction design field related with a medical environment specifically the Operating Room OR, suggest a new environment for these spaces, generally fully restricted, but this restrictions are the main challenge for the designers to provide a better, human safer, reliable and efficient environment for every one in the OR. New ways of interacting with the equipment inside the OR, are being explored as new technologies emerge and are introduced into it. This new hardware and software used as interactive tools to communicate the doctor with the equipment in a variety of ways depending on the procedure.

From the touchscreen to the voice recognition soft-

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ware, it is possible to say that all kinds of this tools are being applied into the operating room.

2.2 Sterile Environment Inside the Operating Room OR, a sterile zone is needed, this area is called “sterile field or sterile zone�, is located around the patient, and is very restricted to avoid contamination, all the tools and materials used inside this zone, must be sterile.

The doctor must wear special sterile surgeon’s gloves and he must not touch any surface outside the sterile zone, to avoid contamination.

However, the zone where the anesthesia equipment is located, is considered outside this field and anesthesiologists can have contact with objects as the anesthesia machine controls, infusion pumps, monitors, pen and notebook etc.

The anesthesiologist must wear sterile gloves and must be properly prepared and washed during the intubation procedure of the patient, process that takes place before starting with the surgery.

Anesthesia Environment

2.3 Automated & Robotic “Even the best designed, least invasive navigation systems available today, the use of the computer is disruptive to the surgical workflow.”

The natural consequence is that surgeons tend to discard or ignore the computer as soon as things get “real”.

On a survey with an anesthesiologist, I asked about the possibility of including robotic systems into the anesthesia equipment, looking for a more natural interaction between the equipment and the anesthesiologist, that can also enhance his concentration on his work.

After being on a surgery during the process of intubation and Monitoring, of a patient, I observed that every patient is different and every one has its own complexity depending on each physiology.

Because of this, the intubation process results very complicated to control by means of a robotic or automated system, however other parts of the anesthesia, like monitoring, can have that chance to explore for an automated system.

System that rely on an Assistant to control the computer on a surgery.

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2.4 Voice Recognition Interaction Right now a great effort is being done to develop an efficient interaction between human to computer, using the voice recognition as the main tool. The doctor does not need to touch any equipment to control it, this is a great solution to prevent contamination when the sterile environment is needed.

2.5 Keyboard Some anesthesia machines are including keyboards, to capture digital data of the surgery directly into a database, such information include medication dosis, changes in pressure, gases etc. But still this kinds of equipment are not used in mexican hospitals where most of the equipment is isolated and is not connected to any database. Every 15 min. are taken notes by the anestesioligist using pen and paper.

2.6 GUI As it is mention on the thesis “MORIS� ( ), many cutting edge technology for Computer Assisted Surgery have experimental GUI (Graphical User Interface). Designed originally to work in an office environment where they work perfectly using a mouse and a keyboard, but there is no equivalent of this interactive elements when this technologies are transported into the Operating Room, generally this limit the user interaction and makes an inconsistent interaction model.

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2.7 Field Work In the visit I had to the hospital of Cardiology -Ignacion ChĂĄvez- in Mexico City, I had the opportunity to observe some interesting situations,

2.7.1 Surgery programming Every day, surgeries are programmed and are written on a white board to be seen by all the doctors, surgeons etc. Anesthesiologists and Surgeons are informed about this surgeries, by a phone call in the afternoon of the day before the surgery is programmed.

This is a very important and interesting point of information, that can help to take important decisions about the surgical procedure, surgery programming, cancellations and changes and main information about the patient.

2.7.2 Mobile Phones Doctors inside the Operating Room keep their mobiles, with them in their pockets or they just leave them over any flat surface on the equipment. This keep them in touch with their contacts, and because a procedure or surgery can last from 1 hour to more than 12 hours.

If the surgeon receives a phone call during a surgery, usually he asks somebody else to answer the call and in some cases a nurse can hold the phone

White Board for Surgery Programming inside the Hospital

Anesthesiologist’s cellular phone, is located on an accessible place on the Vital Signs Monitor.

over the surgeon’s head, while the surgeon is calling. This is done to avoid contamination of the sterile field.

An anesthesiologist in that sense have more chances to receive and answer directly a call during a surgery, while they are not in touch with the sterile field, or as long as they are only in the monitoring process of the patient during the surgery.

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On the surgery.

During the surgery I observed also some situations that are related with the patient information and communication between people inside the OP.

2.7.3 Patient Intubation The intubation process is normally a complex process that takes between 5 to 10 min, but in some cases this time increase to more than 20 minutes, because of the complexity of the patient’s physiology. The anesthesiologist in those cases have to change several times the tool for intubation looking for the proper tool. This process depends on each patient’s physiology and need the experience of the anesthesiologist to have a successful intubation.

Part of the intubation process.

2.7.4 Surgery Planning Before starting the surgery, the procedure of the surgery was modified, and the anesthesiologist obtained this information after having placed all the catheters to measure, the vital sings of the patient. After that change on the procedure, he had to move some of the catheters on the patient, to be sure of obtaining good signals from the patient’s body.

Manual Ventilation of the patient.

2.7.5 Monitor Changes Once the anesthesiologist placed again a new catheter to measure the patient pressure, He needed to add another graphic on the display of the vital signs monitor, and after some attempts it was not possible for the anesthesiologist to get that new graphic on the monitor.

Anesthesia Interface on a surgery

3.Conceptualization

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3.1 Brainstorming Session The brainstorming session was held at Innovamedica, a group formed by biomedical engineers, mechanical engineers, industrial design and other disciplines from various departments inside innovamedica, participated in the session.

The aim of the session had two main objectives, to introduce new creative methodologies in the company and to help producing ideas for this project.

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3.1.2 Selected ideas for development All the ideas were written on big post its and then divided into 2 groups of ideas for development and ideas for further development and consideration.

An earring for the doctor that vibrates whenever something serious is happening to the patient

Having a projector for the graphics and photos.

On-line support.

A wireless connection for all the anesthesia machines, so you can control another machines remotely.

Optical reader as in a supermarket.

Having a training personalized programme for every user, that allow the anesthesiologist to use the equipment and does not allow its use when the training is not registered.

A virtual screen that can be projected on any surface in the operating room.

Having a digital notebook where the introduced information can be displayed as a graphic.

Use a hard disc for all the information generated and for the graphics.

A place to keep a user manual or guide easy to find.

I pod connection to play music.

Video recording.

Having a black box like the one on the airplanes, that registers everything and that can be easily accessible.

Wireless connection to have conferences with other doctors.

Having a touch-screen and that you can draw on it like on a white board.

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A network for the hospital that registers all the information about the procedures done to the patient.

Possibility of seeing the patient’s medical record whenever is needed.

Anesthesia machine capable of sending information like images, numerical data, alarm signals etc. on every defined times.

Anesthesia Machine that shows trends and prognosis of the current information.

Give the doctor a hands free.

To improve the graphics.

Monitor with Sensors.

Medical Record saved in a necklace.

Intuitive Menus.

Having a scanner that helps to intubate the patient.

To include the information of the programmed surgeries in digital format.

Consulting of medical records on the internet, as well as previous and future programmed surgeries.

Monitor projection on glasses.

3.1.3 Ideas for further consideration

Eliminate the use of cables in the anesthesia machine.

Warmer design of the interiors in the Operating Room.

Equipment easily accessible.

Considering a place to hold cables.

Organization of all disposable materials.

Having 2 kinds of drawers, one for easy access and one for material storage.

Illumination on the table.

Wider place to write.

Having a place to keep the personal keys.

Having a “stent” tube to intubate the patient that can be expanded.

Having something to release “stress”.

Having a folding table.

Light anesthesia machine to easily transportation.

Closer screens.

Injection system for the anesthetic agent.

Computer Reports.

Online communication with the storage place, for disposable replacement.

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Use a tool like a necklace to place tools.

3.2 Brainstorming in groups As part of the brainstorming session, a group brainstorming was done, the intention was to discuss in groups of tree persons the topic of “Designing a Service for the Operating Room, linked with Anesthesia�, this part of the session was fruitful and more dynamic due to the discussions around the topic, nevertheless the limited time for this part reflected some tension on the participants to came up with more ideas.

In the middle of the group discussions were introduced to each team, key words to promote different or wild ideas, every team linked then their concept with this word.

At the end of the session the proposals by team were explained and acted by the team members.

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3.2.1 Ideas from group brainstorming Group 1 Introduced Word: Reception

Group 2 Introduced Word: Elevator

Keywords: Patient, Data, Information Having a warmer reception of a patient including music and a nice environment, to avoid the patient’s stress.

On line access to the information of all programmed surgeries.

Having a ring that vibrates whenever an alarm is activated on the anesthesia equipment and a monitor that includes sensors and wireless technology to be updated with the information of the patient.

The sensors would allow the Monitor to follow the head of the anesthesiologist making easier the monitoring.

Group 3

Group 4

Introduced Word: Necklace

Introduced Word: Traffic Light

Having an anesthesia equipment surrounding the patient integrated to the surgical bed, like a belt, allowing to be closer to the patient and having less connections to the body of the patient.

Having a training software on the anesthesia equipment, that gives the anesthesiologist a complete check-list to follow to complete in a reliable way the processes of intubation and anesthesia, in a way that if the doctor does not completes this check-list, a light in red is displayed prohibiting to continue were the process is wrong, and displaying a green light whenever the process has been followed in a correct way.

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3.3 Mobile Concepts I looked at some mobile concepts for reference, after having the brainstorming session.

By means of a new product located inside the home, a mobile interface can be controlled on the Television. A phone call can be answered as a chat conversation while you are watching TV.

An interesting concept done at the UmeĂĽ Institute of Design in UmeĂĽ Sweden, for Nokia, is the Nokia One. A mobile concept for the home, that enhance mobile-home communication, and integrates the mobile into the interface of a home environment.

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3.4 Concept 3.4.1 Paper Prototyping To represent the designed concept, I made some cardboard and paper prototypes.

This method of fast prototyping is regularly used to conceive and illustrate a fast way to represent a service, a user interface UI or a graphical user interface GUI.

3.4.2 The Anesthesia Mobile Concept The anesthesia mobile concept is a service, designed to integrate the mobile phone into the hospital networks.

The service proposes to integrate into a mobile phone valuable information for the doctor and anesthesiologist as the updated list of programmed surgeries, information about the patient, the doctor, and comments from other doctors.

It includes a touch - screen inside the Operating Room where the graphics can be displayed and connected with the anesthesia equipment, include more graphics and have online support for technical issues.

3.4.3 The mobile without mobile With the aim of making easier, safer and diminish the risk of contamination inside the Operating Room, the mobile without the mobile is a new concept introduced on a hospital.

The concept changes the shell of the mobile into many accessories that can be used as the same mobile with the same information, but different capabilities.

This different capabilities are linked with the different spaces on the hospital, a hands-free mobile as headphones can be used inside the Operating Room by the anesthesiologist where is necessary to have the hands free to control the anesthesia machine, a hands-free mobile as glasses can be used for the surgeon to record the surgery, and a virtual mobile, can be displayed on the screen inside the Operating Room having the same graphic interface and information.

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The doctor feels that his ring is vibrating when the programmed surgeries for the next day, are updated

On the locker, the doctor leaves his mobile and prepares for entering to the Operating Room.

3.4.5 Participatory Design Two different scenarios were prepared to be presented alive on a reunion with anesthesiologists, and the design department of Innovamedica, but unfortunately was not possible for the doctors to attend the session.

The participatory design session is intended to include the people for whom is designed the service to cross the boundaries between the designer and the final user.

The doctor checks all the surgeries programmed and check on which one is included.

The doctor enable the hands-free accessory that is connected to his mobile.

3.4.6 Scenario

The doctor receive a message with a sound on the headphones or hands-free accessory.

The designed scenario was presented and recorded on video, and is represented on this pages with a series of images from the video.

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The anesthesiologist enters a password to activate his mobile on the screen inside the OR.

The doctor receives a call and he answers the call with a voice command “answer call”.

Once the mobile is activated the anesthesiologist can check the important message about a change on the procedure

The doctor receives again another call but he doesn’t recognize who is calling, so he decided to hang-up the call by saying “hang-up call”.

The doctor draw on the screen and gets another graphic by selecting and dragging to copy the graphic.

Finally the doctor saves on his virtual mobile the graphics and the drawings of the planing before the surgery started.

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4.References Dietrich, Rainer, Childress, Traci Michelle , Group interaction in high risk environments 2004 Grange, Sébastien ; Siegwart, Roland (dir.) ; Baur, Charles (dir.)

Ph.D. Thesis M/ORIS - Medical / Operating Room Interaction System Lausanne : EPFL, 2007.

Jungk A, Thull B, Fehrle L, Hoeft A, Rau G. A case study in designing speech interaction with a patient monitor.

J ClinMonit 2000; 16: 295^307 Eric G. Devine, PHD, Stephan A. Gaehde, MD, MPH, Arthur C. Curtis, MD, PHD Comparative Evaluation of Three Continuous Speech Recognition Software Packages in the Generation of Medical Reports. Journal of the American Medical Informatics Association Volume 7 Number 5 Sep / Oct 2000.

Standards for Basic Anesthetic Monitoring.

(Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 25, 2005) Deshmukh Imon, Urban Pathfinder MA Thesis / Project Report Institute of Design, Umeå University, 2006.

Tasar Özgur, Nokia One, MA Thesis / Project Report Institute of Design, Umeå University, 2005.

Web http://www.ozgurtasar.com/main.html http://www.ge.com/products_services/healthcare.html http://www.advantech.com/sector/Medical/Solutions.aspx

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