INTRODUCTION & PROBLEM STATEMENT
h"p://www.tu*smedicarepreferred.org/how-‐get-‐more-‐your-‐next-‐doctor-‐visit
Electronic Medical Records (EMR)
"….a type of clinical informa>on system, which is dedicated to collec'ng, storing, manipula'ng, and making available clinical informa'on important to the delivery of pa>ent care……." Ins>tute of Medicine (2007)
8 minutes / patient No time to learn new systems Many lacks of computer skills (Ludwick & Doucette, 2009).
EMRs ARE DISRUPTIVE Attention Clinician
Technology
(-‐)
Stress Inability to time-share Communication w/ patient
Patient
Time per patient é (Boonstra and Broekhuis ,2010)
ASSUMPTIONS OF THIS STUDY 1. The clinician – pa>ent communica>on plays a major role in the healing process. 2. Technology itself is not good or bad 3. A device designed to fit user needs and characteris>cs will: • demand less cogni>ve resources •
be less intrusive to the clinician's rou>ne and interac>on with the pa>ent.
OBJECTIVES & PROCESS
DESIGN & EVALUATE a physical examination kit
that provides the benefits that technology nowadays allows for, producing minimal interference to clinicians’ daily routine or relationship with their patients. Â
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OUTLINE
1 3 2 Study objec>ves
THEORIES GUIDING STUDY PERSON-‐ENVIRONMENT CONGRUENCE
HUMAN FACTORS
MODEL OF HIERARCHY OF HUMAN NEEDS
Interac>on between people and environment
Effect on -‐ wellbeing -‐ human emo>ons -‐ behavior
-‐ safety -‐ performance -‐ sa>sfac>on (Jordan, 1997)
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REQUIREMENTS
PHYSICAL EXAM
FMEA
IDEF0
Failure Mode and Effects Analysis
(Integra>on Defini>on for Func>on Modeling )
PERCEIVE
PROCESS COMPARE
DECIDE
-‐Not save the data at pa>ent’s file -‐Get distracted and omit tasks -‐Not examine all the areas -‐Confuse a normal sound with an abnormal sound and vice-‐versa -‐Wrongly describe an abnormal sound -‐Wrongly categorize findings -‐Not iden>fy S3 or S4 -‐Save data in the wrong field -‐Not inspect all the areas -‐Not iden>fy a suspicious lesion -‐Describe lesions wrongly -‐Enter incorrect data (error when documen>ng, wri>ng something different of what was intended) -‐Save data at other pa>ent's record -‐Document data incompletely
DOCUMENT
REQUIREMENTS FUNCTIONALITY 1
The system shall provide means to communicate with the EMR server 3 The system interface shall provide access to patient electronic medical records. 4 The system shall provide means to update patient’s records with exam data and findings 5 The system shall record data in the absence of an internet connection. 7 The system shall provide means to guarantee the safety of the users 8 The system shall provide means to listen to and record heart sounds. 12 The system shall provide means to listen to and record lung sounds. 13 The system should provide means to record data from the dermatologic inspection. 14,16The system shall provide means to view and capture images and videos of the eyes and ears.
USABILITY 19 The system shall be portable. 20 The system shall be hand held. 32 System interfaces shall be easy to navigate 36 The system should simplify the tasks; do not overload memory, short term or long term, provide memory aids for easy retrieval of information and be sure the user has control over the task. 39 The system should be designed for error. Plan every possible error that can be made and provide a recovery solution them allowing the user to recovery from any possible mistake. 42 The system interface should exploit top-down processing 47 The system interface should minimimaze information access cost 53 The system shall provide user interfaces that are eďŹƒcient, e.g., with reduced training time, task time, errors, and frustration.
PLEASURE 57 The system may provide means to facilitate communication between physicians and patients 58 The system should not interrupt physicians when they are interacting with the patient or analyzing the patient information 60 The system may be confortably carried 61 The system may feel good in the hand 64 The system may be aesthetically pleasing
61 The system may feel good in the hand
14 The system shall provide means to view and capture images and videos of the eyes
REQUIREMENTS FUNCTIONALITY 1
The system shall provide means to communicate with the EMR server 3 The system interface shall provide access to patient electronic medical records. 4 The system shall provide means to update patient’s records with exam data and findings 5 The system shall record data in the absence of an internet connection. 7 The system shall provide means to guarantee the safety of the users 8 The system shall provide means to listen to and record heart sounds. 12 The system shall provide means to listen to and record lung sounds. 13 The system should provide means to record data from the dermatologic inspection. 14,16The system shall provide means to view and capture images and videos of the eyes and ears.
USABILITY 19 The system shall be portable. 20 The system shall be hand held. 32 System interfaces shall be easy to navigate 36 The system should simplify the tasks; do not overload memory, short term or long term, provide memory aids for easy retrieval of information and be sure the user has control over the task. 39 The system should be designed for error. Plan every possible error that can be made and provide a recovery solution them allowing the user to recovery from any possible mistake. 42 The system interface should exploit top-down processing 47 The system interface should minimimaze information access cost 53 The system shall provide user interfaces that are eďŹƒcient, e.g., with reduced training time, task time, errors, and frustration.
PLEASURE 57 The system may provide means to facilitate communication between physicians and patients 58 The system should not interrupt physicians when they are interacting with the patient or analyzing the patient information 60 The system may be confortably carried 61 The system may feel good in the hand 64 The system may be aesthetically pleasing
42 The system interface should exploit top-down processing
REQUIREMENTS FUNCTIONALITY 1
The system shall provide means to communicate with the EMR server 3 The system interface shall provide access to patient electronic medical records. 4 The system shall provide means to update patient’s records with exam data and findings 5 The system shall record data in the absence of an internet connection. 7 The system shall provide means to guarantee the safety of the users 8 The system shall provide means to listen to and record heart sounds. 12 The system shall provide means to listen to and record lung sounds. 13 The system should provide means to record data from the dermatologic inspection. 14,16The system shall provide means to view and capture images and videos of the eyes and ears.
USABILITY 19 The system shall be portable. 20 The system shall be hand held. 32 System interfaces shall be easy to navigate 36 The system should simplify the tasks; do not overload memory, short term or long term, provide memory aids for easy retrieval of information and be sure the user has control over the task. 39 The system should be designed for error. Plan every possible error that can be made and provide a recovery solution them allowing the user to recovery from any possible mistake. 42 The system interface should exploit top-down processing 47 The system interface should minimimaze information access cost 53 The system shall provide user interfaces that are efficient, e.g., with reduced training time, task time, errors, and frustration.
PLEASURE 57 The system may provide means to facilitate communication between physicians and patients 58 The system should not interrupt physicians when they are interacting with the patient or analyzing the patient information 60 The system may be confortably carried 61 The system may feel good in the hand 64 The system may be aesthetically pleasing
61 The system may feel good in the hand
57 The system may provide means to facilitate communication between clinicians and patients
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CONCEPT DESIGN
PHYSICAL EXAMINATION KIT Functionality of: • Stethoscope • Ophthalmoscope • Otoscope • Dermascope • Digital camera
Saves data
Pa>ent’s EMR Wirelessly
CONFIGURATIONS EXPLORED iPad + wireless instruments
iPad + all-in-one wireless instrument
A"achment to iPhone or iPod touch
Independent device that communicates with the iPad
With touch screen Without touch screen
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VISUALIZE IT
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COMPARE IT • Library examples • Pa>ent records
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SHARE IT
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Pa>ent’s records
VISUALIZE IT
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COMPARE IT • Library examples • Pa>ent records
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Pa>ent’s records
GRAPHIC USER INTERFACE The patient’s picture and relevant information Digital files recorded with the instrument. Saved under the physical exam section.
Share to seek for a second opinion. Library of references
Access files from previous recordings
Visualize recording
Compare with reference
Share with specialists
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Objective 3: User Testing USER TESTING
OBJECTIVES a. OVERALL USER EXPERIENCE AND FIT b. VERIFY REQUIREMENTS c. PERCEPTION ABOUT SYSTEM INTERFERENCE
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SAMPLE
LIMITATIONS 1. Non-functional mock up 2. A small, non-random sample 3. Participants’ bias with respect to technology 4. Social desirability bias (Jordan, 2002; Ramsey & Schafer, 2002). 5. Researcher personal biases.
PROCEDURE 1. Introduction 2. Scenario 3. Questionnaire – Close ended questions » » »
System Usability Scale Pleasure with products Requirements
4. Face to face Interview – Audio recorded
FUNCTIONALITY
USABILITY
PLEASURE
POSITIVE
CHALLENGES
DESIGN CONCEPT EASY TO HOLD CONFIDENCE COMMUNICATION ++
71% posi>ve pleasure scores
SATISFACTION
TOY iPad AS TECHNOLOGY
COATS (POCKETS)
EASY TO USE EASY TO LEARN
STATUS
MISTAKES 71% SUS
scores above average
INSTRUMENTS SELECTION
STETHOCOPE USE EFFICIENCY NOT EVALUATED
THERMOMETHER
FUNCTIONS PROVIDED FITS BETTER NOVICES THAN EXPERTS
FUNCTIONALITY
USABILITY
PLEASURE
POSITIVE
DESIGN CONCEPT EASY TO HOLD CONFIDENCE COMMUNICATION ++
CHALLENGES
71% posi>ve pleasure scores
SATISFACTION
TOY iPad AS TECHNOLOGY
COATS (POCKETS)
EASY TO USE EASY TO LEARN
STATUS
MISTAKES 71% SUS
scores above average
STETHOCOPE USE EFFICIENCY NOT EVALUATED
INSTRUMENTS SELECTION THERMOMETHER “It’s a unique concept,….it combines all the elements that I would like to have” FUNCTIONS PROVIDED “I think it would be really useful. “ FITS BETTER NOVICES THAN EXPERTS
FUNCTIONALITY
USABILITY
PLEASURE
POSITIVE
CHALLENGES
DESIGN CONCEPT EASY TO HOLD CONFIDENCE COMMUNICATION ++
71% posi>ve pleasure scores
STATUS TOY iPad AS TECHNOLOGY
“I could see where you could go really crazy if it is really that COATS (POCKETS) easy” EASY TO USE MISTAKES EASY TO “I LEARN was kind of71% skeptical somebody's going to SUS when I first heard STHETOCOPE USE show me a prototype. Oh yeah, they're going to have something scores above SATISFACTION ” that's going toaverage be stupid or -but I'm actually pleasantly surprised. EFFICIENCY NOT EVALUATED
INSTRUMENTS SELECTION
THERMOMETHER
FUNCTIONS PROVIDED FITS BETTER NOVICES THAN EXPERTS
FUNCTIONALITY
USABILITY
PLEASURE
POSITIVE
CHALLENGES STATUS
DESIGN CONCEPT
71% posi>ve EASY TO HOLD "This is what your asthma sounds like lastTOY two- weeks ago and now pleasure you're doing so much better. Listen, now you sound like this,” CONFIDENCE scores iPad AS TECHNOLOGY COMMUNICATION ++ COATS (POCKETS)
EASY TO USE EASY TO LEARN SATISFACTION
MISTAKES 71% SUS
scores above average
INSTRUMENTS SELECTION
STHETOCOPE USE EFFICIENCY NOT EVALUATED
THERMOMETHER
FUNCTIONS PROVIDED FITS BETTER NOVICES THAN EXPERTS
CONCLUSIONS 1. Overall fits clinicians’ needs 2. 9/18 requirements were verified 3. Do not interfere with clinicians’ relationship with patients
CONCLUSIONS Theclinicians’ system is portable 1. Overall fits needs
The system can be comfortably carried The system feels good in the hand The system has useful functions The system’s displays are clearly visible The system is safe to use The system displays provides information from the patient that is useful to achieve the correct diagnosis The system’s displays are legible The system is easy to navigate
2. 9/18 requirements were verified 3. Do not interfere with clinicians relationship with patients
ACKNOWLEDGEMENTS Carmen Steggell Kenneth Funk Andrea Marks James Bauer Diego Traversa Dr. Felipe Schelotto John Dilles Tracy Ann Robinson Belinda Batten Rob Stone Leslie Burns Minjeong Kim Martin Fisk Â
Fede and Mila Daniel de Brum, Eugenia Rodriguez Nelson Cernuschi, Lydia Rodilosso Family and friends from Uruguay Friends from here: Ashley, B.J, Bobby, Chris, Caren, Caroline, Danielle, Elina, Erin, Haley, Joana, Julia, Julia, Keith, Kelly, Lynn, Morgan, Paris, Steph, Sarah,Tara, Valerie, Yan, Dilles Grunder Family Westly Family Steph, Morgan, Michelle, Julia Tara Robinson, Jeff Jimmerson, Danielle Anthony Special thanks to Patti Thrall, Tylee Cairns, Lea Cavestany, Konstantin Brainich, Stuart Feldman
Thanks!! sdebrum@gmail.com