Understanding safety-critical interactions with a home medical device through Distributed Cognition

As healthcare shifts from the hospital to the home, it is becoming increasingly important to understand how patients interact with home medical devices, to inform the safe and patient-friendly design of these devices. Distributed Cognition (DCog) has been a useful theoretical framework for understanding situated interactions in the healthcare domain. However, it has not previously been applied to study interactions with home medical devices. In this study, DCog was applied to understand renal patients’ interactions with Home Hemodialysis Technology (HHT), as an example of a home medical device. Data was gathered through ethnographic observations and interviews with 19 renal patients and interviews with seven professionals. Data was analyzed through the principles summarized in the Distributed Cognition for Teamwork methodology. In this paper we focus on the analysis of system activities, information flows, social structures, physical layouts, and artefacts. By explicitly considering different ways in which cognitive processes are distributed, the DCog approach helped to understand patients’ interaction strategies, and pointed to design opportunities that could improve patients’ experiences of using HHT. The findings highlight the need to design HHT taking into consideration likely scenarios of use in the home and of the broader home context. A setting such as home hemodialysis has the characteristics of a complex and safety-critical socio-technical system, and a DCog approach effectively helps to understand how safety is achieved or compromised in such a system

Evidence-based Health Informatics Frameworks for Applied Use.

Health Informatics frameworks have been created surrounding the implementation, optimization, adoption, use and evaluation of health information technology including electronic health record systems and medical devices. In this contribution, established health informatics frameworks are presented. Important considerations for each framework are its purpose, component parts, rigor of development, the level of testing and validation its undergone, and its limitations. In order to understand how to use a framework effectively, it's often necessary to seek additional explanation via literature, documentation, and discussions with the developers

Modelling Distributed Cognition Systems in PVS

We report on our efforts to formalise DiCoT, an informal structured approach for analysing complex work systems, such as hospital and day care units, as distributed cognition systems. We focus on DiCoT's information flow model, which describes how information is transformed and propagated in the system. Our contribution is a set of generic models for the specification and verification system PVS. The developed models can be directly mapped to the informal descriptions adopted by human-computer interactions experts. The models can be verified against properties of interest in the PVS theorem prover. Also, the same models can be simulated, thus facilitating analysts to engage with stakeholders when checking the correctness of the model. We trial our ideas on a case study based on a real-world medical system

Understanding infusion administration in the ICU through Distributed Cognition

AbstractTo understand how healthcare technologies are used in practice and evaluate them, researchers have argued for adopting the theoretical framework of Distributed Cognition (DC). This paper describes the methods and results of a study in which a DC methodology, Distributed Cognition for Teamwork (DiCoT), was applied to study the use of infusion pumps by nurses in an Intensive Care Unit (ICU). Data was gathered through ethnographic observations and interviews. Data analysis consisted of constructing the representational models of DiCoT, focusing on information flows, physical layouts, social structures and artefacts. The findings show that there is significant distribution of cognition in the ICU: socially, among nurses; physically, through the material environment; and through technological artefacts. The DiCoT methodology facilitated the identification of potential improvements that could increase the safety and efficiency of nurses’ interactions with infusion technology

Exploring medical device design and use through layers of distributed cognition: How a glucometer is coupled with its context

cmtheme: cmoutput: journalcmtheme: cmoutput: journalThis work was supported by the UK Engineering and Physical Sciences Research Council [EP/G059063/1]

Usability standards meet scenario-based design: Challenges and opportunities.

The focus of this paper is on the challenges and opportunities presented by developing scenarios of use for interactive medical devices. Scenarios are integral to the international standard for usability engineering of medical devices (IEC 62366:2007), and are also applied to the development of health software (draft standard IEC 82304-1). The 62366 standard lays out a process for mitigating risk during normal use (i.e. use as per the instructions, or accepted medical practice). However, this begs the question of whether "real use" (that which occurs in practice) matches "normal use". In this paper, we present an overview of the product lifecycle and how it impacts on the type of scenario that can be practically applied. We report on the development and testing of a set of scenarios intended to inform the design of infusion pumps based on "real use". The scenarios were validated by researchers and practitioners experienced in clinical practice, and their utility was assessed by developers and practitioners representing different stages of the product lifecycle. These evaluations highlighted previously unreported challenges and opportunities for the use of scenarios in this context. Challenges include: integrating scenario-based design with usability engineering practice; covering the breadth of uses of infusion devices; and managing contradictory evidence. Opportunities included scenario use beyond design to guide marketing, to inform purchasing and as resources for training staff. This study exemplifies one empirically grounded approach to communicating and negotiating the realities of practice

Distributed cognition for evaluating healthcare technology

Distributed Cognition (DCog) has been proposed as being a better approach to analyzing healthcare work than traditional cognitive approaches, due to the collaborative nature of healthcare work. This study sought to explore this by applying two DCog frameworks, DiCoT and the Resources Model, to the analysis of infusion pump use in an Intensive Care Unit. Data was gathered through observations and interviews, and then analysed using DiCoT and the Resources Model to construct models representing the social structures, information flows, physical layouts and artefact use involved in infusion administration in the ICU. The findings of the study confirm that DCog can be a methodology of choice for studying healthcare work: nurses collaborated significantly, artefacts played a major role in coordinating activity, and the physical environment influenced activity - properties which DCog effectively supports reasoning about

Medical Equipment Library design: Revealing issues and best practice using DiCoT

Medical Equipment Libraries (MELs) are a relatively new function for hospitals in the UK, which aim to save money and make medical practice safer. They centralize the management, maintenance and purchasing of medical equipment. They are being embraced and developed by some hospitals, and considered by others. Hence, there is a growing need to understand MEL practice and design. This paper compares three MELs through interviews and observations of everyday practice using DiCoT (Distributed Cognition for Teamwork) as a method for multisite comparison. This is a novel use of the method that reveals general issues and best practices across contexts. Our results complement the little formal information that is available on MELs, and explores the workings of the library as a socio-technical system. As far as we are aware no empirical studies have been published in this area. We conclude with design opportunities and requirements for MELs, and propose DiCoT as an effective way to compare socio-technical systems, including revealing issues and best practices in other clinical contexts more broadly

Understanding Infusion Administration in the ICU through Distributed Cognition

To understand how healthcare technologies are used in practice and evaluate them, researchers have argued for adopting the theoretical framework of Distributed Cognition (DC). This paper describes the methods and results of a study in which a DC methodology, Distributed Cognition for Teamwork (DiCoT), was applied to study the use of infusion pumps by nurses in an Intensive Care Unit (ICU). Data was gathered through ethnographic observations and interviews. Data analysis consisted of constructing the representational models of DiCoT, focusing on information flows, physical layouts, social structures and artefacts. The findings show that there is significant distribution of cognition in the ICU: socially, among nurses; physically, through the material environment; and through technological artefacts. The DiCoT methodology facilitated the identification of potential improvements that could increase the safety and efficiency of nurses’ interactions with infusion technology