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

Cognitive Artifacts in Support of Medical Shift Handover: An In Use, In Situ Evaluation

Technologies introduced to support complex and critical work practices merit rigorous and effective evaluation. However, evaluation strategies often fall short of evaluating real use by practitioners in the workplace and thereby miss an opportunity to gauge the true impact of the technology on the work. This article reports an in use, in situ evaluation of 2 cognitive artifacts that support the everyday work of handover in a healthcare setting. The evaluation drew inspiration from the theoretical viewpoint offered by distributed cognition, focusing on the information content, representational media, and context of use of the artifacts. The article discusses how this approach led to insights about the artifacts and their support of the work that could not have been obtained with more traditional evaluation techniques. Specifically, the argument is made that the ubiquitous approach of user testing with its reliance on think-alouds and observations of interaction is inadequate in this context and set an initial agenda for issues that should be addressed by in use, in situ evaluations

Representation Effects and Loss Aversion in Analytical Behaviour: An Experimental Study into Decision Making Facilitated by Visual Analytics

This paper presents the results of an experiment into the relationship between the representation of data and decision-making. Three hundred participants online, were asked to choose between a series of financial investment opportunities using data presented in line charts. A single dependent variable of investment choice was examined over four levels of varying display conditions and randomised data. Three variations to line chart visualisations provided a controlled factor between subjects divided into three groups; -˜standard’ line charts, -˜tall’ line charts, and one dual-series line chart. The final results revealed a consistent main effect and two other interactions between certain display conditions and decision-making. The findings of this paper are significant to the study visualisation and to the field of visual analytics. This experiment was devised as part of a study into Analytical Behaviour, defined as decision-making facilitated by visual analytics - a new topic that encompasses existing research and real-world applications

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]

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

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

Human Factors Considerations in a Telemedicine-Integrated Ambulance-Based Caregiving Environment for Stroke Care

Telemedicine, the use of communications technology to connect patients to medical professionals remotely, can be applied to a variety of settings, for example connecting older adults with their physicians from home, specialists to rural county hospitals or patients to physicians for emergency care. This dissertation focuses on the use of telemedicine for ambulance-based care for stroke patients, including how the design of this system impacts caregivers. The initial study investigated both the usability of a telemedicine system implemented in ambulances for stroke care as well as the possibility of human error when using it. The heuristic evaluation of usability violations found several issues that needed to be addressed, including the lack of clarity in the tab structure and the lack of suggestions for correct data inputs. Similarly, the analysis of possible errors also determined several issues with this system, with the two most common being miscommunication and difficulty in locating data input or selecting an incorrect option. Several remediations strategies were recommended based on this study: improvement of the labelling of the tab structure, consistent formatting, rigid or suggested formatting for data input, automation of task structure and camera movement, and audio/visual improvements to support communication. The second study investigated the experience of caregivers with the ambulance-based stroke telemedicine system, focusing on the support of the distributed cognition of the caregiving teams. Teams comprised of a neurologist, nurse, and paramedic were observed conducting 13 simulated stroke consults, after which each caregiver completed a survey on the perceived workload, usability, and teamwork during the session and an interview about their experience with the telemedicine system. In total, thirty-nine caregivers were interviewed, and the data collected were analyzed for themes. The themes that emerged identified such barriers to and facilitators for using telemedicine for ambulance-based stroke caregiving as training and experience, technical difficulty barriers, and patient care and efficiency improvement facilitators. The findings from this study resulted in design recommendations for supporting healthcare professionals during caregiving, especially ones that support their distributed cognition when using ambulance-based telemedicine for stroke care. The final study evaluated the effect of design recommendations implemented in a new telemedicine system on the neurologist’s workload, situation awareness, and task performance in addition to evaluating the perceived usability of this new design and its support of distributed cognition. For this study based on a within-subjects experimental design, 20 neurologists completed simulated stroke assessments using both the new design and the design investigated in the two previous studies and evaluated each system. Overall, the results found that the neurologists experienced a lower workload, performed better in their task, exhibited higher situation awareness, and rated usability highly in the new design. In addition, most participants thought that the new design better supported distributed cognition principles and preferred the new system for ambulance-based stroke consults