Human Factors Considerations in Designing Home-Based Video Telemedicine Systems for the Geriatric Population

Telemedicine is the process of providing healthcare services when large distances separate the patient and the doctor, with the use of communication technology. Telemedicine serves as a substitute to in-person hospital visits and in large, reduces the need to travel and wait in line to visit the doctor. It is predicted to help the geriatric population in managing their healthcare requirements. In order for telemedicine to effectively help the older population, it is essential to understand their needs and issues in telemedicine systems. A study with 40 participants was conducted to understand the usability issues of telemedicine systems with the geriatric population. Four telemedicine video platforms 1) Doxy.me, 2) Polycom, 3) Vidyo and 4) VSee, were used to understand these issues using a between-subject experimental design. Participants completed a demographic survey, followed by a telemedicine session. This was followed by a retrospective think-aloud discussion session to understand their issues and needs concluding with a post-test survey. This survey included general questions about using the system followed by NASA-TLX workload measure and IBM-Computer System Usability Questionnaire (IBM-CSUQ). Some of the issues identified included lengthy email invitation with multiple web links, application download, registration and issues relating to icons used. A Cognitive Task Analysis (CTA) is a method for understanding the cognitive or mental demands involved in performing a task. A Cognitive Task Analysis was conducted for each platform to help identify potential cognitive issues when interacting with telemedicine systems. These solutions include providing a single necessary link in the email, eliminating the necessity to download and register, and, contrast, placement and appropriate labels for icons. As suggested by the participants, detailed step-wise instructions on navigating through a session will also be provided. Future work in this area would be to develop such a system, which theoretically, will increase the efficiency in using telemedicine systems

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Background Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme. Aim To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation. Objectives (1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes? Data sources Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search. Design Mapping review and rapid, systematic evidence syntheses. Setting Care homes with and without nursing in high-income countries. Review methods Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses. Results Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising. Limitations This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded. Conclusions This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation. Future work Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context. Study registration This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938. Funding The National Institute for Health Research Health Services and Delivery Research programme

EMR based telegeriatric system

10.1016/S1386-5056(01)00144-7International Journal of Medical Informatics612-3229-234IJMI