Pervasive Technologies and Support for Independent Living

A broad range of pervasive technologies are used in many domains, including healthcare: however, there appears to be little work examining the role of such technologies in the home, or the different wants and needs of elderly users. Additionally, there exist ethical issues surrounding the use of highly personal healthcare-related data, and interface issues centred on the novelty of the technologies and the disabilities experienced by the users. This report examines these areas, before considering the ways in which they might come together to help support independent-living users with disabilities which may be age-related

Doctor of Philosophy

dissertationPreventable adverse events are one of the leading causes of hospitalized patient deaths. Many of these adverse events occur in Intensive Care Units (ICUs) where nurses often work under cognitive, perceptual, and physical overloads. Contributing to these overloads are spatially separated devices which display treatment relevant information such as orders, monitoring information, and equipment status on numerous displays. If essential information of these separate devices was integrated into a single display at the bedside, nurses could potentially reduce their workload and improve their awareness of the patients' treatment plans and physiological status. We conducted a set of three studies for the purpose of designing an efficient and effective ICU display. We observed ICU nurses during their shifts and found that task-relevant information was often presented in the wrong format, unavailable at the point of care or laborious to obtain. Additionally, nurses were sometimes unaware of significant changes in their patient's status and equipment operation. Based on nurses' feedback, we designed an integrated information display that presents all of the information that nurses need at the patient bedside. Nurses selected a display based on the information organization of existing patient monitors, with added medication management and team communication features. The evaluation of paper-based prototypes of both the integrated display and existing ICU displays showed that nurses could answer questions about the patient's status and treatment faster (p<<0.05) and more accurately (p<<0.05) using the integrated display. The number of adverse events in the ICU could potentially be reduced by integrated displays, but to implement them into clinical practice will require significant engineering efforts

Usability Study on Patient Monitoring Systems: An Evaluation of a User Interface Based on User Experience and Preference

BACKGROUND: The poor ergonomic design of patient monitoring systems can cause user errors and patient harm. This paper presents the results of a comparative usability study based on user experience and the results of a user preference survey. MATERIAL AND METHODS: We conducted a usability study of 3 patient monitoring systems: Mediana M50, Philips IntelliVue MP70, and Philips IntelliVue MX700. Thirty-nine Coronary Care Unit nurses and 19 Pulmonology and Allergy Care Unit nurses participated in this usability study. User experience was assessed with the Post-Study System Usability Questionnaire and the National Aeronautics and Space Administration Task Load Index. A user preference survey was conducted to evaluate the subjective medical device design preferences for the M50 system's user interface. RESULTS: Nurses from the Coronary Care Unit recognized a higher system usability for the MP70 than the M50 (P=0.001) system, and a lower workload for the MP70 compared with the M50 (P=0.005) system. There was no significant (P>0.05) difference in perceived system usability and workload between the M50 and MX700 systems for the nurses from the Pulmonology and Allergy Care Unit. Nurses preferred to activate the arrhythmia alarms except for the ST alarms and missed the beat alarm. They also preferred having a wave freeze function, standby mode, and early warning scoring function, which provides a signal for a patient's deterioration in health. CONCLUSIONS: The study provides valuable data on a user interface evaluation based on user experience and preference. The outcome of this study will be helpful for designing next-generation patient monitors with improved patient safety.ope

Shaped by Design "How User-Interface Design Influences Medical Decision Making: The Role of Monitoring Equipment in Anesthetic Practice"

abstract: Objective: The aim of this research is to uncover, via a comprehensive cross study analysis, data patterns that could potentially point to a positive correlation between two main variables: anesthetic monitoring equipment and anesthetic decision making. Of particular interest is the equipment's monitor screen and the extent to which its user interface design influences anesthetic situation awareness (SA) and hence, decision making. It is hypothesized that poor anesthetic diagnosis from inadequate SA may be largely attributable to patient data displays lacking in human factors design considerations. Methods: A systematic search was conducted of existing empirical studies pertaining to patient physiologic monitoring that spanned across interrelated domains, namely, ergonomics, medical informatics, visual computing, cognitive psychology, human factors, clinical monitoring, intensive care medicine, and intelligent systems etc. all published in scholarly research journals between 1970 to August 2012. Anesthetic-related keywords were queried i.e. anesthetic mishaps, patient physiological data displays, anesthetic vigilance etc. (found in Appendix A). This approach yielded a few thousand results, of which 65 empirical studies were pulled. Further extraction of articles having direct connection to the use of data displays within the anesthetic context produced a total of 20 empirical studies. These studies were grouped under two broad categories of Monitoring and Monitors whereby factors directly contributing to the studies' results were identified with the aim to find emerging themes that provide insights involving interface design and medical decision making. Results: There is a direct correlation between user-interface design and decision making. The situation awareness (SA) required for decision making heavily relies upon data displays oriented towards information extraction and integration. In the systematic assessment of empirical studies, it is undeniable how strikingly prominent visual attributes show up as contributing factors to subjects' enhanced performance in the studies. Conclusions: How and to what users direct their perceptual and cognitive resources necessarily influence their perception of the environment, and by extension, their development of situation awareness (SA). Although patient monitoring equipment employed in anesthetic practice has proven to be indispensable in quality patient care, graphical representations of patient data is still far from optimal in the clinical setting. User-interfaces that lend decision support to facilitate SA and subsequent decision making is critical in crisis management.Dissertation/ThesisM.S.D. Design 201

The role of health kiosks: a scoping review

Background: Health kiosks are publicly accessible computing devices that provide access to services including health information provision, clinical measurement collection, patient self-check-in, telemonitoring and teleconsultation. While the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow. Objectives: We sought to clarify the current and future roles of health kiosks by investigating: (a) the setting, role, and clinical domains in which kiosks are used; (b) whether usability evaluations of health kiosks are being reported and if so, what methods are being utilized; and (c) what the barriers and facilitators are for the deployment of kiosks. Methods: We conducted a scoping review by a bibliographic search of the Google Scholar, PubMed and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers describe the implementation, either as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and through querying key informants. For each article we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and inclusion of usability testing. We then summarized the data in frequency tables. Results: A total of 141 articles were included, 134 primary studies and seven reviews. 47% of the primary studies described kiosks in secondary care settings, other settings included community (23.9%), primary care (17.9%), and pharmacies (6.0%). The most common roles of health kiosks were providing health information (35.1%), taking clinical measurements (20.9%), screening (12.7%), telehealth (8.2%), and patient registration (6.0%). The five most frequent health domains were multiple conditions (24.6%), Human Immunodeficiency Virus (HIV) (7.5%), hypertension (7.5%), pediatric injuries (5.2%), health and wellbeing (4.5%) and drug monitoring (4.5%). Kiosks were integrated in the clinical pathway in 70.1%, opportunistic kiosks accounted for 23.9% and 6.0% were being used in both. Usability evaluations of the kiosk were reported in 20.1% of the papers. Barriers (use of expensive proprietary software) and enablers (handling on-demand consultations) to deploying health kiosks were identified. Conclusions: Health kiosks still play a vital role in the healthcare system, including collecting clinical measurements and providing access to online health services and information to those with little or no digital literacy skills, and others without personal internet access. We identified research gaps, such as training needs for teleconsultations, and scant reporting on usability evaluation methods

Diabetes Self-Management Using Mobile Apps: An Empirical Investigation Based On App Reviews And Through Value Sensitive Design Perspective

Smartphones have penetrated our everyday lives. Novel technologies facilitate self-management of chronic diseases such as diabetes. However, not all the patients are motivated to use technologies to manage their chronic conditions. Patients depend on certain human values to self-manage their conditions and these values are not implicated in the technologies they use. In this research in progress study we draw on value sensitive design methodological and theoretical approach to investigate human responses to self-management technology. We collect app reviews for a diabetes app and schematically code the review. Our findings contribute to designing technologies and systems that account for the human values of the patients-users

Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines

A human-factors approach to capture medical device safety, performance and usability

Advances in medical technology including computer aided and robotic surgery, digital health and increased use of portable devices have improved patient care in both hospital and home environments. These advancements have brought an increased level of complexity in patient care with new challenges to both patients and clinicians. The available performance data on medical devices (MD) is scarce and of variable quality despite work from regulatory bodies, with multiple associated challenges and lack of effective systems in place for its collection. This research used human factor methods to address i) the current state of safety and performance data availability for MDs and ii) methods of capturing safety and usability data in hospital and home environments by using human factor methods. Part A of this thesis concentrated on hospital based devices whilst Part B addressed home use MDs. End user experiences were utilised throughout to gain an understanding of the current system including its challenges and reasons leading to lack of data. Patients, clinicians, manufacturers, human factor specialists and MHRA were involved at all stages of this research. The studies led to the developments of the pathway map to reporting and information transfer in operating theatres and furthermore the development and initial evaluation of the MD-PRS concept (Medical Device Performance Reporting System) as a single dedicated method of reporting all MD malfunctions/ failures. The My-VID usability tool (My Voice in Design) was developed and evaluated as a method for collecting usability data directly from patients on home use MDs. In conclusion, this thesis used human factor methods to better understand the current system of data collection, available data sources on MDs and challenges faced prior to developing methods for improvement, based on end user experiences . Finally, methods of applying this research to clinical practice were addressed in the final chapter.Open Acces