Touchscreen task efficiency and learnability in an electronic medical record at the point-of-care.

The objective of this study was to determine the relative efficiency of novices compared to a prediction of skilled use when performing tasks using the touchscreen interface of an EMR developed in Malawi. We observed novice users performing touchscreen tasks and recorded timestamp data from their performances. Using a predictive human performance modeling tool, the authors predicted the skilled task performance time for each task. Efficiency and rates of error were evaluated with respect to user interface design. Nineteen participants performed 31 EMR tasks seven times for a total of 4,123 observed performances. We analyzed twelve representative tasks leaving 1,596 performances featuring six user interface designs. Mean novice performance time was significantly slower than mean predicted skilled performance time (p<0.001). However, novices performed faster than the predicted skilled level in 208 (13%) of successful task performances. These findings suggest the user interface design supports a primary design goal of the EMR--to allow novice users to perform tasks efficiently and effectively

Dental Hygienists\u27 Cognitive Process in Periodontal Soft Tissue Charting

Introduction: Dental hygienists have not had the opportunity to be involved in the design and development of the periodontal soft tissue charts and the surrounding interface features that are used while examining dental patients in daily practice. In some cases, dentists are able to give their opinions, wants, and needs into the development of the health information systems that they use on a daily basis, but too often, the dental hygienist is forgotten about and no input is ever given to the developers from the dental hygienists. This project considers the impact of well-designed interfaces on effectiveness and workflow particularly in regard to the dental hygienists. It is focused on improving the surrounding interface of the electronic periodontal soft tissue chart in order to provide effective and efficient patient-centered cognitive support to the dental hygienist during a patient\u27s periodontal examination. Current periodontal soft tissue charts used in daily practice lack dental hygienists’ input during development. This study will fill a gap in knowledge by defining dental hygienists’ workflow and needs, and then proposing a layout and prototype for a periodontal soft tissue chart interface that will meet those needs. Methodology: Using a multi-phase methodology (ethnographic observations, focus groups, and cognitive task analysis) the wants and needs of practicing dental hygienists were defined. Based on the results of the ethnographic observations, focus groups, and cognitive task analysis sessions, a prototypical periodontal soft tissue chart interface was developed. The prototype then underwent usability testing by dental hygienists to compare its usability versus the existing commercial software, Dentrix. Results: Ten dental hygienists participated in the ethnographic observations, focus groups, and cognitive task analysis sessions. The wants and needs of dental hygienists were determined, as well as a “common” workflow among them. Using these results, the prototypical periodontal soft tissue chart interface was developed. Usability testing comparing Dentrix and the prototype revealed that the dental hygienists completed tasks on the prototype with greater success and speed than on Dentrix. Furthermore, the dental hygienists provided more positive comments toward the prototype than Dentrix. Conclusions: This study exhibits the need to properly involve the end users – dental hygienists – in the creation of a prototypical periodontal soft tissue chart interface. Health information systems need to involve the end users at all stages in the development process in order to design and develop a system that is efficient and usable for them

Using Touchscreen Electronic Medical Record Systems to Support and Monitor National Scale-Up of Antiretroviral Therapy in Malawi

Gerry Douglas and colleagues describe the rationale and their experience with scaling up electronic health records in six antiretroviral treatment sites in Malawi

Digital support for self-management and meaningful activities of people with mild dementia:Development, implementation and feasibility of a person-centred touch-screen intervention

This thesis reports on the research that was conducted to develop and pilot test a person-centred touchscreen-based program (FindMyApps intervention) that supports people with mild dementia and their informal carers in how to use a tablet and apps for self-management and meaningful activities. The program consists of the FindMyApps training for informal carers in supporting people with mild dementia in using a tablet and the FindMyApps selection tool designed to help people with mild dementia find apps for self-management and meaningful activities that fit their needs, wishes and abilities. The program was developed following the Medical Research Council (MRC) Framework for the design and evaluation of complex interventions and in co-creation with end users. The chapters of this thesis describe the first three phases of this framework i.e.: the preclinical or theoretical phase (0); the modelling phase (I) and the exploratory trial (II). The execution of an RCT (III), and further implementation (IV) in case the intervention proves effective, are beyond the scope of this thesis. In the first phase user needs studies were performed to identify user requirements for desired self-management and meaningful activities and to identify user-requirements related to the use of apps. Eight focus groups were performed in which people with mild cognitive impairment (MCI) or mild dementia (n=13) and informal carers (n=15) participated. We also conducted a literature review to explore which training interventions are most effective for people with mild dementia in (re)learning how to use technologies, including handheld touchscreen devices. An electronic search was conducted in the following databases: PubMed, APA PsycInfo (EBSCO) and CINAHL (EBSCO). In total 16 studies met the inclusion criteria. Our review contributed to the growing amount of promising evidence on the potential impact of Errorless learning training interventions for people with mild to moderate dementia in (re)learning how to use technology. Based on these results we developed the FindMyApps training. In the second phase of the framework we developed a first concept of the FindMyApps selection tool based on identified user requirements. To ensure its usability, the web-based tool was developed using a ‘user-participatory design’ involving the close collaboration of potential users, a development team (researchers, developers and designers) and an expert team (experts in person-centred dementia care and ICT). In three short iterative rounds – so called ‘sprints’ – the users (people with dementia (n=8) and (in)formal carers (n=10)) were invited to test whether the prototypes were in line with their needs, wishes and abilities. This generated important insights into user-interface aspects relating to (i) useful content and (ii) a user-friendly tool design. In the third phase we pilot tested the FindMyApps intervention by means of individual semi-structured interviews and a pilot randomized controlled exploratory trial. Twenty people with mild dementia and informal carer dyads were randomly assigned to the FindMyApps group (n=10), receiving either the FindMyApps training and selection tool, or a control condition (n=10), receiving only a short tablet training. Pre- and post-test measurements at a three month follow-up, consisted of questionnaires and post-test semi-structured interviews. Based on the qualitative results and the effect sizes on the outcomes measured in this study, we consider that the FindMyApps intervention has the potential to positively influence the self-management and engagement in meaningful activities in people with dementia. Future studies with a larger sample should better indicate whether this expectation can be confirmed. The intervention will be further improved and tested in a larger pilot-RCT study and its effectiveness subsequently evaluated in a definite RCT

Technology-assisted healthcare: exploring the use of mobile 3D visualisation technology to augment home-based fall prevention assessments

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonFalls often cause devastating injuries which precipitate hospital and long-term care admission and result in an increased burden on health care services. Fall prevention interventions are used to overcome fall risk factors in an ageing population. There is an increasing need for technology-assisted interventions to reduce health care costs, whilst also lessening the burden that an ageing population increasingly has on health care services. Research efforts have been spent on reducing intrinsic fall risk factors (i.e. functional ability deficits and balance impairments) in the older adult population through the use of technology-assisted interventions, but relatively little effort has been expended on extrinsic risk factors (i.e. unsuitable environmental conditions and lack of assistive equipment use), considering the drive for healthcare outside of the clinical setting into the patients’ home. In the field of occupational therapy, the extrinsic fall-risk assessment process (EFAP) is a prominent preventive intervention used to promote independent living and alleviate fall risk factors via the provision of assistive equipment prescribed for use by patients in their home environment. Currently, paper-based forms with measurement guidance presented in the form of 2D diagrams are used in the EFAP. These indicate the precise points and dimensions on a furniture item that must be measured as part of an assessment for equipment. However, this process involves challenges, such as inappropriate equipment prescribed due to inaccurate measurements being taken and recorded from the misinterpretation of the measurement guidance. This is largely due to the poor visual representation of guidance that is provided by existing paper-based forms, resulting in high levels of equipment abandonment by patients. Consequently, there is a need to overcome the challenges mentioned above by augmenting the limitations of the paper-based approach to visualise measurement guidance for equipment. To this end, this thesis proposes the use of 3D visualisation technology in the form of a novel mobile 3D application (Guidetomeasure) to visualise guidance in a well-perceived manner and support stakeholders with equipment prescriptions. To ensure that the artefact is a viable improvement over its 2D predecessor, it was designed, developed and empirically evaluated with patients and clinicians alike through conducting five user-centred design and experimental studies. A mixed-method analysis was undertaken to establish the design, effectiveness, efficiency and usability of the proposed artefact, compared with conventional approaches used for data collection and equipment prescription. The research findings show that both patients and clinicians suggest that 3D visualisation is a promising development of an alternative tool that contains functionality to overcome existing issues faced in the EFAP. Overall, this research makes a conceptual contribution (secondary) to the research domain and a software artefact (primary) that significantly improves practice, resulting in implications and recommendations for the wider healthcare provision (primary).The Engineering and Physical Sciences Research Council (EPSRC)

Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges.

BACKGROUND: In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as "poor fit" of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. OBJECTIVE: The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. METHODS: Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. RESULTS: The quantitative SUS results revealed that the application may be described as having "marginal-high" and "good" levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. CONCLUSIONS: Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets

User-centered design of the interface prototype of a business intelligence mobile application

Dissertação para obtenção do Grau de Mestre em Engenharia e Gestão IndustrialIn a society in constant technological evolution, companies try to equip themselves with tools that allow them to achieve, or maintain, the leadership position in the markets in which they compete in. Success often lies in the ability to exploit the existent Business Intelligence (BI) in the best possible way. Moreover, mobile devices such as smartphones and tablets assume themselves as elements with an increasingly preponderant use in the everyday life. In the convergence of these two factors, emerges the need to develop mobile “management facilitators”, capable of providing companies’ workers the access to BI, anywhere and at a few touches distance. To make this possible, not only does the correct information needs to be selected, but also organized and presented in a highly intuitive and easy to use way. It’s in this context that the work present in this dissertation emerges: User-Centered Design of the interface prototype of a Business Intelligence mobile application for a company in the retail industry. Thus, the goal of this dissertation resides in the development of an adequate interface, through the continuous interaction with a group of representative users in activities such as users’ needs assessment, interface design, heuristic evaluation and usability tests. From meetings with the users, 29 needs were identified for the BI application. These needs were later converted into functional requirements which originated two prototypes, one for smartphones and the other for tablets. These were subjected to a heuristic evaluation and tested through the application of the Cognitive Walkthrough method to representative users, to collect performance and satisfaction metrics. It was concluded that the designed interfaces were in accordance with 14 of the 16 heuristics, which led to three modifications on the interfaces. The Cognitive Walkthrough results showed that the interfaces are intuitive since all the tasks were completed with 100% success, in reasonable times and with a number of actions close to the ideal

Conservation of Limited Resources: Design Principles for Security and Usability on Mobile Devices

Mobile devices have evolved from an accessory to the primary computing device for an increasing portion of the general population. Not only is mobile the primary device, consumers on average have multiple Internet-connected devices. The trend towards mobile has resulted in a shift to “mobile-first” strategies for delivering information and services in business organizations, universities, and government agencies. Though principles for good security design exist, those principles were formulated based upon the traditional workstation configuration instead of the mobile platform. Security design needs to follow the shift to a “mobile-first” emphasis to ensure the usability of the security interface. The mobile platform has constraints on resources that can adversely impact the usability of security. This research sought to identify design principles for usable security for mobile devices that address the constraints of the mobile platform. Security and usability have been seen as mutually exclusive. To accurately identify design principles, the relationship between principles for good security design and usability design must be understood. The constraints for the mobile environment must also be identified, and then evaluated for their impact on the interaction of a consumer with a security interface. To understand how the application of the proposed mobile security design principles is perceived by users, an artifact was built to instantiate the principles. Through a series of guided interactions, the importance of proposed design principles was measured in a simulation, in human-computer interaction, and in user perception. The measures showed a resounding difference between the usability of the same security design delivered on mobile vs. workstation platform. It also reveals that acknowledging the constraints of an environment and compensating for the constraints yields mobile security that is both usable and secure. Finally, the hidden cost of security design choices that distract the user from the surrounding environment were examined from both the security perspective and public safety perspective

Electronic Medical Records For Trauma Surveillance In South Africa: The Case Of Khayelitsha Hospital

Electronic Medical Records (EMRs) have shown benefit for clinical, organizational, and societal outcomes(1). In South Africa, the desire for effective record keeping will continue to rise with increasing trauma and infectious disease rates. Recognizing this, the Western Cape government in 1999 signed a tender to rollout Clinicom EMR, an online storage system for paper records, to all hospitals within the province(2). In 2012, Khayelitsha Hospital (KH) was opened with the Clinicom EMR installed. In 2013, KH received the ministerial award for clinical excellence as a result of the effective EMR rollout. Due to a high incidence of violence around Khayelitsha, and the need for effective trauma surveillance for efficient resource allocation, the authors sought to calculate the Emergency Center (EC) trauma rate for KH. Retrospective review of both paper charts and the Clinicom EMR from July 2012 to May 2013 was performed. The Clinicom EMR yielded a mean monthly EC trauma visit of 280 patients, mean EC census of 3537 patients and a mean trauma rate of 8%. The latter was much lower than the nationwide estimate of 33%. For the month of July, 66 additional cases were found on the paper registry but not on the EMR. Furthermore for the months of January to May 2013, scanned copies of patient records were unavailable on the EMR online database. The discrepancy between the paper records and the EMR suggest potential difficulties with the implementation of the Clinicom EMR that were overlooked by the award committee, and call into question the 8% trauma rate calculated. The results highlight the need for further evaluation of the functioning of the Clinicom EMR system to identify difficulties in implementation and correct them before the system is utilized in hospitals across South Africa

Guidelines for the user interface design of electronic medical records in optometry

With the prevalence of digitalisation in the medical industry, e-health systems have largely replaced the traditional paper-based recording methods. At the centre of these e-health systems are Electronic Health Records (EHRs) and Electronic Medical Records (EMRs), whose benefits significantly improve physician workflows. However, provision for user interface designs (UIDs) of these systems have been so poor that they have severely hindered physician usability, disrupted their workflows and risked patient safety. UID and usability guidelines have been provided, but have been very high level and general, mostly suitable for EHRs (which are used in general practices and hospitals). These guidelines have thus been ineffective in applicability for EMRs, which are typically used in niche medical environments. Within the niche field of Optometry, physicians experience disrupted workflows as a result of poor EMR UID and usability, of which EMR guidelines to improve these challenges are scarce. Hence, the need for this research arose, aiming to create UID guidelines for EMRs in Optometry, which will help improve the usability of the optometrists’ EMR. The main research question was successfully answered to produce the set of UID Guidelines for EMRs in Optometry, which includes guidelines built upon from literature and made contextually relevant, as well as some new additions, which are more patient focused. Design Science Research (DSR) was chosen as a suitable approach, and the phased Design Science Research Process Model (DSRPM) was used to guide this research. A literature review was conducted, including EHR and EMR, usability, UIDs, Optometry, related fields, and studies previously conducted to provide guidelines, frameworks and models. The review also included studying usability problems reported on the systems and the methods to overcome them. Task Analysis (TA) was used to observe and understand the optometrists’ workflows and their interactions with their EMRs during patient appointments, also identifying EMR problem areas. To address these problems, Focus Groups (FGs) were used to brainstorm solutions in the form of EMR UID features that optometrists’ required to improve their usability. From the literature review, TAs and FGs, proposed guidelines were created. The created guidelines informed the UID of an EMR prototype, which was successfully demonstrated to optometrists during Usability Testing sessions for the evaluation. Surveys were also used for the evaluation. The results proved the guidelines were successful, and were usable, effective, efficient and of good quality. A revised, final set of guidelines was then presented. Future researchers and designers may benefit from the contributions made from this research, which are both theoretical and practical