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

A inteligência artificial a caminho da visão da experiência do paciente

O estudo tem como escopo central examinar o impacto da inteligência artificial na experiência do paciente, a qual pode ser entendida como a soma das interações que ocorrem entre o paciente e os serviços de saúde. A substituição de ferramentas e métodos de gestão ultrapassados por sistemas e tecnologias inovadoras, como a inteligência artificial, aumentam a qualidade dos serviços prestados em saúde e ampliam a segurança dos pacientes. Busca-se uma revisão integrativa com o objetivo de analisar o impacto da inteligência artificial na experiência do paciente. O referencial teórico do estudo ora apresentado toma como base duas linhas institucionais contemporâneas. Trata-se de um trabalho de natureza qualitativa (descritiva e interpretativa), desenvolvido com base em dados documentais. Para a triagem inicial de artigos da área da saúde, utilizou-se as bases de dados LILACS e Medline. Das amostras levantadas, foram selecionados cinco artigos, os quais permitem apontar a relevância do uso de novas tecnologias na experiência do paciente, embora se possa reconhecer que o número de pesquisas que abordam a temática ainda seja incipiente, talvez pela natureza somente descritiva. Não obstante, considera-se que o estudo aqui levado a cabo possa significar uma contribuição para que novas pesquisas sejam realizadas, não somente com dados documentais, mas, sobretudo, com dados empíricos, que permitam dar voz ao paciente para se chegar a uma visão mais naturalística da questão

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

Coping strategies when self-managing care on home haemodialysis

Home haemodialysis can have significant advantages for patients compared with in-centre dialysis, positively impacting on quality of life. In this article, Ann Blandford et al report the findings of a study that looked at the experiences of patients who self-manage their dialysis, focusing particularly on the spectrum of coping strategies implemented

Using FRAM beyond safety: A case study to explore how sociotechnical systems can flourish or stall

FRAM (Functional Resonance Analysis Method) is a relatively new method that has been proposed to explore how functional variability can escalate into unexpected, and often unwanted, events. It has been used for accident analyses and risk assessments in safety. We apply (and slightly modify) FRAM, to analyse how functions are configured to create systems that excel. Our case study focuses on how functions in human factors project work positively resonate to improve the delivery of value. From interviews with 22 practitioners we derived 29 functions and 6 subsystems showing how functions are coupled. Practitioners validated this model through respondent validation. Our case study evaluates the applicability and usability of FRAM. It shows how we adapted the method to make it more usable. It shows that FRAM can be used to examine positive and negative resonance in systems, to investigate how complex sociotechnical systems can flourish or stall.This work was supported by the UK Engineering and Physical Sciences Research Council under Grant [GR/S67494/01], [GR/S67500/01] and [EP/G059063/1

Materiality in information environments: Objects, spaces, and bodies in three outpatient hemodialysis facilities

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152032/1/asi24277.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152032/2/asi24277_am.pd

Usability challenges in the use of medical devices in the home environment: a systematic review of literature

Background Home care medical devices are the fastest-growing segment of the medical device industry with associated safety and usability challenges. Human factor studies in the home environment present many difficulties resulting in limited knowledge of device use in this setting. This systematic review aims to identify usability challenges reported directly by end-users in the home environment. Methods A systematic review of the literature was conducted concentrating on studies involving end user reporting. Reported challenges were grouped into a) device-user, b) device use environment and c) device-user interface challenges. Results 3471 studies were screened and 202 underwent full-text review. Only twelve studies had direct involvement of end users. Multiple challenges were identified, with device-user interface problems being the most common. No effective, standardised method was found to collect patient/user feedback on usability challenges in the post-market stage, leading to a knowledge gap. Conclusions This study brought together multiple usability challenges reported by individual studies. Involvement of medical device end-users in usability studies is essential and their experiences must be effectively utilised in device design

Modelo informático integrado AmI-IoT-DA para el cuidado de personas mayores que viven solas

Elderly people suffer physical and mental deterioration, which they prevent and / or hinder the control of household chores, the loss of their dependence and autonomy, affecting their quality of life and well-being. This paper presents an AmI-IoT-DA integrated layered model integrating functionalities of the Internet of Things (IoT), Ambient Intelligence (AmI) and Data Analytics (DA). The model is applied to the monitoring and assistance of elderly people living alone. The model proposes four segments responsible for automating housing, supervising the user, taking decisions, supervise events, identify habits, and access AmI, IoT and Data Analytics servicesLas personas de la tercera edad sufren deterioro físico y mental que les impiden y/o dificultan el control de las tareas del hogar, la pérdida de su independencia y autonomía, lo que afecta su calidad de vida y bienestar. Este artículo presenta un modelo integrado AmI-IoT-DA en capas que integra funcionalidades de Internet de las Cosas (IoT), Inteligencia Ambiental (AmI) y data analytics(DA). El modelo se aplica al monitoreo y asistencia de las personas de la tercera edad que viven solas. Además, plantea cuatro segmentos encargados de automatizar la vivienda, supervisar al usuario, tomar decisiones, supervisar eventos, identificar hábitos, y acceder a servicios AmI, IoT y Data Analytics

"Tricky to get your head around": Information work of people managing chronic kidney disease in the UK

People diagnosed with a chronic health condition have many information needs which healthcare providers, patient groups, and resource designers seek to support. However, as a disease progresses, knowing when, how, and for what purposes patients want to interact with and construct personal meaning from health-related information is still unclear. This paper presents findings regarding the information work of chronic kidney disease patients. We conducted semi-structured interviews with 13 patients and 6 clinicians, and observations at 9 patient group events. We used the stages of the information journey – recognizing need, seeking, interpreting, and using information – to frame our data analysis. We identified two distinct but often overlapping information work phases, ‘Learning’ and ‘Living With’ a chronic condition to show how patient information work activities shift over time. We also describe social and individual factors influencing information work, and discuss technology design opportunities including customized education and collaboration tools

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