Parkinson's Disease Management through ICT

Parkinson's Disease (PD) is a neurodegenerative disorder that manifests with motor and non-motor symptoms. PD treatment is symptomatic and tries to alleviate the associated symptoms through an adjustment of the medication. As the disease is evolving and this evolution is patient specific, it could be very difficult to properly manage the disease.The current available technology (electronics, communication, computing, etc.), correctly combined with wearables, can be of great use for obtaining and processing useful information for both clinicians and patients allowing them to become actively involved in their condition.Parkinson's Disease Management through ICT: The REMPARK Approach presents the work done, main results and conclusions of the REMPARK project (2011 – 2015) funded by the European Union under contract FP7-ICT-2011-7-287677. REMPARK system was proposed and developed as a real Personal Health Device for the Remote and Autonomous Management of Parkinson’s Disease, composed of different levels of interaction with the patient, clinician and carers, and integrating a set of interconnected sub-systems: sensor, auditory cueing, Smartphone and server. The sensor subsystem, using embedded algorithmics, is able to detect the motor symptoms associated with PD in real time. This information, sent through the Smartphone to the REMPARK server, is used for an efficient management of the disease

Combining situated Cognitive Engineering with a novel testing method in a case study comparing two infusion pump interfaces

We validated the usability of a new infusion pump interface designed with a situated Cognitive Engineering approach by comparing it to a reference interface using a novel testing method employing repeated measurements and process measures, in addition to traditional outcome measures. The sample consisted of 25 nurses who performed eight critical tasks three times. Performance measures consisted of number and type of errors, deviations from a pre-established normative path solution, task completion times, number of keystrokes, mental effort and preferences in use. Results showed that interaction with the new interface resulted in 18% fewer errors, 90% fewer normative path deviations, 42% lower task completion times, 40% fewer keystrokes, 39% lower mental effort and 76% more subjective preferences in use. These outcomes suggest that within the scope of this case study, combining the situated Cognitive Engineering approach with a novel testing method addresses various shortcomings of earlier testing methods

Impact of Interruption Frequency on Nurses\u27 Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting

Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses* medication processes, the impact of interruption frequency on nurses* PCA interaction has not been fully measured or described. Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses* (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses* perceptions of the impact of interruption frequency. Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar*s test, and Friedman*s test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs* perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar*s test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses* perception of interruption frequency: the nature of interruptions and nurses* reaction to the interrupted work environment. Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs* described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs* perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs* performance accuracy and cognitive workload

Parkinson's Disease Management through ICT

Parkinson's Disease (PD) is a neurodegenerative disorder that manifests with motor and non-motor symptoms. PD treatment is symptomatic and tries to alleviate the associated symptoms through an adjustment of the medication. As the disease is evolving and this evolution is patient specific, it could be very difficult to properly manage the disease.The current available technology (electronics, communication, computing, etc.), correctly combined with wearables, can be of great use for obtaining and processing useful information for both clinicians and patients allowing them to become actively involved in their condition.Parkinson's Disease Management through ICT: The REMPARK Approach presents the work done, main results and conclusions of the REMPARK project (2011 – 2015) funded by the European Union under contract FP7-ICT-2011-7-287677. REMPARK system was proposed and developed as a real Personal Health Device for the Remote and Autonomous Management of Parkinson’s Disease, composed of different levels of interaction with the patient, clinician and carers, and integrating a set of interconnected sub-systems: sensor, auditory cueing, Smartphone and server. The sensor subsystem, using embedded algorithmics, is able to detect the motor symptoms associated with PD in real time. This information, sent through the Smartphone to the REMPARK server, is used for an efficient management of the disease

New Product Development Processes for IOT-Enabled Home Use Medical Devices: A Systematic Review

Background: In the new forefront of healthcare at patients’ homes, medical devices developed to use at home setting by lay users are essential. The adoption of home-use medical devices will benefit both patients and public healthcare services in terms of quality of life, enhanced outcomes, and reduced cost of care. Home use medical devices associated with Internet-Of-Things (IOT) technology assists patients in performing self-care as well as providing health information remotely to health care professionals. However, adopting technology requires understanding the nature of the medical device and medical device development (MDD). Existing studies concerning the new product development (NPD) processes or design processes were systematically reviewed to explore knowledge and expertise to provide a framework for IOT engineers or designers to adopt IOT technology to home use medical devices. Objective: This study aimed to review the published literature to explore the current studies in the field of the NPD process, design process, design methodology, and outcome of the device affecting user acceptance. Methods: A systematic review following PRISMA guidelines of the English language literature from four electronic databases and academic search engines published from 2007 to 2018 was conducted. The papers were screened and assessed following predefined inclusive and exclusive criteria. The results were analyzed according to the research questions. Results: The findings revealed state-of-the-art in the NPD process and design process (n=4), the design methodology (n=23), and the resultant outcomes of empirical or clinical research in the validation stage (n=14) of medical device development (MDD). The findings also delineated existing studies in NPD, design process, and design methodologies aimed to ensure that medical devices would be effective and safe. Human factor engineering (HFE), cognitive method, ethnographic, and other methodologies were proposed to understand users, uses and context of use. Barriers, constraints, and multidisciplinary communication were addressed. Tools, processes, and methodologies were proposed to overcome the barriers. Conclusion: As home-use medical device development (MDD) and the adoption of IOT technology is now at a crossroads. This study addresses the necessity for future academic studies related to IOT adoption to MDD, including unique risks, multidisciplinary problems, emerging from IOT technology. Finally, future studies aimed at fabricating the NPD process or design process for IOT home-use medical devices to gain user acceptance were outlined

A systems approach to improving patient safety through medical device purchasing

The purchase of medical devices involves engaging various stakeholders as well as balancing clinical, technical and financial requirements. Failure to consider these requirements can lead to wider consequences in the delivery of care. This study first builds a general knowledge base of current purchasing practice in a sample of NHS Trusts, which confirms the direction and guidance given by policy documents and literature as to the extent of the challenges faced by purchasing stakeholders. This then leads to an analysis to identify inefficiencies in the purchasing process, and how such practice can lead to risks in the delivery of care. These risks range from injury to individuals, impacts to the healthcare delivery service, and financial and litigation risks. Finally, a framework that highlights these potential risks in the life-cycle of medical devices in hospitals is presented. Key policy guidance has encouraged both researchers and implementers of healthcare services to approach patient safety from a systems perspective, acknowledging that medical device errors are not only directly related to device design, but to the design of the healthcare delivery service system in which the device operates. Little evidence exists of successfully applying systems approaches specifically to medical device purchasing practice. Medical device purchasing, because of its implications to patient safety on the one hand, and the uniqueness of the healthcare context, requires a unique approach. By demonstrating the influence of purchasing practice to service delivery and patient care, the thesis made is that taking a holistic systems approach is one method to improve device purchasing practice, and hence influence better care.This work was supported by the UK Engineering and Physical Sciences Research Council [EP/E001777/1

Optimizing Usability Studies by Complementary Evaluation Methods

This paper examines combinations of complementary evaluation methods as a strategy for efficient usability problem discovery. A data set from an earlier study is re-analyzed, involving three evaluation methods applied to two virtual environment applications. Results of a mixed-effects logistic regression suggest that usability testing and inspection discover rather disjunctive sets of problems. A resampling analysis reveals that mixing inspection and usability testing sessions in equal parts finds 20% more problems with the same number of session

An investigation of healthcare professionals’ experiences of training and using electronic prescribing systems: four literature reviews and two qualitative studies undertaken in the UK hospital context

Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient and has been associated with reduced medication errors and improved patient safety. However, these systems have also been associated with unintended adverse consequences. There is a lack of published research about users’ experiences of these systems in UK hospitals. The aim of this research was therefore to firstly describe the literature pertaining to the recent developments and persisting issues with ePrescribing and clinical decision support systems (CDS) (chapter 2). Two further systematic literature reviews (chapters 3 and 4) were then conducted to understand the unintended consequences of ePrescribing and clinical decision support (CDS) systems across both adult and paediatric patients. These revealed a taxonomy of factors, which have contributed to errors during use of these systems e.g., the screen layout, default settings and inappropriate drug-dosage support. The researcher then conducted a qualitative study (chapters 7-10) to explore users’ experiences of using and being trained to use ePrescribing systems. This study involved conducting semi-structured interviews and observations, which revealed key challenges facing users, including issues with using the ‘Medication List’ and how information was presented. Users experienced benefits and challenges when customising the system, including the screen display; however, the process was sometimes overly complex. Users also described the benefits and challenges associated with different forms of interruptive and passive CDS. Order sets, for instance, encouraged more efficient prescribing, yet users often found them difficult to find within the system. A lack of training resulted in users failing to use all features of the ePrescribing system and left some healthcare staff feeling underprepared for using the system in their role. A further literature review (chapter 5) was then performed to complement emerging themes relating to how users were trained to use ePrescribing systems, which were generated as part of a qualitative study. This review revealed the range of approaches used to train users and the need for further research in this area. The literature review and qualitative study-based findings led to a follow-on study (chapter 10), whereby the researcher conducted semi-structured interviews to examine how users were trained to use ePrescribing systems across four NHS Hospital Trusts. A range of approaches were used to train users; tailored training, using clinically specific scenarios or matching the user’s profession to that of the trainer were preferred over lectures and e-learning may offer an efficient way of training large numbers of staff. However, further research is needed to investigate this and whether alternative approaches such as the use of students as trainers could be useful. This programme of work revealed the importance of human factors and user involvement in the design and ongoing development of ePrescribing systems. Training also played a role in users’ experiences of using the system and hospitals should carefully consider the training approaches used. This thesis provides recommendations gathered from the literature and primary data collection that can help inform organisations, system developers and further research in this area

COMBINING HUMAN FACTORS AND DATA SCIENCE METHODS TO EVALUATE THE USE OF FREE TEXT COMMUNICATION ORDERS IN ELECTRONIC HEALTH RECORDS

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion of medication related information in communication for non-medication orders (CNMOs), a type of free text order, has not been adequately studied. This mixed-methods study identified the prevalence, nature and reasons for the inclusion of medication related information in CNMOs using a large sample of CNMOs placed at a mid-Atlantic hospital system in 2017, and via interviews with physicians. The study found that more than 42% of CNMOs contain medication related information. Moreover, the use of CNMOs varied significantly across provider types, hospital locations, patient settings and other factors. The study found 10 themes that might cause providers to adopt such workarounds, including missing functionality and poor usability. The viii study also identified several general challenges in communicating medication information in the EHR, and potential solutions to mitigate these challenges. This dissertation also demonstrates how natural language processing could be used to identify medication related CNMOs

Usability Challenges with Insulin Pump Devices in Diabetes Care: What Trainers Observe with First-Time Pump Users

Insulin pumps are designed for the self-management of diabetes mellitus in patients and are known for their complexity of use. Pump manufacturers engage trainers to teach patients how to use the devices correctly to control the symptoms of their disease. Usability research related to insulin pumps and other infusion pumps with first-time users as participants has centered on the relationship between user interface design and the effectiveness of task completion. According to prior research, the characteristics of system behavior in a real life environment remain elusive. A suitable approach to acquire information about potential usability problems encountered by first-time users is to obtain this information from the health care professionals who train them. The purpose of the study was to discover the lived experiences and shared impressions of insulin pump trainers during training sessions with first-time users. Interpretative Phenomenological Analysis (IPA) was used to uncover the phenomena associated with usability challenges that first-time users of insulin pumps face when learning to use the device. Six participants representing a homogeneous sample were recruited from a wide geographic area in the United States, and semi-structured interviews containing open-ended questions were conducted with the respondents. The data from the lived experiences and shared impressions of the participants were used to develop the following five super-ordinate themes: Emotion-charged Environment, Personalized Training, Safety Issues and Disaster Planning, Professional Dedication, and The Voice. The essence of participants’ experience was described around the pivotal moment when the training sessions are successfully completed and insulin pump therapy becomes alive. The findings of this study have implications for information systems professionals who conduct research on the safe design and usability of safety critical medical devices. In addition, the findings from this study create opportunities for practice to improve the initiation of insulin pump therapy in patients with diabetes