Interaction Design & Psychology (2002) » SlideShare
Leave a CommentI read this presentations. Slides comments are present, yet it is hard to know exactly what the presenter means by some slides.
The presenter starts with comparing usability to psychology. While usability focuses on the product, psychology focuses on the human using the product. Interaction design focuses on five psychological human functions:
- movement
- perception
- language
- memory
- thinking
The points raised by this presentation must be understood by anyone designing computer interfaces. Slide three summarizes the valuable points raised by this presentation.
Can Health Information Systems be Simple and Complex? yes.
I came across this interesting article by Panatazi and colleagues (2006). They argue that health information systems cannot be usable and useful at the same time. Information systems are of two parts: a user interface and a problem solving engine. One of the goals of the problem solving engine is to be useful through solving medical problems. Medical problems tend to be complex. This complexity will eventually creep into the the user interface making it less simple and though less usable. There are many examples in reality. If you look around you will notice that usable systems tend to solve simple problems only. Calculators are highly usable and simple but only solve simple problems. Once you get into the more advanced scientific calculators you loose the simplicity and uablility.
The authors make a vary good argument, and shed light on some solutions that need not yet present technologies. But, they miss on one critical factor. That is the user brain. I believe the best way to solve this “usability usefulness paradox”, as called by the authors, is to allow the user brain bridge the gap between usability and usefulness i.e. have a simple and usable interface that allows that user to solve complex problems. The other part of information system, the problem solving engine, would only perform jobs that would not interfere with the user cognitive processes and would not add complexities to the user interface.
A Summary: Getting to the point: developing IT for the sharp end of healthcare
First I need to explain what is meant by the sharp end of health care. Health care systems can be looked at as a wedge with a sharp edge and a blunt edge. The blunt edge is where management lies. Clinicians directly caring for patients are at the sharp edge. Cognitive work at the sharp edge is more complex and less supported by IT. Unfortunately, there is simplification of these complexities. Changing and conflicting guidelines and varied patients response to treatments are two examples of ignored realities.
Clinicians are the most adaptive elements at the sharp edge end yet their needs must be supported. Developing user centred systems in this environment is oversimplified. Actually, this is an impossible job. The variability between clinicians prohibits reductionist approaches. Yet sciences as psychology, human factors and human-computer interaction should help. Naturalistic decision making approach can be used.
At the sharp edged, the coordination between human and machine needs better understanding. This is inlight that IT can help as can hinder cognitive work.
The authors call to improve the clinicians ability to perform despite changes and challenges; in other wards, to improve resilience.
Goodbye “Single- Sensor- Single- Indicator” Displays
This study used a display method developed using iterative design method. The goal is to replace the numbers displayed on ICU patient monitors with representational graph. The current number based systems use “single-sensor-single-indicator” display paradigm. This requires clinicians to integrate sequential, piecemeal data to reach an understanding of the patient’s condition. This is complicated by the fact that 67-90% of the generated alarms by monitor devices are false positive.
Using graphs generated by multiple sensors would aid the situation awareness and though the prompt response by clinicians. It has been shown that monitoring systems that increase situation awareness shorten the time between the occurrence of unexpected events and correction of the events.
This study is one of multiple that evaluates similar displays. This study focuses on this sort of displays in ICU settings. The study consisted of observation and questionnaire submission. The result shows that clinicians did observe this display and they think it is a desirable addition to current ICU monitors.
The vital thing in such displays is that they generate an easy to understand graphs that pull data from different sensors and though decrease the cognitive load. This should lead to better decisions.
Alerts as the Ones in Computerized Physician Order Entry Systems Harm Physicians
Heath information systems are plagues with alerts. In studies done on Computerized Physician Order Entry systems it has been shown that physicians are flooded with alerts that hardly every change the previously intended action. These experiments in this interesting article prove that these mainly useless alerts have and added negative effects on memory! Alerts decreased the memory accuracy of subjects in this study.
Everyone knows that mistakes in prescribing medication are done daily, and can lead to the loss of human lives, and human suffering to the minimum. But, alerts are not the way to do it. The old way of pharmacist checking on physicians prescriptions seems the methods we should be using till better ways of improving our prescription practices are found.
The Importance of Addressing the Environment When Designing Healthcare Information Systems
Follows is my review of an interesting article titled: artifacts and collaborative work in healthcare: methodological, theoretical, and technological implications of the tangible.
There are things when you read, your brain just refuses to let go of them. This article by Dr. Yan Xiao is one of these. Surprisingly, Dr. Xiao was able to squeeze this article in six pages!
This article is a call to reconsider of how IT is implemented in health care. We humans communicate in explicit and implicit methods. We can appreciate if the other person is paying attention or is upset implicitly by looking into their eyes and listening to their voices. IT focuses on explicit communication. And, unfortunately poorly designed systems impede the vital implicit communication. This is obvious in the technique of work-flow abstraction. Data and information flow is plotted with total ignorance to the physical environment. This physical environment includes us humans and the artifacts we use. Humans over years have devised ways to use these artifacts to optimize communication and cognition. The use of books, paper, and white boards are examples. Dr. Xiao gives examples as the white boards used in emergency rooms and operating theaters. He also mentions and example presented by Boguslaw and Porter (1962) present in restaurants’’, the “spindle wheel”. Read more »
Is openEHR the solution?
Link to the official openEHR website.
This post is from a physician’s and not a developer’s point of view. Whenever I read more about openEHR, I appreciate the work put to in this opensource project but at the same time I get weary about its potential for success. OpenEHR promises to put the users (clinicians and other healthcare workers) in the driving seat[1]. This is done by allowing users determine what information should be collected and shared. My feeling is that uses like car drivers only care about reaching their goals in the most comfortable way. Users like drives don’t usually care what is under the hood as long as they reach their goals.
I hope I am not conveying a message that I think that openEHR is useless. To the contrary, openEHR main mission is to offer interoperability between different healthcare systems. The focus on the front line user, not like most if not all systems that focus on how to serve people in management [1,2]. It focuses on those human beings that need to see value for the effort they put in entering data into these systems. OpenEHR gives insights into how should health care systems should be developed. OpenEHR two layer architecture and spreading archetypes into observation, evaluation, instruction and action archetypes are just some proofs of this insight.
I have three concerns. I must say that my concern seems to have been thought of among openEHR developers. Read more »
‘Rage against the machine?’ nurses and midwives’ experiences of using computerized patient information systems for clinical information. A summary with commentary
This is a qualitative study where data was collected late 1998. The goal is to answer what are nurses’ and midwives’ experiences of using Computerised Patient Information Systems CPIS?
This study is an answer (getting back) to IT professionals who don’t believe in that customers are always right and claim that clinicians resistance is because of ‘resistant to change-period’ or ‘more education and training’ is needed. But, may be IT professionals do care for customers. But, these customers are not the clinicians that will use the new system. The customers are health care management and IT professionals that will choose and pay for the new system.
Researchers conducted 13 focus groups involving 53 practitioners across five Australian states. Although this study was conducted in late 1998 the experiences expressed are similar to the ones I experience.
CPIS developers advertise that these systems could help the complex clinical environments. But according to the the nurses and midwives in this study, these systems failed to capture these complexities. We know more then we can say, and say more then we can write. It seems that we can put in CPIS less then we can write.
Many expressed that CPIS felt like a big black hole. Clinicians exert effort to enter data but could not get this back when needed. Only the powerful groups in the organisation are severed with needed information.
Using qualitative studies to improve the usability of an EMR. A summary with commentary
Authors conducted task analysis and focus groups to study a Longitudinal Medical Record (LMR). They studied the usability of one of these LMR’s modules. This module is the results manager. This module allows physicians to follow up on their patients’ laboratory results. Physicians would assess these results and prepare letters for their patients. Based on the inputs from these two qualitative studies, the authors proposed modifications to the existing results manager module.
It was interesting for me to realise that the criticism I have to our totally different Electronic Medical Record were similar to the ones raised by physicians in this study. This means that systems’ developers are similar and though make similar systems. Here is a summarized list of findings with some commentary: Read more »
Should Electronic Health Systems Address the Interruptive Nature of Healthcare Environments?
I keep complaining about healthcare systems not addressing interruptive nature of
health care environment. I do realize that solving this problem is impossible. We humans fail in multitasking. Prophet Mohammed (peace be upon him) said this in a figurative way when he stated that God did not create humans with two hearts. When multitasking we keep shifting between tasks. This shifting of attention cost time and can lead to mistakes. In a way, we are similar to the processors we designed. When we ask a processor to multitask the processor’s overhead increases with no benefit in the total time spent processing all the requests.
It is the job of clinicians to reduce the distractions in their environment. Two things that are hard to get rid of are the patient and the medical chart. Depending on where you practice, it could be extremely hard to shut out other distractions. The last thing we should do is to make the situation worse with a computer.
What I want to say is; although preventing health care systems from exacerbating distractions is impossible, it should be seriously addressed.
