Jennifer Martin

Transcript

1. Monday, April 29, 2013 1 Med-Tech Innovation Expo 2013 Overcoming technology abandonment through user friendly design Jennifer Martin Senior Research Fellow in Human Factors
2. 2 Human Factors & Healthcare Technology  Recognised as critical for patient safety  Now a Legal requirement in US and EU to consider usability  However, many others benefits:  Adherence: regular and correct use  Self-management  Satisfaction  Efficiency  Etc…  Ultimately… improved health and well-being
3. Human Factors… also known as:  Usability Engineering  Ergonomics  User centred design “The application of knowledge on humans and their behaviour to the design of systems to maximise system and individual safety, efficiency and performance”  Physical: size, shape, strength, dexterity, vision, hearing, etc...  Cognitive: process and interpret information, make decisions  Behavioural: individually and in groups, e.g.  Health-related behaviours  Motivation
4. The interactions between users and a device will be affected by all levels of a system A systems approach
5. Human Factors is designing to fit the user... ”the computer says I need to upgrade my brain to be compatible with its new software” ... Not expecting them to adapt to bad design So it’s easy to do the right thing... And hard (or impossible) to do the wrong thing
6. The User-Centred Design process Start early... Test often... In the Context of Use... With real users
7. Consequences of not considering user requirements Death and Severe Harm Near misses Moderate / low harm Incorrect use Abandonment Social Issues – e.g. stigma? Over-use? 7
8. Case study: A new blood vessel imaging device Device for imaging blood vessels developed by UK SME  Aims to aid blood taking & drug delivery  Low Cost  Portable and light  Non-contact With anticipated benefits for  Patients - pain  Clinicians – efficiency  Hospitals/Trusts - cost
9. The User-Centred Design process
10. Study 1: Requirements Specification Aims:  Is there a need for this device?  And if so, what is the need?  Who will the users be? (regular & occasional)  Anticipated impact on clinical practice  Potential barriers to safe and effective use  Not just... ‘Collect design information for Prototype’  Face to face interviews with a range of all potential users at 2 hospitals
11. Results There is a need for this device, but it is a very different need...  Phlebotomy is generally a successful procedure – overestimated need  Regular difficulties with renal & oncology patients – unknown need  Vulnerable patients likely to benefit significantly – not general hosp population Design information collected  User preferences – but vague and varied (difficult when no prototype available) Potential barriers identified  Time to set-up and use device crucial  Not size or weight... Which was the main objective of the technological work –  Results contradicted company’s initial user research (conducted with small number of senior (local) clinicians)
12. The User-Centred Design process Start early... Test often... In the Context of Use... With real users
13. Study 2: Early Prototype Evaluation Evaluate prototype imaging device in the clinical environment:  Usability of the device in the clinical environment  Environmental & organisational barriers to safe and effective use  Identify training needs  Identify any potential risks with device 12 ‘Contextual Inquiries’ of healthcare staff using device on patients  Observation/interview research method – roots in ethnography: ‘Discovery’  Any sensitive issues were discussed once patient had left  Clinician and patient were free to ask researcher to leave at any time  De-brief session following each observation
14. Usability was affected by: • Physical Environment • Dimensions of consulting rooms • Presence of other equipment, access to electric sockets, etc. • Patient Characteristics • Size, shape, mobility • Clinical & Operational Requirements • Time to start up, scan time – both far too long • Other Usability Issues: • Complex Programming Procedure • Lack of feedback from user interface – lead to errors • Difficult to recover from errors – lead to delays, frustration • Instruction for use – Lengthy, complex and liable to get lost Device in current form is not suitable – discovered early and problems could be quickly and cheaply fixed before a clinical trial
15. Patient Use Devices  Number of home and Patient Use devices increasing  Ageing population  Telemedicine and assisted living  Reduce healthcare costs  Allow patients to remain independent for longer  Human factors must considered if devices are to be used:  Safely  Correctly  Regularly  At all...
16. Physiotherapy device for Teenagers with Cystic Fibrosis Adolescents are an important user group:  Poor compliers with medication and treatment  Overlooked – not small adults or big children  Transitional stage of life Problem (not exclusive to adolescents)  Device not used as often as it should be (3x20 mins each day)  Device not used optimally (sufficient vibration to break up mucus) Our findings:  Adolescent specific:  Device designed for young children: “it’s baby-ish”  Social issues: stigma, identity (customise?)  General:  Lack of feedback on use and posture: “I don’t know when I’m doing it right”  Expectations of technology: interaction, share data with clinicians, parents, entertainment?  Supports other research: patients want to do more than just the clinical task...
17. Physiotherapy device for Teenagers with Cystic Fibrosis Possible Solutions:  Use of sensors to measure and feedback vibration  Ability to connect device to ICT and share data  Use of games to improve motivation  Customised design?
18. Auto-injectors for allergies ‘epipens’ • Balancing conflicting risks: • When you try to use it is it effective? • Do you always have it with you when you need it? • Primary factor influencing both = size • Must be large enough to get through clothing • But size = cumbersome to carry • Other factors: • Lack of training / awareness of risks • Social issues of carrying ‘weapon like’ device • Ignoring expiry dates – relying on old devices that were kept at work/ school
19. That’s the thing that annoys me, it’s long and sort of bulky. It means I have to take a bigger bag than I otherwise would. You know, you can’t put it in a pocket It could be like a lipstick, a pretty lipstick. But it’s so revealing, that plastic case... it’s yellow on yellow as well, and it’s revealing, you know, like a weapon There’s been a couple of times where I’ve been almost mugged, and I’ve thought, what would happen if they’d used that on me? I’m so unsure about how far it needs to get, like do I need to be going blue? I’ve not got a clue... I’ve not really had any training in it either. Why don’t people always carry their epipens? I don’t take it if I’m going to a football match or concert or something ‘cos there’s security and what would they think if they found it?
20. Blood Glucose Monitoring for Type II Diabetes Problem: Low compliance = poor control of blood glucose levels:  Conflicting goals  Once-a-day ‘reassurance’ check (clinicians)  Ability to control and learn about disease (patients)  Leading to poor communication and deception  Device introduction and Training  Variable: many patients simply given a sealed box: “take one on your way out”  Devices not meeting needs of patients –particularly changing needs  ‘Innovation’ seems to mean as small a device as possible  Suits younger/more active patients  Older patients reported using a 10 year old device due to changes in dexterity and eyesight  Had not reported this to healthcare professionals  Was this device still accurate after 1000+ readings?
21. Human Factors Research: Potential Pitfalls  Not clearly defining aims of user research: collect data that you will be able to use  Not starting early enough  Focusing down too soon in development (unknown unknowns?)  Assuming that users are able to tell you what they want or need  Asking users questions they aren’t able to answer  Inappropriate proxies: senior clinicians, parents, healthy people  Viewing ‘users’ as a homogenous group with similar needs and characteristics  Over-reliance on focus groups (they don’t tell you how people behave)  Not appreciating the importance of user information  Do the research yourself – prevents lose of information  How representative are your volunteers?  Make sure you can implement the results!
22. The User-Centred Design process Start early... Test often... In the Context of Use... With real users
23. Thank you Any Questions? jennifer.martin@nottingham.ac.uk