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DESIGNING A USEFUL AND USABLE MOBILE EMR APPLICATION THROUGH A PARTICIPATORY DESIGN METHODOLOGY:
A CASE STUDY
ir. Robin De Croon, dr. Joris Klerkx, prof. dr. ir. Erik Duval http://about.me/robindecroon & robin.decroon@cs.kuleuven.be
IEEE International Conference on Healthcare Informatics 2014 (ICHI 2014)
Who Am I?
• Robin De Croon • Scientific Researcher • Computer Science background
• KU Leuven (Belgium) • Human Computer Interaction
• Prof. dr. ir. Erik Duval • Dr. Joris Klerkx
• datavislab • http://datavislab.org
Saturday 21 February 15 2
Secure & Usable medical applications in the cloud (MAPC)
• IWT R&D company project
è “How can a mobile device help general practioners, using context and mobile affordances, to maintain an electronic patient file on a house visit?
Saturday 21 February 15 3
Secure & Usable medical applications in the cloud (MAPC)
• IWT R&D company project à case study
è “How can a mobile device help general practioners, using context and mobile affordances, to maintain an electronic patient file on a house visit?
Saturday 21 February 15 4
target user
Target Audience
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• General Practitioners in Flanders (Belgium)
Independent of:
• Experience & age
• Individual or group practice
• ICT-‐knowledge
• Current medical software
http://marketingyoucanuse.com/wp-‐content/uploads/2010/12/HittingTarget.jpg
Methodology: Participatory Design
1. Initial research • existing research papers • existing electronic patient files and applications
2. Discovery process • initial questionnaire • initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 6
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Where should I register
medication?
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Methodology: Participatory Design
1. Initial research • existing research papers • existing electronic patient files and applications
2. Discovery process • initial questionnaire • initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 7
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Where should I register
medication?
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Related work (i)
• Which information does a general practitioner need?
• Abd Ghani, M. K. (2011). The design of flexible Pervasive Electronic Health Record (PEHR). In 2011 IEEE Colloquium on Humanities, Science and Engineering (pp. 249–254). IEEE. doi:10.1109/CHUSER.2011.6163727
• Plancke, L. (2013). Het thuisdossier voor de wachtarts : stand van zaken. Universiteit Gent. Retrieved from http://lib.ugent.be/fulltxt/RUG01/002/002/163/RUG01-‐002002163_2013_0001_AC.pdf
• Mobile applications in the medical world • Fischer, S. (2002). Handheld Computing in Medicine. Journal of the American Medical Informatics Association, 10(2), 139–149. doi:
10.1197/jamia.M1180
• Ebell, M. H., Gaspar, D. L., & Khurana, S. (1997). Family physicians’ preferences for computerized decision-‐support hardware and software. The Journal of Family Practice, 45(2), 137–141.
• Page, T. (2013). Usability of text input interfaces in smartphones. J. of Design Research, 11(1), 39. doi:10.1504/JDR.2013.054065
• Kelly, J. (2000). Going wireless. Hospitals & Health Networks / AHA, 74(11), 65–66, 68. doi:10.1038/sj.bdj.2011.41
• Nyssen, M., Thomeer, K., & Buyl, R. (2010). Generating and transmitting ambulatory electronic medical prescriptions. In P. Bamidis & N. Pallikarakis (Eds.), XII Mediterranean Conference on Medical and Biological Engineering and Computing 2010 (pp. 890–892). Springer Berlin Heidelberg. doi:10.1007/978-‐3-‐642-‐13039-‐7_225
• Chen, Y., & Atwood, M. E. (2010). Challenges of Mobile Clinical System Design: What do Nurses Think? In 2010 43rd Hawaii International Conference on System Sciences (pp. 1–9). IEEE. doi:10.1109/HICSS.2010.99
• Grossman, J. M., Gerland, A., Reed, M. C., & Fahlman, C. (2007). Physicians’ experiences using commercial e-‐prescribing systems. Health Affairs (Project Hope), 26(3), w393–404. doi:10.1377/hlthaff.26.3.w393
Saturday 21 February 15 8
Related work (ii)
• Usability problems with medical software • Grossman, J. M., Gerland, A., Reed, M. C., & Fahlman, C. (2007). Physicians’ experiences using commercial e-‐prescribing systems. Health Affairs (Project Hope), 26(3), w393–404. doi:10.1377/hlthaff.26.3.w393
• Schumacher, R. M., Berkowitz, L., Abramson, P., & Liebovitz, D. (2010). Electronic Health Records: Physician’s Perspective on Usability. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 54(12), 816–820. doi:10.1177/154193121005401202
• Van der Sijs, H., Aarts, J., Vulto, A., & Berg, M. (2006). Overriding of drug safety alerts in computerized physician order entry. Journal of the American Medical Informatics Association : JAMIA, 13(2), 138–47. doi:10.1197/jamia.M1809
• Williams, W. G., & Morgan, J. M. (1995). The clinician-‐information interface. Medinfo. MEDINFO, 8 Pt 1, 801–5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8591334
• Devine, E. B., Hollingworth, W., Hansen, R. N., Lawless, N. M., Wilson-‐Norton, J. L., Martin, D. P., … Sullivan, S. D. (2010). Electronic prescribing at the point of care: a time-‐motion study in the primary care setting. Health Services Research, 45(1), 152–71. doi:10.1111/j.1475-‐6773.2009.01063.x
• Han, S., Harkke, V., Mustonen, P., Seppanen, M., & Kallio, M. (2004). Mobilizing Medical Information and Knowledge: Some Insights from a Survey. Retrieved from http://aisel.aisnet.org/ecis2004/69/
Saturday 21 February 15 9
Related work (iii)
• Participatory design in the medical domain • Tang, K., Hirano, S., Cheng, K., & Hayes, G. (2012). Balancing Caregiver and Clinician Needs in a Mobile Health Informatics Tool for Preterm Infants. In Proceedings of the 6th International Conference on Pervasive Computing Technologies for Healthcare (pp. 1–8). IEEE. doi:10.4108/icst.pervasivehealth.2012.248716
• Hwang, A., Truong, K., & Mihailidis, A. (2012). Using participatory design to determine the needs of informal caregivers for smart home user interfaces. In Proceedings of the 6th International Conference on Pervasive Computing Technologies for Healthcare (pp. 41–48). IEEE. doi:10.4108/icst.pervasivehealth.2012.248671
• Miller, A., Pater, J., & Mynatt, E. (2013). Design Strategies for Youth-‐Focused Pervasive Social Health Games. In Proceedings of the ICTs for improving Patients Rehabilitation Research Techniques. IEEE. doi:10.4108/pervasivehealth.2013.252081
• Using context • Stocky, T., Faaborg, A., & Lieberman, H. (2004). A commonsense approach to predictive text entry. In Extended abstracts of the 2004 conference on Human factors and computing systems -‐ CHI ’04 (p. 1163). New York, New York, USA: ACM Press. doi:10.1145/985921.986014
• Abowd, G. D., Dey, A. K., Brown, P. J., Davies, N., Smith, M., & Steggles, P. (1999). Towards a Better Understanding of Context and Context-‐Awareness. Ubiquitous Computing/Handheld and Ubiquitous Computing (pp. 304–307). doi:10.1007/3-‐540-‐48157-‐5_29
Saturday 21 February 15 10
Methodology: Participatory Design
1. Initial research • existing research papers • existing electronic patient files and applications
2. Discovery process • initial questionnaire • initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 11
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Where should I register
medication?
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Saturday 21 February 15 12
https://www.ehealth.fgov.be/nl/registratie-‐van-‐de-‐medische-‐softwarepakketten
Where should I register
medication?
Methodology: Participatory Design
1. Initial research • existing research papers
• existing electronic patient files and applications
2. Discovery process • initial questionnaire
• initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 14
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Initial Questionnaire & Talks
• What kind of information or material do you carry with you during house visits?
• Do you already use an EMR application or, if not, what kinds of patient information do you take with you?
• Which data is entered in the EMR application (after the house visits)?
• How do you prescribe medicine? • Do you take pictures of wounds or rash? • What kind of patients do you normally treat during a house visit?
• …
Saturday 21 February 15 15
https://picasaweb.google.com/100923738088214702616/Omini3d#5456698262314545906
http://goo.gl/Wxh3Gi (questionnaire, Dutch)
Information overload
Saturday 21 February 15 20
http://m.c.lnkd.licdn.com/mpr/mpr/p/5/005/061/1de/3cc6bc7.jpg
Result
• Patient data gets rarely registered on a house visit
• Patient data registered afterwards is error prone
è Solution is needed!
Saturday 21 February 15 22
http://static.squarespace.com/static/52e99ee6e4b074062a408c89/t/52eb6098e4b008799dcd8d23/1391157403129/3D%20Person%20-‐%20Magnifing%20Glass-‐Edited.png
Methodology: Participatory Design
1. Initial research • existing research papers • existing electronic patient files and applications
2. Discovery process • initial questionnaire • initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 23
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Where should I register
medication?
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Funtional Requirement Research Question
• “How can a mobile device help general practioners, using context and mobile affordances, to maintain an electronic patient file on a house visit?
• What information does a GP instantly needs on a house visit?
• How should mobile affordances be applied when designing a mobile health record?
è Not just a port of existing applications!
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Timeline prototypes
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Paper prototype 5
Sketches Paper
prototype 1 Paper
prototype 4 Paper
prototype 3 Paper
prototype 2
Digital prototype Design V1
5 GPs 3 GPs 3 GPs 3 GPs
5 GPs
6 HCI colleagues 53 students
Problems è Requirements
① Not optimized for mobile è Use mobile affordances
② Too slow è Show timely & relevant information
③ Necessary patient information è Quick overview important information
④ Registering data è Efficient and effective data input
⑤ Prescribing medicine è Raise motivation to register
Saturday 21 February 15 27
Methodology: Participatory Design
1. Initial research • existing research papers • existing electronic patient files and applications
2. Discovery process • initial questionnaire • initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 28
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Where should I register
medication?
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Dashboard
Saturday 21 February 15 30
Sá, M. de, & Carriço, L. (2006). Low-‐Fi Prototyping for Mobile Devices. In CHI ’06 Extended Abstracts: Human Factors in Computing Systems (pp. 694–699). ACM. doi:10.1145/1125451.1125592
Subjective Input
Saturday 21 February 15 31
Stocky, T., Faaborg, A., & Lieberman, H. (2004). A commonsense approach to predictive text entry. In Extended abstracts of the 2004 conference on Human factors and computing systems -‐ CHI ’04 (p. 1163). New York, New York, USA: ACM Press. doi:10.1145/985921.986014
Objective Input
Saturday 21 February 15 32
Weibel, N., Emmenegger, C., Lyons, J., Dixit, R., Hill, L., & Hollan, J. (2013). Interpreter-‐Mediated Physician-‐Patient Communication: Opportunities for Multimodal Healthcare Interfaces. In Proceedings of the ICTs for improving Patients Rehabilitation Research Techniques. IEEE. doi:10.4108/icst.pervasivehealth.2013.252026
Problems è Requirements
① Not optimized for mobile è Use mobile affordances
② Too slow è Show timely & relevant information
③ Necessary patient information è Quick overview important information
④ Registering data è Efficient and effective data input
⑤ Prescribing medicine è Raise motivation to register
Saturday 21 February 15 34
Problems è Requirements
① Not optimized for mobile è Use mobile affordances
② Too slow è Show timely & relevant information
③ Necessary patient information è Quick overview important information
④ Registering data è Efficient and effective data input
⑤ Prescribing medicine è Raise motivation to register
Saturday 21 February 15 37
Workflow
• Information
• Messages
• SOAP subjective à objective à assessment à planning
• Medication
Saturday 21 February 15 39
Robin De Croon
Problems è Requirements
① Not optimized for mobile è Use mobile affordances
② Too slow è Show timely & relevant information
③ Necessary patient information è Quick overview important information
④ Registering data è Efficient and effective data input
⑤ Prescribing medicine è Raise motivation to register
Saturday 21 February 15 43
Problems è Requirements
① Not optimized for mobile è Use mobile affordances
② Too slow è Show timely & relevant information
③ Necessary patient information è Quick overview important information
④ Registering data è Efficient and effective data input
⑤ Prescribing medicine è Raise motivation to register
Saturday 21 February 15 50
Input through colored sliders
Saturday 21 February 15 54
Weibel, N., Emmenegger, C., Lyons, J., Dixit, R., Hill, L., & Hollan, J. (2013). Interpreter-‐Mediated Physician-‐Patient Communication: Opportunities for Multimodal Healthcare Interfaces. In Proceedings of the ICTs for improving Patients Rehabilitation Research Techniques. IEEE. doi:10.4108/icst.pervasivehealth.2013.252026
Problems è Requirements
① Not optimized for mobile è Use mobile affordances
② Too slow è Show timely & relevant information
③ Necessary patient information è Quick overview important information
④ Registering data è Efficient and effective data input
⑤ Prescribing medicine è Raise motivation to register
Saturday 21 February 15 57
Pharmocovigilance
Saturday 21 February 15 60
http://www.amazingpregnancy.com/blog/wp-‐content/uploads/2013/05/drug_or_alimentary_supplement_idea_of_health_and_disease.jpg
Methodology: Participatory Design
1. Initial research • existing research papers • existing electronic patient files and applications
2. Discovery process • initial questionnaire • initial talks
3. Rapid prototyping • functional requirements • prototypes (paper & digital) • usability evaluation
Saturday 21 February 15 61
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg
Where should I register
medication?
Spinuzzi, C. (2005). The methodology of participatory design. Technical Communication, 52(August 2004), 163–174.
Saturday 21 February 15 62
Schulenberg, S. E., & Melton, A. M. a. (2008). The Computer Aversion, Attitudes, and Familiarity Index (CAAFI): A validity study. Computers in Human Behavior, 24(6), 2620–2638. doi:10.1016/j.chb.2008.03.002
Computer Aversion, Attitudes and Familiarity Index (CAAFI)
Questionnaire
System Usability Scale (SUS) Questionnaire
Saturday 21 February 15 63
http://iqcontent.com/blog/files/wp/2013/05/sus.png
Bangor, A., Kortum, P., & Miller, J. (2009). Determining what individual SUS scores mean: Adding an adjective rating scale. Journal of Usability Studies, 4(3), 114–123. Retrieved from http://66.39.39.113/upa_publications/jus/2009may/JUS_Bangor_May2009.pdf
Evaluation general practice students
• During general practice course Leuven
• Last year general practice
• ≈ 120 hours experience
• Presentation ≈ 30 minutes
• Accompanied with questionnaire
Saturday 21 February 15 64
53 last year general practice students
Gender Age
Saturday 21 February 15 65
0 5 10 15 20 25 30
53
31
30
29
28
27
26
25
24
17
tablet
smartphone
man
geen tablet
dumbphone
vrouw
0 10 20 30 40 50
Computer Aversion, Attitudes and Familiarity Index (CAAFI)
Score Students
Saturday 21 February 15 66
Factors Average Standard Deviation
Factor 1 (familiarity) 0.76 0.75
Factor 2 (attitudes) 1.91 0.69
Factor 3 (aversion) 0.68 1.1
Schulenberg, S. E., & Melton, A. M. a. (2008). The Computer Aversion, Attitudes, and Familiarity Index (CAAFI): A validity study. Computers in Human Behavior, 24(6), 2620–2638. doi:10.1016/j.chb.2008.03.002
System Usability Scale (SUS) Score students
Saturday 21 February 15 67
Bangor, A., Kortum, P., & Miller, J. (2009). Determining what individual SUS scores mean: Adding an adjective rating scale. Journal of Usability Studies, 4(3), 114–123. Retrieved from http://66.39.39.113/upa_publications/jus/2009may/JUS_Bangor_May2009.pdf
Average score: 70
Saturday 21 February 15 68
Likert Scores students
0.03
0.02
0.06
0.12
0.32
0.04
0.12
0.2
0.04
0.02
0.42
0.22
0.3
0.28
0.14
0.12
0.04
0.19
0.6
0.44
0.36
0.68
0.5
0.7
0.03
0.08
0.08
0.04
0.14
0.36
0.26
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
SOAP -‐ Planning
SOAP -‐ evaluation
SOAP -‐ objective
SOAP -‐ subjective
Documents
Patient informartion
Dashboard
Very poor Poor Neutral Good Very good
Difference between generations
• SOAP note system <-‐> Medical History
De Croon, R., Klerkx, J., Duval, E. (2014). The involvement of students in the user-‐centered design process of a mobile health record: a case study. Workshop on Designing the Future of Mobile Healthcare Support. Toronto, Canada, 23 September 2014, accepted.
Saturday 21 February 15 69
Conclusion
• Smaller subset on dashboard
• Five core considerations
• Difference between generations
• Interface under active development
Saturday 21 February 15 70
http://cdn.makeuseof.com/wp-‐content/uploads/2012/12/3D-‐Man-‐Presenting-‐Intro-‐Image.jpg?a53b57
Future work
• Generation difference / two paradigms (SOAP <-‐> EBM)
• Expand research (not only Belgian markets)
• Can a GP inform a patient with an EMD more efficiently?
Saturday 21 February 15 71
You think our work interesting?
• We’re expanding our team! à erik.duval@cs.kuleuven.be
Saturday 21 February 15 72
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