Designing a useful and usable mobile EMR application through a participatory design methodology: a case study

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 & [email protected]

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?


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?


target user

Target Audience


• 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


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.


1.   Initial research •  existing research papers •  existing electronic patient files and applications






medication?


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


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/


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









medication?



https://www.ehealth.fgov.be/nl/registratie-‐van-‐de-‐medische-‐softwarepakketten



medication?


1.   Initial research •  existing research papers

•  existing electronic patient files and applications

2.   Discovery process •  initial questionnaire

•  initial talks





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?

•  …


https://picasaweb.google.com/100923738088214702616/Omini3d#5456698262314545906

http://goo.gl/Wxh3Gi (questionnaire, Dutch)

Battery


Weight


http://www.elmospa.com/userfiles/image/Varie/forza.png

No internet connection


Time expensive


Information overload


http://m.c.lnkd.licdn.com/mpr/mpr/p/5/005/061/1de/3cc6bc7.jpg

Usability


Result

•  Patient data gets rarely registered on a house visit

•  Patient data registered afterwards is error prone

è Solution is needed!


http://static.squarespace.com/static/52e99ee6e4b074062a408c89/t/52eb6098e4b008799dcd8d23/1391157403129/3D%20Person%20-‐%20Magnifing%20Glass-‐Edited.png




3.   Rapid prototyping •  functional requirements •  prototypes (paper & digital) •  usability evaluation




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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!


Timeline prototypes


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

Some Sketches


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









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Demonstration

Dashboard


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


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


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

Messages










Mobile Affordances


Medical Affordances








GPS to patient & open right file


Workflow

•  Information

•  Messages

•  SOAP subjective à objective à assessment à planning

• Medication


Robin De Croon

Patient records


Filter messages


Camera & calendar & search





③   Necessary patient information è Quick overview important information






Requirement 3 quick overview of the most important data


Participatory design approach

•  WEL à Onderzoek •  Vergelijkend onderzoek


Final Dashboard







④   Registering data è Efficient and effective data input



Keyboard uses much screen space


Speech-‐to-‐Text



Input through colored sliders


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

Auto Complete


Assessment à Tree Structure (ICPC, ICD10, …)









Slow law adaptation


Tools


Pharmocovigilance


http://www.amazingpregnancy.com/blog/wp-‐content/uploads/2013/05/drug_or_alimentary_supplement_idea_of_health_and_disease.jpg








medication?



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


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


53 last year general practice students

Gender Age


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


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


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


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.


Conclusion

•  Smaller subset on dashboard

•  Five core considerations

•  Difference between generations

•  Interface under active development


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?


You think our work interesting?

• We’re expanding our team! à [email protected]


Thank you!


http://2.bp.blogspot.com/-‐gZjNR3XVULs/T_ZOVgE-‐5lI/AAAAAAAAAg8/6YVmd5Q064o/s1600/questions11.jpg

[email protected]

Presentations & Public Speaking

Designing a useful and usable mobile EMR application through a participatory design methodology: a case study