Healthcare and Medical Devices

AHFE International

Accelerating Open Access Science in Human Factors Engineering and Human-Centered Computing

Healthcare and Medical Devices

book-cover

Editors: Jay Kalra, Nancy Lightner

Topics: Healthcare and Medical Devices

Publication Date: 2022

ISBN: 978-1-958651-27-8

DOI: 10.54941/ahfe1002090

Articles

Electronic Product Information for Human Medicines: A Blockchain Solution

Electronic Product Information (ePI) is a digital alternative to the current paper leaflet found in every medicine package. The paper leaflets are costly to produce and have a high environmental impact. Moreover, once printed and distributed the leaflets are no longer possible to be updated. A blockchain-based technical solution for an ePI is currently being developed under the PharmaLedger Project following the EMA-HMA-EC principles for ePI in the EU. The paper discusses this blockchain-based ePI solution based on a data flow analysis.

Galia Kondova

Conference Proceedings

Describing and disarming health information system snares that capture and conceal characters.

Characters in computing are symbols that stand for a single unit of data such as a number, alphabetical letter, or punctuation mark. In health information entry and exchange, correct encoding and decoding of characters in computing is essential for accurate documentation and interpretation of information. When something goes wrong and there are changes to or deletions of the intended characters, there is missing or inaccurate data in the health information system. Due to the very nature of health information systems, it is difficult to detect when information is missing. Another hidden attribute that is invisible to users is the way characters are interpreted by computing systems. Lost and invisible information can lead to patient safety issues.The Food and Drug Administration (FDA) Maude database and the Institute for Safe Medication Practice (ISMP) describe a few isolated issues with computing characters and health information. Though the loss of health information due to failure to correctly translate computing characters would seem to be a problem with potentially high severity, we were unable to locate a collection of reported issues or a discussion summarizing fail-safe and error-tolerant system designs addressing this topic area. The human factors and human-centered design communities are uniquely knowledgeable and skilled for addressing issues with visibility of system states and error-tolerant design and would be in an ideal position for considering solutions to this issue.In this paper, we review and group issue reports on characters in computing and information entry and exchange. We reflect on human factors and safety engineering principles for designing systems to prevent, detect, and mitigate latent issues in this problem space. Furthermore, we explore special characters that present with added challenges when used in computing systems.To facilitate fail-safe interoperability and health information exchange, systems will require designs that address latent issues brought on by hidden attributes of characters in computing. Using human factors and safety engineering principles, we can help prospectively design to detect and disarm the snares found within and across health information systems.

Tim Arnold, Helen Fuller, Angela Laurio

Conference Proceedings

How self-report affects digital health-related behavior change

This study aims to identify how self-report method affects digital health-related behavior change and further detect its potential broader application. Two groups of 10 participants engaged in a 28-day behavior change program with one group using self-report and the other group not. After the experiment, the group using self-report participated in a semi-structured interview to report their experiences. The initial experiment showed that self-report did not affect behavior; this indicated that self-report is an appropriate method to collect behavior change data. However, the semi-structured interviews suggested that self-reporting brought benefits and encouraged users to further improve their behavior. The paper, thus, summarized that perceived effects of self-report in behavior change are stronger than actual effects of self-report.

Yuan Yin, Yurong Yu

Conference Proceedings

Applying User Interface Profiles to Ensure Safe Remote Control within the Open Networked Operating Room in accordance with ISO IEEE 11073 SDC

The ISO IEEE 11073 SDC Standard family enables manufacturer independent device connectivity and therefore interoperability in the OR and hospital. Supplementary standards like the Devices Specializations (IEEE 11073-107XX) describe how medical devices present themselves in the network and the requirements other network participants must comply with in order to interact in the sense of a plug-and-play approach. However, these device models and requirements do not include information about Human Machine Interaction (HMI) characteristics like visualization, control types or any other user interface related specifications and guidelines, which are necessary to create a safe and usable remote user interface. This will be relevant for central or mobile OR/ICU cockpits/units. Additional device-based UI specifications and rules are necessary for medical device manufacturers and clinical operators to allow safe and usable remote interfaces, and future-proof plug-and-play solutions.The question of liability in the operation of openly networked medical devices is of course an interesting and important aspect for medical device manufacturers. Here, on the one hand, technical interoperability and, on the other hand, safe HMI in the combined use of medical devices must be guaranteed.A systematic approach to create a safe and usable UI in open networked ORs by providing UI requirements to the network participants within a SDC complemental UI standard (e.g., in DevSpecs or KeyPurposes) would greatly facilitate the conformity assessment process for manufacturers, especially for the controlling network participant (SDC service Consumer), who needs to perform a comprehensive usability evaluation and human-induced risk analysis in a new context of use.The Chair of Medical Engineering (mediTEC) at RWTH Aachen University has addressed these issues and has developed a methodological approach to create a specific User Interface Profile for each medical device type and corresponding HMI design rules, considering risk- and process-related requirements for medical device functions and for input and output devices. This approach defines a set of rules, requirements, and specifications regarding Human Machine Interactions a network subscriber must fulfill to display or operate device properties.The User Interface Profile contains among other things: a list of device properties, grouping information, additional applicable standards, user profile, input and output devices that are suitable and/or required from a risk analysis point of view, screen parameters according to DIN 6868-157 and speaker parameters. In addition, for every device property the following properties must be defined: visibility level, elementary task, criticality, and necessary labeling information.These initial implementations have been integrated and validated by a representative user group (neurosurgeons, orthopedic surgeons and ENT surgeons of the University Clinic RWTH Aachen) within a surgical SDC workstation as a part of a surgical SDC demonstrator (Yilmaz et al. 2020). Looking ahead, parts of the User Interface Profiles will be applied and implemented into the ISO IEEE P11073-10721 draft (using the example of high frequency cutting devices) in collaboration with the leading enterprises in Germany.

Okan Yilmaz, Armin Janß, Klaus Radermacher

Conference Proceedings

Shared Living Providers (SLP) Experience Documentation Burden While Caring for Individuals with Intellectual and Developmental Disabilities (I/DD)

Shared living providers (SLPs) have identified administrative burden as a major contributor to burnout and the decreased effectiveness of care delivery. SLPs are individuals that allow persons with I/DD to reside in their residential home while providing caregiving support in daily living activities, community integration, and many other activities. This project addresses health information technology (HIT)-related documentation burden, which is a critical barrier to progress in the intellectual and developmental disabilities (I/DD) support field. The aim of this study is to determine SLPs’ perception of documentation burden while caring for individuals with I/DD.MethodsSeventeen SLPs were surveyed to understand their perception of documentation burden to determine its role in burnout. The survey used to measure documentation burden was the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. The BurDoNsaM is a 28-item validated survey, categorized using 6 subscales, representing essential areas of documentation burden. Three of the six subscale in the BurDoNsaM survey was used in this study. The three subscales included were: (1) views about value of clinical documentation, (2) burden of documentation, and (3) time taken to complete documentation. Seventeen of the 28 survey items were relevant to SLP duties and was included in our pilot study. SLPs were recruited after their clinic visit from University of Nebraska Medical Center (UNMC) Munroe Meyer Institute (MMI) Adult I/DD clinic. Survey data was recorded and stored in a secure database. The data was summarized using descriptive statistics.DiscussionThis pilot study was able to identify the areas that cause documentation burden for SLPs. Respondents found value in clinical documentation. Despite its value, respondents reported that the documentation process complex and is time consuming. SLPs are required to comply with an increasing, wide-ranging body of requirements to deliver and receive payment for care of individuals with I/DD. The cost of compliance with these requirements has long term effects, such as, increased cognitive load and burnout. Limitations of this pilot study include a small sample size. Future research should include a larger sample size and qualitative data to further identify the specific areas that cause the most burden.

Martina A. Clarke, Lisa L Neitzke, Kathryn M Cooper

Conference Proceedings

The Positive Distraction Effect of Toys in Children's Venous Blood Sampling

Based on the positive distraction concept in Roger S. Ulrich's supportive design theory, this research selected toys as positive distraction elements in children's venous blood sampling to find more game elements that can effectively divert children's attention and alleviate children's anxiety and fear emotions. The research designed the Children’s Venous Blood Sampling Anxiety Scale by referring to the modified version of the Yale Preoperative Anxiety Scale. The experiment took 3-5 years old children as the research object, and accessed the general distraction effects of toys on children in the process of venous blood sampling. As well as the differences of the distraction effect between normative toy and medical toy on children in blood sampling process, and the differences in long-term impact on children's emotional recovery after blood sampling were compared.

Huifang Shang, Guo Xincheng, Chuanshun Wang

Conference Proceedings

Augmented Reality Application for HoloLens Dedicated to the Accuracy Test: Evolution and Results

Augmented Reality (AR) proposes new ways to visualize and to interact with virtual objects. Depending on the target interaction modality and the application requirements, different type of devices can be chosen. If AR on smartphones can propose a Graphical User Interface without impacting the immersion, AR headset procures a more immersive experience, the interaction modality relying mainly on hand gesture control even if various types of interactions modalities have been explored in literature. One of the most widespread headsets is the Microsoft Hololens which offers a documentation about the set-up of interactions between the users and virtual entities. However, the ergonomic of the proposed hand gesture needs to be learnt and is not intuitive for most people and cannot be well fitted depending on the type of application.The goal of this paper is to test, in a medical application perspective, the ergonomic of different types of human machine interface in AR, the impact of changes made by the return of the users and the usability of the final human machine interface. An application dedicated to the accuracy test of the headset has been made. This application has been tested by different users who never had any previous experience with AR headset before. The virtual object used inside this application is a simple cube to simplify the interaction with the virtual entity as much as possible. After that, a users’ return of experience protocol has been propose. It has been used to feed proposals for changing interaction modalities in the application. This return of experience is based on the estimation of the ease to place the virtual entity relatively to elements of the real world, the estimation of the ease to orientate the entity and the estimation of quality of the visualization. At the end of the protocol, the final human machine interface is tested, and a comparison is made between the different types of interaction modalities proposed.Among the proposed solutions, the one without any graphical user interface artifacts (i.e. using only hand tracking to interact with the cube) results in bad comprehension and manipulation that can lead to prevent the use of this application. One explanation can be tied to the lack of precise hand tracking which can result in bad hand pose. The second solution, based on the addition of a 3D plane GUI, demonstrates a more precise appropriation of the AR context. However, the GUI plane must be positioned manually by the user to have better result. Besides, results shows that the cube must be rendered with boxes to delimit the edge and thus helping the user to make the cube closer to his/her perception expectations.These experiments showed that the use of world anchored graphical user interface for high accuracy application is needed to provide a better understanding for newcomers and can be considered as an intuitive way to use the application. If for most entertainment applications the hand interaction can be sufficient, the hand tracking is not accurate enough for the moment to allow a high precision positioning of virtual entities for medical application.

Julien Barbier, Franck Gechter, Sylvain Grosdemouge

Conference Proceedings

User Requirements for a Health Care Service Based on Point-of-care Testing in the Context of Ambulatory Care and Telemedicine for Older People

In healthcare, point-of-care testing, i.e., diagnostic testing at the time and place of patient care, allows for early diagnosis and therefore timely treatment of various diseases. These on-site tests are particularly beneficial to people living in remote areas and those with limited mobility. Our study focused on the design of a service for older people, whereby ambulatory care and telemedicine consultations are based on point-of-care testing. Its aim was to elicit user requirements, specifically for the use case of iron deficiency in older people. A textual scenario was developed which formed the foundation for the simulated or “enacted” scenario, with both undergoing participatory evaluations. A wide range of “socio-technical” requirements were elicited that are expected to be crucial for the implementation of this service. Based on content analysis they were categorized into technology-, people-, organization- and environment-related requirements. The results are discussed regarding the specific use case and methods used.

Kamalatharsi Mutuura, Mario Niederhauser, Nico Erb, Freddie Van Den Anker

Conference Proceedings

Phase-Based Assessment of Arthroscopic Skill Using Motion Smoothness Metrics: A Simulator-based Proof-of-Concept Study

Minimally invasive surgeries are meticulous procedures that require complex movement within a limited range of motion, requiring intensive training. Medical training simulators often have limited sensing modalities, restricting the quality of metrics to quantify skill. We created a multi-modal 3D printed simulator that is affordable and easily replicable for remote, automated, and phase-based skill assessment in arthroscopy, a type of minimally invasive surgery. In this pilot study, four subjects of non-medical experience levels performed a peg transfer task in the arthroscopy simulator with synchronized motion and video. The task is segmented into phases to determine the relative efficacy of motion smoothness and other calculated metrics. One phase showed more significant differences in metrics than the other phases, demonstrating the potential for phase-based skill evaluation in tasks with more complex maneuvers. Our novel simulator design allowed for metrics computation at a phase-based level, with initial results demonstrating its importance.

Simar Singh, Chelse Vanatter, Ravikiran Singapogu

Conference Proceedings

AR-Coach: Using Augmented Reality (AR) for Real-Time Clinical Guidance During Medical Emergencies on Deep Space Exploration Missions

Space travel imposes significant risks to crew health due to physiological adaptations, exposure to physical and psychological stressors, and limited capabilities to provide medical care. When medical emergencies occur, appropriate use of diagnostic and procedural guidance tools are crucial countermeasures against the risks of injury and mission failure. Point-of-care ultrasound (POCUS) is the only portable imaging modality available during exploration missions that can provide critical and dynamic medical information. Developing competency in POCUS is time-consuming and it is usually achieved through years of medical residency or clinical fellowship training programs. Due to the amount of astronaut training currently required, it is not feasible to also provide them with in-depth POCUS training. Current cognitive aids for POCUS-based procedures are either paper-based or static electronic checklists, which can be cumbersome to use, non-intuitive, and sometimes distracting; applying their written guidance to real actions can be difficult. To overcome these limitations, we developed a proof of concept of an augmented reality (AR) Coach (AR-Coach) as an Augmented Clinical Tool (ACT): a hands-free virtual coach system that guides the crew in real-time on how to perform POCUS during medical emergencies in space. To better understand the context and design requirements for the proposed ACT, we applied a human-centered design approach as part of our wider space medicine research program. We convened a multidisciplinary expert panel (n=46), including astronauts, flight surgeons, clinicians, XR and AI experts, to identify essential capability requirements. Task analysis with five experts, including clinicians, human factors researchers, and an XR developer, was used to create a process model of a POCUS-guided procedure to diagnose a potentially life-threatening condition (i.e., pneumothorax) that could occur during space travel. An iterative design and prototyping process was conducted. Informed by the expert panel and task analysis, we created a proof of concept of the AR-Coach which includes holographic panels that guide the crew in confirming the diagnosis of pneumothorax using POCUS. The results of this study can be applied in advancing space technologies that support astronauts in managing medical events during space exploration missions, optimizing performance, and improving crew safety.

Mahdi Ebnali, Andrew Goldsmith, Barbara Burian, Byonne Atamna, Nicole Duggan, Chanel Fischetti, Steven Yule, Roger Dias

Conference Proceedings

A Smartwatch Based system for Monitoring Fluid Consumption of End Stage Kidney Patients

Background:End Stage Kidney disease (ESKD) patients must follow unique dietary restrictions. The most onerous of these is the need to restrict fluid intake. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations with diagnoses of heart failure and pulmonary edema, increased hospital length of stay, and increased total cost of care. Fluid intake control is a bedrock component of treatment for ESKD Patients, but continues to be a major challenge for patients, healthcare providers, and organizations. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations and increased total cost of care. The goal of this work is to investigate the feasibility of leveraging smartwatch technology to monitor fluid consumption of ESKD patients outside of the clinic. Adequate assessment of fluid intake of patients with ESKD on HD and offering timely feedback to patients and clinicians has the potential of curbing the extra fluid intake, hence reduce mortality and morbidity, and hopefully cut the costs of the need of frequent hospitalizations and/or extra dialysis treatments.Methods:We have designed a smartwatch app called Fluisense (available on Android play store,, https://play.google.com/store/apps/details?id=com.mob.fluisense) to help ESKD patients monitor their fluid intake. Fluisense helps patients record Fluid intake logs in an intuitive manner. Fluisense also collects sensor data such as mobility, acceleration, and heart rate to investigate biomarkers indicative of fluid overload. To the best of our knowledge, this is the first work leveraging smartwatches to monitor fluid accumulation of ESKD patients.N=15 ESKD patients were given an Android smartwatch with Fluisense pre-installed and were asked to log their fluid intake through the app by choosing from a list of predefined volumes each time they consume any liquid. The app computed and displayed the self-reported daily volume intake to help patients monitor their own fluid consumption. Patients received text messages twice a day (9am and 8pm) to remind them to use the watch. We also recorded patients’ weights before and after each of the thrice weekly dialysis sessions. The sum of self-reported interdialytic fluid intake was computed and compared against the interdialytic weight gain recorded in the clinic.Results: Patients recorded Fluids in 214 days out of 259 total days (i.e., 83% compliance rate). The average self-reported interdyalitic fluid consumption is 51 oz +/-64, and the average interdialytic weight gain is 2.67 kg +/- 1.56. We found a moderate but significant correlation between the self-reported fluid volumes and the interdialytic weight gain (r=0.363, P<0.001, r2=0.06). A deep learning method has also been designed to predict the interdialyctic weight gain from sensor data. Results validated through leave one subject out cross validation show an F1 score of 91 at predicting the level of weight change.Conclusion: Leveraging smartwatch-based sensing technology is a promising solution for fluid monitoring of ESKD patients. This can be related to the ease of utilization of this technology and the ecological validity of its measurements given they are collected close to when they happen, reducing recall biases.

Mehdi Boukhechba, Mingyue Tang, Brendan Bowman, Jamie Zoellner, Emaad Abdel-Rahman

Conference Proceedings

Development of a web-based tool –The Score Bebé ®– for enhancing neonatal risk stratification: A nationwide retrospective study

Background: In Ecuador, the neonatal mortality rate has increased from 4.1 to 6.0 per 1000 live births between 2014 and 2019. We aimed to develop and validate a health risk assessment tool for predicting neonatal mortality and to reach a nationwide consensus on stratified management. Methods: We retrospectively analyzed all neonatal deaths registered by the Ministry of Public Health between 2014 and 2017 in Ecuador. We developed a health risk assessment tool by using the information of deceased neonates between 2014 and 2016, and subsequently validated it using the information of deceased neonates in 2017. Several perinatal predictors were tested. The score was qualitatively refined by ~70 healthcare professionals in five Ecuadorian cities, and it was transformed into a web-based calculator with stratified suggestions of care. Results: Survival estimates differed significantly across the risk bands. The resulting Score Bebé® is available at https://scorebebe.com/ and includes stratified suggestions for care.

Luciana Armijos, Betzabé Tello, Carmenza Sevilla, Isaac Cano, Johanna Fonseca, Luis Vivas, María F. Rivadeneira, Ruth Jimbo, Xavier Sánchez, Nancy Santillán, Iván Dueñas Espín

Conference Proceedings

Enhancing the Quality and Delivery of Healthcare: A Decade Review of Autopsy Data

Quality management is of the utmost importance for providing the best patient care in our healthcare system. Patients rightfully expect the care that they receive to be of sound quality. The medical autopsy has been used as the gold standard of diagnostic medicine and continues to provide insights into strategies for healthcare quality improvement. The discordance and concordance rates between autopsy and clinical diagnoses have been used to identify areas of improvement and provide education opportunities to healthcare professionals. Discordance between autopsy and clinical diagnoses has revealed several areas in which clinicians need to improve their diagnostic skills and implement systemic changes to detect and mitigate diagnostic errors. Unfortunately, the rate of hospital autopsies has declined over the past several decades. The purpose of this study was to expand our previous work and combine the analyses of discordance and concordance between autopsy and clinical diagnoses across a 10-year period from 2002 to 2011 and to assess the role of the medical autopsy as a quality improvement tool in modern healthcare systems. Within our study, the autopsy rate of all in-patient deaths was approximately 6%. Our study indicates that the concordance rate between clinical and autopsy diagnoses was 77.5%, the discordance rate was 19.4%, and 3.1% were inconclusive. The discordance rate varied from as low as 9.7% in 2007 to as high as 27.1% in 2002. These findings suggest that overall, approximately 1 in 5 autopsies revealed discordance between autopsy and clinical diagnoses. This is a significant number of cases for which there exists both quality improvement and educational opportunities, thus, supporting the continued use of autopsy. We suggest these data should be used to encourage residents and physicians to continue using autopsy as an important quality tool to extend our understanding of disease processes. Hospital autopsies are closely associated with quality improvement and better patient care.

Jay Kalra, Daniel Markewich, Zoher Rafid-Hamed, Patrick Seitzinger

Conference Proceedings

Immediate Effects of Posture Correction Girdle on Adolescents with Early Scoliosis

Adolescent idiopathic scoliosis (AIS) is the complex three-dimensional deformity of the spine. AIS is commonly accompanied by postural alterations and imbalance problems. Adolescents with a spinal curvature between 6-20 degrees are defined as being in the early stages of scoliosis. Generally, bracing treatment with a hard brace is only recommended for adolescents with a spinal curvature between 21-40 degrees, while observation with periodical re-examination of the spine is suggested for cases of early scoliosis. Nevertheless, more treatment options could be provided to adolescents with early scoliosis as opposed to only observation. Therefore, a posture correction girdle has been developed with the aim to reduce posture imbalance problems and the possibility of spinal curve progression. In this study, the immediate effects of the posture correction girdle on four adolescents with early scoliosis are reported. Each subject undergoes a 2-hour trial of the girdle. Data collection is carried out before and after the trial by using radiographic imaging and three-dimensional body scanning. To evaluate the immediate effects of the posture correction girdle, comparisons are made pre and post results. Apart from the radiographic analysis, the changes of the postural angles in the frontal, horizontal, and sagittal planes during standing are also considered. The evaluation results show that the girdle has positive effects on the subjects. Two of them show a significant reduction in their spinal curve, while all of them reduce their postural imbalance during the time that the posture correction girdle is worn.

Pak Yiu Liu, Joanne Yip, Brian Chen, Lifang He, Jason Cheung, Kit Lun Yick, Sun Pui Ng

Conference Proceedings

Direct Weighting Interactive Design of Patient Preferences for Shared Decision Making in Orthopaedic Practice

Patients need the ability to accurately and efficiently communicate their preferences across outcome domains to their healthcare providers.1-7 No existing system provides an efficient and timely approach to collect and communicate patient preferences across outcome domains to support shared decision making (SDM) in orthopaedic practice.2-4,8-19 The overarching goal of this research is to design, build, and test an app that collects baseline patient preferences and health status across orthopaedic outcomes and reports this information to the provider for use in patient care. A core component of the app is a Direct-Weighting (DW) preference assessment approach, originated from our prior research, and applied in a touchscreen based interactive design. It is envisioned that patients will use the app after scheduling a first visit to a surgeon for a new orthopaedic condition. Direct weighting (DW) approaches calculate patient-specific preference weights across outcomes by asking patients to disperse portions of a hypothetical “whole” across outcomes in a manner that reflects a patient’s preferences.20 DW has low respondent burden but it requires respondents to make “implicit” comparisons which may be difficult to conceptualize.20 However, the DW approach has become generally accepted in the quality-of-life literature and it has been shown that patients dividing up pieces of a “pie” across quality-of-life domains yields valid representations of patient preferences across the domains.20-22 However, the DW approach has not been validated with specific clinical scenarios using a clinically focused set of outcomes or by using a mobile software app. Drawing on prior research, we iteratively design and develop the app with input from prior DW research, informaticians, and clinicians. We use a qualitative approach to pilot test the app with 20 first-time visit patients presenting with joint pain and/or function deficiency. Participants were interviewed about their outcome preferences for care, used the app to prioritize outcome preferences, answered interview questions about their experience using the app, and completed a mHealth App Usability Questionnaire (MAUQ). Interview questions focused on the utility and usability of the mobile app for communicating with their provider, and capability of the app to capture their outcome preferences. Results validated five core preference domains, with most users dividing their 100-point allocation across 1-3 domains. The tool received moderate to high usability scores. Patients with older age and lower literacy found the DW approach more difficult in terms of allocating 100 points across 5 domains. Suggestions for DW interface interaction improvement included instantiation of a token/points oriented DW preference scoring methodology rather than a 1-10 sliding scale approach for improved preference weighting cognition and SDM with a provider. As more patient reported outcome (PRO) apps hit the marketplace across a broad spectrum of health conditions, these results provide evidence for a DW approach and interactive design for patients to communicate their treatment preferences to their providers.References:1.Baumhauer JF, Bozic KJ. Value-based Healthcare: Patient-reported Outcomes in Clinical Decision Making. Clin Orthop Relat Res. 2016;474(6):1375-1378.2. Slim K, Bazin JE. From informed consent to shared decision-making in surgery. J Visc Surg. 2019;156(3):181-184.3. Damman OC, Jani A, de Jong BA, et al. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract. 2020;26(2):524-540.4. Sorensen NL, Hammeken LH, Thomsen JL, Ehlers LH. Implementing patient-reported outcomes in clinical decision-making within knee and hip osteoarthritis: an explorative review. BMC Musculoskelet Disord. 2019;20(1):230.5. Kamal RN, Lindsay SE, Eppler SL. Patients Should Define Value in Health Care: A Conceptual Framework. J Hand Surg Am. 2018;43(11):1030-1034.6. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine. 1999;49(5):651-661.7. Niburski K, Guadagno E, Mohtashami S, Poenaru D. Shared decision making in surgery: A scoping review of the literature. Health Expect. 2020.8. Selten EM, Geenen R, van der Laan WH, et al. Hierarchical structure and importance of patients' reasons for treatment choices in knee and hip osteoarthritis: a concept mapping study. Rheumatology (Oxford). 2017;56(2):271-278.9. Kannan S, Seo J, Riggs KR, Geller G, Boss EF, Berger ZD. Surgeons' Views on Shared Decision-Making. J Patient Cent Res Rev. 2020;7(1):8-18.10. Briffa N. The employment of Patient-Reported Outcome Measures to communicate the likely benefits of surgery. Patient Relat Outcome Meas. 2018;9:263-266.

Ben Schooley, Akanksha Singh, Sarah Floyd, Stephan Pill, John Brooks

Conference Proceedings

Preliminary wear trial of anisotropic textile brace designed for adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is a common condition that involves the curvature of the lateral spine and rotation of vertebrae often found in adolescents from age 10 to skeletal maturity. There are various kinds of treatments that prevent the natural progression of the spinal curvature, such as bracing and surgery. However, spinal surgery is mainly reserved for patients with severe scoliosis (spinal curvature that exceeds 45 degrees). For those with moderate scoliosis (spinal curvature larger than 21 but less than 40 degrees), bracing treatment is usually recommended as a non-operative treatment. In this study, the anisotropic textile brace (ATB) is designed to help those with moderate AIS to stop any further progression of their curvature. A case study of a female patient with AIS who has participated a 2-hour wear trial with the ATB is reported. The result of her Cobb angle values shown in the in-brace radiograph is compared without wearing a brace so as to evaluate the immediate effects of this treatment with a soft brace. Besides, the in-brace radiograph is also compared with a supine radiograph to determine the effectiveness of the bracing treatment. A positive result is found in that there is an immediate reduction of the spinal curvature.

Hoi Yan Cheung, Joanne Yip, Kit Lun Yick, Sun Pui Ng

Conference Proceedings

Medical Error Disclosure: A Quality Perspective and Ethical Dilemma in Healthcare Delivery

Medical errors are a significant public health concern that affects patient care and safety. Highlighted as a substantial problem in the 1999 Institute of Medicine report, medical errors have become the third leading cause of death in the United States of America. Failure to inform the patient of adverse events caused by a medical error compromises patient autonomy. Disclosure of adverse events to patients and families is critical in managing the consequences of a medical error and essential for maintaining patient trust. When errors occur, healthcare practitioners are faced with the ethical and moral dilemmas of if and to whom to disclose the error. Healthcare providers face these disclosure dilemmas across all disciplines, locations, and generations and have far-reaching implications on healthcare quality and the progress of medicine. We have previously reported the Canadian provincial initiatives encouraging open disclosure of adverse events and have suggested its integration into a 'no-fault' model. Though similar in content, the Canadian provincial initiatives remain isolated because of their non-mandatory nature and absence of federal or provincial laws on disclosure. The purpose of this study was to review and compare the disclosure policies implemented by individual health care regions/authorities in various parts of Canada to identify quality issues related to medical error disclosure based on several ethical and professional principles. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners balance the moral complexities involved in error disclosure. Effective communication between health care providers, patients, and their families throughout the disclosure process is integral in sustaining and developing the physician-patient relationship. We believe that the disclosure policies can provide a framework and guidelines for appropriate disclosure, leading to more transparent practices. We suggest that disclosure practice can be improved by creating a uniform policy centered on addressing errors in a non-punitive manner and respecting the patient's right to an honest disclosure and be implemented as part of the standard of care.

Jay Kalra, Zoher Rafid-Hamed, Lily Wiebe, Patrick Seitzinger

Conference Proceedings

Technological Innovations for ADHD treatment

The attention-deficit/ hyperactivity disorder (ADHD), is a neurobiological disorder and belongs to those called neurodevelopmental disorders, since it is commonly diagnosed in childhood, and persists into adulthood. The ADHD is divided by its central symptomatology in hyperactivity, and inattention, variable according to the case. It is one of the most diagnosed disorders in the child and education psychology fields, it has been considered that every child and adolescent must have an integral treatment plan, where technology advances can be part of it, and being available at home, becoming psycho-educative, and supportive in the treatment process. Thus, in this article, a revision of current applications about ADHD is presented.

María López, Mónica Acosta-Rodas, Mónica Bolaños-Pasquel, Jaime Moscoso, Carlos Ramos-Galarza

Conference Proceedings

Implications and Consequences of Artificial Intelligence in Healthcare Quality and Medical Training

Technology is playing an increasing role in the delivery of healthcare. The appropriate implementation of new technologies is a delicate balance of managing risk and meeting the emerging needs of the population. Healthcare strategies requires ongoing adaptation to deliver high quality healthcare to populations with complex healthcare needs. The implementation of Artificial Intelligence warrants careful deliberation to ensure that implications are considered, and consequences are mitigated. The complexity of Artificial Intelligence systems limits the ability of patients to provide informed consent and for clinicians to detect when an error has occurred. This creates new challenges to concepts of privacy, liability, and shared decision-making in healthcare. As a decision-making tool, Artificial Intelligence is only as accurate as the data with which it is provided. Artificial Intelligence systems incorporate and often amplify existing patterns of practice, including societal biases and inequitable healthcare practices. The momentum created by such innovations can lead to blind optimism and unintentional consequences. Navigating the transition to an Artificial Intelligence-assisted era of healthcare delivery will require an appreciation of the opportunities and limits of each technology. Healthcare educators are tasked with preparing learners across all disciplines of healthcare to function in an increasingly technological and rapidly evolving field of practice. This entails instilling learners with the digital literacy to leverage new tools as well as acknowledgement of limitations. We suggest that using Artificial Intelligence correctly has the potential to enhance the efficiency and quality of healthcare delivery. However, if implemented incorrectly these technologies may exacerbate health disparities, disempower patients, and lead to a reduction in the humanity of medical practice.

Jay Kalra, Patrick Seitzinger

Conference Proceedings

User Interface Assessment of a Tool for Digital Learning in Nursing

Digital Learning has gained importance for vocational training in a broad range of professions. In times of uncertainty, like experienced with the COVID-19 pandemic, this is especially true for the healthcare sector, as classrooms and training facilities may not be accessible or even available. At this point, tools for digital prequalification and learning can generate a decisive benefit, as they allow individual, self-paced transfer of knowledge independently from physical facilities, and as part of on-site or online classroom teaching. Web-based trainings (WBTs) are a good example of appropriate, proven technology, which makes interactive, multi-lingual learning content available on a broad range of mobile devices, like laptops, tablet PCs and smartphones. As WBTs offer manifold possibilities to accommodate information, an adequate user inface is crucial to make this information accessible, but also to reduce the on-screen information where reasonable. In our paper, we present a learning module for nursing training and its user interface. We outline the interaction concept behind it and describe all its interactive elements, such as tabs, buttons, and pop-up boxes. We also show the results of an empirical study featuring eye tracking in which we assess perception, comprehensibility, and motivation.

Jan Neuhöfer, Sabine Hansen, Tim Wöllenstein

Conference Proceedings

Drawing Connections: Artificial Intelligence to Address Complex Health Challenges

Pattern recognition is a cornerstone of clinical care and public health practice. Historically, advances in medicine have relied on the ability of humans to detect patterns and make inferences. Modern healthcare challenges involve vast amounts of data and a level of complexity that require additional support to understand. The advancement of Artificial Intelligence has expanded our capability to detect, understand, and address patterns that were previously beyond our grasp. Artificial Intelligence has the capability to analyze otherwise insurmountable quantities of data in order to bring meaning and clarity to patterns that were previously deemed random or unintelligible. We, therefore, aim to charter a strategic path forward for innovative applications of Artificial Intelligence technology to understand and address pressing complex health challenges. The modelling capabilities of Artificial Intelligence have allowed for the simulation of potential viral mutations, as well as the development of therapeutic agents. The predictive analyses provided by Artificial Intelligence allow for a more holistic yet precise understanding of the aging process and the progression of disease, thereby allowing the extent and timing of treatments to be optimized. It has brought a new lens through which to identify malignant cells on imaging and to decode parts of the human genome previously labelled as sequences of unknown significance. On a global scale, Artificial Intelligence has given us the opportunity to better understand and anticipate the effects of climate change on health including the effects on displacement and the potential spillover and spread of new zoonotic infection diseases. We suggest how Artificial Intelligence is beginning to re-conceptualize our understanding of health and disease. The implementation of Artificial Intelligence is a pivotal time in developmental of other modern era of medical practice and public health strategies. Appropriate utilization of these new tools requires innovative thinking, critical appraisal, and tactful resource allocation to ensure issues are addressed in a timely and feasible manner.

Patrick Seitzinger, Jay Kalra

Conference Proceedings

Real Time Battlefield Casualty Care Decision Support

Tactical combat casualty care (TCCC) involves care for casualties in armed conflict from one’s own service (e.g., U.S. Marine Corps), other services (i.e., U.S. Army, Air Force,), allied forces, adversaries, and civilians. To minimize injury and preserve life, medics perform TCCC which includes casualty retrieval, stabilization and documentation, transport, triage, and treatment. In future scenarios, delays in evacuation are expected to require extended care including prolonged field care (PFC) over hours to days, increasing the potential for complications such as bloodstream infection (sepsis). Most medics have only simple equipment and essential medications and will need assistance at point of care to make decisions on how to treat more complex cases and perform procedures in an austere setting.We describe a project for the Defense Health Agency (DHA) over 3 years to develop and evaluate the Trauma Triage Treatment and Training Decision Support (4TDS), a real-time decision support system (DSS) to monitor casualty health. The operating 4TDS prototype uses the Samsung smart phone and tablet certified for use in the Department of Defense (DoD) Nett Warrior program. Connection to a simple VitalTag (Pacific Northwest National Laboratory, Richland, WA) vital signs monitor placed on a casualty at point of injury (PoI) will stream patient data including heart rate, respiration rate, peripheral oxygen saturation (SpO2), and diastolic and systolic blood pressure. Nurses, technicians, and physicians can use the tablet to display an expanded data set including lab values while providing care at a Battalion Aid Station (BAS) and Field Hospital (FH).4TDS includes a Machine Learning (ML) model to indicate shock probability, risk of internal hemorrhage, and probability of the need for a massive transfusion. The shock model was trained on Mayo Clinic Intensive Care Unit (ICU) patient data, then evaluated in a 6-month “silent test” comparing shock prediction with actual clinician diagnoses. The model only uses 6 vital signs, which is suited to battlefield care, while other published results include lab tests (e.g., lactate), and produces a Receiver Operator Characteristic Curve (ROC) of 0.83 for shock detection. The model only decreases by 0.05 90 minutes, identifying shock probability well before its onset. Medic reviews indicate a 30-minute advanced warning would be more than sufficient to initiate treatment.Medics who provide PFC may need to perform life-critical procedures such as shock management, cricothyroidotomy intubation, and transfusion that may not have been used for an extended period. 4TDS includes refresher training in how to perform such a procedure, as well as whether to perform the procedure. Usability assessments with healthcare providers from the Army, Navy, and Air Force at Joint Base San Antonio, TX have demonstrated 4TDS and its capabilities align with TCCC practice. This work is supported by the US Army Medical Research and Materiel Command under Contract No. W81XWH‐15‐9‐0001.

Christopher Nemeth, Adam Amos-Binks, Gregory Rule, Dawn Laufersweiler, Natalie Keeney, Yuliya Pinevich, Vitaly Herasevich

Conference Proceedings

Influence of Ergonomics of Electric Power Industry Enterprises on Nervous System Diseases

Working at several electric power facilities exposes workers to hazardous factors are risk of electrical shock and electromagnetic waves of industrial frequency of 50 Hz) and less intense fields of the radio frequency range, noise and vibration levels, harmful chemicals like burning gases and fumes in the air, and psychological stress due to the on-call emergency state. In this work, we develop hybrid fuzzy decision rules is a promising tool that combines clinical knowledge with artificial intelligence. The developed model allows diagnosis of nervous system diseases at early stage. The selected decision rules took into account the environmental situation and individual health risk factors. This provides confidence in the prediction decisions of contracting nervous diseases shows the high accuracy of more than 0.85. The prediction of early stages reached minimum accuracy of worse than 0.92, which makes it a valuable tool to support physicians’ diagnoses. The developed model is valuable for health treatment decision making.

Riad Taha Al-Kasasbeh, Nikolay Korenevskiy, Altyn Amanzholovna Aikeyeva, Mahdi Salman Alshamasin, Sofia Nikolaevna Rodionova, Ashraf Shaqdan, Ashraf Shaqadan, Sergey Filist, Yousif Eltous

Conference Proceedings

The hospitalization experience design using gamification applied to a pediatric 3d scanner for compound fractures

Physical, social and mental well-being is the basic assumption which allows children to experience hospitalization positively. In this age of medical-scientific progress and technological development on hospital equipment, the designers of instruments for healthcare focus their activities on developing a coherent patient-centered approach which aims to consider the person globally. Currently, the rigors of the humanization of pediatric care are elaborating products which have both technological innovation and effective design specifications on children’s implicit needs and expectations. Mainly, the active, collaborative, and coordinated presence and accessibility of the family and of the pediatric patient in the care setting are unachieved goals in this field. The article presents the research project Oplà, a 3D acquisition system, as a demonstration of how emerging technologies, culture, communication and collaboration can help significantly in mapping out new diversification measures in standard clinical practice, to enhance the assistance services, by adopting a Human-centered approach strengthened by the iterative process of design thinking.

Sara Viviani, Rocco Furferi, Alessandra Rinaldi

Conference Proceedings

Design-for-user Acceptance of IOT Home use medical device: A design process for IOT home use medical device

Medical devices are migrating from hospital use to home use along with health professional users to lay users. New technologies, including Internet-Of-Things, lead home use medical devices to a new generation of easy to use, smart, portable, and communicable from anywhere. IOT technology enables the home use medical devices to seamlessly detect and connect home patient health status and health activities allowing the patients to remotely connect and share their health data to friends, family, and healthcare staff. Thus, home use medical devices with IOT connectivity play an essential role in assisting home patients to continue their medical care at home and monitor health activities, reducing the risk associated with non-communicable diseases (NCDs) in the first place. The devices empower the home patients to actively manage their health treatment and activities by themselves, either without or with minimum training experience and support. The targeted users of such devices are not limited to patients with chronic diseases but consumers who want to prevent them from serious illness and maintain good health. Accordingly, the success of the IOT home use medical devices also depends on the acceptance and adherence of the users to use the device as a part of their everyday lives. Developing medical devices concerning human factors to be safe and effective is crucial. Many studies contribute to providing design processes and methodologies in this regard. Furthermore, in the case of the IOT home use medical device development, engineers or designers must also understand the acceptance and adherence of the users toward the use of the devices in their daily life routine. Several studies coined the term as consumer medical devices bringing the consumer product development concept to use in this home use medical device development. Though several studies revealed factors influencing user acceptance of the devices such as convenience, ease-of-use, or usefulness, it still is difficult for engineers or designers who do not have expertise or experience in human factor research to integrate the knowledge with existing device development processes. This study proposes a T-A-C-V-I-U model linking relationships from IOT functions to device attributes, consequence, personal values, attitude toward using, and behavioral intention. The model aimed to analyze how device attributes would affect user acceptance. It was constructed from literature reviews on IOT functions, wearable and IOT device attributes, and factors influencing personal value and user acceptance based on Technology Acceptance Model (TAM), Health Belief Model (HBM), and Hierarchical Value Map (HVM). The model would assist non-user research or less-experienced human factor designers to consider which IOT functions should be embedded on a home use medical device to gain user acceptance. Vice versa, it would help assess how determined IOT functions would influence targeted users' acceptance. Finally, the Design-for-user Acceptance of IOT Home use medical device (DfAIH), a design process dedicated for IOT home use medical device development, is proposed. The design process is constructed following the design-for-x framework. It provides a step-by-step design process to convey product development and validation using the T-A-C-V-I-U model to gain user acceptance.

Apiwat Thongprasert, Arisara Jiamsanguanwong, Uthai Tanlamai

Conference Proceedings

Effective Remote Human Factors Support During COVID-19: Challenges and Lessons Learned

As with many aspects of our personal and professional lives, the COVID-19 pandemic has impacted the way that human factors researchers and specialists are able to conduct their work. As an organization providing human factors, patient safety, and risk management support nationally to healthcare institutions, we have had to adapt our established processes to find innovative solutions to continue our research and our work. Namely, we have had to work remotely from our partners and collaborators, which severely restricts opportunities for field work and first-hand observations. Besides the obvious challenges with technology and connectivity issues, we had to be mindful of our stakeholders and participants knowing that ‘Zoom fatigue’ was and continues to impact individuals both mentally and physically. As well, as practitioners we feel restricted in building a rapport with various end users, which is an essential component for understanding the stakeholder needs. In this talk, we present a number of strategies and best practices, including the use of electronic tools and tips for engagement and collaboration during virtual sessions. As well, we highlight the new opportunities that remote work affords the human factors specialist.We present these techniques within the context of patient safety projects conducted over the past year. In 2021, we partnered with a healthcare delivery institution to conduct a virtual Failure Mode and Effects Analysis (FMEA). The FMEA was conducted remotely via Zoom with five two-hour sessions, as physical distancing rules were in effect. In order to balance time commitments and Zoom fatigue, two-hour sessions were found to be sufficient for productive discussions while also respecting stakeholders’ schedules and care responsibilities. Furthermore, we decided on a dedicated facilitator to avoid cognitive overload and to avoid having to time-share between a number of responsibilities at the expense of a productive conversation. In the full talk, we discuss a number of other strategies on using technological aids to facilitate discussion, maintaining an amicable and open work environment, and staying on schedule. As well, we discuss the opportunities afforded by remote work, such as being able to provide support to a large number of organizations across the country without the overhead of travel.We anticipate that hybrid and remote work will continue to be part of the work reality for human factors specialists in healthcare for the foreseeable future. We have adopted these techniques into our standard practice, and believe that human factors practitioners will value hearing details about conducting these sessions in a remote setting. In particular, we provide lessons learned for scheduling and preparing for the sessions, collecting user data using a web-based voting system, and the challenges of logistics of running remote sessions. These will be practical and useful for specialists and researchers planning to conduct remote sessions with healthcare providers.

Anthony Soung-Yee, Carleene Bañez, Stefano Gelmi, Catherine Gaulton, Trevor Hall

Conference Proceedings

Improving healthcare-system safety through near misses: learning from transport industries

The aim of this study was to understand how the transport industries of aviation, rail and maritime have implemented near-miss management systems, and the impact of their learning from near misses. Grounded Theory, augmented by a scoping review, was used to generate the theory and principles behind how the industries manage near misses. The paper summarises the key findings from the scoping review and the themes identified through interviews with safety/human factors leads across various transport organisations. The findings provide insights into how healthcare might better manage near misses. However, the findings also challenge healthcare perceptions that other industries have perfected safety, and the specific value of near misses if used in isolation. The paper finishes by recommending safety management systems in healthcare.

Nick Woodier, Charlotte Burnett, Paul Sampson, Iain Moppett

Conference Proceedings

Ageing and medication adherence: An overview of key challenges, technologies, and opportunities

A growing ageing population and the rise in the number of people living with long-term conditions lead to increasing demand for resources to support healthcare in a pandemic impacted world. Medication self-management or adherence remains a major challenge that creates additional pressure on the global healthcare system. Poor medication management puts the patients at risk of poor health outcomes, increased mortality and burden on the National Health Service (NHS) in the United Kingdom. In this paper, the authors provide an overview of medication adherence and discuss its underlying challenges and emerging opportunities in the smart packaging sector. This includes exploring the relevant challenges for older people’s medication self-management through interviews with medical experts. Finally, conclusions and an outlook are presented towards future opportunities for personalized product-service systems of the future.

Bahar Khayamian Esfahani, Daniel Ganji, Emily Louise Mann, Jelena Milisavljevic Syed

Conference Proceedings

A design of emergency services for pre-hospital cardiac arrest

The frequency of sudden cardiac death is increasing year by year. Timely rescue of cardiac arrest patients using aed devices can greatly improve patient survival rates. However, in most cases, patients do not receive timely assistance. The purpose of this project is to provide more timely and safer rescue for cardiac arrest patients. Therefore, this design integrates relevant resources through a set of service design to improve the response rate of cardiac arrest events and allow patients to receive timely assistance. First, we use literature reading method to understand the current development of technology and services. Then, we conducted structured interviews with stakeholders about the EMS process. Based on this, we used functional analysis and scenario simulation methods to explore the needs and summarize the service touchpoints. Finally, service design tools, such as service blueprints, user journey maps,system map etc., are used to describe the service design. The results of this project will help to improve the survival rate of cardiac arrest patients, and also have some reference value for the improvement of urban EMS system.

Jinyu Cai, Jing Luo, Ruling Yang

Conference Proceedings

Human Factors Analysis of Goal-Directed Perfusion in Cardiac Surgery

The cardiac surgery operating room (OR) is a complex sociotechnical environment requiring the seamless integration of human-human and human-machine teams. Perfusionists in particular play a critical role in ensuring patient stability by operating the cardiopulmonary bypass (CPB) machine. Goal-directed perfusion (GDP) (oxygen delivery [DO2] ≥ 280 mL/min/m2 during CPB in cardiac surgery) is recommended given the positive results of the Goal-Directed Perfusion Trial (GIFT). However, the additional cognitive burden required by the perfusionist, and associated with the heightened vigilance needed to maintain the GDP threshold, is unknown. The objective of this study was to investigate the relationship between DO2 and perfusionists’ perceived cognitive workload in cardiac surgery.Methods: Experienced perfusionists indicated their perceived cognitive workload immediately after cardiac surgery procedures (N=15) using the validated SURG-TLX index dimensions (mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions). A two-tailed Spearman’s correlation was calculated to investigate the relationship between DO2 and SURG-TLX. IRB approval and informed consent from all participants were obtained.Results: Cases analyzed included 13 coronary artery bypass graft and 2 aortic valve replacement procedures. Patients averaged 66.3 years (SD: 8.3 years) with an average 30-day predicted mortality of 1.03% and 30-day predicted morbidity of 9.36%. Average pump time was 113 minutes (range 77 minutes to 170 minutes). Average body surface area was 2.15 m2 (SD: 0.17 m2).Lower DO2 levels (averaged across the duration of total pump time) were significantly associated with higher overall perceived task load (rs(13) = -0.62, p = 0.014), mental demands (rs(13) = -0.73, p = 0.002), and situational stress (rs(13) = -0.62, p = 0.017) (Figure 1). No significant correlations were detected between average DO2 levels and remaining cognitive workload dimensions.Conclusions: This is the first study to evaluate human factors associated with achieving GDP in cardiac surgery. Self-reported measures indicate an elevation in mental demands and situational stress which correspond to lower DO2 values, supporting further investigation into perfusionists’ cognitive state to avoid episodes of cognitive overload and facilitate maintenance of GDP.

Lauren Kennedy-Metz, Roger Dias, Rithy Srey, Geoffrey Rance, Kay Leissner, Suzana Zorca, Alexander Shapeton, Marco Zenati

Conference Proceedings

Real World Constraints for Actualizing Human Factors Findings for Healthcare System Interoperability

While theoretical and applied research findings recommend methods to optimize human-computer interaction, using them in a real-world scenario requires understanding and accommodation of constraints not normally included in experiments. This study describes steps to include research findings to incorporate interoperability requirements in the use of commercial-off-the-shelf products. This study focuses on a satisfactory and productive user experience while meeting organizational goals for the project.

Nancy Lightner

Conference Proceedings

Prototype of a piece of clothing for patients for quick and easy patient mobilizations in healthcare facilities

Caregivers are exposed to musculoskeletal strains during patient mobilizations. Especially for patient transfers, hoists were developed, but hoists have a low acceptance and when used incorrectly strains are still high. This paper develops a user-centered prototype to increase the use of hoists. The developed prototype is based on a market comparison, workflow analyses (n = 88), semi-structured interviews (n = 10) and a usability test with caregivers (n = 12). Instead of slings, the prototype lifts patients directly by their clothing. This reduces the transfer time and the steps required to lift a patient. The usability and the caregiver acceptance is high. Improvements address patients' comfort.

Lorenz Müller, Niels Hinricher, Janina Gersie, Claus Backhaus

Conference Proceedings

Considerations and Strategies for Operationalizing Heuristic Evaluation Work

Heuristic evaluation (HE) is a popular usability inspection method that allows expert evaluators to document usability problems with the design of interfaces. The relatively low resource requirements and high utility of identifying usability issues and suggesting dimensions along which to correct them have made HE highly scalable. However, there are several limitations and concerns when operationalizing HE for a large enterprise, and education and communication along with combining HE with other usability techniques may greatly increase the utility of the work.

Helen Fuller, Timothy Arnold, Kyle Maddox, Kathleen Adams

Conference Proceedings

Analysis of antibiotic purchasing service design based on SAPAD-AHP method

In the medical field, more than half of people will choose antibiotics for self-medication, they believe that antibiotics can be used for illnesses such as colds and fevers, or even for viral infections, which accelerates bacterial immunity to antibiotics. Misuse of antibiotics is not only unhelpful, but can damage the organism in a variety of ways that can lead to drug resistance, drug toxicity and allergic reactions. Worldwide, hundreds of thousands of people die each year due to bacterial resistance. In China, the use of antibiotics is even higher in outpatient and inpatient settings. The misuse of antibiotics poses a serious threat to the effectiveness of their use. In order to raise awareness of the dangers of antibiotic misuse, reduce people's choice of non-essential antibiotic medication, and expand and improve monitoring of health care institutions, this study introduces the SAPAD model and AHP to tap into users' real needs and complete a study of users' service design system for antibiotic drug purchase.The article uses observation method, user interview method and questionnaire method in the early stage to get the process of users' medicine purchase in common flu. Based on the SAPAD model framework, the user behavior is disassembled, and the people and things involved in the drug purchase process are listed to complete the mapping of behavior-object-meaning. The study obtained meaning clusters by clustering analysis of meaning layers, and combined with AHP to calculate the weight of each meaning cluster to derive core meaning clusters. The SAPAD model is a user-centered model framework for solving practical problems, which can start from the user's behavior, analyze, cluster and reorganize the meaning behind the behavior layer by layer, and finally dig into the user's real needs; the AHP method combines qualitative and quantitative analysis, and is highly logical and scientific, which can be applied to this topic The effective combination of SAPAD model and hierarchical analysis can gradually quantify the qualitative analysis and obtain more objective research results, which provides new ideas for the theoretical research framework of service design.This study completes the construction of meaning-based objects through the mapping of core meaning clusters to objects. The research process analyzes the key behaviors of users in purchasing drugs in common influenza, and obtains four semantic level meaning clusters through cluster analysis, namely "want to buy drugs quickly and correctly", "want to fully understand the effects of drugs", "want doctors to provide advice on appropriate medication" and "want to raise awareness of antibiotic medications". The study used AHP to analyze the meaning clusters and calculated the weights of each level to obtain the core meaning clusters of "buy the right medicine quickly", "get the right medication diagnosis", and "understand the effect of the medicine".The study reconstructed the service design system for users to purchase drugs in the process of common influenza through user requirements, summarized the key design elements, and improved the service function modules of online drug purchase and online consultation and advice.This study combines SAPAD model and AHP to design research on the user's antibiotic purchase process. Through the SAPAD model, we deeply study the user behavior, get the mapping of user behavior and meaning, and combine the quantitative research of AHP to get the core meaning cluster "quickly buy the right medicine", "get the right diagnosis of medication" and "understand the effect of medication", which guide the design of the service system of user's medication purchase process and the design of the APP for online medication purchase consultation. The SAPAD-AHP method in this study improved the function of the service system for antibiotic purchase process, and the designed output APP effectively improved the user's knowledge on the cautious use of antibiotics, strengthened the supervision of doctors' prescribing of antibiotics, and provided an effective solution to improve the problem of excessive use of antibacterial drugs in primary care institutions and rural areas.

Miao Liu, Wenjun Wang

Conference Proceedings

A Novel Headset System Synchronizing Vision and EEG testing for a Rapid Assessment and Diagnosis of Concussions and Other Brain Injuries

Millions of concussions happen each year in the US alone. A proportionally large number of these concussions are due to high impact sports injury. Currently, there exists no solution to quickly monitor brain functions and test the oculomotor functions of individuals who have suffered a traumatic brain injury in order to diagnose them as having suffered a concussion. What is presently done to diagnose concussions is a CT scan or MRI, which are lengthy procedures to schedule, set up, and conduct; and furthermore, takes additional time to analyze the results in order to arrive at a diagnosis. This prolongation of the diagnosing process is inherently problematic since the longer time it takes between time of injury and time of diagnosis, there is greater risk of decisions and actions which can worsen damage to the brain. The sooner a concussion can be diagnosed, the sooner and better the treatment can be performed for recovery. In order to ameliorate this issue, we seek to develop a device to perform the function of diagnosis and monitoring of brain activity in a more rapid and timely manner. Literature review into the anatomy of vestibular and ocular brain functions was performed; as well as research into various testing and monitoring methodologies of these vestibular and ocular functions. One such method that has proven to be a reliable method for diagnosis is Vestibular Ocular Motor Screening (VOMS), which is a visual and balance test performed by a doctor with a patient. Further research was also done into existing technologies whose functionalities would allow the device in order to perform brain monitoring, visual testing, and ultimately diagnosis; namely EEG, VR, and infrared eye tracking. Currently, very few devices on the market take advantage of these technologies together for medical uses. A device incorporating these technologies together allows would allow for more consistent administering of visual tests and real-time monitoring of brain activity. With a functional prototype, user testing is to be performed in order to assess the function and viability of the device.

David Edquilang, Jeff Feng

Conference Proceedings

Design of Proton Radiotherapy Room Based on Environmental Psychology

Proton radiotherapy is currently a more advanced tumor treatment method in radiotherapy, which can accurately eliminate tumor cells while reducing damage to surrounding healthy cells. However, anxiety and depression often occur in cancer patients during treatment. On the one hand, it will cause the displacement of the lesion and affect the effect of radiotherapy. On the other hand, negative psychology is not conducive to physical rehabilitation. In this paper, the principle of environmental psychology is used to guide the design of indoor environment of radiotherapy from the perspective of visual and auditory senses. Through the influence of environment on psychology, the purpose of calming the mood of patients and improving the therapeutic effect is achieved, and it provides support and reference for the design of humanized radiotherapy room space in the future.

Zikun Gao, Xinxiong Liu

Conference Proceedings

A Product-Service System Approach to Light Therapy for Treatment of Seasonal Depression

Seasonal Affective Disorder (SAD), also known as seasonal depression, is a subtype of depression in which the patient is affected by hours of daylight received during specific seasons. Besides the classic symptoms of a depressive disorder, SAD causes hypersomnia and cravings for carbohydrates. SAD is caused by several psychological and biological mechanisms of which the shift of the circadian rhythm caused by an imbalance of melatonin is one. This specific mechanism can be treated using bright light therapy. During daily light therapy sessions, the user is subjected to a strong light source directed to the eyes. Although bright light therapy (BLT) is proven to be an effective non-pharmaceutical treatment, compliance and motivation of patients is low.In this paper, we analyse the specific needs and wishes of seasonal depression sufferers, to gain an understanding in the ways in which the light therapy market is currently lacking. By conducting in-depth interviews as well as diary surveys and field research, insights were collected to map the users’ needs and experiences. After a short analysis of the technical specifications and market segments of daylight lamps, a list of requirements was composed to support the design process of a new, innovate light therapy system in which there is a clear focus on user experience.This paper contributes to the literature on light therapy and SAD, offering a new user-centred angle to the theoretical line-up of research papers in order to increase therapy compliance and improve user experience during light therapy sessions.

Kaat Kenis, Ivo Dewit

Conference Proceedings

Comparison of Lab- and Remote-Based Human Factors Validation – A Pilot Study

The possibility of conducting human factors validations remotely becomes increasingly important, not only due to the COVID-19 pandemic. However, there is a lack of research addressing the reliability of remotely obtained data in the field of medical products. Observability seems to be a key factor and has therefore be ensured in remote setups. This research focuses on producing and analyzing first data to compare lab-based and remote-based setups. The goal is to evaluate if and under which circumstances human factors validations of medical devices could be conducted remotely and which methodological aspects must be considered. In a simulated human factors validation / usability test, two lab-based and two remote-based conditions were investigated. The lab-based observer was present in the test room during the evaluation. Afterwards, the session’s recording could be reviewed as a second variant of the lab-based observation. The remote-based observer had the recording as a resource for observation only and the chance to review it afterwards as a second condition. The observations were based on a simulated human factors validation for two different medical products (device and software). The main basis for data analysis was an observation protocol in which the individual actions to be performed were categorized by the two observer groups according to classification derived from FDA’s Human Factors Guidance. Five human factors professionals in the lab-based and the remote-based setup respectively, with prior knowledge about both products in focus of the evaluation, generated the protocol data. The datasets from the lab-based and the remote-based observations were compared regarding their level of agreement. In addition, the quality of observations was assessed by comparing them to a sample solution, including the effect of the setups on the observers’ cognitive workload. Descriptively assessed, any-two agreement and Cohen´s κ calculations showed differences in observations of the lab-based vs. remote-based setup that became smaller when potentially critical actions were in focus. For the medical software less than 10% of the observations differed compared to around 15% for the medical device considering only critical use errors. The quality of observations was slightly higher when the observer was on-site, and better overall for the medical device compared to medical software regarding percentual agreement with the sample solution. Interestingly, a particularly high cognitive workload occurred when the medical device was observed remotely comparing the total NASA-TLX scores between the setups. Findings do not seem to strongly favor either lab-based or remote-based setups. For the medical device, the lab-based observation seemed to be more appropriate while for the medical software the result is not clear. However, remote observation performed better for the medical software than for the medical device. Observing the evaluation remotely and verifying the results with the help of video recordings detected the highest number of critical use errors. Overall, initial results from the feasibility study highlight the potential of remote evaluations. However, more research is needed to validate the results with a larger sample size and determine the influencing factors that might favor remote vs. lab-based approaches.

Karoline Johnsen, Bernhard Wandtner, Michael Thorwarth

Conference Proceedings

Work-related noise exposure in a neonatal intensive care unit

Premature infants are children born before the 37th week of gestation. They often need to be cared for in neonatal intensive care units (NICUs) after birth, where they are continuously exposed to noise that can affect sleep patterns and lead to growth and developmental delays. To date, there are no unified limits for the prevention of noise exposure in NICUs. Recommendations for maximal continuous sound levels vary - depending on the professional society - between 35 and 60 dB(A) for daytime values and 20 to 60 dB(A) for nighttime values. They span a range from quiet whispering to normal road traffic noise. Existing studies of noise measurements in NICUs indicate that these recommendations are generally not met. A limitation of previous work is their short time periods that noise measurements were made for, usually one or two hours. As a result, it is not possible to make statements about the diurnal cyclic change in noise exposure, which may have an influence on the circadian rhythm of premature infants, for example. The present work aims to determine the intensity and diurnal cyclic differences of noise exposure in a NICU. In addition, particularly noisy work activities are identified in order to derive suggestions for prevention.For this purpose, the continuous sound levels are recorded for 22 work shifts in a German level 1 perinatal center. Measurements are made in the patient room and the inside of an infant incubator. The mean daily noise exposure levels (LEX,8h) of the early, late and night shifts are calculated and the peak sound level (LpCpeak) is recorded. To test for a day-night rhythm, these are compared using one-factor ANOVA. Using the Contextual Inquiry method, work analyses are performed for 12 work shifts and the early, late and night shifts with the highest equivalent continuous sound level (LAeq) are examined for noise-intensive work activities as examples. The measurement results in LEX,8h and LpCpeak values of up to 49.7 dB(A) and 124.4 dB(C) inside the infant incubator and 55.4 dB(A) and 110.3 dB(C) in the patient room. A day-night rhythm of noise exposure could not be demonstrated. The most noise-intensive work activities included the suctioning of patients and the conversations conducted in the process, with an LAeq of 63 dB(A). In addition, numerous very high impulsive noise events are identified which contribute to the noise exposure of premature infants. The presented study proves that the noise exposure is too high, which is very likely to affect the sleep behavior of premature infants. The results correspond with the statements of comparable studies. It is remarkable that especially the high peak noise levels are mainly due to trivial causes, which can be avoided by simple preventive measures.

Claus Backhaus, Simon Siebers

Conference Proceedings

Is Latvia Ready For The Value-Based Healthcare Era?

The Value Based Health Care (VBHC) has recently become the leading conceptual approach to health care in the world, but no value-based healthcare programme has yet been established in Latvia. Despite the critical interest in the implementation of VBHC programmes on the part of the health sector stakeholders, still the key persons in VBHC programmes are physicians. Goal of research: To clarify the views of physicians and young physicians on values-based health care fundamental principles and their vision for their further inclusion in Latvian health care. Method: The research uses data from a survey conducted among physicians and young physicians who practice at Pauls Stradins Clinical University Hospital.Results: 42% of physicians responded that patient surveys on the effectiveness of treatment for certain groups of patients could help to improve the results of treatment; 51% of physicians responded that patient surveys on their experience during treatment can help to improve their treatment results; much more cautious were physicians regarding the question whether comparing the results of treatment between physicians teams/hospitals could help to improve the results – 39% replied ‘Yes’ and 24% ‘Rather yes than no’; similarly cautious was the reply to the question whether the voluntary public availability of treatment results from a medical treatment facility could have a positive impact on the visibility of the service provider – 31% replied ‘Yes’ and 25% ‘Rather yes’; the convincing 82% of replies were to the question whether an exchange of experience and knowledge in the team of physicians helps to improve the results of treatment; the convincing majority of 86% of physicians believe that a multidisciplinary team of physicians can help improve the results of treatment; as a positive response, can be considered that 63% of respondents think that reforms in health care may be initiated not only by the Ministry of Health. The most interesting answer would be to the question of what management strategies should be developed in the healthcare system, where the first place, with 349 points, was taken by the answer “Cooperation with external partners (manufacturers, scientific centres, insurers, IT and other service providers)”.Conclusions: The results of the survey show that the application of VBHC principles will not contradict to views of physicians on traditional management models in health care and their role in it.Proposals: However, prior to starting the introduction of VBHC programmes in Latvian health care, there are grounds for launching discussions on the benefits of VBHC compared to the traditional management model. Policy recommendations: For hospital management and health sector supervisors to avoid resistance of physicians to implementing VBHC, the strategy should focus not on VBHC resource-efficient programmes but on patient-centred healthcare.

Mara Petersone, Ingars Erins, Karlis Ketners

Conference Proceedings