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Usability and Human Factors People and Technology, Studies of Technology Lecture b This material (Comp15_Unit1b) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC

People and Technology, Studies of Technology Learning Objectives 2 Patient safety issues (Lecture b) Demonstrate concept knowledge of principles of user- centered design, methods of cognitive research, and sources of usability evidence (Lecture b) Describe the seven stages of User Activity in Norman’s Theory of Action (Lecture b) Describe the role of human factors and human computer interaction concerning patient safety in the healthcare setting (Lecture b) Demonstrate concept knowledge of principles of user- centered design and sources of usability evidence (Lecture b) Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Patient Safety 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b Freedom from accidental injury Institute of Medicine Report: 98,000 preventable deaths due to human error Eighth leading cause of death “Given the complexity of health care and the formidable obstacles it presents to change, to overcome these barriers and create a safe culture does indeed seem to be the ultimate challenge for those who specialize in human factors” (Lucian Leape, 1994)

Annual Death Rates in US 1.1 Table: (Kohn, L. T., Corrigan, J., & Donaldson, M. S., 2000). 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Medical Device Errors 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b FDA recognizes most user errors with medical devices are: –Influenced by device design and device labeling –Not "inevitable human error"

FDA Device Reports Flicker image (2010). 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Glucose Monitors Kaufman, D.R. & Starren, J. B. (2006). 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Digital Divide Socioeconomic and demographic divisions between computer users and nonusers –Elderly adults over age 65 –Earn less than $25,000 –Hispanics and African Americans –Rural populations –Education less than high school A Nation Online (2002) 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Community-Related Initiatives Kaufman, D.R. & Rockoff, M.L. (2006). 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Community-Related Initiatives (cont.) Kaufman, D.R. & Rockoff, M.L. (2006). 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Telemedicine Device Kaufman, D.R., Pevzner, J, Hilliman, C., et. Al. (2006). 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Touch Screen Device Kaufman, D.R., Pevzner, J, Hilliman, C., et. Al. (2006). 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Design 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b A plan/scheme conceived in mind & intended for executionTradeoffs balancing conflicting requirementsGenerating alternativesUse representations Natural language, diagrams, prototypes Interaction design Developing plan informed by product’s intended use, target domain & relevant practical considerations

Iterative Design Process 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b Needs analysis Develop alternatives PrototypeImplementEvaluate

User-Centered Design Ruland, C. M., Starren, J., & Vatne, T. M. (2008). 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Norman's Seven Stages of User Activity Norman (1986). 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

Bridging Gulfs 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b Gulf of Execution Gap between user’s goals & state of system How do I… ? Gulf of Evaluation Gap between observed & expected system state What happened?

Sources of Usability Evidence 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b Basic ObservationExpert review/usability inspection Testing situation End-user observationVideo capture & review Qualification & quantification Formal coding

People and Technology, Studies of Technology Summary – Lecture b Patient safety has been an issue of tremendous concern over the last 10 or so years. Medical devices are potential sources of error that can compromise patient safety Digital divide explains the unequal access to computer resources and their consequence 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

People and Technology, Studies of Technology Summary – Lecture b (cont.) Iterative design is integral to developing sounds design practices that can improve patient safety –User-centered design is an exemplary method for engaging users into the design process. Norman’s seven stages of user interactivity Sources of usability evidence In the next class, we will discuss various examples of good and poor design 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

People and Technology, Studies of Technology References – Lecture b References 1.Kaufman, D.R. & Starren, J. B. (2006). A methodological framework for evaluating mobile health devices. In the Proceedings of the American Medical Informatics Annual Fall Symposium. Philadelphia: Hanley & Belfus Kaufman, D.R., Pevzner, J, Hilliman, C., Weinstock, R.S., Teresi, J. Shea, S. & Starren, J. (2006). Re-designing a telehealth diabetes management program for a digital divide seniors population. Home, Healthcare, Management & Practice. 18: Kaufman, D.R. & Rockoff, M.L. (2006). Promoting online health information-seeking in seniors: a community-based organizations approach. Generations 30(2): Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: building a safer health system: National Academy Press. 5.Leape, L. L., Error in Medicine. (1994). JAMA, 272: Norman, D. A. (1986). Cognitive engineering. In D. A. Norman & S. W. Draper (Eds.), User centered system design: New perspectives on human-computer interaction (pp ). Hillsdale, NJ: Lawrence Erlbaum Associates. 7.Ruland, C. M., Starren, J., & Vatne, T. M. (2008). Participatory design with children in the development of a support system for patient-centered care in pediatric oncology. J Biomed Inform, 41(4), U.S. Department of Commerce. (2002). A nation online: How Americans are expanding their use of the Internet. Washington, DC: U.S. Government Printing Office. 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b

People and Technology, Studies of Technology References – Lecture b Charts, Tables & Figures 1.1 Table: Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: building a safer health system: National Academy Press. Images: Slide 6: Infusion pump. Retrieved on August 3rd, 2010 from Slide 7: Kaufman, D.R. & Starren, J. B. (2006). A methodological framework for evaluating mobile health devices. In the Proceedings of the American Medical Informatics Annual Fall Symposium. Philadelphia: Hanley & Belfus. 978 Slide 9: Kaufman, D.R. & Rockoff, M.L. (2006). Promoting online health information-seeking in seniors: a community- based organizations approach. Generations 30(2): Slide 10: Kaufman, D.R. & Rockoff, M.L. (2006). Promoting online health information-seeking in seniors: a community- based organizations approach. Generations 30(2): Slide 11: Kaufman, D.R., Pevzner, J, Hilliman, C., Weinstock, R.S., Teresi, J. Shea, S. & Starren, J. (2006). Re- designing a telehealth diabetes management program for a digital divide seniors population. Home, Healthcare, Management & Practice. 18: Slide 12: Kaufman, D.R., Pevzner, J, Hilliman, C., Weinstock, R.S., Teresi, J. Shea, S. & Starren, J. (2006). Re- designing a telehealth diabetes management program for a digital divide seniors population. Home, Healthcare, Management & Practice. 18: Slide 15: Ruland, C. M., Starren, J., & Vatne, T. M. (2008). Participatory design with children in the development of a support system for patient-centered care in pediatric oncology. J Biomed Inform, 41(4), Slide 16: Norman, D. A. (1986). Cognitive engineering. In D. A. Norman & S. W. Draper (Eds.), User centered system design: New perspectives on human-computer interaction (pp ). Hillsdale, NJ: Lawrence Erlbaum Associates. 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors People, Technology, Studies of Technology Lecture b