IMPROVING THE HUMAN TECHNOLOGY INTERFACE NURSING INFORMATICS CHAPTER 4 1

CHAPTER OBJECTIVES 1. Define human-technology interface. 2. describe problems with human-technology interfaces currently available in healthcare 3. describe models, strategies, and exemplars for improving interfaces during analysis, design and evaluation phases of the development life cycle. 4. Reflect on the future of the human-technology interface 2

CHAPTER INTRODUCTION In today’s healthcare settings, we encounter a wide variety of human-technology interfaces. Scientists and engineers are making excellent efforts in understanding Human Technology Interface problems and proposing solutions. Any time a human uses technology, there is some type of hardware and/or software that enables and supports the interaction. 3

Human-Technology Interface (HTI): The hardware and software through which the user interacts with any technology (e.g., computers, patient monitors, telephone) Human-Technology Interaction (HTI): How users interact with technology; also the study of that interaction. 4

Human Computer Interaction (HCI): The processes, dialogues and actions that a user employs to interact with a computer; also the study of interaction between people (users) and computers; deals with people, software applications, computer technology and the ways they influence each other. 5

Examples of human-technology interfaces the nurse might encounter include: Defibrillators Intravenous pumps Patient-controlled analgesia (PCA) pumps Physiologic monitoring systems Electronic thermometers Cardiac Monitoring systems Telephones & Pagers 6

The human interfaces for each of these technologies are different—and can even differ among different brands or versions of the same device. Our healthcare technologies may present information to us via computer screen, printer, or a personal data assistant (PDA). Sometimes Telehealth interfaces allow patients to interact with a virtual nurse or clinician. 7

Human-technology interfaces may present information using text, numbers, pictures, icons, or sound. The growing use of large databases for research has led to the design of novel human-technology interfaces that help researchers visualize and understand patterns in the data that generate new knowledge or lead to new questions. The human-technology interface is everywhere in healthcare and takes many forms. 8

Human Technology Interface Problem Human-technology interface problems are the major cause of up to 87% of all patient monitoring incidents. The technology may perform flawlessly, but the interface design may lead the human user to make errors. 9

Improving Human Technology Interface We can learn a lot from the related fields of Cognitive Engineering, Human Factors, and Ergonomics about how to make our interfaces more compatible with their human users and the context of care. The design process should be literative, allowing for evaluation and correction of identified problems Iteration: means the act of repeating a process usually with the aim of approaching a desired goal or target or result 10

Ergonomics: In the United States, this term is used to describe the physical characteristics of equipment, for example, the optimal fit of a scissors to a human hand. In Europe, the term is synonymous with Human Factors. It is the interaction of humans with physical attributes of equipment or the interaction of humans and the arrangement of equipment in the work environment. 11

Formal evaluation should take place using rigorous experimental and/or qualitative methods. Task Analysis examines how a task must be accomplished. Cognitive Task Analysis (CTA) usually starts by identifying, through interviews or questionnaires, the particular task and its typicality and frequency. Cognitive Work Analysis (CWA) was developed specifically for the analysis of complex, high technology work domains. 12

A complete CWA includes five types of analysis: work domain, control tasks, strategies, social- organizational, and worker competencies. Today there are available both principles and techniques for developing human-technology interfaces that people will be able to use with minimal stress and maximal efficiency. Perhaps one of the best characteristics of that any interface can achieve is that it is “transparent.” 13

An interface becomes transparent when it is so easy to use that users no longer think about it, but only about the task at hand. The more transparent the interface, the easier the interaction should be. Usability is a term that denotes the ease with which people can use an interface to achieve a particular goal. Usability of a new human-technology interface needs to be evaluated early and often throughout its development. 14

Typical usability indicators include: ease of use, ease of learning, satisfaction with using, efficiency of use, error tolerance, and fit of the system to the task. Increased attention to improving the human- technology interface through human factors approaches has already led to significant improvement in one area of healthcare— anesthesiology. 15

Example: Anesthesia machines that used to have hoses that would fit into any delivery port now have hoses that can only be plugged into the proper port, thus reducing the chance for error. 16

Anesthesiologists have also been actively working with engineers to improve the computer interface through which they monitor their patients’ status and are among the leaders in investigating the use of audio techniques as an alternative way to help anesthesiologists stay “situationally aware.” As a result, anesthesia-related deaths dropped from 1 in 10-20,000 to 1 in 200,000 in under 10 years. 17

The increased amount of informatics research in this area is encouraging, but there is a long way to go. 18