1. Usability and Human Factors Requirements Engineering This material (Comp15_Unit2) 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 1U24OC000003. Unit 2

2. Unit Objectives Students will be able to: Explain the role of requirements gathering in usability evaluation. Identify the uses, advantages, and disadvantages of data collection methods used for requirements gathering Demonstrate an understanding of how to conduct a workflow analysis –Identify contextual design principles as they apply to the healthcare setting Describe the methods to interpret results of data collection 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

3. What Are Requirements? An explanation of what the system should “be” or should “do” Documentation of “needs” in order to communicate between everyone involved in system development A set of goals that define objectives for design 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

4. What Are We Trying to Achieve? Identify needs so that the system can support the user’s goals Produce a set of stable requirements that can be moved forward into the design activity 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

5. Why Do We Need Requirements? 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering To make communication clear, unambiguous and specific on system “needs” To identify potential mismatch between user needs and designers’ understanding To reduce the time and costs involved in developing a system To evaluate the functions of a system during testing

6. What Documents Do We Need to Communicate Requirements? 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Product Requirements Documentation Development Estimates Prototype Test Case Scenarios Maintenance Plan Product Support Documentation

7. Different Types of Requirements? 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Can also be grouped into more precise categories: Data requirementsTechnological requirements Requirements are conventionally categorized into the two groups: Functional RequirementsNon-functional Requirements

8. Functional Requirements 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Describe the capabilities of the system Describe what the user should be able to do with the system “The order entry screen will allow the user to enter the first and last name of the patient” “The order entry screen will display the first and last name of the patient” Examples:

9. Non-functional Requirements 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering User characteristics General and technical constraints Security Organizational environment Everything else:

10. Specific Requirement Types 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Data types, size/amount, persistence, standards of accuracy Data Requirements Lighting, noise, privacy and traffic Environmental requirements/contexts of use Is management supportive? Quality/availability of user support? Resources for training? Organizational environment Platform, interoperability, compatibility Technological environment Experts vs novices User characteristics

11. Methods for Eliciting Requirements 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering TechniqueUseAdvantagesDisadvantages QuestionnairesAnswer specificsReach many people Response rate InterviewsExplore IssuePersonal ContactTime consuming Focus Groups /Workshops Multiple viewsBuild consensusNot all voices heard Naturalistic Observation Context of user activity Observing workVery time consuming Documentation analysis Procedures, Regulations. Operational insight May be difficult to comprehend without insider help Cognitive Research Skill, knowledgeModel of performance Complex, time 1.1 Table: (Preece, 2007).

12. Health Care Workflow Medical work is collaborative Coordination of tasks is required Medical record is used as a coordinating tool to communicate activities and patient status There is no single, unambiguous perspective on tasks and processes performed by users, who are the medical staff 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

13. Analysis of Workflow of Nurse Case Manager (Kaufman, 2009) 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

14. Analyzing Workflow 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Tasks that people do Roles of the various actors Event sequence for a particular process Describe technologies, documents or artifacts (e.g., post-it notes) The nature of the communication process

15. Schematic of Nurse Workflow (Kaufman, 2009) 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

16. Contextual Inquiry (Holtzblatt and Jones, 1993) 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Understanding tasks being performed at work, Structure of an organization Roles within health care organization Approach to uncovering requirements related to the context of use in health care workflow Structured approach to the collection and interpretation of data from fieldwork Much more focused and limited in scope Interpreted observations versus rich description Emerged from ethnographic method

17. Contextual Inquiry (cont.) 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Designer works as apprentice to user (learning the ropes) Apprenticeship model Lengthy interview that also involves observation and reconstruction of past events Contextual Interview 1. Context: emphasis on seeing what happens in workplace 2. Partnership: developer and user collaborate in understanding work 3. Interpretation: observations interpreted to be used in design 4. Focus: data gathering focused on goals and specific questions Guided by four principles:

18. Context of Requirements The context of health care helps in understanding what happens in the workplace This includes the social and cultural structure of the organization –The employees of an organization may be more accepting of changes in workflow and technology than a different organization –The beliefs and attitudes of an organization has an impact on the success of implementing a new system 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

19. Partnership in Requirements Learning about the workplace through observation and discussion with users The roles and responsibilities of health care workers influence their perspective on system needs –Defining requirements necessitates a partnership with users to understand their concerns with technology and to utilize their ideas for improvement 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

20. Interpretation Into Requirements Observations of the workplace are interpreted into system needs Assumptions and dependencies must be examined –Requirements should be based on the actual tasks and processes within the workplace –Reducing or eliminating repetitive tasks can be accomplished through identification of other people’s activities 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

21. Focus on Goals 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering To understand why or how something is done To understand why or how something is not done To understand how the context of health care work practices impact system needs Focus on the goals of developing requirements

22. “A day in the life of an analyst” Scenario 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering The staff in a private doctor’s office needs to keep track of the patients that have been referred to external specialists You have been contacted to meet with the head nurse to identify requirements for a system to track patients and external specialists

23. “A day in the life of an analyst” 8AM 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering You prepare a list of questions and take notes on his answers You interview the head nurse How many staff members are employed by the office? Which staff members are involved in the current practice? What is each of their individual roles? What documentation is used? What problems currently are found with the current practice? What solutions have the staff come up with for those problems? What ideas do they have for a future system to automate referral tracking? You ask about the current practice of keeping track of referrals:

24. “A day in the life of an analyst” 10AM 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering You observe the office staff in their daily tasks, focusing on the current method of referral tracking You obtain copies of the documentation used in referral tracking You take notes about what you see in the office

25. “A day in the life of an analyst” 12PM 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering You take notes on their answers You ask them how they feel about the current referral tracking process and if they have any ideas on potential solutions You meet with two other members of the office staff: one is involved with the referral tracking and the second is not

26. “A day in the life of an analyst” 3PM 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering You meet with the head nurse again to discuss your observations The nurse is surprised to find out that a staff member not part of the process is printing out each referral letter and placing them in patient folders He indicates to you that there needs to be security restrictions on who has access to external physician records The results of this discussion become the requirements for security and privacy of patient data

27. “A day in the life of an analyst” 4PM 27 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering You make a note in your calendar that tomorrow you need to analyze the documentation and begin to create your own document to communicate system requirements You now have an understanding of the purpose of referral tracking as well as the roles and tasks required in maintaining external physician referrals As you end the day, you begin to organize your notes into different categories of requirements

28. Methods to Organize Ideas and Data 28 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Affinity diagrams Sort and display ideas from multiple sources Process flow Depicts the overall flow of activities and the relation between parts of a system including individuals

29. Affinity Diagrams 29 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Affinity diagrams display a grouping of ideas and data. Steps: 1. Write down individual ideas on a note card or post-it note 2. Look for ideas with similar themes 3. Group the ideas with similar themes together

30. Affinity Diagram: “A Day in the Life” Referral creation process Head nurse makes appt for patient with external physician Receptionist calls patient with appt time Student intern notes appt in patient record and prints letter to send Track external referrals Documents created or modified Patient Appointment letter External Physician letter Patient record noteSecurity rolesAdministratorData Entry 30 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

31. Requirements Engineering 31 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering Need requirements to communicate with everyone on teamDifferent requirements for different aspects of system Need to focus on the purpose of the system while interpreting the context in which the system will be used by partnering with the users Creating requirements consists of a process of steps Includes interviewing medical staff, observing daily routines within the medical work place & analyzing current documentation used by the medical staff Many methods for process of requirements analysis Including diagrams and process flows

32. Conclusions Requirements engineering emphasizes the necessity of understanding the nature of user needs Different requirement types and methods for eliciting them Importance of understanding workflow Method of contextual inquiry Affinity diagrams as a method to organize ideas and data 32 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering

33. References Holtzblatt, K., & Jones, S. (1993). Contextual inquiry: A participatory technique for system design. In D. Schuler, & A. Namioka (Eds.), Participatory Design: Perspectives on Systems Design (pp. 177-210). Hillsdale, New Jersey: Lawrence Erlbaum Associates. Websites Retrieved on June 21, 2010 from http://en.wikipedia.org/wiki/Requirementhttp://en.wikipedia.org/wiki/Requirement Retrieved on June 21. 2010 from http://en.wikipedia.org/wiki/Contextual_inquiryhttp://en.wikipedia.org/wiki/Contextual_inquiry Table 1.1Table: Preece, J. Rogers, Y. & Sharp, H. (2007) Interaction Design: Beyond Human-Computer Interaction. 2nd Edition. New York, NY: John Wiley & Sons Images Slide 13: Kaufman, D. R., Pevzner, J., Rodriguez, M., Cimino, J. J., Ebner, S., Fields, L., et al. (2009). Understanding workflow in telehealth video visits: Observations from the IDEATel project. Journal of Biomedical Informatics, 42(4), 581-592. Slide 15: Kaufman, D. R., Pevzner, J., Rodriguez, M., Cimino, J. J., Ebner, S., Fields, L., et al. (2009). Understanding workflow in telehealth video visits: Observations from the IDEATel project. Journal of Biomedical Informatics, 42(4), 581-592. 33 Health IT Workforce Curriculum Version 3.0/Spring 2012 Usability and Human Factors Requirements Engineering