1. Comp 15 - Usability and Human Factors Unit 4a - Human Factors and Healthcare This material 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.

2. Overview Introduction to human factors principles Applied cognitive psychology/selective attention Patient safety Understanding human errors A Systems-centered approach to human errors Mental workload Medical devices Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 2

3. Human Factors & Health Care Health Devices Electronic Health Record Systems Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 3

4. Human Factors and HCI Redux Histories, journals, academic and professional societies HCI focused on computing and innovative design HF focused on any system and greater emphasis on work/workplace and on devices Safety is a core issue in HF Differences: –Histories, journals, academic and professional societies –HCI focused on computing and innovative design –HF focused on any system and greater emphasis on work/workplace and on devices –Safety is a core issue in HF Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 4

5. Human Factors and HCI Redux User-centered and systems approach Draws on cognitive psychology and other social sciences Similar methods with regards to usability evaluation Cognitive task analysis Usability testing Similarities: Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 5

6. History of Human Factors Industrial efforts to increase worker productivity 1900-1945: Formal beginning of the profession – military 1945 – 1960: Rapid growth and expansion – space program, product design, workplace design 1960 – 1980: Human computer interaction, safety/human error 1980 – 1990: e.g., healthcare, aging, aviation safety, standardization 1990 – Present expansion Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 6

7. Why is Human Factors Increasingly Important Diversity of user groups Complexity of systems Increased use of technology Increased “costs” of human error Societal emphasis on well-being and quality of life Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 7

8. Human Factors Objective Focus: Human beings and their interactions with products/equipment, tasks, environments (Micro, macro, ambient) Goal: Design systems and system components to match the capabilities and limitations of humans who use them Optimize working & living conditions Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 8

9. Examples of Application Areas Military Highway systems –e.g. readability and comprehensibility of signs Automobile design and driver behavior Human-computer systems Healthcare and patient safety Aging and accessibility Nuclear power Workplace layout and furnishings Airline industry –e.g. pilot workload, aircraft design, automation, aircraft maintenance Quality control Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 9

10. Nuclear Power Plant Control Room Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 10

11. Airplane Cockpit Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 11

12. Human Factors in Medicine Infusion pumps Anesthesia equipment Medication errors Effects of fatigue on resident’s performance Judgmental limitations in medical decision making Inadequate infection control Unintended consequences of automation Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 12

13. Human Factors/Ergonomics (Carayon, 2007) Scientific discipline concerned with understanding interactions –Among humans –Other elements of a system Profession that applies theory, principles, data, methods to design to optimize: –human well-being –overall system performance System can be a technology, device, person, team, organization, policy, etc. Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 13

14. Human Factors Ergonomics: 3 Major Domains Physical Ergonomics Cognitive Ergonomics Organizational / Macroergonomics Physical Ergonomics Cognitive Ergonomics Organizational / Macroergonomics Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 14

15. Physical Ergonomics Topics: Repetitive movements, workplace layout, safety and health Application to Health: Reducing and preventing injury, designing workstations and work rooms for optimal human performance Examples: Designing a patient room to facilitate and support patient care Designing medical labels so that they are readable and understandable Concerned with physical activity Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 15

16. Organizational Ergonomics Topics: communication, teamwork, participatory design, quality management Application to Health: Reducing stress and burnout, improving satisfaction and retention, implementing improvement activities Examples: Management training in surgery teams Designing work schedules for reduced fatigue and enhanced performance Concerned with sociotechnical systems Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 16

17. Cognitive Ergonomics Topics: mental workload, decision making, skilled performance, HCI, work stress, Application to Health: usability, designing training systems, usable interfaces Examples: Event report systems Implementing incident analysis system Concerned with mental processes –Topics: mental workload, decision making, skilled performance, HCI, work stress, –Application to Health: usability, designing training systems, usable interfaces –Examples: Event report systems Implementing incident analysis system Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 17

18. Human Factors & Applied Cognitive Psychology Applies knowledge about human strengths and limitations to design of interactive systems, equipment, and their environment to ensure their effectiveness, safety, and ease of use Perception, attention, memory, mental models and decision making are central to human factors research and analysis Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 18

19. Human Attention Selective MechanismResource needed for information processingLimitedSharableFlexible Selective Mechanism Resource needed for information processing Limited Sharable Flexible Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 19

20. Selective Attention Ability to ignore extraneous information and focus on relevant inputs Performance typically declines as the number of sources of information increases Humans can only process information at a finite rateInformation overload contributes to errors Ability to ignore extraneous information and focus on relevant inputs Performance typically declines as the number of sources of information increases Humans can only process information at a finite rate Information overload contributes to errors Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 20

21. Information Overload Speed StressLoad Stress Speed/Accuracy Tradeoff Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 21

22. Selective Attention Four factors drive the selection of channels to attend (and the filtering of channels to ignore): Events or stimuli that are salient capture attention (this represents a bottom-up process) Salience: We tend to “sample” the world where we expect to find information, and attend to channels based on how valuable it is to look or costly to miss Expectancy and Value: Selective attention may be inhibited if it is effortful Effort: Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 22

23. Divided Attention or Time Sharing Time-sharing: –ability to perform more than one cognitive task by attending to both at once or rapidly switching back and forth between them Because cognitive resources for attention are relatively limited, time-sharing often results in a drop in performance for one or both tasks People can also “modulate” the resources given to one task or the other Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 23

24. Human Factors Design Implications Reduce the number of competing channels of information Make sources of information as distinct as possible Provide feedback Use redundant cues Work/rest scheduling Training Component 15/Unit 4a Health IT Workforce Curriculum Version 2.0/Spring 2011 24