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DESIGNING	
  A	
  USEFUL	
  AND	
  USABLE	
  
MOBILE	
  EMR	
  APPLICATION	
  	
  
THROUGH	
  A	
  PARTICIPATORY	
  	
  
DESIGN	
  METHODOLOGY:	
  
	
  A	
  CASE	
  STUDY	
  	
  
ir.	
  Robin	
  De	
  Croon,	
  dr.	
  Joris	
  Klerkx,	
  prof.	
  dr.	
  ir.	
  Erik	
  Duval	
  	
  
	
  	
  	
  	
  	
  	
  	
  http://about.me/robindecroon	
  &	
  	
  	
  	
  	
  	
  robin.decroon@cs.kuleuven.be	
  
	
  
	
  IEEE	
  International	
  Conference	
  on	
  Healthcare	
  Informatics	
  2014	
  (ICHI	
  2014)	
  
Who	
  Am	
  I?	
  
• 	
  Robin	
  De	
  Croon	
  
• 	
  Scientific	
  Researcher	
  
• 	
  Computer	
  Science	
  background	
  	
  
• 	
  KU	
  Leuven	
  (Belgium)	
  
• 	
  Human	
  Computer	
  Interaction	
  
•  	
  Prof.	
  dr.	
  ir.	
  Erik	
  Duval	
  
•  	
  Dr.	
  Joris	
  Klerkx	
  
• 	
  datavislab	
  	
  
•  http://datavislab.org	
  
Saturday	
  21	
  February	
  15	
   2	
  
Secure	
  &	
  Usable	
  medical	
  	
  
applications	
  in	
  the	
  cloud	
  (MAPC)	
  
• 	
  IWT	
  R&D	
  company	
  project	
  
	
  è	
  “How	
  can	
  a	
  mobile	
  device	
  help	
  general	
  
practioners,	
  using	
  context	
  and	
  mobile	
  
affordances,	
  to	
  maintain	
  an	
  electronic	
  patient	
  
file	
  on	
  a	
  house	
  visit?	
  
Saturday	
  21	
  February	
  15	
   3	
  
Secure	
  &	
  Usable	
  medical	
  	
  
applications	
  in	
  the	
  cloud	
  (MAPC)	
  
• 	
  IWT	
  R&D	
  company	
  project	
  à	
  case	
  study	
  
	
  è	
  “How	
  can	
  a	
  mobile	
  device	
  help	
  general	
  
practioners,	
  using	
  context	
  and	
  mobile	
  
affordances,	
  to	
  maintain	
  an	
  electronic	
  patient	
  
file	
  on	
  a	
  house	
  visit?	
  
Saturday	
  21	
  February	
  15	
   4	
  
target	
  user	
  
Target	
  Audience	
  
Saturday	
  21	
  February	
  15	
   5	
  
• General	
  Practitioners	
  in	
  Flanders	
  (Belgium)	
  
Independent	
  of:	
  
• 	
  Experience	
  &	
  age	
  
• 	
  Individual	
  or	
  group	
  practice	
  
• 	
  ICT-­‐knowledge	
  
• 	
  Current	
  medical	
  software	
  
http://marketingyoucanuse.com/wp-­‐content/uploads/2010/12/HittingTarget.jpg	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   6	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   7	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Related	
  work	
  (i)	
  
• 	
  Which	
  information	
  does	
  a	
  general	
  practitioner	
  
need?	
  
•  Abd	
  Ghani,	
  M.	
  K.	
  (2011).	
  The	
  design	
  of	
  flexible	
  Pervasive	
  Electronic	
  Health	
  Record	
  (PEHR).	
  In	
  2011	
  IEEE	
  Colloquium	
  on	
  Humanities,	
  
Science	
  and	
  Engineering	
  (pp.	
  249–254).	
  IEEE.	
  doi:10.1109/CHUSER.2011.6163727	
  
•  Plancke,	
  L.	
  (2013).	
  Het	
  thuisdossier	
  voor	
  de	
  wachtarts	
  :	
  stand	
  van	
  zaken.	
  Universiteit	
  Gent.	
  Retrieved	
  from	
  http://lib.ugent.be/fulltxt/
RUG01/002/002/163/RUG01-­‐002002163_2013_0001_AC.pdf	
  
• 	
  Mobile	
  applications	
  in	
  the	
  medical	
  world	
  
•  Fischer,	
  S.	
   (2002).	
   Handheld	
  Computing	
   in	
   Medicine.	
  Journal	
   of	
   the	
  American	
   Medical	
   Informatics	
  Association,	
   10(2),	
   139–149.	
   doi:
10.1197/jamia.M1180	
  
•  Ebell,	
   M.	
   H.,	
  Gaspar,	
   D.	
   L.,	
   &	
   Khurana,	
   S.	
   (1997).	
   Family	
   physicians’	
   preferences	
   for	
   computerized	
   decision-­‐support	
   hardware	
   and	
  
software.	
  The	
  Journal	
  of	
  Family	
  Practice,	
  45(2),	
  137–141.	
  
•  Page,	
  T.	
  (2013).	
  Usability	
  of	
  text	
  input	
  interfaces	
  in	
  smartphones.	
  J.	
  of	
  Design	
  Research,	
  11(1),	
  39.	
  doi:10.1504/JDR.2013.054065	
  
•  Kelly,	
  J.	
  (2000).	
  Going	
  wireless.	
  Hospitals	
  &	
  Health	
  Networks	
  /	
  AHA,	
  74(11),	
  65–66,	
  68.	
  doi:10.1038/sj.bdj.2011.41	
  
•  Nyssen,	
  M.,	
  Thomeer,	
  K.,	
  &	
  Buyl,	
  R.	
  (2010).	
  Generating	
  and	
  transmitting	
  ambulatory	
  electronic	
  medical	
  prescriptions.	
  In	
  P.	
  Bamidis	
  &	
  N.	
  
Pallikarakis	
  (Eds.),	
  XII	
  Mediterranean	
  Conference	
  on	
  Medical	
  and	
  Biological	
  Engineering	
  and	
  Computing	
  2010	
  (pp.	
  890–892).	
  Springer	
  
Berlin	
  Heidelberg.	
  doi:10.1007/978-­‐3-­‐642-­‐13039-­‐7_225	
  
•  Chen,	
  Y.,	
  &	
  Atwood,	
  M.	
  E.	
  (2010).	
  Challenges	
  of	
  Mobile	
  Clinical	
  System	
  Design:	
  What	
  do	
  Nurses	
  Think?	
  In	
  2010	
  43rd	
  Hawaii	
  International	
  
Conference	
  on	
  System	
  Sciences	
  (pp.	
  1–9).	
  IEEE.	
  doi:10.1109/HICSS.2010.99	
  
•  Grossman,	
  J.	
   M.,	
  Gerland,	
  A.,	
   Reed,	
   M.	
  C.,	
   &	
   Fahlman,	
  C.	
   (2007).	
   Physicians’	
   experiences	
   using	
   commercial	
   e-­‐prescribing	
   systems.	
  
Health	
  Affairs	
  (Project	
  Hope),	
  26(3),	
  w393–404.	
  doi:10.1377/hlthaff.26.3.w393	
  
Saturday	
  21	
  February	
  15	
   8	
  
Related	
  work	
  (ii)	
  
• 	
  Usability	
  problems	
  with	
  medical	
  software	
  
•  Grossman,	
  J.	
  M.,	
  Gerland,	
  A.,	
  Reed,	
  M.	
  C.,	
  &	
  Fahlman,	
  C.	
  (2007).	
  Physicians’	
  experiences	
  using	
  commercial	
  e-­‐
prescribing	
  systems.	
  Health	
  Affairs	
  (Project	
  Hope),	
  26(3),	
  w393–404.	
  doi:10.1377/hlthaff.26.3.w393	
  
•  Schumacher,	
  R.	
  M.,	
  Berkowitz,	
  L.,	
  Abramson,	
  P.,	
  &	
  Liebovitz,	
  D.	
  (2010).	
  Electronic	
  Health	
  Records:	
  Physician’s	
  
Perspective	
  on	
  Usability.	
  Proceedings	
  of	
  the	
  Human	
  Factors	
  and	
  Ergonomics	
  Society	
  Annual	
  Meeting,	
  54(12),	
  
816–820.	
  doi:10.1177/154193121005401202	
  
•  Van	
  der	
  Sijs,	
  H.,	
  Aarts,	
  J.,	
  Vulto,	
  A.,	
  &	
  Berg,	
  M.	
  (2006).	
  Overriding	
  of	
  drug	
  safety	
  alerts	
  in	
  computerized	
  physician	
  
order	
   entry.	
   Journal	
   of	
   the	
   American	
   Medical	
   Informatics	
   Association	
   :	
   JAMIA,	
   13(2),	
   138–47.	
   doi:10.1197/
jamia.M1809	
  
•  Williams,	
  W.	
  G.,	
  &	
  Morgan,	
  J.	
  M.	
  (1995).	
  The	
  clinician-­‐information	
  interface.	
  Medinfo.	
  MEDINFO,	
  8	
  Pt	
  1,	
  801–5.	
  
Retrieved	
  from	
  http://www.ncbi.nlm.nih.gov/pubmed/8591334	
  
•  Devine,	
  E.	
  B.,	
  Hollingworth,	
  W.,	
  Hansen,	
  R.	
  N.,	
  Lawless,	
  N.	
  M.,	
  Wilson-­‐Norton,	
  J.	
  L.,	
  Martin,	
  D.	
  P.,	
  …	
  Sullivan,	
  S.	
  D.	
  
(2010).	
   Electronic	
   prescribing	
   at	
   the	
   point	
   of	
   care:	
   a	
   time-­‐motion	
   study	
   in	
   the	
   primary	
   care	
   setting.	
   Health	
  
Services	
  Research,	
  45(1),	
  152–71.	
  doi:10.1111/j.1475-­‐6773.2009.01063.x	
  
•  Han,	
   S.,	
   Harkke,	
   V.,	
   Mustonen,	
   P.,	
   Seppanen,	
   M.,	
   &	
   Kallio,	
   M.	
   (2004).	
   Mobilizing	
   Medical	
   Information	
   and	
  
Knowledge:	
  Some	
  Insights	
  from	
  a	
  Survey.	
  Retrieved	
  from	
  http://aisel.aisnet.org/ecis2004/69/	
  
Saturday	
  21	
  February	
  15	
   9	
  
Related	
  work	
  (iii)	
  
• 	
  Participatory	
  design	
  in	
  the	
  medical	
  domain	
  
•  Tang,	
  K.,	
  Hirano,	
  S.,	
  Cheng,	
  K.,	
  &	
  Hayes,	
  G.	
  (2012).	
  Balancing	
  Caregiver	
  and	
  Clinician	
  Needs	
  in	
  a	
  Mobile	
  
Health	
   Informatics	
  Tool	
   for	
   Preterm	
   Infants.	
   In	
   Proceedings	
   of	
   the	
   6th	
   International	
   Conference	
   on	
  
Pervasive	
   Computing	
   Technologies	
   for	
   Healthcare	
   (pp.	
   1–8).	
   IEEE.	
   doi:10.4108/icst.pervasivehealth.
2012.248716	
  
•  Hwang,	
  A.,	
  Truong,	
   K.,	
   &	
   Mihailidis,	
  A.	
   (2012).	
  Using	
   participatory	
   design	
   to	
   determine	
   the	
   needs	
   of	
  
informal	
  caregivers	
  for	
  smart	
  home	
  user	
  interfaces.	
  In	
  Proceedings	
  of	
  the	
  6th	
  International	
  Conference	
  
on	
   Pervasive	
   Computing	
   Technologies	
   for	
   Healthcare	
   (pp.	
   41–48).	
   IEEE.	
   doi:10.4108/
icst.pervasivehealth.2012.248671	
  
•  Miller,	
  A.,	
  Pater,	
  J.,	
  &	
  Mynatt,	
  E.	
  (2013).	
  Design	
  Strategies	
  for	
  Youth-­‐Focused	
  Pervasive	
  Social	
  Health	
  
Games.	
  In	
  Proceedings	
  of	
  the	
  ICTs	
  for	
  improving	
  Patients	
  Rehabilitation	
  Research	
  Techniques.	
  IEEE.	
  doi:
10.4108/pervasivehealth.2013.252081	
  
• 	
  Using	
  context	
  
•  Stocky,	
  T.,	
  Faaborg,	
  A.,	
  &	
  Lieberman,	
  H.	
  (2004).	
  A	
  commonsense	
  approach	
  to	
  predictive	
  text	
  entry.	
  In	
  
Extended	
   abstracts	
   of	
   the	
   2004	
   conference	
   on	
   Human	
   factors	
   and	
   computing	
   systems	
   -­‐	
  CHI	
   ’04	
   (p.	
  
1163).	
  New	
  York,	
  New	
  York,	
  USA:	
  ACM	
  Press.	
  doi:10.1145/985921.986014	
  
•  Abowd,	
  G.	
  D.,	
  Dey,	
  A.	
  K.,	
  Brown,	
  P.	
  J.,	
  Davies,	
  N.,	
  Smith,	
  M.,	
  &	
  Steggles,	
  P.	
  (1999).	
  Towards	
  a	
  Better	
  
Understanding	
   of	
   Context	
   and	
   Context-­‐Awareness.	
   Ubiquitous	
   Computing/Handheld	
   and	
   Ubiquitous	
  
Computing	
  (pp.	
  304–307).	
  doi:10.1007/3-­‐540-­‐48157-­‐5_29	
  
Saturday	
  21	
  February	
  15	
   10	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   11	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Saturday	
  21	
  February	
  15	
   12	
  
https://www.ehealth.fgov.be/nl/registratie-­‐van-­‐de-­‐medische-­‐softwarepakketten	
  	
  
Saturday	
  21	
  February	
  15	
   13	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   14	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Initial	
  Questionnaire	
  &	
  Talks	
  
• 	
  What	
  kind	
  of	
  information	
  or	
  material	
  do	
  you	
  carry	
  with	
  
you	
  during	
  house	
  visits?	
  	
  
• 	
  Do	
  you	
  already	
  use	
  an	
  EMR	
  application	
  or,	
  if	
  not,	
  what	
  
kinds	
  of	
  patient	
  information	
  do	
  you	
  take	
  with	
  you?	
  	
  
• 	
  Which	
  data	
  is	
  entered	
  in	
  the	
  EMR	
  application	
  (after	
  the	
  
house	
  visits)?	
  	
  
• 	
  How	
  do	
  you	
  prescribe	
  medicine?	
  	
  
• 	
  Do	
  you	
  take	
  pictures	
  of	
  wounds	
  or	
  rash?	
  	
  
• 	
  What	
  kind	
  of	
  patients	
  do	
  you	
  normally	
  treat	
  during	
  a	
  
house	
  visit?	
  	
  
• 	
  …	
  
Saturday	
  21	
  February	
  15	
   15	
  
https://picasaweb.google.com/100923738088214702616/Omini3d#5456698262314545906	
  
http://goo.gl/Wxh3Gi	
  (questionnaire,	
  Dutch)	
  
Battery	
  
Saturday	
  21	
  February	
  15	
   16	
  
Weight	
  
Saturday	
  21	
  February	
  15	
   17	
  
http://www.elmospa.com/userfiles/image/Varie/forza.png	
  	
  	
  
No	
  internet	
  connection	
  
Saturday	
  21	
  February	
  15	
   18	
  
Time	
  expensive	
  
Saturday	
  21	
  February	
  15	
   19	
  
Information	
  overload	
  
Saturday	
  21	
  February	
  15	
   20	
  
http://m.c.lnkd.licdn.com/mpr/mpr/p/5/005/061/1de/3cc6bc7.jpg	
  	
  
Usability	
  
Saturday	
  21	
  February	
  15	
   21	
  
Result	
  
• 	
  Patient	
  data	
  gets	
  rarely	
  registered	
  on	
  a	
  house	
  visit	
  
• 	
  Patient	
  data	
  registered	
  afterwards	
  is	
  error	
  prone	
  
	
  	
  è	
  Solution	
  is	
  needed!	
  
Saturday	
  21	
  February	
  15	
   22	
  
http://static.squarespace.com/static/52e99ee6e4b074062a408c89/t/52eb6098e4b008799dcd8d23/1391157403129/3D%20Person%20-­‐%20Magnifing%20Glass-­‐Edited.png	
  	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   23	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Funtional	
  Requirement	
  
Research	
  Question	
  
• 	
  “How	
  can	
  a	
  mobile	
  device	
  help	
  general	
  practioners,	
  using	
  context	
  and	
  
mobile	
  affordances,	
  to	
  maintain	
  an	
  electronic	
  patient	
  file	
  on	
  a	
  house	
  
visit?	
  
• 	
  What	
  information	
  does	
  a	
  GP	
  instantly	
  needs	
  on	
  a	
  house	
  visit?	
  
• 	
  How	
  should	
  mobile	
  affordances	
  be	
  applied	
  when	
  designing	
  a	
  
mobile	
  health	
  record?	
  
	
  	
  è	
  Not	
  just	
  a	
  port	
  of	
  existing	
  applications!	
  
Saturday	
  21	
  February	
  15	
   24	
  
Timeline	
  prototypes	
  
Saturday	
  21	
  February	
  15	
   25	
  
Paper	
  
prototype	
  5	
  
Sketches	
  
Paper	
  
prototype	
  1	
  
Paper	
  
prototype	
  4	
  
Paper	
  
prototype	
  3	
  
Paper	
  
prototype	
  2	
  
Digital	
  
prototype	
  
Design	
  V1	
  
5	
  GPs	
   3	
  GPs	
   3	
  GPs	
   3	
  GPs	
  
5	
  GPs	
  
6	
  HCI	
  colleagues	
   53	
  students	
  
Some	
  Sketches	
  
Saturday	
  21	
  February	
  15	
   26	
  
Problems	
  è	
  Requirements	
  
① 	
  Not	
  optimized	
  for	
  mobile 	
  è	
  	
  	
  Use	
  mobile	
  affordances	
  
② 	
  Too	
  slow 	
  è	
  	
  	
  Show	
  timely	
  &	
  relevant	
  information	
  
③ 	
  Necessary	
  patient	
  information	
  è	
  	
  	
  Quick	
  overview	
  important	
  information	
  
④ 	
  Registering	
  data 	
  è	
  	
  	
  Efficient	
  and	
  effective	
  data	
  input	
  
⑤ 	
  Prescribing	
  medicine 	
  è	
  	
  	
  Raise	
  motivation	
  to	
  register	
  
Saturday	
  21	
  February	
  15	
   27	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   28	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Saturday	
  21	
  February	
  15	
   29	
  
Demonstration	
  
Dashboard	
  
Saturday	
  21	
  February	
  15	
   30	
  
Sá,	
  M.	
  de,	
  &	
  Carriço,	
  L.	
  (2006).	
  Low-­‐Fi	
  Prototyping	
  for	
  Mobile	
  Devices.	
  In	
  CHI	
  ’06	
  Extended	
  Abstracts:	
  Human	
  
Factors	
  in	
  Computing	
  Systems	
  (pp.	
  694–699).	
  ACM.	
  doi:10.1145/1125451.1125592	
  
Subjective	
  Input	
  
Saturday	
  21	
  February	
  15	
   31	
  
Stocky,	
  T.,	
  Faaborg,	
  A.,	
  &	
  Lieberman,	
  H.	
  (2004).	
  A	
  commonsense	
  approach	
  to	
  predictive	
  text	
  entry.	
  In	
  Extended	
  
abstracts	
  of	
  the	
  2004	
  conference	
  on	
  Human	
  factors	
  and	
  computing	
  systems	
  -­‐	
  CHI	
  ’04	
  (p.	
  1163).	
  New	
  York,	
  New	
  York,	
  
USA:	
  ACM	
  Press.	
  doi:10.1145/985921.986014	
  
Objective	
  Input	
  
Saturday	
  21	
  February	
  15	
   32	
  
Weibel,	
  N.,	
  Emmenegger,	
  C.,	
  Lyons,	
  J.,	
  Dixit,	
  R.,	
  Hill,	
  L.,	
  &	
  Hollan,	
  J.	
  (2013).	
  Interpreter-­‐Mediated	
  Physician-­‐Patient	
  
Communication:	
  Opportunities	
  for	
  Multimodal	
  Healthcare	
  Interfaces.	
  In	
  Proceedings	
  of	
  the	
  ICTs	
  for	
  improving	
  
Patients	
  Rehabilitation	
  Research	
  Techniques.	
  IEEE.	
  doi:10.4108/icst.pervasivehealth.2013.252026	
  
Messages	
  
Saturday	
  21	
  February	
  15	
   33	
  
Problems	
  è	
  Requirements	
  
① 	
  Not	
  optimized	
  for	
  mobile 	
  è	
  	
  	
  Use	
  mobile	
  affordances	
  
② 	
  Too	
  slow 	
  è	
  	
  	
  Show	
  timely	
  &	
  relevant	
  information	
  
③ 	
  Necessary	
  patient	
  information	
  è	
  	
  	
  Quick	
  overview	
  important	
  information	
  
④ 	
  Registering	
  data 	
  è	
  	
  	
  Efficient	
  and	
  effective	
  data	
  input	
  
⑤ 	
  Prescribing	
  medicine 	
  è	
  	
  	
  Raise	
  motivation	
  to	
  register	
  
Saturday	
  21	
  February	
  15	
   34	
  
Saturday	
  21	
  February	
  15	
   35	
  
Mobile	
  Affordances	
  
Saturday	
  21	
  February	
  15	
   36	
  
Medical	
  Affordances	
  
Problems	
  è	
  Requirements	
  
① 	
  Not	
  optimized	
  for	
  mobile 	
  è	
  	
  	
  Use	
  mobile	
  affordances	
  
② 	
  Too	
  slow 	
  è	
  	
  	
  Show	
  timely	
  &	
  relevant	
  information	
  
③ 	
  Necessary	
  patient	
  information	
  è	
  	
  	
  Quick	
  overview	
  important	
  information	
  
④ 	
  Registering	
  data 	
  è	
  	
  	
  Efficient	
  and	
  effective	
  data	
  input	
  
⑤ 	
  Prescribing	
  medicine 	
  è	
  	
  	
  Raise	
  motivation	
  to	
  register	
  
Saturday	
  21	
  February	
  15	
   37	
  
GPS	
  to	
  patient	
  &	
  open	
  right	
  file	
  
Saturday	
  21	
  February	
  15	
   38	
  
Workflow	
  
• 	
  Information	
  
• 	
  Messages	
  
• 	
  SOAP	
  
subjective	
  à	
  objective	
  à	
  assessment	
  à	
  planning	
  
• Medication	
  
Saturday	
  21	
  February	
  15	
   39	
  
Robin	
  De	
  Croon	
  
Patient	
  records	
  
Saturday	
  21	
  February	
  15	
   40	
  
Filter	
  messages	
  
Saturday	
  21	
  February	
  15	
   41	
  
Camera	
  &	
  calendar	
  &	
  search	
  
Saturday	
  21	
  February	
  15	
   42	
  
Problems	
  è	
  Requirements	
  
① 	
  Not	
  optimized	
  for	
  mobile 	
  è	
  	
  	
  Use	
  mobile	
  affordances	
  
② 	
  Too	
  slow 	
  è	
  	
  	
  Show	
  timely	
  &	
  relevant	
  information	
  
③ 	
  Necessary	
  patient	
  information	
  è	
  	
  	
  Quick	
  overview	
  important	
  information	
  
④ 	
  Registering	
  data 	
  è	
  	
  	
  Efficient	
  and	
  effective	
  data	
  input	
  
⑤ 	
  Prescribing	
  medicine 	
  è	
  	
  	
  Raise	
  motivation	
  to	
  register	
  
Saturday	
  21	
  February	
  15	
   43	
  
Saturday	
  21	
  February	
  15	
   44	
  
Saturday	
  21	
  February	
  15	
   45	
  
Requirement	
  3	
  
quick	
  overview	
  of	
  the	
  most	
  important	
  data	
  	
  
Saturday	
  21	
  February	
  15	
   46	
  
Participatory	
  design	
  approach	
  
• 	
  WEL	
  à	
  Onderzoek	
  
• 	
  Vergelijkend	
  onderzoek	
  
	
  
Saturday	
  21	
  February	
  15	
   47	
  
Final	
  Dashboard	
  
Saturday	
  21	
  February	
  15	
   48	
  
Saturday	
  21	
  February	
  15	
   49	
  
Problems	
  è	
  Requirements	
  
① 	
  Not	
  optimized	
  for	
  mobile 	
  è	
  	
  	
  Use	
  mobile	
  affordances	
  
② 	
  Too	
  slow 	
  è	
  	
  	
  Show	
  timely	
  &	
  relevant	
  information	
  
③ 	
  Necessary	
  patient	
  information	
  è	
  	
  	
  Quick	
  overview	
  important	
  information	
  
④ 	
  Registering	
  data 	
  è	
  	
  	
  Efficient	
  and	
  effective	
  data	
  input	
  
⑤ 	
  Prescribing	
  medicine 	
  è	
  	
  	
  Raise	
  motivation	
  to	
  register	
  
Saturday	
  21	
  February	
  15	
   50	
  
Keyboard	
  uses	
  much	
  screen	
  space	
  
Saturday	
  21	
  February	
  15	
   51	
  
Speech-­‐to-­‐Text	
  
Saturday	
  21	
  February	
  15	
   52	
  
Saturday	
  21	
  February	
  15	
   53	
  
Input	
  through	
  colored	
  sliders	
  
Saturday	
  21	
  February	
  15	
   54	
  
Weibel,	
  N.,	
  Emmenegger,	
  C.,	
  Lyons,	
  J.,	
  Dixit,	
  R.,	
  Hill,	
  L.,	
  &	
  Hollan,	
  J.	
  (2013).	
  Interpreter-­‐Mediated	
  Physician-­‐Patient	
  
Communication:	
  Opportunities	
  for	
  Multimodal	
  Healthcare	
  Interfaces.	
  In	
  Proceedings	
  of	
  the	
  ICTs	
  for	
  improving	
  
Patients	
  Rehabilitation	
  Research	
  Techniques.	
  IEEE.	
  doi:10.4108/icst.pervasivehealth.2013.252026	
  
Auto	
  Complete	
  
Saturday	
  21	
  February	
  15	
   55	
  
Assessment	
  à	
  Tree	
  Structure	
  	
  
(ICPC,	
  ICD10,	
  …)	
  
Saturday	
  21	
  February	
  15	
   56	
  
Problems	
  è	
  Requirements	
  
① 	
  Not	
  optimized	
  for	
  mobile 	
  è	
  	
  	
  Use	
  mobile	
  affordances	
  
② 	
  Too	
  slow 	
  è	
  	
  	
  Show	
  timely	
  &	
  relevant	
  information	
  
③ 	
  Necessary	
  patient	
  information	
  è	
  	
  	
  Quick	
  overview	
  important	
  information	
  
④ 	
  Registering	
  data 	
  è	
  	
  	
  Efficient	
  and	
  effective	
  data	
  input	
  
⑤ 	
  Prescribing	
  medicine 	
  è	
  	
  	
  Raise	
  motivation	
  to	
  register	
  
Saturday	
  21	
  February	
  15	
   57	
  
Slow	
  law	
  adaptation	
  
Saturday	
  21	
  February	
  15	
   58	
  
Tools	
  
Saturday	
  21	
  February	
  15	
   59	
  
Pharmocovigilance	
  
Saturday	
  21	
  February	
  15	
   60	
  
http://www.amazingpregnancy.com/blog/wp-­‐content/uploads/2013/05/drug_or_alimentary_supplement_idea_of_health_and_disease.jpg	
  	
  
Methodology:	
  Participatory	
  Design	
  
1.  Initial	
  research	
  
• 	
  existing	
  research	
  papers	
  
• 	
  existing	
  electronic	
  patient	
  files	
  and	
  applications	
  
2.  Discovery	
  process	
  
• 	
  initial	
  questionnaire	
  
• 	
  initial	
  talks	
  
3.  Rapid	
  prototyping	
  
• 	
  functional	
  requirements	
  
• 	
  prototypes	
  (paper	
  &	
  digital)	
  
• 	
  usability	
  evaluation	
  
Saturday	
  21	
  February	
  15	
   61	
  
http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg	
  
Where	
  should	
  I	
  
register	
  
medication?	
  
Spinuzzi,	
  C.	
  (2005).	
  The	
  methodology	
  of	
  participatory	
  design.	
  Technical	
  Communication,	
  52(August	
  2004),	
  163–174.	
  	
  
Saturday	
  21	
  February	
  15	
   62	
  
Schulenberg,	
  S.	
  E.,	
  &	
  Melton,	
  A.	
  M.	
  a.	
  (2008).	
  The	
  Computer	
  Aversion,	
  Attitudes,	
  and	
  Familiarity	
  Index	
  (CAAFI):	
  A	
  validity	
  study.	
  Computers	
  in	
  
Human	
  Behavior,	
  24(6),	
  2620–2638.	
  doi:10.1016/j.chb.2008.03.002	
  
Computer	
  Aversion,	
  Attitudes	
  and	
  
Familiarity	
  Index	
  (CAAFI)	
  
Questionnaire	
  
System	
  Usability	
  Scale	
  (SUS)	
  
Questionnaire	
  
Saturday	
  21	
  February	
  15	
   63	
  
http://iqcontent.com/blog/files/wp/2013/05/sus.png	
  
Bangor,	
  A.,	
  Kortum,	
  P.,	
  &	
  Miller,	
  J.	
  (2009).	
  Determining	
  what	
  individual	
  SUS	
  scores	
  mean:	
  Adding	
  an	
  adjective	
  rating	
  scale.	
  Journal	
  of	
  
Usability	
  Studies,	
  4(3),	
  114–123.	
  Retrieved	
  from	
  http://66.39.39.113/upa_publications/jus/2009may/JUS_Bangor_May2009.pdf	
  
Evaluation	
  general	
  practice	
  students	
  
• 	
  During	
  general	
  practice	
  course	
  Leuven	
  
• 	
  Last	
  year	
  general	
  practice	
  
• 	
  ≈	
  120	
  hours	
  experience	
  	
  
• 	
  Presentation	
  ≈	
  30	
  minutes	
  
• 	
  Accompanied	
  with	
  questionnaire	
  
Saturday	
  21	
  February	
  15	
   64	
  
53	
  last	
  year	
  	
  
general	
  practice	
  students	
  
Gender	
   Age	
  
Saturday	
  21	
  February	
  15	
   65	
  
0	
   5	
   10	
   15	
   20	
   25	
   30	
  
53	
  
31	
  
30	
  
29	
  
28	
  
27	
  
26	
  
25	
  
24	
  
17	
  
tablet	
  
smartphone	
  
man	
  
geen	
  tablet	
  
dumbphone	
  
vrouw	
  
0	
   10	
   20	
   30	
   40	
   50	
  
Computer	
  Aversion,	
  Attitudes	
  and	
  
Familiarity	
  Index	
  (CAAFI)	
  
	
  Score	
  Students	
  
Saturday	
  21	
  February	
  15	
   66	
  
Factors Average Standard	
  Deviation
Factor	
  1	
  
(familiarity)
0.76 0.75
Factor	
  2	
  
(attitudes)
1.91 0.69
Factor	
  3	
  
(aversion)
0.68 1.1
Schulenberg,	
  S.	
  E.,	
  &	
  Melton,	
  A.	
  M.	
  a.	
  (2008).	
  The	
  Computer	
  Aversion,	
  Attitudes,	
  and	
  Familiarity	
  Index	
  (CAAFI):	
  A	
  validity	
  study.	
  Computers	
  in	
  
Human	
  Behavior,	
  24(6),	
  2620–2638.	
  doi:10.1016/j.chb.2008.03.002	
  
System	
  Usability	
  Scale	
  (SUS)	
  
Score	
  students	
  
Saturday	
  21	
  February	
  15	
   67	
  
Bangor,	
  A.,	
  Kortum,	
  P.,	
  &	
  Miller,	
  J.	
  (2009).	
  Determining	
  what	
  individual	
  SUS	
  scores	
  mean:	
  Adding	
  an	
  adjective	
  rating	
  scale.	
  Journal	
  of	
  
Usability	
  Studies,	
  4(3),	
  114–123.	
  Retrieved	
  from	
  http://66.39.39.113/upa_publications/jus/2009may/JUS_Bangor_May2009.pdf	
  
Average	
  score:	
  70	
  
Saturday	
  21	
  February	
  15	
   68	
  
Likert	
  Scores	
  students	
  
0.03	
  
0.02	
  
0.06	
  
0.12	
  
0.32	
  
0.04	
  
0.12	
  
0.2	
  
0.04	
  
0.02	
  
0.42	
  
0.22	
  
0.3	
  
0.28	
  
0.14	
  
0.12	
  
0.04	
  
0.19	
  
0.6	
  
0.44	
  
0.36	
  
0.68	
  
0.5	
  
0.7	
  
0.03	
  
0.08	
  
0.08	
  
0.04	
  
0.14	
  
0.36	
  
0.26	
  
0	
   0.1	
   0.2	
   0.3	
   0.4	
   0.5	
   0.6	
   0.7	
   0.8	
   0.9	
   1	
  
SOAP	
  -­‐	
  Planning	
  
SOAP	
  -­‐	
  evaluation	
  
SOAP	
  -­‐	
  objective	
  
SOAP	
  -­‐	
  subjective	
  
Documents	
  
Patient	
  informartion	
  
Dashboard	
  
Very	
  poor	
   Poor	
   Neutral	
   Good	
   Very	
  good	
  
Difference	
  between	
  generations	
  
• 	
  SOAP	
  note	
  system	
  <-­‐>	
  Medical	
  History	
  
De	
  Croon,	
  R.,	
  Klerkx,	
  J.,	
  Duval,	
  E.	
  (2014).	
  The	
  involvement	
  of	
  
students	
  in	
  the	
  user-­‐centered	
  design	
  process	
  of	
  a	
  mobile	
  health	
  
record:	
  a	
  case	
  study.	
  Workshop	
  on	
  Designing	
  the	
  Future	
  of	
  Mobile	
  
Healthcare	
  Support.	
  Toronto,	
  Canada,	
  23	
  September	
  2014,	
  accepted.	
  	
  
Saturday	
  21	
  February	
  15	
   69	
  
Conclusion	
  
• 	
  Smaller	
  subset	
  on	
  dashboard	
  
• 	
  Five	
  core	
  considerations	
  
• 	
  Difference	
  between	
  generations	
  
• 	
  Interface	
  under	
  active	
  development	
  
Saturday	
  21	
  February	
  15	
   70	
  
http://cdn.makeuseof.com/wp-­‐content/uploads/2012/12/3D-­‐Man-­‐Presenting-­‐Intro-­‐Image.jpg?a53b57	
  	
  
Future	
  work	
  
• 	
  Generation	
  difference	
  /	
  two	
  paradigms	
  (SOAP	
  <-­‐>	
  EBM)	
  
• 	
  Expand	
  research	
  (not	
  only	
  Belgian	
  markets)	
  
• 	
  Can	
  a	
  GP	
  inform	
  a	
  patient	
  with	
  an	
  EMD	
  more	
  efficiently?	
  
Saturday	
  21	
  February	
  15	
   71	
  
You	
  think	
  our	
  work	
  interesting? 	
  	
  
• We’re	
  expanding	
  our	
  team!	
  
	
  
	
  à	
  erik.duval@cs.kuleuven.be	
  
Saturday	
  21	
  February	
  15	
   72	
  
Thank	
  you!	
  
Saturday	
  21	
  February	
  15	
   73	
  
http://2.bp.blogspot.com/-­‐gZjNR3XVULs/T_ZOVgE-­‐5lI/AAAAAAAAAg8/6YVmd5Q064o/s1600/questions11.jpg	
  	
  
robin.decroon@cs.kuleuven.be	
  

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Designing a useful and usable mobile EMR application through a participatory design methodology: a case study

  • 1. DESIGNING  A  USEFUL  AND  USABLE   MOBILE  EMR  APPLICATION     THROUGH  A  PARTICIPATORY     DESIGN  METHODOLOGY:    A  CASE  STUDY     ir.  Robin  De  Croon,  dr.  Joris  Klerkx,  prof.  dr.  ir.  Erik  Duval                  http://about.me/robindecroon  &            robin.decroon@cs.kuleuven.be      IEEE  International  Conference  on  Healthcare  Informatics  2014  (ICHI  2014)  
  • 2. Who  Am  I?   •   Robin  De  Croon   •   Scientific  Researcher   •   Computer  Science  background     •   KU  Leuven  (Belgium)   •   Human  Computer  Interaction   •   Prof.  dr.  ir.  Erik  Duval   •   Dr.  Joris  Klerkx   •   datavislab     •  http://datavislab.org   Saturday  21  February  15   2  
  • 3. Secure  &  Usable  medical     applications  in  the  cloud  (MAPC)   •   IWT  R&D  company  project    è  “How  can  a  mobile  device  help  general   practioners,  using  context  and  mobile   affordances,  to  maintain  an  electronic  patient   file  on  a  house  visit?   Saturday  21  February  15   3  
  • 4. Secure  &  Usable  medical     applications  in  the  cloud  (MAPC)   •   IWT  R&D  company  project  à  case  study    è  “How  can  a  mobile  device  help  general   practioners,  using  context  and  mobile   affordances,  to  maintain  an  electronic  patient   file  on  a  house  visit?   Saturday  21  February  15   4  
  • 5. target  user   Target  Audience   Saturday  21  February  15   5   • General  Practitioners  in  Flanders  (Belgium)   Independent  of:   •   Experience  &  age   •   Individual  or  group  practice   •   ICT-­‐knowledge   •   Current  medical  software   http://marketingyoucanuse.com/wp-­‐content/uploads/2010/12/HittingTarget.jpg  
  • 6. Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   6   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Where  should  I   register   medication?   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 7. Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   7   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Where  should  I   register   medication?   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 8. Related  work  (i)   •   Which  information  does  a  general  practitioner   need?   •  Abd  Ghani,  M.  K.  (2011).  The  design  of  flexible  Pervasive  Electronic  Health  Record  (PEHR).  In  2011  IEEE  Colloquium  on  Humanities,   Science  and  Engineering  (pp.  249–254).  IEEE.  doi:10.1109/CHUSER.2011.6163727   •  Plancke,  L.  (2013).  Het  thuisdossier  voor  de  wachtarts  :  stand  van  zaken.  Universiteit  Gent.  Retrieved  from  http://lib.ugent.be/fulltxt/ RUG01/002/002/163/RUG01-­‐002002163_2013_0001_AC.pdf   •   Mobile  applications  in  the  medical  world   •  Fischer,  S.   (2002).   Handheld  Computing   in   Medicine.  Journal   of   the  American   Medical   Informatics  Association,   10(2),   139–149.   doi: 10.1197/jamia.M1180   •  Ebell,   M.   H.,  Gaspar,   D.   L.,   &   Khurana,   S.   (1997).   Family   physicians’   preferences   for   computerized   decision-­‐support   hardware   and   software.  The  Journal  of  Family  Practice,  45(2),  137–141.   •  Page,  T.  (2013).  Usability  of  text  input  interfaces  in  smartphones.  J.  of  Design  Research,  11(1),  39.  doi:10.1504/JDR.2013.054065   •  Kelly,  J.  (2000).  Going  wireless.  Hospitals  &  Health  Networks  /  AHA,  74(11),  65–66,  68.  doi:10.1038/sj.bdj.2011.41   •  Nyssen,  M.,  Thomeer,  K.,  &  Buyl,  R.  (2010).  Generating  and  transmitting  ambulatory  electronic  medical  prescriptions.  In  P.  Bamidis  &  N.   Pallikarakis  (Eds.),  XII  Mediterranean  Conference  on  Medical  and  Biological  Engineering  and  Computing  2010  (pp.  890–892).  Springer   Berlin  Heidelberg.  doi:10.1007/978-­‐3-­‐642-­‐13039-­‐7_225   •  Chen,  Y.,  &  Atwood,  M.  E.  (2010).  Challenges  of  Mobile  Clinical  System  Design:  What  do  Nurses  Think?  In  2010  43rd  Hawaii  International   Conference  on  System  Sciences  (pp.  1–9).  IEEE.  doi:10.1109/HICSS.2010.99   •  Grossman,  J.   M.,  Gerland,  A.,   Reed,   M.  C.,   &   Fahlman,  C.   (2007).   Physicians’   experiences   using   commercial   e-­‐prescribing   systems.   Health  Affairs  (Project  Hope),  26(3),  w393–404.  doi:10.1377/hlthaff.26.3.w393   Saturday  21  February  15   8  
  • 9. Related  work  (ii)   •   Usability  problems  with  medical  software   •  Grossman,  J.  M.,  Gerland,  A.,  Reed,  M.  C.,  &  Fahlman,  C.  (2007).  Physicians’  experiences  using  commercial  e-­‐ prescribing  systems.  Health  Affairs  (Project  Hope),  26(3),  w393–404.  doi:10.1377/hlthaff.26.3.w393   •  Schumacher,  R.  M.,  Berkowitz,  L.,  Abramson,  P.,  &  Liebovitz,  D.  (2010).  Electronic  Health  Records:  Physician’s   Perspective  on  Usability.  Proceedings  of  the  Human  Factors  and  Ergonomics  Society  Annual  Meeting,  54(12),   816–820.  doi:10.1177/154193121005401202   •  Van  der  Sijs,  H.,  Aarts,  J.,  Vulto,  A.,  &  Berg,  M.  (2006).  Overriding  of  drug  safety  alerts  in  computerized  physician   order   entry.   Journal   of   the   American   Medical   Informatics   Association   :   JAMIA,   13(2),   138–47.   doi:10.1197/ jamia.M1809   •  Williams,  W.  G.,  &  Morgan,  J.  M.  (1995).  The  clinician-­‐information  interface.  Medinfo.  MEDINFO,  8  Pt  1,  801–5.   Retrieved  from  http://www.ncbi.nlm.nih.gov/pubmed/8591334   •  Devine,  E.  B.,  Hollingworth,  W.,  Hansen,  R.  N.,  Lawless,  N.  M.,  Wilson-­‐Norton,  J.  L.,  Martin,  D.  P.,  …  Sullivan,  S.  D.   (2010).   Electronic   prescribing   at   the   point   of   care:   a   time-­‐motion   study   in   the   primary   care   setting.   Health   Services  Research,  45(1),  152–71.  doi:10.1111/j.1475-­‐6773.2009.01063.x   •  Han,   S.,   Harkke,   V.,   Mustonen,   P.,   Seppanen,   M.,   &   Kallio,   M.   (2004).   Mobilizing   Medical   Information   and   Knowledge:  Some  Insights  from  a  Survey.  Retrieved  from  http://aisel.aisnet.org/ecis2004/69/   Saturday  21  February  15   9  
  • 10. Related  work  (iii)   •   Participatory  design  in  the  medical  domain   •  Tang,  K.,  Hirano,  S.,  Cheng,  K.,  &  Hayes,  G.  (2012).  Balancing  Caregiver  and  Clinician  Needs  in  a  Mobile   Health   Informatics  Tool   for   Preterm   Infants.   In   Proceedings   of   the   6th   International   Conference   on   Pervasive   Computing   Technologies   for   Healthcare   (pp.   1–8).   IEEE.   doi:10.4108/icst.pervasivehealth. 2012.248716   •  Hwang,  A.,  Truong,   K.,   &   Mihailidis,  A.   (2012).  Using   participatory   design   to   determine   the   needs   of   informal  caregivers  for  smart  home  user  interfaces.  In  Proceedings  of  the  6th  International  Conference   on   Pervasive   Computing   Technologies   for   Healthcare   (pp.   41–48).   IEEE.   doi:10.4108/ icst.pervasivehealth.2012.248671   •  Miller,  A.,  Pater,  J.,  &  Mynatt,  E.  (2013).  Design  Strategies  for  Youth-­‐Focused  Pervasive  Social  Health   Games.  In  Proceedings  of  the  ICTs  for  improving  Patients  Rehabilitation  Research  Techniques.  IEEE.  doi: 10.4108/pervasivehealth.2013.252081   •   Using  context   •  Stocky,  T.,  Faaborg,  A.,  &  Lieberman,  H.  (2004).  A  commonsense  approach  to  predictive  text  entry.  In   Extended   abstracts   of   the   2004   conference   on   Human   factors   and   computing   systems   -­‐  CHI   ’04   (p.   1163).  New  York,  New  York,  USA:  ACM  Press.  doi:10.1145/985921.986014   •  Abowd,  G.  D.,  Dey,  A.  K.,  Brown,  P.  J.,  Davies,  N.,  Smith,  M.,  &  Steggles,  P.  (1999).  Towards  a  Better   Understanding   of   Context   and   Context-­‐Awareness.   Ubiquitous   Computing/Handheld   and   Ubiquitous   Computing  (pp.  304–307).  doi:10.1007/3-­‐540-­‐48157-­‐5_29   Saturday  21  February  15   10  
  • 11. Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   11   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Where  should  I   register   medication?   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 12. Saturday  21  February  15   12   https://www.ehealth.fgov.be/nl/registratie-­‐van-­‐de-­‐medische-­‐softwarepakketten    
  • 13. Saturday  21  February  15   13  
  • 14. Where  should  I   register   medication?   Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   14   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 15. Initial  Questionnaire  &  Talks   •   What  kind  of  information  or  material  do  you  carry  with   you  during  house  visits?     •   Do  you  already  use  an  EMR  application  or,  if  not,  what   kinds  of  patient  information  do  you  take  with  you?     •   Which  data  is  entered  in  the  EMR  application  (after  the   house  visits)?     •   How  do  you  prescribe  medicine?     •   Do  you  take  pictures  of  wounds  or  rash?     •   What  kind  of  patients  do  you  normally  treat  during  a   house  visit?     •   …   Saturday  21  February  15   15   https://picasaweb.google.com/100923738088214702616/Omini3d#5456698262314545906   http://goo.gl/Wxh3Gi  (questionnaire,  Dutch)  
  • 16. Battery   Saturday  21  February  15   16  
  • 17. Weight   Saturday  21  February  15   17   http://www.elmospa.com/userfiles/image/Varie/forza.png      
  • 18. No  internet  connection   Saturday  21  February  15   18  
  • 19. Time  expensive   Saturday  21  February  15   19  
  • 20. Information  overload   Saturday  21  February  15   20   http://m.c.lnkd.licdn.com/mpr/mpr/p/5/005/061/1de/3cc6bc7.jpg    
  • 21. Usability   Saturday  21  February  15   21  
  • 22. Result   •   Patient  data  gets  rarely  registered  on  a  house  visit   •   Patient  data  registered  afterwards  is  error  prone      è  Solution  is  needed!   Saturday  21  February  15   22   http://static.squarespace.com/static/52e99ee6e4b074062a408c89/t/52eb6098e4b008799dcd8d23/1391157403129/3D%20Person%20-­‐%20Magnifing%20Glass-­‐Edited.png    
  • 23. Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   23   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Where  should  I   register   medication?   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 24. Funtional  Requirement   Research  Question   •   “How  can  a  mobile  device  help  general  practioners,  using  context  and   mobile  affordances,  to  maintain  an  electronic  patient  file  on  a  house   visit?   •   What  information  does  a  GP  instantly  needs  on  a  house  visit?   •   How  should  mobile  affordances  be  applied  when  designing  a   mobile  health  record?      è  Not  just  a  port  of  existing  applications!   Saturday  21  February  15   24  
  • 25. Timeline  prototypes   Saturday  21  February  15   25   Paper   prototype  5   Sketches   Paper   prototype  1   Paper   prototype  4   Paper   prototype  3   Paper   prototype  2   Digital   prototype   Design  V1   5  GPs   3  GPs   3  GPs   3  GPs   5  GPs   6  HCI  colleagues   53  students  
  • 26. Some  Sketches   Saturday  21  February  15   26  
  • 27. Problems  è  Requirements   ①   Not  optimized  for  mobile  è      Use  mobile  affordances   ②   Too  slow  è      Show  timely  &  relevant  information   ③   Necessary  patient  information  è      Quick  overview  important  information   ④   Registering  data  è      Efficient  and  effective  data  input   ⑤   Prescribing  medicine  è      Raise  motivation  to  register   Saturday  21  February  15   27  
  • 28. Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   28   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Where  should  I   register   medication?   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 29. Saturday  21  February  15   29   Demonstration  
  • 30. Dashboard   Saturday  21  February  15   30   Sá,  M.  de,  &  Carriço,  L.  (2006).  Low-­‐Fi  Prototyping  for  Mobile  Devices.  In  CHI  ’06  Extended  Abstracts:  Human   Factors  in  Computing  Systems  (pp.  694–699).  ACM.  doi:10.1145/1125451.1125592  
  • 31. Subjective  Input   Saturday  21  February  15   31   Stocky,  T.,  Faaborg,  A.,  &  Lieberman,  H.  (2004).  A  commonsense  approach  to  predictive  text  entry.  In  Extended   abstracts  of  the  2004  conference  on  Human  factors  and  computing  systems  -­‐  CHI  ’04  (p.  1163).  New  York,  New  York,   USA:  ACM  Press.  doi:10.1145/985921.986014  
  • 32. Objective  Input   Saturday  21  February  15   32   Weibel,  N.,  Emmenegger,  C.,  Lyons,  J.,  Dixit,  R.,  Hill,  L.,  &  Hollan,  J.  (2013).  Interpreter-­‐Mediated  Physician-­‐Patient   Communication:  Opportunities  for  Multimodal  Healthcare  Interfaces.  In  Proceedings  of  the  ICTs  for  improving   Patients  Rehabilitation  Research  Techniques.  IEEE.  doi:10.4108/icst.pervasivehealth.2013.252026  
  • 33. Messages   Saturday  21  February  15   33  
  • 34. Problems  è  Requirements   ①   Not  optimized  for  mobile  è      Use  mobile  affordances   ②   Too  slow  è      Show  timely  &  relevant  information   ③   Necessary  patient  information  è      Quick  overview  important  information   ④   Registering  data  è      Efficient  and  effective  data  input   ⑤   Prescribing  medicine  è      Raise  motivation  to  register   Saturday  21  February  15   34  
  • 35. Saturday  21  February  15   35   Mobile  Affordances  
  • 36. Saturday  21  February  15   36   Medical  Affordances  
  • 37. Problems  è  Requirements   ①   Not  optimized  for  mobile  è      Use  mobile  affordances   ②   Too  slow  è      Show  timely  &  relevant  information   ③   Necessary  patient  information  è      Quick  overview  important  information   ④   Registering  data  è      Efficient  and  effective  data  input   ⑤   Prescribing  medicine  è      Raise  motivation  to  register   Saturday  21  February  15   37  
  • 38. GPS  to  patient  &  open  right  file   Saturday  21  February  15   38  
  • 39. Workflow   •   Information   •   Messages   •   SOAP   subjective  à  objective  à  assessment  à  planning   • Medication   Saturday  21  February  15   39   Robin  De  Croon  
  • 40. Patient  records   Saturday  21  February  15   40  
  • 41. Filter  messages   Saturday  21  February  15   41  
  • 42. Camera  &  calendar  &  search   Saturday  21  February  15   42  
  • 43. Problems  è  Requirements   ①   Not  optimized  for  mobile  è      Use  mobile  affordances   ②   Too  slow  è      Show  timely  &  relevant  information   ③   Necessary  patient  information  è      Quick  overview  important  information   ④   Registering  data  è      Efficient  and  effective  data  input   ⑤   Prescribing  medicine  è      Raise  motivation  to  register   Saturday  21  February  15   43  
  • 44. Saturday  21  February  15   44  
  • 45. Saturday  21  February  15   45  
  • 46. Requirement  3   quick  overview  of  the  most  important  data     Saturday  21  February  15   46  
  • 47. Participatory  design  approach   •   WEL  à  Onderzoek   •   Vergelijkend  onderzoek     Saturday  21  February  15   47  
  • 48. Final  Dashboard   Saturday  21  February  15   48  
  • 49. Saturday  21  February  15   49  
  • 50. Problems  è  Requirements   ①   Not  optimized  for  mobile  è      Use  mobile  affordances   ②   Too  slow  è      Show  timely  &  relevant  information   ③   Necessary  patient  information  è      Quick  overview  important  information   ④   Registering  data  è      Efficient  and  effective  data  input   ⑤   Prescribing  medicine  è      Raise  motivation  to  register   Saturday  21  February  15   50  
  • 51. Keyboard  uses  much  screen  space   Saturday  21  February  15   51  
  • 52. Speech-­‐to-­‐Text   Saturday  21  February  15   52  
  • 53. Saturday  21  February  15   53  
  • 54. Input  through  colored  sliders   Saturday  21  February  15   54   Weibel,  N.,  Emmenegger,  C.,  Lyons,  J.,  Dixit,  R.,  Hill,  L.,  &  Hollan,  J.  (2013).  Interpreter-­‐Mediated  Physician-­‐Patient   Communication:  Opportunities  for  Multimodal  Healthcare  Interfaces.  In  Proceedings  of  the  ICTs  for  improving   Patients  Rehabilitation  Research  Techniques.  IEEE.  doi:10.4108/icst.pervasivehealth.2013.252026  
  • 55. Auto  Complete   Saturday  21  February  15   55  
  • 56. Assessment  à  Tree  Structure     (ICPC,  ICD10,  …)   Saturday  21  February  15   56  
  • 57. Problems  è  Requirements   ①   Not  optimized  for  mobile  è      Use  mobile  affordances   ②   Too  slow  è      Show  timely  &  relevant  information   ③   Necessary  patient  information  è      Quick  overview  important  information   ④   Registering  data  è      Efficient  and  effective  data  input   ⑤   Prescribing  medicine  è      Raise  motivation  to  register   Saturday  21  February  15   57  
  • 58. Slow  law  adaptation   Saturday  21  February  15   58  
  • 59. Tools   Saturday  21  February  15   59  
  • 60. Pharmocovigilance   Saturday  21  February  15   60   http://www.amazingpregnancy.com/blog/wp-­‐content/uploads/2013/05/drug_or_alimentary_supplement_idea_of_health_and_disease.jpg    
  • 61. Methodology:  Participatory  Design   1.  Initial  research   •   existing  research  papers   •   existing  electronic  patient  files  and  applications   2.  Discovery  process   •   initial  questionnaire   •   initial  talks   3.  Rapid  prototyping   •   functional  requirements   •   prototypes  (paper  &  digital)   •   usability  evaluation   Saturday  21  February  15   61   http://farm8.staticflickr.com/7221/7351141086_85640e3c06.jpg   Where  should  I   register   medication?   Spinuzzi,  C.  (2005).  The  methodology  of  participatory  design.  Technical  Communication,  52(August  2004),  163–174.    
  • 62. Saturday  21  February  15   62   Schulenberg,  S.  E.,  &  Melton,  A.  M.  a.  (2008).  The  Computer  Aversion,  Attitudes,  and  Familiarity  Index  (CAAFI):  A  validity  study.  Computers  in   Human  Behavior,  24(6),  2620–2638.  doi:10.1016/j.chb.2008.03.002   Computer  Aversion,  Attitudes  and   Familiarity  Index  (CAAFI)   Questionnaire  
  • 63. System  Usability  Scale  (SUS)   Questionnaire   Saturday  21  February  15   63   http://iqcontent.com/blog/files/wp/2013/05/sus.png   Bangor,  A.,  Kortum,  P.,  &  Miller,  J.  (2009).  Determining  what  individual  SUS  scores  mean:  Adding  an  adjective  rating  scale.  Journal  of   Usability  Studies,  4(3),  114–123.  Retrieved  from  http://66.39.39.113/upa_publications/jus/2009may/JUS_Bangor_May2009.pdf  
  • 64. Evaluation  general  practice  students   •   During  general  practice  course  Leuven   •   Last  year  general  practice   •   ≈  120  hours  experience     •   Presentation  ≈  30  minutes   •   Accompanied  with  questionnaire   Saturday  21  February  15   64  
  • 65. 53  last  year     general  practice  students   Gender   Age   Saturday  21  February  15   65   0   5   10   15   20   25   30   53   31   30   29   28   27   26   25   24   17   tablet   smartphone   man   geen  tablet   dumbphone   vrouw   0   10   20   30   40   50  
  • 66. Computer  Aversion,  Attitudes  and   Familiarity  Index  (CAAFI)    Score  Students   Saturday  21  February  15   66   Factors Average Standard  Deviation Factor  1   (familiarity) 0.76 0.75 Factor  2   (attitudes) 1.91 0.69 Factor  3   (aversion) 0.68 1.1 Schulenberg,  S.  E.,  &  Melton,  A.  M.  a.  (2008).  The  Computer  Aversion,  Attitudes,  and  Familiarity  Index  (CAAFI):  A  validity  study.  Computers  in   Human  Behavior,  24(6),  2620–2638.  doi:10.1016/j.chb.2008.03.002  
  • 67. System  Usability  Scale  (SUS)   Score  students   Saturday  21  February  15   67   Bangor,  A.,  Kortum,  P.,  &  Miller,  J.  (2009).  Determining  what  individual  SUS  scores  mean:  Adding  an  adjective  rating  scale.  Journal  of   Usability  Studies,  4(3),  114–123.  Retrieved  from  http://66.39.39.113/upa_publications/jus/2009may/JUS_Bangor_May2009.pdf   Average  score:  70  
  • 68. Saturday  21  February  15   68   Likert  Scores  students   0.03   0.02   0.06   0.12   0.32   0.04   0.12   0.2   0.04   0.02   0.42   0.22   0.3   0.28   0.14   0.12   0.04   0.19   0.6   0.44   0.36   0.68   0.5   0.7   0.03   0.08   0.08   0.04   0.14   0.36   0.26   0   0.1   0.2   0.3   0.4   0.5   0.6   0.7   0.8   0.9   1   SOAP  -­‐  Planning   SOAP  -­‐  evaluation   SOAP  -­‐  objective   SOAP  -­‐  subjective   Documents   Patient  informartion   Dashboard   Very  poor   Poor   Neutral   Good   Very  good  
  • 69. Difference  between  generations   •   SOAP  note  system  <-­‐>  Medical  History   De  Croon,  R.,  Klerkx,  J.,  Duval,  E.  (2014).  The  involvement  of   students  in  the  user-­‐centered  design  process  of  a  mobile  health   record:  a  case  study.  Workshop  on  Designing  the  Future  of  Mobile   Healthcare  Support.  Toronto,  Canada,  23  September  2014,  accepted.     Saturday  21  February  15   69  
  • 70. Conclusion   •   Smaller  subset  on  dashboard   •   Five  core  considerations   •   Difference  between  generations   •   Interface  under  active  development   Saturday  21  February  15   70   http://cdn.makeuseof.com/wp-­‐content/uploads/2012/12/3D-­‐Man-­‐Presenting-­‐Intro-­‐Image.jpg?a53b57    
  • 71. Future  work   •   Generation  difference  /  two  paradigms  (SOAP  <-­‐>  EBM)   •   Expand  research  (not  only  Belgian  markets)   •   Can  a  GP  inform  a  patient  with  an  EMD  more  efficiently?   Saturday  21  February  15   71  
  • 72. You  think  our  work  interesting?     • We’re  expanding  our  team!      à  erik.duval@cs.kuleuven.be   Saturday  21  February  15   72  
  • 73. Thank  you!   Saturday  21  February  15   73   http://2.bp.blogspot.com/-­‐gZjNR3XVULs/T_ZOVgE-­‐5lI/AAAAAAAAAg8/6YVmd5Q064o/s1600/questions11.jpg     robin.decroon@cs.kuleuven.be