15.03.12 amia d cog webinar v1

Exploring medical device design and use through layers of Distributed Cognition

Dominic

Furniss

• Have a notion of ‘the medical device reaching out’

• Understand Distributed Cognition basics and its applicability to informatics

• Know about methods to facilitate its application

• Understand DiCoT-CL: a framework to evaluate how devices are coupled to layers of context

Learning Aims

The Computer Reaches Out

Grudin, J. (1990). The computer reaches out: the historical continuity of interface design. In Proceedings of the SIGCHI conference on Human factors in computing systems (pp. 261-268). ACM.

Traditional View of Cognition

Distributed Cognition

Distributed Cognition

Two key principles distinguish DCog:

1. Delimiting unit of cognitive analysis

– Not what’s just inside the brain

– Accounting for brain, body and world

2. Expanding the range of mechanisms that can be involved in cognition

– The world is not just stimuli

– The body is not just an input device

Distributed Cognition

How cognition is distributed:

1. Cognitive processes may be distributed across members of a social group

2. Cognitive processes may involve processes between internal and external (material or environmental) structure

3. Processes may be distributed through time in such a way that the products of earlier events can transform the nature of later events

DiCoT’s Five Models

• Information Flow Model

• Physical Model

• Artefact Model

• Social Model

• Evolutionary Model

Open Clip Art from Geralg_G 2010

DiCoT: From analysis to design

1. Understanding the basic mechanics of a system

2. Understanding some deeper conceptual insight

3. Considering incremental design possibilities

4. Considering revolutionary design possibilities

Method

• About 150hrs of fieldwork, over 11days and 5nights. Detailed field notes were kept

• Observations and interviews on oncology ward

• 26 episodes of blood glucose monitoring were observed, plus more general ward observations

• We also referred to the device’s manual

• DiCoT was used to guide data gathering and analysis

Basic mechanics

Artefact

Evolutionary

Social

Patient

Healthcare Assistant

Nurse

Biochemist

Diabetes Specialise

Nurse

Information Flow

1.#Go#to#the#[next]#pa; ent#

2.#Greet#pa; ent#and#get#consent#from#them#for#the#reading#

4.#Scan#pa; ent#wristband#

5.#Scan#a#vial,#retrieve#a#test#strip#from#it,#and#place#

it#in#the#glucometer##

Readings#

3.#Scan#staff#ID#

6.#Prick#pa; ent’s#finger#with#a#lance#

7.#Put#blood#on#test#strip#and#give#pa; ent#a#swab#

8.#Note#the#reading#in#pa; ent’s#notes,#tell#pa; ent,#tell#the#nurse#

if#it#is#a#high#or#low#reading#

Physical

B"

A"

1%4"

5"

6"

7"

9"10"11%14"

17%20"

21%24"

16"

15" 8"

C" D"

Highlights from results

Design Consideration (Micro interactions)

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Other&icons&and&informa0on&

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3&Other&icons&and&informa0on&

Strip&no:&456474&Pa0ent:&4774848&

2&Other&icons&and&informa0on&

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1&Other&icons&and&informa0on&

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Strip&no:&456474&Pa0ent:&4774848&

Other&icons&and&informa0on&

Strip&no:&456474&Pa0ent:&4774848&

Other&icons&and&informa0on&

3&Other&icons&and&informa0on&

Strip&no:&456474&Pa0ent:&4774848&

2&Other&icons&and&informa0on&

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1&Other&icons&and&informa0on&

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Design Consideration (Macro interactions)

• Configuring the SAT lock feature so staff can override the need for a quality control check in an emergency

• Also not knowing the patient hospital number was reported as an issue. DSN surprised as they should know 2222 or 9999 can be used as a proxy

Design Consideration (within different layers)

• Information flow: Developing ability of the device to support a ward round rather than just one reading at a time. HCA seen writing bed numbers on their hands, tissue paper, etc.

• Evolutionary: Data over months and years –new possibilities for data mining and analysis in the longer term

Design Consideration (between different layers)

• Social: Note taking feature is currently underutilised by staff. Notes are monitored by DSN, who would like more information. Possibility of two way communication between staff to encourage further use?

Take home messages

• As medical devices ‘reach out’ they can be coupled to their context in interesting ways

• DiCoT-CL helps explore these different forms of coupling, through layers of distributed cognition

• The performance of the glucometer is influenced both micro- and macro- interactions

• DiCoT-CL can encourage one to think about novel design considerations (within & between)

• Have a notion of ‘the medical device reaching out’

• Understand Distributed Cognition basics and its applicability to informatics

• Know about methods to facilitate its application

• Understand DiCoT-CL: a framework to evaluate how devices are coupled to layers of context

Learning Aims

• Furniss, D., Masci, P., Curzon, P., Mayer, A. & Blandford, A. (2015). Exploring Medical Device Design and Use Through Layers of Distributed Cognition: How a glucometer is coupled with its context. Journal of Biomedical Informatics.

• Furniss, D., Masci, P., Curzon, P., Mayer, A., & Blandford, A. (2014). 7 Themes for guiding situated ergonomic assessments of medical devices: A case study of an inpatient glucometer. Applied Ergonomics, 45(6), 1668-1677.

Main References

Questions

Dominic Furnissd.furniss@ucl.ac.uk @domfurniss

AcknowledgementsCo-authors: Paolo Masci, Paul Curzon, Astrid Mayer & Ann Blandford.Thank-you to the staff who gave their time for the study.