Download - 15.03.12 amia d cog webinar v1
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Exploring medical device design and use through layers of Distributed Cognition
Dominic
Furniss
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• 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
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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.
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Traditional View of Cognition
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Distributed Cognition
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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
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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
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DiCoT’s Five Models
• Information Flow Model
• Physical Model
• Artefact Model
• Social Model
• Evolutionary Model
Open Clip Art from Geralg_G 2010
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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
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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
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Basic mechanics
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Artefact
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Evolutionary
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Social
Patient
Healthcare Assistant
Nurse
Biochemist
Diabetes Specialise
Nurse
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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#
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Physical
B"
A"
1%4"
5"
6"
7"
9"10"11%14"
17%20"
21%24"
16"
15" 8"
C" D"
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Highlights from results
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Design Consideration (Micro interactions)
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Other&icons&and&informa0on&
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2&Other&icons&and&informa0on&
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1&Other&icons&and&informa0on&
Strip&no:&456474&Pa0ent:&4774848&
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&
Strip&no:&456474&Pa0ent:&4774848&
1&Other&icons&and&informa0on&
Strip&no:&456474&Pa0ent:&4774848&
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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
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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
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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?
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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)
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• 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
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• 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
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Questions
Dominic [email protected] @domfurniss
AcknowledgementsCo-authors: Paolo Masci, Paul Curzon, Astrid Mayer & Ann Blandford.Thank-you to the staff who gave their time for the study.