StructureSituation & Problem Objective & ApproachResults & Conclusion

SituationPossibilitiesResourcesICT to gain higher quality, safety and efficiency!

Problem

Objective Before developing ICT solutions: improve the understanding of healthcare working systems!

Specifying usability context analysis by domain specific models!

ApproachConcept based approachScreening of Ergonomic Standards: Usability Framework;Identifying, adopting and developing of domain specific ergonomic models and methods (MedicoErgonomics);Exemplary use in an analysis of the context of use (Case Study).

Results (1/4) Usability Frameworkenvironmenttaskequipmentuserproduct (ICT) goalseffectivnessefficiencysatisfactionContext of UseIntended outcomeOutcome of useUsability measuresUsability

Results (2/4) Model of collaborative workcoordinationcommunication[Steinheider & Legrady, 2001]Model of collaborative workshared knowledge

Results (3/4) Case Study; Context of UseRequirements to support collaborative workCoordination:better use of resources (more efficient)reduction of treatment time (reducing of unnecessary treatments)active, holistic therapy planning and controllingsupport of administrative processesCommunication:effective communication and information flowsno changes in mediumsimproved information transparencyhigh quality of used data

Results (4/4) Case Study: Tools/ FunctionsEvident process support collaborative work

CoordinationCommunicationresource planning tool procurement support and documentation tool(user-oriented) structured documentation of health biographyworkflow supporting toolstructured diagnosis and therapy documentation and codificationinterface management: harmonizing different mediums and electronic systems(user-oriented) structured documentation of health biography(user-oriented) medical encyclopediauser specific communitieslogbook

Lessons Learned, Discussion and OutlookMedicoErgonomic models are able to support the usability context analysis better understanding of the healthcare working system by structuring the requirementsFurther usability context analysis are recommended (chronic heart diseases, dementia patients, diabetes mellitus etc.).

ESCTAICs 21st Annual Meeting 2010Vrije Universiteit medical centre, Amsterdam Netherlands 06 09th October 2010

Thank you very much for your attention!

www.awb.tu-berlin.de

More Information: http://www.igi-global.com/http://www.igi-global.com/ bookstore/TitleDetails.aspx?TitleId=45949&DetailsType=AffiliateBioB. Podtschaske, M. Koch, W. Friesdorf : Medico Ergonomics A human centered approach for developing smart health care applicationsIn: M. Ziefle & C. Rcker (Eds.): Human-Centered Design of E-Health Technologies: Concepts, Methods and Applications(30. October 2010)

Additionally investigations such as usability tests and simulations for Evaluation of the efficiency of use and the satisfaction with the product are necessary.

Results (3/3) Case StudyenvironmenttaskequipmentuserContext of Useusertaskequipmentenvironment

Results (2/3) Domain specific modelsenvironmenttaskequipmentuserContext of Useusertaskequipmentenvironment

Thank you for your nice introduction welcome to my presentation!I would like to present you today how to identify ergonomic requirements of ICT in healthcare working systems.*30 Minutes 20 25 Minutes Presentation, 5 10 Minutes Questions?My presented is structured as followed:First I would like to give you an quick overview about the situation and problem.Second, Ill introduce you to our approach for the work: what was the objective and what steps did we take to achieve the goalAnd finally I would like to show you some of our results and will conclude with a short discussion and outlook!

*Situation (1 Folie): ICT als Rationalisierungsansatz im Gesundheitswesen Rationalisierung durch Informationstransparenz! When I am talking about ergonomic requirements I dont talk about the micro-ergonomic level for example is blue the right screen color like we see it in this picture but I am more interested in the working process and their support by ICT.As we all know in industrialized countries most healthcare systems struggle with the trade-off between rising demands and possibilities and the limited resources. Therefore rationalization is essential!Complex disease patterns require the integration of a large number of specialized work persons. These interprofessional teams are generating an enormous amount of data and information. One approach to gain higher quality, safety and efficiency is ICT that already worked very well in other domains over the last decade. The reason is that information transparency could help to avoid errors and to reduce redundant activities.

*Problem (1 Folie): Mangelnde Gebrauchstauglichkeit und Prozessuntersttzung der ICT-Lsungen, denn fehlendes Verstndnis ber den Nutzungskontext

The problem is that available ICT solutions for healthcare systems often lack in evident process support different studies shows that one reason for this phenomenon is a lack of understanding the working conditions, the working processes and the context of use for such ICT solutions.

*Ziel (1 Folie): Konkretisierung der Nutzungskontextanalyse durch Zusammenfhrung und Anwendung domnenspezifischer Modelle und Methoden

There are several ergonomic guidelines. They support the ergonomic product development in general but healthcare working systems are very complex and not easy to understand - thats why in our opinion these standards alone are not sufficient for developing usable ICT for healthcare working systems these standards must be specified by domain specific models and methods.The usability framework in accordance to the ISO standard 9241-11 was the starting pointWe extended this framework especially to support the usability context analysis by identifiying, adopting and developing so-called medico-ergonomic models and methods to describe and therefore better understanding of healthcare working systemsTo evaluate our models and methods we analzed the context of use with the help of our models and methods for a web-based patient record in a case study.*Ziel (1 Folie): Konkretisierung der Nutzungskontextanalyse durch Zusammenfhrung und Anwendung domnenspezifischer Modelle und Methoden

There are several ergonomic guidelines. They support the ergonomic product development in general but healthcare working systems are very complex and not easy to understand - thats why in our opinion these standards alone are not sufficient for developing usable ICT for healthcare working systems these standards must be specified by domain specific models and methods.The usability framework in accordance to the ISO standard 9241-11 was the starting pointWe extended this framework especially to support the usability context analysis by identifiying, adopting and developing so-called medico-ergonomic models and methods to describe and therefore better understanding of healthcare working systemsTo evaluate our models and methods we analzed the context of use with the help of our models and methods for a web-based patient record in a case study.*First of all I would like to introduce you the usability framework as the starting point.There is always a user of the product, here ICT for example a web-based patient record. This user wants to achieve several goals. These goals define the intended outcome.The user has to fulfill different tasks and has in most cases several equipment to support its work. The user works in certain environment which can be described in physiological way, in social way and so on.The interaction of the user in its working system defines the actual outcome of use - which means there is a dependancy between these elements.The difference between the intended and the actual outcome can be measured and answers the questions is the product effective, efficient and satisfying in this context of use!As already mentioned this context of used is here of interest - a deep understanding of the context of use allows to define process supporting requirements and help to develop process supporting ICT!Description of the user: Relevant characteristics of the users need to be described (e.g. knowledge, skill, experience, education, training, physical attributes etc.)Description of the tasks: Tasks are the activities undertaken to achieve a goal. Characteristics of tasks which may influence usability should be described (e.g. frequency and the duration of the task).Description of equipment: Relevant characteristics of the euipment need to be described (e.g. hardware, software and materials).Description of environment: Relevant characteristics of the physical and social environment need to be described

Ergebnisse (2 Folien): Ausgangspunkt sind die Normen, Ergnzung des Gestaltungsprozess um entsprechende Modelle/ Methoden (z.B. PAMS, TaPTa, Ida etc.) Ich knnten mir hier eine Visualisierung hnlich der Darstellung von Sebastian (Entwicklungsprozess) vorstellen, bei mir wre es dann der Gestaltungsprozess gem ISO Norm... obere Ebene: allgemeiner Prozess zur Nutzungskontextanalyse gem ISO Norm: The context of use encloses the elements (ISO 9241-11, 1998):user,work tasks,available work equipment (e.g., hardware, software and materials) andthe physical as well as social work environment. mittlere Ebene: Modelle zur Untersttzung einzelner ProzessschritteDescription of Users: The extended Patient-Staff-Machine-Interaction-Model Description of tasks: The adapted Medical-Task-Model and the Task-Process-Task-ModelDescription of equipment: Clinical-Information-Process-Unit-ModelDescription of environments: The model of interdisciplinary cooperation untere Ebene: Beispiele ?!...

*We are now focusing on the context of use and how to analyze and describe the context of use for healthcare working system in a sufficient way. To examine the social environment, for example, we identified and adopted the model of collaborative work. As already mentioned the work in healthcare systems is highly collaborative and interprofessional thats why this model seemed to be very helpful.According to this model, collaborative work can be improved by improving the three sub-processes communication, coordination and shared knowledge.Communication: Enables the actors to exchange data, information and knowledgeCoordination: Manages the dependencies between the actors and activities, integrates and harmonizes individual tasks with view to the superordinate objectiveShared knowledge: Enables the collaboration of actors with different professional backgrounds by using shared mental models, metaphors and analogies

Process of Communication: A frictionless exchange of data, information and knowledge between the involved work persons is often possible. In this context, intercultural factors can also play a role. This process can be supported by suitable communication-technical aids.Process of Coordination: The tasks, activities and interactions of involved participants are regulated unambiguously. All individual sub tasks are integrated and harmonized to reach the overall goal. This process can be supported by methods and instruments of project management.Process of shared knowledge: Creating a common or shared knowledge supports successful communication and coordination processes. To achieve a shared knowledge, a common understanding of the aims, work content/ work tasks and terms/ definitions is essential. To support this process, there is a considerable need for further research. Nevertheless, methods such as process visualization and haptic models can be helpful.If these sub processes are optimized ergonomically, a strong likelihood that the working system will succeed exists.

*In an examplary case study we analyzed the context of use of a web-based patient record for an abdominal surgery treatment process.Some of the results are shown on this slide: you can see here some of the identified requirements for supporting the collaborative work, these requirements can be transferred into collaborative process supporting functions*Diskussion/Ausblick (1 Folie): Was es noch zu tun gibt Case study shows that the models are able to support the usability context analysesWide variety of functionality requirements for a web-based patient record to improve the quality of the results further usability context analysesare recommended Validation through other patient groups (chronic heart diseases, dementia patients, diabetes mellitus etc.)Additionally investigations such as usability tests and simulations are necessary to evaluate the efficiency of use and the satisfaction with the productDistribution of expected process benefits of ICT-Tools to the required development costs (efficiency, quality and patient safety)

The case study shows the suitability of models to illustrate complex interrelations of patient treatment. Based on the results the requirements are defined and task-supporting functions are derived. The models afford the development of a common ground of understanding between the potential user and the developers of the product. Necessary expertise and different perspectives can be submitted in the process of product development and product evaluation. This is a crucial pre-condition for developing integrated and utilizable (software) products and therewith for developing ergonomic working systems.In order to improve the quality of the results further usability context analyses (e.g. chronic heart diseases, dementia patients, diabetes mellitus) are recommended. Additionally investigations such as usability tests and simulations are necessary to evaluate the efficiency of use and the satisfaction with the product.

**The case study illustrates various tasks that have to be supported by ICT during an abdominal surgical treatment process. With the aid of a requirement catalogue it is possible to derive detailed functions that are suitable for the task. Such a catalogue of requirements is essential in order to define and develop an utilizable ICT for healthcare working systems. Some requirements cannot be implemented easily. For example, the consideration of different demands of stakeholders is not a trivial task. Design requirements, e.g. concerning aggregation of data and information, depend on the corresponding care provider and the (sub) task.

Need for tools to support the communication, coordination and shared-knowledge processes.ICT-Tools e.g. web-based patient record have potential to support communication processes.3)Evolutionary Development of an Supporting Tool.

*Description of the user: The extended Patient-Staff-Machine-Interaction-Modelit is necessary to identify all possible users. The human-machine-system model helps to describe the interrelation between working humans and implemented resources in the working process and to derive characteristics. In the context of health care the well-known human-machine-system-model used in the industry must be extended. It is necessary to differentiate the system element human into patient on the one hand and into physician or nurse on the other hand. The patient is not only a passive working object but can also help to influence the treatment success by actively supporting the treatment task. Since outpatient care is becoming increasingly common the patients as well as the caretaker become important users of medical devices. The system element staff represents every care provider that is involved in the treatment process. Medical equipment as well as any other device that is used for the treatment belongs to the system element machine (Friesdorf, 1990; Friesdorf, Konichezky, Gross-Alltag & Schwilk, 1993; Friesdorf & Marsolek, 2009). The following interrelations are shown by the model (Friesdorf et al., 2007):The interaction between medical care provider and machines, analogous to the original human-machine model;The interaction between patient and machine, e.g. the patient is monitored or treated by the machine;The interaction between medical care provider and patient, e.g. patient interview, diagnostics, therapy.Description of the tasks: The adapted Medical-Task-Model and the Task-Process-Task-ModelA task analysis serves to give a detailed description of tasks and responsibilities necessary to fulfill the task. The description of the division of work between human and machine also plays a key role in the task analysis. Depending on the status of the patient and the aspired health status the medical care provider defines the treatment task. The quality is measured by the degree of fulfillment of the given task (effectiveness); in consideration of the used resources the degree of efficiency is obtained as a result. If the correct medical treatment is chosen, the question regarding the appropriate execution of the medical procedure arises. The ideal accomplishment process should be possible without any potential danger or waste of resources (Carayon & Friesdorf, 2006; Friesdorf & Marsolek, 2009). While in the industrial sector work tasks and processes can easily be identified, restricted and described, the tasks and processes in the medical field are characterized by a higher complexity. The universal approach of the patient-staff-machine-model does not define priority system boundaries; therefore the examination level can be varied corresponding to the investigation focus. Depending on which medical procedure is considered as a work task, a more or less distinguished picture can be detected by decomposition or aggregation of workflows. This flexible focusing on different levels is described by the Task-Process-Task-Model. The same rules are valid for all examination levels however (Marsolek & Friesdorf, 2007):Every work task, that describes What has to be done? can be hierarchically subdivided into sub tasks by the question How is it done? (zoom in).In the opposite direction, every sub task and its impact for the whole work process can be validated by the question Why is it done? (zoom out").To avoid insufficient searching for causes or developing of stand-alone solutions, it is necessary to run through both "zoom directions". At each examination level quality and efficiency of the working processes can be judged.

Description of environment: The model of interdisciplinary cooperationPhysical environments as contexts of use can be extremely different. Within hospitals physical dimensions can strongly differ, and the different basic conditions of a medical practice or private environment also vary strongly. Hence, physical conditions must be examined specifically for each context. To describe characteristics of social environments, the model of interdisciplinary cooperation (Steinheider & Legrady, 2000) is suitable in order to gain a deep understanding.Complex disease patterns require the integration of a large number of specialized work persons. For this reason, the performance occurs through highly interdisciplinary and interprofessional work processes which are executed in parallel and in series. On the one hand this specialization promises the coping with complex medical tasks. But at the same time, managing collaborative work effectively and efficiently is a significant challenge (Henke et al., 2008). The cooperation of the differently specialized experts within the medical treatment process, according to the model of interdisciplinary cooperation, depends on the quality of the following sub processes (Steinheider & Legrady, 2000):Process of Communication: A frictionless exchange of data, information and knowledge between the involved work persons is often possible. In this context, intercultural factors can also play a role. This process can be supported by suitable communication-technical aids.Process of Coordination: The tasks, activities and interactions of involved participants are regulated unambiguously. All individual sub tasks are integrated and harmonized to reach the overall goal. This process can be supported by methods and instruments of project management.Process of shared knowledge: Creating a common or shared knowledge supports successful communication and coordination processes. To achieve a shared knowledge, a common understanding of the aims, work content/ work tasks and terms/ definitions is essential. To support this process, there is a considerable need for further research. Nevertheless, methods such as process visualization and haptic models can be helpful.If these sub processes are optimized ergonomically, a strong likelihood that the working system will succeed exists.

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