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15.03.12 amia d cog webinar v1

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Exploring medical device design and use through layers of Distributed Cognition

This presentation accompanies work presented in a paper by the same name: http://authors.elsevier.com/a/1QeZu5SMDQIJeU

Published in: Technology
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15.03.12 amia d cog webinar v1

  1. 1. Exploring medical device design and use through layers of Distributed Cognition Dominic Furniss
  2. 2. • 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
  3. 3. 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.
  4. 4. Traditional View of Cognition
  5. 5. Distributed Cognition
  6. 6. 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
  7. 7. 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
  8. 8. DiCoT’s Five Models • Information Flow Model • Physical Model • Artefact Model • Social Model • Evolutionary Model Open Clip Art from Geralg_G 2010
  9. 9. 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
  10. 10. 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
  11. 11. Basic mechanics
  12. 12. Artefact
  13. 13. Evolutionary
  14. 14. Social Patient Healthcare Assistant Nurse Biochemist Diabetes Specialise Nurse
  15. 15. 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#
  16. 16. Physical B" A" 1%4" 5" 6" 7" 9"10"11%14" 17%20" 21%24" 16" 15" 8" C" D"
  17. 17. Highlights from results
  18. 18. Design Consideration (Micro interactions) 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& 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&
  19. 19. 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
  20. 20. 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
  21. 21. 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?
  22. 22. 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)
  23. 23. • 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
  24. 24. • 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
  25. 25. Questions Dominic Furniss d.furniss@ucl.ac.uk @domfurniss Acknowledgements Co-authors: Paolo Masci, Paul Curzon, Astrid Mayer & Ann Blandford. Thank-you to the staff who gave their time for the study.

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