Purpose: The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Methods: Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram showing the relationship of computer technology, cognition, practitioner behavior, and system failure in the area of medical infusion devices. We subsequently conducted a systematic literature review on user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and noted the usability problems found with particular methods. Next, we assigned usability problems and related methods to the levels in the Impact Flow Diagram. Results: Most study methods used to find user interface issues with infusion pumps focused on observable behavior rather than on how artifacts shape cognition and collaboration. A concerted and theorydriven application of these methods when testing infusion pumps is lacking in the literature. Detailed analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well as how the scope of analysis may be broadened to include organizational and regulatory factors. Conclusion: Research methods to uncover use problems with technology may be used in many ways, with many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology.
This white paper is presented by the Ethics Working Group of the uNLock Consortium This white paper presents findings of the Ethics Working Group, from the conceptual phase of investigation into the ethical issues of the uNLock solution, providing identity management solutions for sharing and presentation of medical COVID-19 credentials (test results) in the context of healthcare institutions. We have provided an outline of direct and indirect stakeholders for the uNLock solution and mapped values, benefits, and harms to the respective stakeholders. The resulting conceptual framework has allowed us to lay down key norms and principles of Self Sovereign Identity (SSI) in the specific context of uNLock solution. We hope that adherence to these norms and principles could serve as a groundwork for anticipatory mitigation of moral risk and hazards stemming from the implementation of uNLock solution and similar solutions. Our findings suggest that even early stage of conceptual investigation in the framework of Value Sensitive Design (VSD), reveals numerous ethical issues. The proposed implementation of the uNLock app in the healthcare context did not proceed further than prototype stage, thus our investigation was limited to the conceptual stage, and did not involve the practical implementation of VSD method involving translation of norms and values into engineering requirements. Nevertheless, our findings suggest that the implementation of VSD method in this context is a promising approach that helps to identify moral conflicts and risks at a very early stage of technological development of SSI solutions. Furthermore, we would like to stress that in the light of our findings it became painfully obvious that hasty implementation of medical credentials system without thorough ethical assessment, risks creating more ethical issues rather than addressing existing ones.
Abstract Background: With the growing shortage of nurses, labor-saving technology has become more important. In health care practice, however, the fit with innovations is not easy. The aim of this study is to analyze the development of a mobile input device for electronic medical records (MEMR), a potentially labor-saving application supported by nurses, that failed to meet the needs of nurses after development. Method: In a case study, we used an axiomatic design framework as an evaluation tool to visualize the mismatches between customer needs and the design parameters of the MEMR, and trace these mismatches back to (preliminary) decisions in the development process. We applied a mixed-method research design that consisted of analyzing of 118 external and internal files and working documents, 29 interviews and shorter inquiries, a user test, and an observation of use. By factoring and grouping the findings, we analyzed the relevant categories of mismatches. Results: The involvement of nurses during the development was extensive, but not all feedback was, or could not be, used effectively to improve the MEMR. The mismatches with the most impact were found to be: (1) suboptimal supportive technology, (2) limited functionality of the app and input device, and (3) disruption of nurses’ workflow. Most mismatches were known by the IT department when the MEMR was offered to the units as a product. Development of the MEMR came to a halt because of limited use. Conclusion: Choices for design parameters, made during the development of labor-saving technology for nurses, may conflict with the customer needs of nurses. Even though the causes of mismatches were mentioned by the IT department, the nurse managers acquired the MEMR based on the idea behind the app. The effects of the chosen design parameters should not only be compared to the customer needs, but also be assessed with nurses and nurse managers for the expected effect on the workflow.
LINK
