Ludivine Watbled

A distributed coordination platform for home care: analysis, framework and prototype

Good cooperation between health care (HC) professionals, patient, and family is indispensable during homecare as mentioned in reports and analyses from different countries. In a French National project named coordination for the quality of care (COQUAS), we aimed to address the problem of improving such cooperation with current tools and techniques. We hypothesized that, as in some other domains, a better integration of use and users in informatics systems could improve the usefulness of the cooperative tool. The first part of this paper is devoted to the cognitive analysis of the homecare process and highlights the requirements which should be met according to this analysis. We describe some specific features of asynchronous cooperation and some communication issues in the cooperation of HC workers. We then detail the analysis of the homecare process: methodology, description of the processes, cognitive activity analyses, and of the requirements which flow from this analysis. The second part of this paper proposes a framework and then describes a modular system prototype, designed to take into account these requirements, including aspects of both cooperation and interoperability. It uses a meta-description of actions and information derived from a cognitive study to build dynamically the interface settings; it respects the current trend in distributed architecture and uses XML communication of messages, manages complex coordination with a workflow and allows mobile work. The last part of the paper presents the evaluation which has been done with the implemented prototype, with actual homecare users.

Usability of production systems for discharge letters

At the end of an inpatient stay, the hospital physician produces a discharge letter intended for the General Practitioner in order to ensure the continuity of care between hospital and general practice. The French National Health Authority recommends (i) that the discharge letter should reach its addressee within 8 days and (ii) that it includes the information necessary to guarantee the quality of continued care. In order to achieve these goals, the discharge letter process is increasingly computerized. However, the usability of the technologies employed to produce the discharge letter may impair their impact; therefore it is important to evaluate the usability of those technologies to interpret their impact (or absence thereof) on performance and quality. This paper reports on the usability evaluation of two digital audio recorders. These technologies are different in terms of available features and material (wired connection vs. mobile). Three evaluation methods have been used: heuristic evaluation, user testing, and direct observation of usage in the hospital wards. Data are analyzed so as to identify usability flaws in the recorders and to highlight the consequences of these flaws on the user and on the work system. Our results show that the most important consequences are an increase in the production duration of a letter and in the risk of patient misidentification.

Prise en compte des facteurs humains pour une implémentation sûre et efficace des nouvelles technologies de l’information en santé

This paper describes at a national institutional level the installation of new centers for innovative technologies in charge of designing and applying proper evaluation methodologies to health IT applications. It addresses the problem of the necessary evaluation of the usability dimensions of innovative Health Technology applications to ensure their safe transfer to the actual care providing environment. In Health IT, usability is closely intertwined with safety as a number of human errors compromising patient safety occur because of a product’s design and usability flaws. The last part discusses initiatives health authorities and administrations have undertaken to integrate usability engineering methods across the design and development lifecycle of health IT applications.