Richard Harte

Human Centred Design Considerations for Connected Health Devices for the Older Adult

Connected health devices are generally designed for unsupervised use, by non-healthcare professionals, facilitating independent control of the individuals own healthcare. Older adults are major users of such devices and are a population significantly increasing in size. This group presents challenges due to the wide spectrum of capabilities and attitudes towards technology. The fit between capabilities of the user and demands of the device can be optimised in a process called Human Centred Design. Here we review examples of some connected health devices chosen by random selection, assess older adult known capabilities and attitudes and finally make analytical recommendations for design approaches and design specifications.

A human-centered design methodology to enhance the usability, human factors, and user experience of connected health systems: a three-phase methodology

Background Design processes such as human-centered design, which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of human-centered design can often present a challenge when design teams are faced with the necessary, rapid, product development life cycles associated with the competitive connected health industry. Objective We wanted to derive a structured methodology that followed the principles of human-centered design that would allow designers and developers to ensure that the needs of the user are taken into account throughout the design process, while maintaining a rapid pace of development. In this paper, we present the methodology and its rationale before outlining how it was applied to assess and enhance the usability, human factors, and user experience of a connected health system known as the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system, a system designed to continuously assess fall risk by measuring gait and balance parameters associated with fall risk. Methods We derived a three-phase methodology. In Phase 1 we emphasized the construction of a use case document. This document can be used to detail the context of use of the system by utilizing storyboarding, paper prototypes, and mock-ups in conjunction with user interviews to gather insightful user feedback on different proposed concepts. In Phase 2 we emphasized the use of expert usability inspections such as heuristic evaluations and cognitive walkthroughs with small multidisciplinary groups to review the prototypes born out of the Phase 1 feedback. Finally, in Phase 3 we emphasized classical user testing with target end users, using various metrics to measure the user experience and improve the final prototypes. Results We report a successful implementation of the methodology for the design and development of a system for detecting and predicting falls in older adults. We describe in detail what testing and evaluation activities we carried out to effectively test the system and overcome usability and human factors problems. Conclusions We feel this methodology can be applied to a wide variety of connected health devices and systems. We consider this a methodology that can be scaled to different-sized projects accordingly.

A Multi-Stage Human Factors and Comfort Assessment of Instrumented Insoles Designed for Use in a Connected Health Infrastructure

Wearable electronics are gaining widespread use as enabling technologies, monitoring human physical activity and behavior as part of connected health infrastructures. Attention to human factors and comfort of these devices can greatly positively influence user experience, with a subsequently higher likelihood of user acceptance and lower levels of device rejection. Here, we employ a human factors and comfort assessment methodology grounded in the principles of human-centered design to influence and enhance the design of an instrumented insole. A use case was developed and interrogated by stakeholders, experts, and end users, capturing the context of use and user characteristics for the instrumented insole. This use case informed all stages of the design process through two full design cycles, leading to the development of an initial version 1 and a later version 2 prototype. Each version of the prototype was subjected to an expert human factors inspection and controlled comfort assessment using human volunteers. Structured feedback from the first cycle of testing was the driver of design changes implemented in the version 2 prototype. This prototype was found to have significantly improved human factors and comfort characteristics over the first version of the prototype. Expert inspection found that many of the original problems in the first prototype had been resolved in the second prototype. Furthermore, a comfort assessment of this prototype with a group of young healthy adults showed it to be indistinguishable from their normal footwear. This study demonstrates the power and effectiveness of human factors and comfort assessment methodologies in influencing and improving the design of wearable devices.

Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users

Background Design processes such as human-centered design (HCD), which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of HCD can often conflict with the necessary rapid product development life-cycles associated with the competitive connected health industry. Objective The aim of this study was to apply a structured HCD methodology to the development of a smartphone app that was to be used within a connected health fall risk detection system. Our methodology utilizes so called discount usability engineering techniques to minimize the burden on resources during development and maintain a rapid pace of development. This study will provide prospective designers a detailed description of the application of a HCD methodology. Methods A 3-phase methodology was applied. In the first phase, a descriptive “use case” was developed by the system designers and analyzed by both expert stakeholders and end users. The use case described the use of the app and how various actors would interact with it and in what context. A working app prototype and a user manual were then developed based on this feedback and were subjected to a rigorous usability inspection. Further changes were made both to the interface and support documentation. The now advanced prototype was exposed to user testing by end users where further design recommendations were made. Results With combined expert and end-user analysis of a comprehensive use case having originally identified 21 problems with the system interface, we have only seen and observed 3 of these problems in user testing, implying that 18 problems were eliminated between phase 1 and 3. Satisfactory ratings were obtained during validation testing by both experts and end users, and final testing by users shows the system requires low mental, physical, and temporal demands according to the NASA Task Load Index (NASA-TLX). Conclusions From our observation of older adults’ interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials.

Toward a Connected Health System for Older Adults: Lessons Learned

This paper aims to provide some lessons learned during the development of the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system that can be generalized for all connected health devices for older adults. The analysis of the different results confirms that there is a clear challenge for modern technologically driven healthcare systems to meet the complex needs of an ageing society. We observed three major themes which should be taken into considerations when tackling the barriers to the uptake of technology enabled care: 1. Face cultural resistance and concerns toward technology enabled care; 2. Improve engagement of users in design; 3. Built or Increase users trust in connected health by spreading awareness and knowledge among end users about technology’s benefit and utility.

Defining User Needs for a New Sepsis Risk Decision Support System in Neonatal ICU Settings Through Ethnography: User Interviews and Participatory Design

The diagnosis of late onset sepsis in neonates is complex and therefore usually late, resulting in increased risks. The Digi-NewB project proposes a novel solution to this problem, by designing a non-invasive Decision Support System (DSS) which will use vital signs, images and sounds to measure the risk of sepsis in the preterm infant and therefore support clinicians in diagnosis. The introduction of any new system to a neonatal intensive care unit (NICU) environment presents a challenge for designers who must account for a technology laden environment and a demanding work-load for clinicians. To define the user needs and therefore build the first use cases for such a system, a multi-method approach was adopted and is described in this paper. This approach consisted of a period of ethnography, eleven semi-structured interviews and the application of a prototyping exercise based on the principles of participatory design.

Prototyping a User Interface for a New Sepsis Risk Decision Support System Using Participatory Design

Digi-NewB is a system currently being developed to monitor and predict the risk of sepsis in infants within a Neonatal Intensive Care Unit (NICU) setting. More than 300,000 preterm infants are hospitalized each year in a European care unit. Sepsis diagnosis is complex and therefore usually late, resulting in an increased risk. In this paper, we present on our experience with applying a participatory design based prototyping method to create user interface (UI) concepts for the Digi-Newb system and then testing the prototypes with end-users. Prototype making within the participatory design framework was found to be an effective method to rapidly develop potential design solutions, utilizing the experience of the end-user as a design partner.

State of the Art and Future Trends in the Usability of Patient Monitors

According to the recent literature, approximately 250,000 deaths occur annually in U.S. hospitals resulting from medical error, making it the 3rd leading cause of death. One of the most commonly used devices in hospitals is the Patient Monitor (PM), a device which constantly monitors the vital signs of the patient. This paper reports on a review of the scientific literature on the usability of PMs in critical care. A detailed analysis of the data reveals that: (i) PMs are undergoing a slow, but continuous process of evolution with new advances focusing on enhancing the interaction between the caregivers and the PM, (ii) the usability of PMs is beginning to receive particular attention as usability is now considered to be strongly associated with patient safety. The data from this study will be used to carry out further investigations into the usability of PMs and to inform the design of future PMs.

Investigation of the Human Factors, Usability and User Experience of Patient Monitors used in a Hospital Setting

According to the recent literature, approximately 250,000 deaths occur annually in U.S. hospitals resulting from medical error, making it the 3rd leading cause of death. One of the most commonly used devices in hospitals is the Patient Monitor (PM), a device which constantly monitors the vital signs of the patient. In this study, nurses and physicians who regularly interact with patient monitors were surveyed on their perceptions of the usability of the PMs they use on a regular basis. Results indicate that clinicians appeared to be mostly satisfied with the general usability of the monitors, particularly in terms of the information being presented and how it is presented. However, participants pointed out problems with the menu navigation during moments of high stress and the high frequency of false alarms. Also, participants expressed the desire to see additional information displayed on screen.

Does culture affect usability? A trans-European usability and user experience assessment of a falls-risk connected health system following a user-centred design methodology carried out in a single European country.

BACKGROUND User-centred design (UCD) is a process whereby the end-user is placed at the centre of the design process. The WIISEL (Wireless Insole for Independent and Safe Elderly Living) system is designed to monitor fall risk and to detect falls, and consists of a pair of instrumented insoles and a smartphone app. The system was designed using a three-phase UCD process carried out in Ireland, which incorporated the input of Irish end-users and multidisciplinary experts throughout. OBJECTIVE In this paper we report the results of a usability and user experience (UX) assessment of the WIISEL system in multiple countries and thus establish whether the UCD process carried out in Ireland produced positive usability and UX results outside of Ireland. METHODS 15 older adults across three centres (Ireland, Italy and Israel) were recruited for a three-day trial of the system in their home. Usability and UX data were captured using observations, interviews and usability questionnaires. RESULTS The system was satisfactory in terms of the usability and UX feedback from the participants in all three countries. There was no statistically significant difference in the usability scores for the three countries tested, with the exception of comfort. CONCLUSIONS A connected health system designed using a UCD process in a single country resulted in positive usability and UX for users in other European countries.