Wolfgang Friesdorf

MedicoErgonomics – A Human Factors Engineering Approach for the Healthcare Sector

Health care expenditures have risen considerably in the past – especially in Germany they have already exceeded 10% of the entire gross domestic product (OECD 2006). The main reason for this development is a dramatic demographic change process. Enormous medical progress and continuous technological improvements, together with a positive socio-economical situation, are leading to an aging population, which is directly resulting in a growing number of elderly and chronically ill patients. The consequence is a clear tendency to longer hospitalizations and growing costs per treated case. However, our societies are not able to allow this “cost explosion” to continue. Instead, a growing number of governmental attempts are explicitly focusing on a more efficient utilization of the existing healthcare resources. For example, in Germany hospitals were traditionally reimbursed by negotiated budgets and feesper-day, encouraging a systematic prolongation of hospitalizations. Therefore, in 1996 this capitation system was shifted towards pre-defined case and procedure fees. Since the beginning of 2004 it is entirely being transferred into a system relying on a hospital reimbursement based on Diagnosis Related Groups (DRGs) only (HENKE & SCHREYOGG 2004). Its aim is to reimburse the entire in-hospital patient treatment through a fixed fee depending solely on the severity of the patient’s disease. As a direct result healthcare providers are today much more motivated to utilize their resources as efficiently as possible and the former

Integrated therapy safety management system

The aim is to demonstrate the benefit of the medico‐ergonomic approach for the redesign of clinical work systems. Based on the six layer model, a concept for an ‘integrated therapy safety management’ is drafted. This concept could serve as a basis to improve resilience.

Agent-Based Information Logistics

Situated and context-sensitive information logistics surface as decisive requirement for supporting critical care units, because information relevant for patient treatment stems from heterogeneous as well as distributed data sources. Immediate treatment starts with an incomplete and almost empty array of information which fills continuously over time by examinations conducted by organizationally as well as geographically distributed departments. Agent technology and multiagent systems appear as a promising enabling technology to improve information logistics in intensive care units. However, an overall development methodology is required that enables an engineering process from the capture of know-how about clinical processes towards a model-based generation of multiagent systems. This contribution reports on an agile development methodology used for the design, implementation and testing of applications for agent-based information logistics.

Investigation of the Usability of Computerized Critical Care Information Systems in Germany

Introduction: The term “usability” describes how effectively, efficiently, and with what level of user satisfaction an information system can be used to accomplish specific goals. Computerized critical care information systems (CCISs) with high usability increase quality of care and staff satisfaction, while reducing medication errors. Conversely, systems lacking usability can interrupt clinical workflow, facilitate errors, and increase charting time. The aim of this study was to investigate and compare usability across CCIS currently used in Germany. Methods: In this study, German intensive care unit (ICU) nurses and physicians completed a specialized, previously validated, web-based questionnaire. The questionnaire assessed CCIS usability based on three rating models: an overall rating of the systems, a model rating technical usability, and a model rating task-specific usability. Results: We analyzed results from 535 survey participants and compared eight different CCIS commonly used in Germany. Our results showed that usability strongly differs across the compared systems. The system ICUData had the best overall rating and technical usability, followed by the platforms ICM and MetaVision. The same three systems performed best in the rating of task-specific usability without significant differences between each other. Across all systems, overall ratings were more dependent on ease-of-use aspects than on aspects of utility/functionality, and the general scope of the functions offered was rated better than how well the functions are realized. Discussion: Our results suggest that manufacturers should shift some of their effort away from the development of new features and focus more on improving the ease-of-use and quality of existing features.

A System Ergonomic Analysis Approach for Potential Critical Incidents in Medical Treatment Processes

The necessity for safe treatment processes in clinical work systems is obvious. In recent years an increasing number of “Clinical Incident Reporting Systems” (CIRS) has been established in hospitals worldwide in order to monitor and report critical incidents and to improve the underlying treatment processes. However, CIRS are always restricted to the identification of critical incidents, which have lately occurred, whereas only a systematic analysis of clinical workflows can identify also potential critical incidents of the future. For this reason we have developed a system ergonomic analysis approach for potential critical incidents in medical treatment processes based on a realistic simulation of clinical work processes in combination with their video documentation and expert interviews. The set-up of the simulation is performed directly with the help of the involved medical staff and within their very own clinical environment. The video documentation of the simulated clinical work processes then guarantees a systematic foundation for the later process analysis and optimization based on structured interviews of all system experts involved (physicians, nurses, technicians etc.) and a system ergonomic MTO concept aiming at a well balanced design of all system elements (Men, Technology & Organization). Using this system ergonomic approach in cooperation with the Department of Anaesthesia and Intensive Care at the Klinikum Ernst von Bergmann in Potsdam (Germany) for the analysis of the inner clinical transfer of ICU patients resulted not only in a significant amount of critical incidents, which have lately occurred, but also a wide variety of potential critical incidents likely to happen in the future.

Sustainable System Understanding & Empathic Product Design — A Custom-Built Qualification Concept for Biomedical Engineers

The design of process and user oriented biomedical technology is a fundamental basis for safe and efficient clinical treatment processes. Therefore, especially biomedical engineers need a sustainable and empathic understanding of clinical work systems and medical patient treatment processes. In this context the Department for Human Factors Engineering and Product Ergonomics at the Technical University of Berlin has developed a custom-built three day qualification program for biomedical engineers in close cooperation with the Klinikum Ernst von Bergmann in Potsdam combining theoretical basics with simulated medical treatment scenarios and an additional visitation of according clinical work places. Our experience with this qualification concept for biomedical engineers especially results from a training course designed for ten engineering staff members of the Department for Product Development of B. Braun Melsungen. An anonymous evaluation of the various course contents clearly shows, that especially the simulated treatment scenarios in combination with getting personally acquainted with the everyday work processes of the clinical reality helps to achieve the desired learning effect among the different course participants: a sustainable system understanding as a basis for an empathic development of technological solutions especially adapted to the complexity of the underlying clinical work processes and specific user requirements. In addition to that, the evaluation of similar qualification courses for other (non-engineering) staff members of the very same company showed quite similar assessment results underlining the immense importance of a sustainable and empathic understanding of clinical work systems and their complexity for everyone directly or indirectly involved within the optimization of clinical work processes.

A Systematic Approach to Analyze the Optimization Potential for ICT-Tools Supporting Collaborative Work Processes in Healthcare

Over the past, the continuous increase of medical knowledge in combination with a high number of medical and technological innovations has lead to an enormous quality improvement in healthcare. But this development also requires a professional staff specialization resulting in an increased fragmentation and division of the entire patient treatment processes to individual specialists and/or departments. Therefore the improvement potential associated with the introduction of modern Information and Communication Technology (ICT) supporting the cooperation of all involved medical actors seems to be obvious. However, in reality the majority of such ICT-Tools does not meet those high expectations. A major reason for this is often an insufficient functionality directly resulting from an inadequate user integration into the development process. In this context a systematic analysis approach has been developed for the identification of optimization potential for ICT-Tools supporting collaborative work processes in healthcare based on a participatory analysis of the underlying medical treatment processes and a cooperative functionality definition. In a first investigative study this system ergonomic analysis approach was tested for the identification of the existing optimization potential for a web-based patient record to be introduced into the pre-, in- and post-hospital treatment processes of an emergency abdominal surgery. Together with the involved medical users a total number of 11 functionality requirements have been identified being essential for a systematic improvement of the underlying communication and coordination processes, whereas an improvement of the shared knowledge was rather less important for the later users. However, a broader optimization of web-based patient records in general will only be possible when also the treatment processes of different patient groups are taken into account.