Wednesday


Conference&Wednesday23 Mar 2006 08:19 am

One of the final conference streams on Wednesday afternoon was a masterclass titled ‘Human factors engineering: the path to usable software design’, presented by Prof. Peter Elkin, of the Mayo Clinic, Rochester, Minnesota, USA. Peter set his presentation, and the resulting discussion, within the premise that software usability is vitally intertwined with good interface design, supported by usability testing with real end users, and that most health IT failures result from lack of respect for, or attention to, human-computer interaction, rather than necessarily technical flaws.

Peter covered some of the basic theory of human-computer interaction, beginnning with the three elements – humans, activity, context – within Bailey’s Human Performance Model. He discussed some of the reasons that software and other IT products are often hard to use, including their being designed with an emphasis on the machine or system, rather than the end-users, the target audience often being a moving target, lack of full design specification, and development teams not being well integrated. Too often, he said, engineers design machines to talk to machines, but they are not the end-users who must wrestle with the product. He stressed the need for user-centred design, including an early focus on the needs of users and the teasks they will perform, and empiric measurement of usage, often through usability testing laboratories (such as he runs).

He moved on to discuss some of the principles of human factors analysis, including contextual inquiry (understanding the end-user needs), competitive usability evaluations, and low-fidelity prototypes for ealry testing. He suggested that ‘the user is always right’ – although this may not always be the case – and that in terms of interface design, ‘less is more’, as each widget in an interface (eg screen) places an additional burden on the user. He suggested that usability of a system often depends on ‘minor’ interface details, and that without proper usability testing, these may not be uncovered, and so the reasons for resistance to use, for example, may not be found and corrected.

Peter discussed 5 usability attributes:

  • learnability;
  • efficiency;
  • memorability;
  • error prevention; and
  • satisfaction.

He devoted the last part of the masterclass to description of the theory and some examples of usability testing. He defined usability testing as replicable studies of products and processes in a controlled environment, and described 4 types:

  • exploratory;
  • assessment testing – often expanding on exploratory test findings;
  • validation testing – often occurring late in the development cycle; and
  • comparative testing, often of two products, processes or designs.

He described the limitations of usability testing, including it always being an artificial situation, difficulties in determining whether the test users are typical of the target population, and that testing may not always be the best technique. He recommended adherence to the relevant ISO stantards, including ISO 13407, the human-centred design development cycle.

This was a very useful and informative session that it would have benefitted many of a more technical or policy orientation to attend.

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Conference&medinfo2007&Wednesday22 Mar 2006 10:02 pm

The HC conference and the exhibition seem much quieter and less stimulating than previous years. Delegate and exhibitor numbers are down and there is little of the “excitement” of previous years (perhaps I’ve just been too many times).
This may be because everyone is so busy with implementation, and may also reflect a recognition that what has been bought is not (easily or soon) going to be deliveing the benefits many had dreamed of.

The non participation of Connecting for Health has been very obvious, and seems to have been a missed opportunity to share lessons from one area of the country to another. Almost all the speakers seemed to be very careful to “toe the party line” and any criticisms which were made were couched very carefully and not made explicit.
There also doesn’t seem to have been the innovations which have been a feature of this event in the past. I feel that next years conference (19th to 21st march 2007) will need speakers and participants who are willing to challenge the status Quo and bring the spark back into HC.

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Conference&Keynotes&Wednesday22 Mar 2006 09:59 pm

The final plenary session was not well attended as many people had left the conference before it tok place.

Prof Sir Muir Gray was presented with the BCS HC achievement award as the “first knight of health informatics”. He received his knighthood last year for knowledge management in the NHS.

He then gave a lecture in which he drew parrallels between the health benefits of clean and filtered water and the health benefits of clean and filtered information. He divided the lecture around several “tools”, those for changing society, community building , knowledge logistics and those for clinicans and patients. He managed to cover the Kaleidoscopic workforce and the national knwledge service as the only way forward for the NHS. I’m sure that many of the items will be dealt within more depth on his new blog Soundshealthy

Muir’s lecture was followed by the final keynote from Prof Nick Bosanquet (Professor of Health Policy, Imperial College, London), who talked about a “new informatics for the post-boom NHS”. He examined NHS funding and how new initiatives which have already been announced will mean that growth in NHS budgets will lead to reductions in growth between now and 2010, and the subsequent mechanisms for the control of expenditure (based on calaculations available on the Reform website in his paper The NHS in 2010). He argued that we are moving to an era of local pluralism rather than central control and likened Connecting for Health to a “cast iron framework in a dynamic sysem”, suggesting that it will need to provide data for cost control and meet the “Jeavons challenge” of increasing independance and autonomy in a system with multiple healthcare providers.

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Conference&Keynotes&Wednesday22 Mar 2006 02:24 pm

Dr Martin Baggaley (C4H clinical lead for London & Consultant Psychiatist) gave an interesting presentation setting out some specific issues for mental health trusts in London. He stressed the low base, in terms of electronic records systems, that mental health trusts are faced with, and the vital need for interoperability – not just with acute trust systems, but also with other agencies such as social services and the criminal justice system.

He pointed out some of the implications of Our Health, Our Care, our Say and its implicit moves from secondary to primary care and the balance between “stalinist” central control and “arguing local fifedoms”, and the problems which emerge from this. He described the “tactical” move by many London Mental Health Trusts to use RiO until fuller tools are available from the National Programme – and suggested that the spine would be, ultimately, the best route to address the ineroperability issues he highlighted. During the question and answer session he agreed with a questioner that for many London MH trusts which already have effective sysems the best solution may be to sit tight at present. I asked another question about mental health patients having “particularly sensitive” information which they may wish to go in the “sealed envelope” before it is uploaded to the spine. He suggest that many “career” MH patients are very open about their condition & may not wish to restrict access to their records, but that for many people with transient mental health problems the development of the sealed envelope is vital before information is uploaded.

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Conference&Wednesday22 Mar 2006 01:08 pm

To Blog or Not to Blog – not a question put to Peter & I but the title of a paper by Adrienne Speake from Northumberland Tyne & Wear SHA, who described the establishment of a blog “Talking Knowledge Management” by the knowledge management specialist library of the National Library for Health. She described the rationale for the blogs creation, based on perceived problems with email and commercial discussion lists. The uptake and use of the blog had been minimal & Ady had conducted a survey to explore why this might be. I was surprised that the technology was seeen as being a difficult barrier when the target audience are those working in knowledge management. The final part of her presentation and some of the question and answer session lookied at blog use in general and some other emerging technologies such as wikis.

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Conference&Exhibition&Wednesday22 Mar 2006 12:18 pm

Wednesday morning started for me with an interesting tutorial on Radio Frequency Identification (RFID) and it’s potential for healthcare, led by Colin Jervis, Director, Kinetic Consulting Ltd

Colin started with a bit of context setting, particularly his suggestion that adverse events and medication errors may be our 4th biggest killer! He linked this to a common issues for clinicians, that when they are under pressure the patients needs come first and recording is left till later – previously described as the intensive care information paradox.

He gave a brief overview of passive (no battery) and active (with their own battery) RFID tags and the readers etc required for their use and touched on the different wavelengths (Low, High, UHP & microwave). He used a range of examples, primarily from the retail sector, before going on to look at their potential use in the more comploex and difficult clinical environment. He passed round example wristbands from companies such as Zebra which can have RFID tags inserted along with the barcodes etc and then listed 5 ways in which RFID could transform healthcare:

  • Identification
  • Tracking
  • Alerting
  • Recording Interventions
  • Sensing

A wide range of questions and potential appliations were raised by the audience including tracking blood products, surgical instruments and equipment and issues where the medical equipment may cause problems with “tuning in” tag readers to cope with background interference.

He pointed participants to the stand of Safe Surgery Systems Ltd for further information & I visited them later to find out a bit more and get materials I could use in education.

More details are available on Colin’s Blog Future Health IT

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