Usability and Human Factors

1. Usability and Human Factors Unit 4: Human Factors and Healthcare Lecture a This material (Comp 15 Unit 4) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003. This material was updated by The University of Texas Health Science Center at Houston under Award Number 90WT0006. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Human Factors and HealthcareLecture a – Learning Objectives • Objective 1: Distinguish between human factors and human computer interactions (HCI) as they apply to usability (Lecture a) • Objective 2: Explain how cognitive, physical and organization ergonomics can be applied to human factors engineering (Lecture a) • Objective 3: Describe how the concepts of mental workload, selective attention and information overload affect usability (Lecture a) • Objective 4: Describe the different dimensions of the concept of human error (Lecture b)

3. Human Factors and HealthcareLecture a – Learning Objectives (Cont’d – 1) • Objective 5: Describe a systems-centered approach to error and patient safety (Lecture b) • Objective 6: Apply methods for measuring mental workload and information overload (Lecture c) • Objective 7: Describe how human factors analysis can be applied to the study of medical devices (Lecture c)

4. Electronic Health Devices & Health Record Systems Image 1.1: Patel, V. L., Kaufman, D., & Kubose T. (2002) Image 1.2: Kaufman, D.R. & Starren, J. B. (2006). Image 1.3: Kaufman, D.R., Pevzner, J, Hilliman, C., et. Al. (2006). Image 1.4: Horsky, J., Kaufman, D.R., Oppenheim, M.I. & Patel, V.L. (2003). Image 1.4: Kaufman, D. R., Pevzner, J., Rodriguez, M., et al. (2009). Image 1.5: Kaufman, D.R., Patel, V.L., Hilliman, C., et. Al. (2003). Image 1.6: Kaufman, D., & Hripcsak, G. (2008).

5. Human Factors and HCI Redux • Differences: • Histories, journals, academic and professional societies • HCI focused on computing and innovative design • HF focused on any system and greater emphasis on work/workplace and on devices • Safety is a core issue in HF

6. Human Factors and HCI Redux (Cont’d – 1) • Similarities • User-centered and systems approach • Draws on cognitive psychology and other social sciences • Similar methods with regards to usability evaluation • Cognitive task analysis • Usability testing

7. History of Human Factors • 1900-1945: • Industrial efforts to increase worker productivity • 1945 – 1960: • Formal beginning of the profession – military • 1960 – 1980: • Rapid growth and expansion – space program, product design, workplace design

8. History of Human Factors(Cont’d – 1) • 1980 – 1990: • Human computer interaction, safety/human error • 1990 – Present expansion • e.g., healthcare, aging, aviation safety, standardization

9. Why is Human Factors Increasingly Important • Diversity of user groups • Complexity of systems • Increased use of technology • Increased “costs” of human error • Societal emphasis on well-being and quality of life

10. Human Factors Focus and Goals Focus • Human beings and their interactions with products/equipment, tasks, environments • Micro, macro, ambient Goal • Design systems and system components to match the capabilities and limitations of humans who use them • Optimize working & living conditions

11. Examples of Application Areas • Military • Highway systems • e.g. readability and comprehensibility of signs • Automobile design and driver behavior • Human-computer systems • Healthcare and patient safety • Aging and accessibility • Nuclear power • Workplace layout and furnishings • Airline industry • e.g. pilot workload, aircraft design, automation, aircraft maintenance • Quality control

12. Nuclear Power Plant Control Room Lambrev, Y. (2009).

13. Airplane Cockpit Headly, A. (2005). CC BY NC-SA 4.0.

14. Human Factors in Medicine • Infusion pumps • Anesthesia equipment • Medication errors • Effects of fatigue on resident’s performance • Judgmental limitations in medical decision making • Inadequate infection control • Unintended consequences of automation

15. Human Factors/Ergonomics (Carayon, 2007) • Scientific discipline concerned with understanding interactions • Among humans • Other elements of a system • Profession that applies theory, principles, data, methods to design to optimize: • human well-being • overall system performance • System can be a technology, device, person, team, organization, policy, etc.

16. Human Factors Ergonomics:3 Major Domains • Physical Ergonomics • Cognitive Ergonomics • Organizational / Macro-ergonomics

17. Physical Ergonomics • Concerned with physical activity: • Topics: Repetitive movements, workplace layout, safety and health • Application to Health: Reducing and preventing injury, designing workstations and work rooms for optimal human performance • Examples: • Designing a patient room to facilitate and support patient care • Designing medical labels so that they are readable and understandable

18. Organizational Ergonomics • Concerned with socio-technical systems • Topics: communication, teamwork, participatory design, quality management • Application to Health: Reducing stress and burnout, improving satisfaction and retention, implementing improvement activities • Examples: • Management training in surgery teams • Designing work schedules for reduced fatigue and enhanced performance

19. Cognitive Ergonomics • Concerned with mental processes • Topics: mental workload, decision making, skilled performance, HCI, work stress, • Application to Health: usability, designing training systems, usable interfaces • Examples: • Event report systems • Implementing incident analysis system

20. Human Factors & Applied Cognitive Psychology • Applies knowledge about human strengths and limitations to design of interactive systems, equipment, and their environment to ensure their effectiveness, safety, and ease of use • Perception, attention, memory, mental models and decision making are central to human factors research and analysis

21. Human Attention • Selective Mechanism • Resource needed for information processing • Limited • Sharable • Flexible

22. Selective Attention • Ability to ignore extraneous information and focus on relevant inputs • Humans can only process information at a finite rate Performance typically declines as the number of sources of information increases Information overload contributes to errors

23. Information Overload • Speed Stress • Load Stress • Speed / Accuracy Tradeoff

24. Selective Attention (Cont’d – 1) • Four factors drive the selection of channels to attend (and the filtering of channels to ignore): • Salience: • Events or stimuli that are salient capture attention (this represents a bottom-up process) • Expectancy and Value: • We tend to “sample” the world where we expect to find information, and attend to channels based on how valuable it is to look or costly to miss • Effort: • Selective attention may be inhibited if it is effortful

25. Divided Attention or Time Sharing • Time-sharing: • Ability to perform more than one cognitive task by attending to both at once or rapidly switching back and forth between them • Because cognitive resources for attention are relatively limited, time-sharing often results in a drop in performance for one or both tasks • People can also “modulate” the resources given to one task or the other

26. Human Factors Design Implications • Reduce the number of competing channels of information • Make sources of information as distinct as possible • Provide feedback • Use redundant cues • Work/rest scheduling • Training

27. Unit 4: Human Factors and HealthcareSummary – Lecture a • Growing importance of human factors in health and other domains • Domains of human factors • Applied cognitive psychology and human performance • Human attention, performance and design implications • Next section: Patient safety and human error

28. Unit 4: Human Factors and HealthcareReferences – Lecture a References Bubb, H. Information Ergonomics. In Herczeg, M., & Stein, M., eds. (2012). Information Ergonomics: A theoretical approach and practical experience in transportation. Springer Berlin Heidelberg, p. 23. Images Slide 4: Image 1.2: Kaufman, D.R. & Starren, J. B. (2006). A methodological framework for evaluating mobile health devices. In the Proceedings of the American Medical Informatics Annual Fall Symposium. Philadelphia: Hanley & Belfus. 978 Image 1.3: Kaufman, D.R., Pevzner, J, Hilliman, C., Weinstock, R.S., Teresi, J. Shea, S. & Starren, J. (2006). Re-designing a telehealth diabetes management program for a digital divide seniors population. Home, Healthcare, Management & Practice. 18: 223-234 Image 1.1: Patel, V. L., Kaufman, D., & Kubose T. (2002). Infusion Pump—unpublished work

29. Unit 4: Human Factors and HealthcareReferences – Lecture a (Cont’d – 1) Images Slide 4: Image 1.4: Kaufman, D. R., Pevzner, J., Rodriguez, M., Cimino, J. J., Ebner, S., Fields, L., et al. (2009). Understanding workflow in telehealth video visits: Observations from the IDEATel project. Journal of Biomedical Informatics, 42(4), 581-592. Image 1.4: Horsky, J., Kaufman, D.R., Oppenheim, M.I. & Patel, V.L. (2003). A framework for analyzing the cognitive complexity of computer-assisted clinical ordering. Journal of Biomedical Informatics, 36, 4-22. Image 1.5: Kaufman, D.R., Patel, V.L., Hilliman, C., Morin, P.C., Pevzner, J, Weinstock, Goland, R. Shea, S. & Starren, J. (2003). Usability in the real world: Assessing medical information technologies in patients’ homes. Journal of Biomedical Informatics, 36, 45-60. Image 1.6: Kaufman, D., & Hripcsak, G. (2008). eClinicalWorks screen. Unpublished usability analysis of eClinicalWorks.

30. Unit 4: Human Factors and HealthcareReferences – Lecture a a (Cont’d – 2) Images Slide 12: Lambrev, Yovko. (2009). Kozloduy nuclear plantc- control room. Retreived on August 20th, 2010 from http://it.wikipedia.org/wiki/File:Kozloduy_Nuclear_Power_Plant_-_Control_Room_of_Units_3_and_4.jpg. [CC-BY-3.0 (http://www.creativecommons.org/licenses/by/3.0)] via Wikimedia Commons Slide 13: Headly, Aaron. (2005). Retrieved on September 10th, 2010 from http://www.flickr.com/photos/mugland/35440009/

31. Unit 4: Human Factors and HealthcareLecture a This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003. This material was updated by The University of Texas Health Science Center at Houston under Award Number 90WT0006.