Multi-mode wireless nursing information system user interface usability evaluation:
In case of emergency triage
Usability Evaluation of a Wireless Multi-Modal Interaction Nursing Information System: Taking the Emergency Triage Support System as
an Example
Po-Lun Zhu original Ka Chen Ying stirrup Shen Yu Xiang
National Yang-Ming University, Institute for Health Information and Decision Making
polun@ym.edu.tw yuanchia@ebtnet.net genego@mail2000.com.tw normansheng1211@yahoo.com.tw
Abstract
Usability Engineering for the care and information in an important issue to improve the system availability can effectively reduce errors, increase speed, thereby improving efficiency, protect patient safety. The man-machine interface is an important part of system availability, with the evolution of technology, the system user interface has been the evolution of the traditional text to graphical, voice, touch, handwriting, gesture, and then to cut a variety of interface length weaknesses were integrated model for multi-user interface. This study
integrates voice and touch technology, using Microsoft Visual Basic 6.0,Speech SDK 5.1, wireless headset microphoneLogitech cordless freedom headset and the large size touch screen SONY PCV LX900,develop a multi-mode interactive triage support system, and invited three 10 emergency nursing staff to assist the
implementation of usability evaluation, so as to provide multi-modal user interface into care information system pilot test experience. The developed system consists of a large and clear touch interface, hands and eyes free voice input, and use simple rules, some through the user input data to provide triage triage classification, classification, the recommended value of partition can be used as reference for nursing staff category. The system total of 26 images, voice, vocabulary 338. Assessment is that if a mixture of many modes with voice touch interface, there are more than simple voice interface to the high of fault
tolerance. Comparison of voice and touch, while touch the correct rate is high but the average speed of fast speech. Comparison of multi-mode, single mode and the Acceptance of the old system, nursing colleagues favorite multi-modal interface. The system built in this study averaged 106seconds to complete a triage operation, at 63 dB noise environment of up to 94% of the speech recognition rate.
Keyword
Multi-mode user interface (Multi-Modal Interaction), Usability (Usability), ED triage (Emergency Triage)
Background
Usability Engineering (usability engineering) for the nursing information in the important issue, whether the ICU information system, clinical decision support, patient referral tracking systems, medical devices and equipment, drugs or even a drawer to place furnishings, all research proposals on the development of design or assessment of procurement and must import the concept of usability
engineering, usability testing, or through (usability testing)to assess and
improve. Available through the usability engineering point of view closer to the user needs to review the medical information system human-machine interface design, effectively reduce errors, increase speed, thereby improving efficiency, protect patient safety. The users of these systems or equipment for the hospital nurses are most colleagues [14,11].
Man-machine interface design of information systems the main text has been gradually converted by the graphical user interface [6; 20], in recent years, there are many new technologies began to be applied to the human-machine interface design, such as voice, touch , handwriting, gestures and other advantages and disadvantages. At present, there was a lot of speech recognition used in medical-related software, the majority of medical doctors is to provide the input function, but the voice technology into easy to use although the system can, but research shows no significant increase work efficiency [10 ]. Touch is a widely used technologies, such as store point of sale (POS) systems, natural touch although a number of advantages [16], studies indicate that the speed and the correct rate is less than the traditional keyboards [1; 12]. Handwriting is also very valuable technology, however, is still present major obstacles to the recognition rate is not high [7; 9]. The front of the computer through gestures for input
gesture pattern is still in the research stage, there is no product on the market- oriented system [5]. W3C (world wide web consortium) of multi-mode interactive panel (multimodal interaction working group) to further promote the new generation of multi-modal user interface, I hope to integrate the above technologies such as voice, touch, handwriting, gestures, etc., for the use of more convenient to design a more friendly interaction [13].
Faster speech rate, but the right touch of two modes to fully integrate each other's deficiencies, to develop a multi-modal user interface for the design concept of the system with a multi-modal user interface for import medical information to provide the experience of the pilot test.
The hospital emergency room the most complex environmental, human-
computer interface design for quite a challenge. The emergency room for people to seek emergency, emergency, non-generally the most important disease of patients in the place of medical care in China every ten emergency patients have 1-5 of an emergency with severe, urgent need to dispose of, or which endanger life or limb [ 2] while working for the emergency room triage work first, and therefore selected as the system test environment for emergency room triage station. The man-machine interface for acute critical care information system is important, a good man-machine interface will be able to improve patient safety and improve the productivity of nurses [15]. Emergency room triage system used by the terminal system remains, a text mode interface, many of room for
improvement. However, if a more advanced technology, whether to enhance the effect of system availability is worth doubts. In fact the emergency room
environment is very complex, ambulance sirens, telephone ring tones, hospital radio, the shuttle's patients and their families, and so are likely to seriously affect the efficiency of speech recognition factors. Nurses also need from time to time to answer the phone, answering inquiries from family members, talking with colleagues, etc., would disrupt the implementation process. Problems may be caused by poor availability of the reason, how to solve these problems this study also adds a number of challenges.
Research Methods
First, the development principles
In order for systems similar to the previously operated by the nurses of the old system, to the availability of "similar to the original work" and "easy learning"
principle [17], this study of nurses who used the old 3270 terminal inspection trauma systems analysis to the nurses to familiarize themselves with the system architecture, re its user interface. And the graphical user interface design, information design of its new PDAsystem [2], as far as possible to familiarize themselves with the original user interaction model, but adjusted to fit the design of a large touch screen. Analysis of voice interface, please help nurses during the day classes, respectively, the midnight shift, evening shift on the triage record the actual situation, to analyze the actual time for the patients to triage the case of voice interaction, to find the best audio interface mode. System development method is used embryonic development (prototyping), and nursing staff continued to modify and discussed.
Second, development tools
The system uses a program development tool for the Microsoft of Microsoft Visual Basic 6.0, with its speech recognition development tools, Microsoft Speech SDK 5.1 and Simplified Chinese Language Pack [18]. Wireless headset
microphone you use Logitech Logitech Cordless Freedom Headset [12], as shown in Figure 1, touch-screen desktop computers for the SONY PCV LX900 its carrying Intel Pentium III 1GHz, 128 RAM, and 17-inch touch screen [19], as shown in Figure 2. System components of the concept, modular, and three layers programming architecture, all triage patients on the part of the logic design elements, while the front-end user interface associated with the more fragmented due in part to difficult design components, the order for the module.
Figure 1Logitech © Cordless Freedom Headset Model No. 8701
Figure 2 SONY PCV
LX900 Third, multi-mode interactive design
The touch-screen design according to user needs, design a large screen, big buttons, large font visual interface. All the boxes are the screen can touch the button, a pink top left corner of the first part of the basic data for the area, is registered by the emergency area by the incoming data, the blue box below the button input for the triage, no value has not yet entered the box to show the deep blue, after the value input box is displayed as light blue, if the touch of the box will flash after three seconds, the role of the box is rendered as yellow, and
making the use of in the box to the default color rendering, the orange part of the information for the computer-aided decision-making were triage classification, triage, partition and so on. Voice control box if the green is ongoing voice input, if the click will become orange is the voice to suspend the case, and then click will restore the status of voice input. Voice of the controlling party status for the volume below the article, would speak with the voice volume to change the size of the length of the best radio results is in the range of green, yellow is too sound, too loud red.
Figure 3 touch screen interface design, divided into the basic information region (upper left red zone), triage information region (central blue region) and
computer-assisted area (the right side of Orange District) Third District.
4, system architecture design
The system uses object-oriented programming methods and principles of the structure formed the core object to triage patients object, the object store to take care of emergency patients present all information and information stored in accordance with a simple check, and then trigger event, such as blood pressure, diastolic blood pressure higher than 100 issued a warning on the event too.
Triage was an intelligent agents module, triage patients by monitoring the properties of objects and events, the decision for the proposed classification and disposal, and can perform a number of built-in actions, such as the transmission of information related processes, or notify the relevant emergency doctor or nurse. Since this system uses multi-modal user interface, and therefore user interaction module is responsible for coordinating all information should be presented to the user to coordinate distribution, the best way to present to the user. Coordination and synchronization of voice, touch screen, and the future is combined with the PDA, PDA on the information presented to the user. Voice
module using the Microsoft Speech SDK 5.1of SOC, which provides speech
recognition and text to speech function. WirelessPDA communication module is responsible for Information and PDA version of the program synchronization.
Lexical database for the XML file, store and vocabulary needed to identify relevant information.
5, evaluation design
Assessment of this study is divided into two phases, the first pre-assessment for the development of the second stage after the completion of the assessment for the development. In the early stages of development, in order to get the user's response and early development of systems required to collect knowledge, and advanced users to participate in the design process [14], the early days of this study was to develop rapidly based on limited information, a prototype system and test the system by nursing staff and offer suggestions.
When the system prototype developed by the method of stability and meet the requirements, then enter the second stage assessment. The second stage assessment prior to the implementation of the objectives will be measured by an official of the display shows those with education and training, after training the subjects of this study will have some degree of understanding of the system.
About the implementation of a formal assessment of 30 minutes per test, the test is divided into two stages: the first phase of training computers for the
establishment of voice files, time-consuming about ten minutes, the second stage of system testing. Test record completion time, environmental noise, the wrong situation and the number of items to calculate the error recognition rate,
recognition rate compared with the completion time to assess the relevance of its fault tolerance. Please test after test to fill a similar technology acceptance model (TAM) questionnaire, and make recommendations on testing and test record in the situation observed in the sidelines.
Outcome
The study subjects were mostly around 30 years of age (60%)of women (90%), the more qualifications for the emergency room more than a decade (43%) of nurses (60%), mostly college educated (53%) and specialist (43%). Average monthly participation in triage work are 1 to 5 times (80%). Most users will use a computer at least once a week (76%), of which one third of the participants for the high- volume users, the computer several times per day (33%), with Qi Cheng (73%) or
more subjects in the test before the speech recognition has come into contact with the relevant information. Test subjects for more positive about this system, although now consider themselves to use unskilled (90%), but that can be qualified as long as little preparation (87%), sticking (63%) of users the current system efficiency has been satisfactory, while the majority (87%) of the user that the system (multi-modal user interface) than the PDA to the good.
Figure 4.1 The basic initial screen
Figure 4.2 determine triage results screen
Figure 4.3 The results of the screen printed
Discuss
As the user's behavior is unpredictable, the system development on the light as far as possible in order to be able to all users of the system made possible action, in the development of the code will likely be more complex and scattered. If the
point of view from the hierarchical, the closer the information layer, the structure of the code, the easier the closer the more close to the user interface layer, exceptions will be more and more code written thus will be more difficult to grasp the structure of error-prone. Multi-mode user interface to give users greater flexibility, on the other hand also represents such a large order to provide the flexibility to use in the development must be better ways to design and management of code.
During development, this study first user interface and data structure triage patients and determine the logical part of the triage to dismantle as much as possible, the data structure and triage patients to judge the logical design for the device, and users referred plane will no longer have any logical data structure and determine the code can be simplified to a part of the function. As part of the user interface less structured, to design the components is difficult, therefore the first to be modular. The current design, multi-mode interface mode for each interface module are designed, such as voice module and touch module, these
modules are coordinated through an interactive module to communicate with the underlying components and, apart from the addition, coordination module through an interactive mode synchronous behavior of all interfaces, such as when to voice input on a project, it has also produced a touch input of the project should be in return. Will coordinate the functions of independent simultaneous dismantling them will simplify the code and then make the code easier to manage and reduce errors. If we can more clearly interactive mode, you can try to change the design for the device, the user interaction module is a fundamental design element, and all of the interactive mode, such as voice, touch and other Zeyi inheritance based approach to handle all components to modify the content, so will be able to enjoy the advantages of easy maintenance.
However, although this structure can cope with most of the situation, but there will still be there a number of possible exceptions, different users use different modes of operation are more likely to produce unexpected results, so if multiple users want to have to ask tests to detect problems and to ameliorate.
Conclusion
In this study, triage is an example of a combination of voice and touch develop as many models interactive information system, to examine the multi-modal human-machine interface in the care of the issue of information availability. The
results showed a multi-modal user interface will enhance the system's fault tolerance, the user can interact through with a different use models to cater for different situations and conditions, the shortfall in order to achieve optimal efficiency. Overall, users of multi-modal user interface of acceptance than a single mode (voice only). The recommendations of the emergency triage mode of voice as the main input devices, with touch screen of the auxiliary. The
Institute developed the overall system efficiency and fault tolerance is still strengthening.
The system is designed for nurses simulation as an assessment of the situation is the test, because subjects were faced with the situation on paper, so the test results should be with the real situation on the difference between the test results.
In addition, the current design of the system can only process a case, but
discussions with the nurses, because they must triage, we often deal with multiple cases simultaneously, so the system also need to have this function next to meet the demand.
The system dictionary is 3270 according to the old terminal system design, while the old system when the encounter can not meet the exception dictionary is to ask users to enter the "other" option, the system is not addressed, the future must find better exception. In conducting the actual field tests, should be able to use the last two months of the ED triage information system for the exception of the tolerance test.
The future system will be developed in this research can have two continuity issues, a front-end user interface usability studies for the extension of an intelligent decision support for the back-end component design of the study.
Usefulness of the front, which can be tested in accordance with advice provided by users of the system continued to improve, but also can continue to try to join a different multi-modal human-computer interaction model combination, for
example, test subjects had at the time mentioned Handwriting recognition and fingerprint recognition and other technologies to explore the extension of the availability of multi-modal human-machine interface. Back-end components of the extension of triage of patients is quite large, in addition to the specifications of the components continue to develop more suitable for the more perfect, the present study only to join the simple rules of triage, the future can try to standardize the rules of the database integration (eg, Arden Syntax) Let the system more flexible, able to provide a better quality of decision support.
References
1. Barrett J, Krueger H. Performance effects of reduced proprioceptive feedback on touch typists and casual users in a typing task. 13 ed. 1994. P. 378-81.
2. Chang P, Tzeng YM, Sang YY. The Development of Wireless PDA Support Systems for Comprehensive and Intelligent Triage in Emergency Nursing. Journal of Nursing (in chinese) 2003 Aug; 50 (4) :29-39.
3. Chang L, Scott M. A comparison of two handwriting recognizers for pen-based computers.
1994 p. 9.
4. David N. Mohr, David W. Turner, Gregory R. Pond, Joseph S. Kamath, Cathy B. De Vos, Paul C. Carpenter. Speech Recognition as a Transcription Aid: A Randomized Comparison With Standard Transcription. J Am Med Inform Assoc 2003; 10 (1) :89-93.
5. GWindows: Light-weight Stereo Vision for Interaction. Microsoft 2004 [cited 20040 Jul 5];
Available from: URL: http://research.microsoft.com/ ~ nuria / GWindows / GWindows.htm
6. Head J. Question of interface design: How do online service GUIs measure up? 1997. P. 20- 9.
7. Janet R, Stuart M, Chris C. Oops! Silly me! Errors in a handwriting recognition-based text entry interface for children. 2002 p. 35-40.
8. Logitech Cordless Freedom Headset Model No. 8701. Logitec 2004 [cited 1906 30];
2004Available from: URL: http://www.logitech.com
9. McLaughlin R. Redesigning the Crash Cart: Usability testing improves one facility medication drawers. American Journal of Nursing 2003; 103 (4): 64A-F.
10. Marcus A. Principles of Effective Visual Communication for Graphical User Interface Design. 1990. P. 107-11.
11. Miguel A, Valero M, Teresa A, Marcos F, Sanz Francisco P. Usability Engineering in Patients Follow-up Medical Information Systems. Amsterdam: IEEE; 1996 p. 2307-8.
12. Murphy T. Innovative interfaces: New GUIs help zero in on information. 4 ed. 1997. P.
20-3.
13. Multimodal Interaction Activity. W3C 2004 [cited 20040 Jun 30]; 2004Available from:
URL: http://www.w3.org/2002/mmi/
14. Susan F, Barry F. The Role of Usability Testing and Documentation in Medical Device Safety. Istanbul, Turkey 2001 p. 4008-10.
15. Staggers N. Human Factors: Imperative Concepts for Information Systems in Critical Care. American Association of Critical-Care Nurses 2003; 14 (3) :310-9.
16. Shneiderman B. Designing the User Interface: Strategies for Effective Human Computer Interaction. Addison-Wesley; 1998.
17. Staggers N. Usability Concepts and Clinical Computing. In: Marion J. Ball KJH, editor.
Nursing Informatics-Where Caring and Technology Meet. Springer; 2000. P. 95-109.
18. Speech SDK 5.1 for Windows applications. Speech SDK 5 1 for Windows applications 2002 June 24 [cited 20040 Jul 1]; Available from: URL:
http://www.microsoft.com/speech/download/sdk51/
19. SONY PCV LX900. SONY 2004 [cited 2004 Jun 30]; 2004Available from: URL:
http://www.sony.com
20. Wilson S, Inderrieden M, Liu S. A comparison of five user interface devices designed for point-of-sale in the retail industry. 1995 p. 273-7. [1] Susan F, Barry F. The Role of Usability Testing and Documentation in Medical Device Safety. Istanbul, Turkey 2001 p. 4008-10.
