Medical Usability

Usability
Guiding
Principles
of Medical

Medical equipments play a vital role in the treatment of critically ill patients and
the medical staff needs to be well versed with its operation. Hence, such a
raising dependence on various medical equipments for patient care is putting
higher demands on user capabilities, which means that the medical staff has to
take significant efforts in learning to operate these equipments. The medical staff
needs to be knowledgeable regarding the details of the medical equipments like
layouts of control panels and switchboards, design of user interfaces, placement
of buttons and knobs related to medical equipments, etc. Several principles in
regards to medical usability are to be taken into consideration while designing
the medical equipments.

30 Jul-Sep 2009 n Medical Equipment & Automation


I
n a developing country like
India, medical facilities and
equipments need to be
enhanced from the point of
view of design and its usability.
When patients arrive at hospitals
for treatment, they lose precious
time in locating the departments
and end up disturbing the
patients as well as the medical
staff, due to lack of standardized
signage system for guidance. At
the time of treating the critically
ill patients, the medical staff
Medical Equipment & Automation n Jul-Sep 2009
Medical Usability
has to quickly decide and act.
Increasing dependence on
various medical equipments for
patient care is putting higher
demands on user capabilities,
which means that the medical
staff has to take significant efforts
in learning to operate these
equipments. This is the time
when layouts of control panels
and switchboards, design of user
interfaces, placement of buttons
and knobs related to medical
equipments matter.
If the layouts of control panels
are not logically arranged or
design of user interface is not
intuitive enough to understand
or the buttons and knobs of
the equipment are not easily
reachable or it is ambiguous
to know which is meant for
what purpose; it can cause
misjudgment, inaccuracy and
delay in starting the medical
treatment. Such usability
problems pertaining to medical
equipments can be very risky for
medical practitioners and cost
the life of a patient.
Role of usability in
the context of medical
equipments
As per International Standards
Organization (ISO), usability
means the “effectiveness,
efficiency and satisfaction with
which a specified set of users can
achieve a specified set of tasks in a
particular environment”. Study of
usability can be more holistic and
even suggest innovative ideas to
overcome the design problems.
The practice of usability in
various specialized domains has
produced different knowledge
about the topic and revealed
different facets. Therefore, it
becomes important to extend
and define the principles of
usability in the context of medical
equipments.
Hospitals use variety of
medical equipments like
ventilator system, defibrillator,
multi-parameter monitoring
system, central monitoring
station, Electrocardiogram (ECG)
analyzer, etc. All such equipments
are helpful in diagnosis,
observations and therapies. Most
Indian hospitals use an interesting
mix of mechanical, embedded
31
 Medical Usability
and computer-based medical
equipments. Such technological
heterogeneity poses major
challenges for integration and
automation in hospitals.
Mechanical age medical
equipments are now undergoing
major technological upgradation
with the advent of embedded
electronic equipments, small
size displays, innovative ways of
interacting with equipments and
ubiquitous applications wherein
the equipments can directly
communicate with each other. On
considering the need of design
enhancements and the possibilities
of technological innovation,
following principles are proposed
to define the medical usability.
The principles are comprehensive
and generic in nature and each
one signifies the most desirable
aspects that need to be addressed.
The design and capabilities of
medical equipments need to be
continually upgraded in the light
of these principles to achieve all
round medical usability.
The principles of medical
usability
Following are the principles of
medical usability that need due
consideration while designing the
medical equipments:
• Application-oriented features -
Medical equipments are
usually designed to provide
very specialized information
inputs to physicians. General
presumption is that physicians
will maintain its record and
apply the information on their
own. For example, glucometer
provides the approximate
concentration of glucose in
the blood. Usually, a diabetic
patient requires to monitor
the levels of glucose for a
number of days. Similarly,
32
Fig.1: Right-handed design of ventilator system
blood pressure needs to
be monitored with greater
frequency for a number of
days. For such requirements,
it will be ideal to have detailed
application-oriented features
to store, manage and analyze
the trends.
• Proactive intelligence -
Most medical equipments
lack intelligence and
require manual intervention.
Intelligent support for error
recovery, inputs to enable the
decision makers in different
situations will be of immense
help. Provision of a library
of settings and proactive
suggestion of templates
could be helpful during
emergency. For example,
ECG analyzer is able to detect
the displacement of its leads
from their standard locations
and provide an alarm to the
medical staff while monitoring
the patient.
• Mobile alerts and forewarnings -
Expert physicians may not be
available for patient monitoring
due to their busy schedule. It is
possible to design the medical
equipments to send mobile
alerts directly to physicians for
updating them about changing
health condition of patients.
Certain forewarnings could also
be given so as to plan out the
actions in advance.
• Integration and connectivity
with associated equipments -
Hospitals use heterogeneous
type of equipments
like ventilator systems,
electrocardiogram (ECG)
analyzers, Magnetic
Resonance Imaging (MRI)
scanners and multi-parameter
monitoring systems and
many more. Some of them
are mechanical, electronic or
computer based. It is necessary
to bring technological
homogeneity among these
equipments so that it will be
possible to integrate them,
link them together through
Jul-Sep 2009 n Medical Equipment & Automation

LAN, Bluetooth, infrared or
WiFi technology. This can
help in co-relating the data
being received from different
sources and in synchronizing
the process of diagnosis as
well as therapy.
• Storage and retrieval of patient
data -
Medical equipments often have
the limited storage capacity.
Patient data is stored only for
the current patient. When a new
patient is connected it deletes
the data pertaining to the earlier
patient. It should be possible to
provide unique patient ID and
store multiple patient records
for a specified period for faster
and accurate retrieval of data
when required.
• Neutrality towards left and right-
handed users and ergonomic
design -
Most medical equipments
are designed only for right-
handed users (Refer Figure
1). It is clearly reflected in
the layout of control panel,
placement of knobs and
Medical Usability
buttons. Such design may not
prove efficient for left-handed
users. Therefore, neutrality
for both left and right-handed
users and ergonomic design
are most desirable.
• Manual and remote control -
There are many patients being
treated in Intensive Care Unit
(ICU) or other hospital wards.
Physicians and support
staff controls most of these
equipments manually. Remote
controllability of these equipments
may prove very effective in
reducing the disturbance for
other patients, maintaining the
cleanliness of equipment due to
reduced handling and for faster
actions. Therefore, manual and
remote both type of controls are
essential.
• Adaptability to changes in
patient condition -
Medical equipments should
dynamically respond to
changing health conditions
of the patient whenever need
arises. Many ventilator systems
adjust the artificial respiratory
rate according to the criticality
of the patient.
• Context awareness -
Medical equipments need
to be enriched with sensors
to understand the context in
terms of environmental and
circumstantial changes.
• Contextual help / guidance in
English and regional languages
-
User manuals with medical
equipments are often not
readable for assisting medical
staff as the information is
presented in English or foreign
languages like French or Dutch.
User manuals need to be
translated in Indian languages
like Hindi and other regional
languages. The manuals
are often not locatable when
needed. Therefore, contextual
and online help should be
provided in the equipment itself.
It is important to note that the
guiding principles of medical
usability are more technological in
nature and highlight the essential
capabilities for effective use. Ì

Ganesh Bhutkar is Computer Engineering and Management postgraduate and currently pursuing PhD in Medical
Usability. He is an Assistant Professor at Vishwakarma Institute of Technology, Pune, India. He has about 14 years of
academic experience and has published about 15 research papers. He is a member of reviewer board with International
Journal of Human-Computer Studies - Elsevier..

Ganesh Bhutkar

Dr. Dinesh Katre is presently heading the Human-Centred Design and Computing Group at C-DAC, Pune. He has Ph.D.
in Human-Computer Interaction from Birla Institute of Technology and Science, Pilani and Master of Design from Indian
Institute of Technology, Mumbai. He has 17 years of professional experience related to design / usability research and
information technology applications.

Dr. Dinesh Katre

Medical Equipment & Automation n Jul-Sep 2009 35