CHI+MED: Multidisciplinary Computer-Human Interaction research for the design and safe use of interactive medical devices

Lead Research Organisation: University College London
Department Name: UCL Interaction Centre

Abstract

Patient safety is a major concern. Reliance on interactive medical devices is growing, both in clinical settings and, increasingly, for patients without direct clinical supervision. The usability and reliability of such devices is critical. For example, decimal points are a well-known source of error (e.g., .5mg misread as 5mg), yet few devices detect decimal keying errors. Considering the broader context of use, a nurse familiar with one kind of infusion pump may absent-mindedly use the same set-up procedure on a similar one, leading to incorrect dosage. These and other user programming errors cause patient deaths. Even when devices are programmed correctly, interaction difficulties raise workload and stress, increasing overall system vulnerability. For example, it is common for clinicians to turn pumps off and on to reset the state, but patient data may be lost in the process and need to be re-entered. Better interaction design, the focus of CHI+MED, will improve safety by a scientific approach to understanding and designing out latent errors. It will have very broad impact because interactive systems are encroaching everywhere in healthcare. CHI+MED complements other initiatives on the ergonomics and engineering of safer devices.CHI+MED is multidisciplinary. A combination of empirical approaches, drawn from the disciplines of HCI, computer science, psychology and the social sciences, will be applied. Empirical findings will build on, be subjected to, and be challenged by precise computational representation and reasoning. This will support integration across perspectives and generalisation of findings, as well as enforcing a distinctive rigour in all aspects of analysis. The CHI+MED approach will advance, and transform, the science of user-device interactions and the design of interactive medical devices.We will investigate which device properties are most important from safety and usability perspectives (relating to whether adverse incidents can occur, whether there are unsafe inconsistencies between device behaviours under similar conditions, etc.), and which system descriptions best support reasoning about them. We will study the causes of errors when interacting with devices and how a better science of error can improve design. This will include factors affecting slips such as stress, attention, task structure and the design of cues and feedback. We will also study the broader situational factors that provoke or mitigate interaction errors (interruptions may provoke errors; colleagues checking may mitigate them, etc.). CHI+MED will deliver a significantly better understanding of interaction design and associated cognitive and situational factors, new tools to support design and evaluation, underlying better informed standards and incident investigations, and more resilient practices.As well as addressing new scientific questions that generalise beyond the medical domain, CHI+MED will develop a dialogue with stakeholders, to raise awareness of the role of interaction design in medical errors and to develop evidence-based techniques for designing medical devices that mitigate potential errors while accommodating the cultures and processes of stakeholder groups. It will draw on research in Public Engagement and Knowledge Transfer, and explore the appropriateness and effectiveness of different approaches for different contexts. We will investigate how informed principles and tools can help developers to design more reliable and usable devices, identify factors that influence design and procurement decisions, and explore how stakeholders can be better informed about interaction design.CHI+MED involves and integrates three leading groups on a single, focused problem. It will contribute to the UK's status as an international leader in research in multidisciplinary, rigorous HCI, and make significant and informed contributions to the international agenda on design for patient safety.
 
Title HCI engineering: Upfront effort and downstream payback 
Description [An abstract of this video is published in: Proceedings of the 2013 Conference on Human Factors in Computing Systems (CHI-2013), Extended Abstracts, 2807. New York: ACM. (Video showcase abstract.) Also available at http://www.chi-med.ac.uk/researchers/bibdetail.php?docID=648. In an age where HCI research is embracing softer approaches, we must not neglect the practical value of engineering research for HCI. This video challenges the assumption that engineering interactive systems takes a lot of effort with little pay-back or reward. We take CANCEL as an example. Not many people think about the challenges of implementing CANCEL effectively even though CANCEL buttons pervade modern life. Adding CANCEL is not just about adding a button: the processes behind the button needs to work, accurately, reliably, and in a timely way. Engineering research for HCI combines science, guidance and tools to make better products faster. In one study a company measured their return on investment as high as 17 to 1. This video provokes debate about the importance of engineering for HCI. 
Type Of Art Image 
 
Description This project studied the use, usability and safety of interactive medical devices. These include infusion devices for delivering drugs and fluids intravenously, machines used to support people with chronic kidney disease, and measuring devices used by people with diabetes. We have developed methods for assessing the user interfaces, and also ways of better understanding the needs of people using these devices.
Exploitation Route This work is of immediate relevance to people concerned with patient safety, particularly in relation to the use of interactive medical devices (such as infusion devices and haemodialysis machines). This includes clinicians, those involved in health policy, those responsible for procurement of new equipment, and also design and development teams working on the next generation of interactive medical devices. See http://www.chi-med.ac.uk/insights/index.php for a summary of the outcomes from the programme.

We have produced a collection of resources for health services professionals, including developers, policy makers, and those involved in procurement, focusing on infusion technology. See http://www.chi-med.ac.uk/research/industrypublications.php
Sectors Digital/Communication/Information Technologies (including Software),Healthcare

URL http://www.chi-med.ac.uk/
 
Description The findings are being used for checking the safety of current and future medical devices and have informed MHRA policy on human factors for medical devices (https://www.gov.uk/government/publications/guidance-on-applying-human-factors-to-medical-devices). Our methodological work is advancing methods for identifying user needs for future devices.
First Year Of Impact 2013
Sector Digital/Communication/Information Technologies (including Software),Healthcare
Impact Types Societal,Policy & public services

 
Description MHRA Keynote talk
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact The outcomes of that meeting have included the establishment of a Task and Finish Group (on which I now serve) to review the role of human factors in medical device regulation.
 
Description MHRA Task & Finish group on Human Factors in device regulations
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description CareErrs (Furniss)
Amount £2,000 (GBP)
Organisation University College London 
Sector Academic/University
Country United Kingdom
Start 06/2014 
End 06/2015
 
Description Exploring the Current Landscape of Intravenous Infusion Practices and Errors (ECLIPSE)
Amount £556,803 (GBP)
Funding ID 12/209/27 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 07/2014 
End 06/2017
 
Description FP7 - TACTIC
Amount £242,552 (GBP)
Organisation European Commission 
Sector Public
Country European Union (EU)
Start 06/2014 
End 10/2017
 
Description PAMBAYESIAN
Amount £1,538,497 (GBP)
Funding ID EP/P009964/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Academic/University
Country United Kingdom
Start 05/2017 
End 04/2020
 
Description Travel Award (Blandford)
Amount £6,000 (GBP)
Organisation The Royal Society 
Sector Academic/University
Country United Kingdom
Start 02/2013 
End 02/2014
 
Description FDA 
Organisation Food and Drug Administration (FDA)
Department Center for Devices and Radiological Health
Country United States 
Sector Public 
PI Contribution Applying research findings to regulatory policy in interaction design of medical devices.
Collaborator Contribution Ensuring practical relevance of research findings.
Impact A joint publication (listed elsewhere). Formal methods & Human-Computer Interaction
Start Year 2010
 
Description MHRA 
Organisation Medicines and Healthcare Regulatory Agency
Country United Kingdom 
Sector Public 
PI Contribution Advising on human factors for medical device design, contributing to MHRA consultation meetings on this topic, and contributing to the authoring of MHRA guidance on human factors for medical devices (currently in draft form).
Collaborator Contribution Facilitating the impact of research on practice in medical device regulation.
Impact Report still at draft stage.
Start Year 2015
 
Description NHS England 
Organisation NHS England
Country United Kingdom 
Sector Public 
PI Contribution New interpretations of NRLS data to inform future incident reporting.
Collaborator Contribution Data sharing agreement giving access to NRLS incident data to complement other data sources informing research
Impact Ongoing. HCI and Pharmacy
Start Year 2014
 
Description Acharya magazine article 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Publication in (members-only) magazine of British Academy of Audiology:
Hearing aid battery ingestion: Medical error or poor design?
Authors: Chitra Acharya, Vinaya K. C. Manchaiah, Alexis Lewis, and Harold Thimbleby
Summer 2014, 31, 27-28
Year(s) Of Engagement Activity 2014
 
Description Errordiary 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Errordiary is about sharing errors so people can think about human error in a new way. We already know that the same psychological principles lie behind everyday errors and those errors of a more serious nature. Whether they are funny, frustrating or fatal depends on the context. Whatever context you find yourself in you can share your errors via Twitter. You can also favourite and comment on the ones already displayed on this site. Reflecting on the errors we make may lead to insights, which can be used to develop a more detailed understanding of their causes.
Year(s) Of Engagement Activity 2010,2011,2012
URL http://www.errordiary.org/
 
Description Final report "glossy" 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This booklet summarises the key outcomes from the CHI+MED programme grant, as realised in its final year. It is too early to assess significant impact of the booklet, but a range of practitioners have received it and requested copies.
Year(s) Of Engagement Activity 2016
URL http://www.chi-med.ac.uk/insights/index.php
 
Description NHS England / MHRA symposium for Medication Safety Officers and Medical Device Safety Officers (MSOs / MDSOs) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This is one of a series of interactive presentations to obtain feedback on preliminary findings from ECLIPSE and build dialogue with key practitioners. Also presented findings from CHI+MED study of NRLS incident reports.
Year(s) Of Engagement Activity 2017
 
Description Standing up for science 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Performing stand up comedy has allowed me to share my work with people who otherwise I'd never have had a chance to talk to. I'd recommend the experience to anyone who wants to improve their presentation skills, or get more involved in public engagement.

tbc
Year(s) Of Engagement Activity 2013
URL http://www.chi-med.ac.uk/researchers/bibdetail.php?docID=695
 
Description cs4fn magazine - Machines making medicine safer 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact cs4fn is an outreach magazine which aims to enthuse school age children about computing. Issue 17 was specifically about the CHI+MED project and how computer scientists work with ergonomists and human factors researchers to make interactive medical devices safer.

The electronic copy has been downloaded over 6,000 times and around 14,000 print copies were sent (as class sets) to schools and given away at events (science festivals and fairs etc). Most of the feedback is from teachers who tell us that they use articles in the magazine in their classroom for discussion, or leave copies in the library for pupils to read.

We've been asked to send copies in bulk to events at Microsoft Research Ltd, TeenTech and the Computing At Schools conference.
Year(s) Of Engagement Activity 2014
URL http://chimedblog.wordpress.com/2014/04/03/machines-making-medicine-safer-chi_med-joins-forces-with-...