How to Overcome Barriers for the Implementation of New Information Technologies in Intensive Care Medicine

Poncette, Akira-Sebastian; Meske, Christian; Mosch, Lina; Balzer, Felix

doi:10.1007/978-3-030-22649-7_43

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…This study evaluated the usability of a remote patient-monitoring system (design A) by identifying the individual usability problems that informed the conceptualization and design of a revised prototype version (design B). Most of the usability problems identified were related to labeling, followed by the perceived lack of usefulness of the monitoring system [ 10 , 53 , 54 ]. The UI’s navigation was frequently criticized by participants.…”

Section: Discussionmentioning

confidence: 99%

“…To link a patient to the system, the Admit Patient screen was accessed, and the patient ID was entered, after which the bed location and monitoring device could be selected to complete the admission process ( Figure 3 ) [ 36 - 38 ]. Further technical description and details regarding the use of the software can be found elsewhere [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Effective implementation of novel technologies, such as remote patient-monitoring devices, faces a variety of barriers [ 10 - 12 ], including lack of adoption by clinicians, often because of poor usability of the respective technologies [ 13 - 15 ]. In addition to its importance in successful implementation, usability is closely related to the efficacy of the technology [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation

Poncette¹,

Mosch²,

Stablo³

et al. 2022

JMIR Hum Factors

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Background Continuous monitoring of vital signs is critical for ensuring patient safety in intensive care units (ICUs) and is becoming increasingly relevant in general wards. The effectiveness of health information technologies such as patient-monitoring systems is highly determined by usability, the lack of which can ultimately compromise patient safety. Usability problems can be identified and prevented by involving users (ie, clinicians). Objective In this study, we aim to apply a human-centered design approach to evaluate the usability of a remote patient-monitoring system user interface (UI) in the ICU context and conceptualize and evaluate design changes. Methods Following institutional review board approval (EA1/031/18), a formative evaluation of the monitoring UI was performed. Simulated use tests with think-aloud protocols were conducted with ICU staff (n=5), and the resulting qualitative data were analyzed using a deductive analytic approach. On the basis of the identified usability problems, we conceptualized informed design changes and applied them to develop an improved prototype of the monitoring UI. Comparing the UIs, we evaluated perceived usability using the System Usability Scale, performance efficiency with the normative path deviation, and effectiveness by measuring the task completion rate (n=5). Measures were tested for statistical significance using a 2-sample t test, Poisson regression with a generalized linear mixed-effects model, and the N-1 chi-square test. P<.05 were considered significant. Results We found 37 individual usability problems specific to monitoring UI, which could be assigned to six subcodes: usefulness of the system, response time, responsiveness, meaning of labels, function of UI elements, and navigation. Among user ideas and requirements for the UI were high usability, customizability, and the provision of audible alarm notifications. Changes in graphics and design were proposed to allow for better navigation, information retrieval, and spatial orientation. The UI was revised by creating a prototype with a more responsive design and changes regarding labeling and UI elements. Statistical analysis showed that perceived usability improved significantly (System Usability Scale design A: mean 68.5, SD 11.26, n=5; design B: mean 89, SD 4.87, n=5; P=.003), as did performance efficiency (normative path deviation design A: mean 8.8, SD 5.26, n=5; design B: mean 3.2, SD 3.03, n=5; P=.001), and effectiveness (design A: 18 trials, failed 7, 39% times, passed 11, 61% times; design B: 20 trials, failed 0 times, passed 20 times; P=.002). Conclusions Usability testing with think-aloud protocols led to a patient-monitoring UI with significantly improved usability, performance, and effectiveness. In the ICU work environment, difficult-to-use technology may result in detrimental outcomes for staff and patients. Technical devices should be designed to support efficient and effective work processes. Our results suggest that this can be achieved by applying basic human-centered design methods and principles. Trial Registration ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation

Poncette¹,

Mosch²,

Stablo³

et al. 2022

JMIR Hum Factors

Self Cite

View full text Add to dashboard Cite

show abstract

“…Additional assistance was provided as needed. Further technical description and use of the software can be found elsewhere [ 39 , 40 ].…”

Section: Methodsmentioning

confidence: 99%

“…Our data included interview transcripts and quantifiable results of a questionnaire with key stakeholders in the ICU, informal meetings and discussions among the research group, field observations, and the results of previous explorations [ 39 , 43 ]. The outer setting and manufacturer’s perspective were not part of this study because we could not evaluate these domains with the data given.…”

Section: Methodsmentioning

confidence: 99%

Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study

Mosch¹,

Poncette²,

Spies³

et al. 2022

JMIR Form Res

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Background Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

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Transparency and Trust in Human-AI-Interaction: The Role of Model-Agnostic Explanations in Computer Vision-Based Decision Support

Meske

Bunde

2020

Lecture Notes in Computer Science

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How to Overcome Barriers for the Implementation of New Information Technologies in Intensive Care Medicine

Cited by 10 publications

References 24 publications

A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation

A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation

Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study

Transparency and Trust in Human-AI-Interaction: The Role of Model-Agnostic Explanations in Computer Vision-Based Decision Support

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