merlin.net remote care system: a human factors approach to understanding workflow
DESCRIPTION
Merlin.net Remote Care System: A Human Factors Approach to Understanding Workflow. Joy Hamerman Matsumoto. Introduction. St Jude Medical Cardiac Rhythm Management Division manufactures implantable cardiac devices Pacemakers Implanted defibrillators - PowerPoint PPT PresentationTRANSCRIPT
Merlin.net Remote Care System: A Human Factors Approach to
Understanding WorkflowJoy Hamerman Matsumoto
St Jude Medical Cardiac Rhythm Management Division manufactures implantable cardiac devices◦ Pacemakers◦ Implanted defibrillators
Many newer devices are capable of remote communication between the device and a web-based data base
Clinicians perform both review of remote care data and in-clinic patient follow ups
Introduction
3
St. Jude MedicalCardiac Rhythm Management Division focus on devices
and platforms that diagnose and treat heart disease
St Jude deploys a web-based system, Merlin.net, for remote follow ups
Patient devices communicate through a transmitter in their home to the web portal
Clinicians use Merlin.net to enroll patients in remote care, to schedule remote care “appointments” and to review patient data
Clinicians log into Merlin.net on a regular basis to assess patient and device status
Merlin.net remote care system
5
Management recognized that users work with multiple computer systems to perform their work
Our understanding of the workflow that defines remote care of patients was limited to our product in isolation
To better integrate our product into the overall workflow, we needed to gain an understanding of users’ tasks and system interactions as it relates to remote care
Expand our knowledge
Most clinicians use multiple software systems to manage their patients◦ Scheduling programs◦ Electronic medical records◦ Device manufacturers web-based programs
Systems are not integrated and do not share information
The addition of these multiple systems has impacted the workflow for clinicians
What can we do to improve users’ workload and impact user satisfaction?
Value of the research
Teams of Human Factors and Clinical Systems Engineers conducted all research
Human Factors Engineers◦ Trained in cognitive psychology, interface design
and studying human behavior◦ Use these principles to guide design of equipment
and systems◦ Knowledgeable in structuring research and
analyzing results Clinical Systems Engineers
◦ Partners in working with our users◦ Knowledge of clinical applications and practices◦ Biomedical engineering background
Roles and definitions
Used a contextual inquiry approach◦ Puts the researcher in the users’ environments◦ User-centered design method that enables
collection of detailed work practices through observation and interview
◦ Used to understand how and why tasks are done Visited 13 clinics in the U.S. and 7 clinics in
Europe◦ Total of 28 participants
Summarized data to detail tasks, time, obstacles
How did we collect data?
Enrollment◦ Enter patient information so the patient can perform
remote transmissions Scheduling
◦ Arranging each patient’s schedule for remote follow ups and in-clinic appointments
Reviewing Transmissions◦ Patient data recorded on the device is available for
review Patient Management
◦ Follow up to ensure patients are complying, answering patient questions, reminders for appointments
What are clinicians doing?
Q: Do you perform these tasks?
Enrollm
ent
Sched
uling
Revie
wing Tr
ansm
ission
s
Alert M
anagem
ent
Billin
g Docu
mentati
on
In-clin
ic *0%
20%
40%
60%
80%
100%
75%
96%86% 89%
46%
68%
Percentage of people interviewed who answered yes
Enrollment Workflow
Schedule next follow-up
Deliver letter to mail outbox
Patient Chart is completed
Update EHR; Update Schedule
Print patient reminder
Retrieve Patient Info
Receive Chart
Log-in to Remote Care System
Enrollment system
Schedule Workflow
Resource pageTransmissions page
Edit Schedule page
Scheduling is the most frequent task in remote care Multiple system interactions are necessary to schedule
Schedule page
Modify schedule
Update Schedule(s) EHR
Access RC site Check transmission
Determine next date Access RC
siteManage
transmission
Proliferation of electronic records and software systems have mixed results◦ Some tasks are easier and less error prone◦ Different user interfaces and need for multiple
passwords causes frustration Users learn multiple methods of
accomplishing similar tasks (little transfer of knowledge)
Clinicians are wary of Electronic health records – lack of integration; multiple data entry points
General Findings
Europe U.S.More integrated electronic health records
Slow adoption of electronic health records
Physicians use our system with little help from SJM personnel
SJM personnel often available to provide on-site assistance to support physician
IVR systems are used and the translations are not optimal
IVR systems are used; some messages are confusing
Transmitters paired and given to patients in clinic
Transmitters mailed to patients’ homes (this has recently changed)
Differences between Europe and U.S. users and systems
Localization challenges Difficult to accommodate text expansion on
certain screens – technical constraints / character limitations
Support for locales in IVR format only – no written support for language
Dynamic web interface – ownership of content varies by placement of content (regulatory versus marketing)
Adequate review of content by local subject matter experts (Chinese champion reviews the Simplified Chinese GUI for correct usage)
Items identified as issues in the study are prioritized for implementation◦ Many concerns addressed in the current
development plan Positioned Human Factors team to be
included earlier in development planning◦ Identify key customer issues ◦ Design, iterate and evaluate changes to the user
interface Maintain awareness of customer workflow in
a broader sense to improve the experience and reduce inefficiencies
Conclusions
Thank you