Can anyone identify the technology in this scene?

What do nuclear power plants have to do with healthcare?

As we will see, the human technology interface has a lot in common in high tech, complex, teamwork environments such as nuclear power plants, ICUs and operating suites.

Here we have an elephant on water skis. This question which is the main theme of evaluating the human-tech interface: What could possibly go wrong?
If we think of the elephant as health care systems, water skis as the technology, and the motorboat as humans in their workflow, we can wonder -what happens when all three are combined? Is the outcome always safe, effective, satisfying, and predictable? Often, it is not, because many things can go awry in the HTI (human-tech interface.)

Health care examples: badge reader, clock punch, infusion pump, smartphone, defibrillator, anesthesia machine, EHR

the interface often presents information - information may be presented graphically, using text, numbers, icons, images, sound
may be controlled via keyboards, digital pens, voice activation, touch, or tactile manipulation
input and output may be auditory, visual, or tactile.

Difference between interface and interaction -
The situation or occurrence in which two or more objects or events act upon one another to produce a new effect; the effect resulting from such a situation or occurrence.
Interface • The connection between a user and a machine.

Problems with the human-technology interface can be summarized as the six E's. (made up by me)

Rice and Tahir (2014) summed up problems in the HTI by stating "recent studies have found that rapid implementation of new medical technology ...can lead to adverse patient events when it is not thoughtfully integrated into workflow. The right processes require understanding the devices and the users. Testing in controlled environments often does not adequately consider "the human factor" or how people interact with technology in high-pressure, real-life situations."

workarounds - are a way of circumventing troublesome tech to get the job done. As nurses we are all resourceful and we all have used workarounds when workarounds are at best, a bandaid on a systems problem , a delay to meaningful change, and at worst, a cause of patient safety issues that may harm the patient.
Vicente in 2004 cited the many safety issues identified in the 1999 IOM report, and as a case in point, described his study of nurse use of a PCA pump errors in which medication errors by nurses were linked to the number of steps to program the pump. When 27 steps were needed for programing,errors increased, an d when program steps were reduced to 12 steps, then PCA pump medication errors decreased. In 2005 Koppel reported that a Computer Based PROvider Order entry system meant to reduce medication errors actually increaed 22 types of errors due to mutliple Human Tech interface issues. Remember that more tech does not mean better healthcare or safety - it is the interface between the human and the machine that determines efficacy and safety.
ERgonomic injuries -we are all familiar with Musckuloskeletal overuse syndromes from clicking and mousing. Text neck. And in 2014 Longo and Reese desribed Computer Vision Syndrome with symptoms including fatigue, blurred vison, headache, irritated eyes, neck aches, backaches, and double vision. They remind us to look 20 feet away from your screen every 20 minutes for a minim of 20 seconds.

Link to Video: https://youtu.be/xB_tSFJsjsw

This 4 minute video features Dr. Zubin Damania, an advocate for health care reform, who goes by the name ZDogg MD. This video came out in 2015, so many of you have seen it. Even if you have seen it before, watch it again thru the eyes of the human -technology interface.
Video – questions to ask as you watch - can you identify the six E's of the human-tech interface expressed in the video?
- What is the user experience?
- Identify the clinician feelings of satisfaction or dissatisfaction
- How many clicks to prescribe an ambien?
- how do autocorrect terms impeded charting?
- Pop up distractions
- Alarm fatigue
- Too many clicks to achieve task
- Ergonomic issues
- Lack of end-user collaboration in design and evaluation
- Health care lag in innovation compared to other industries?
- What is the link between EHR exasperation and Clinician burnout?
- How does lack of chart sharing in Electronic Silos between agencies affect patient care? This video and lyrics address all of these issues of the human-technology interface - see which ones you can name as you watch.
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Effken in 2016 proposed the ecological approach to interface design. The field of ecological psychology emerged after the 3 mile Island nuclear disaster. This approach has been applied to many arenas of complex operator processes, including ICUs, operating suites and nuclear power plants. Ecological displays can help controllers more easily identify deviations from normal processes. Effken proposes that we can apply the ecological approach to the goal of an EHR that is more meaningful, transparent, and more useful.

Accoringing to McGonigle and Mastrian (2018), there are three axioms for effective human-technology interactions.
The first one is:

phrase comes from Rubin, 1994 who used the term user-centered design.
The concept of
Minimal effort and maximal efficiency is also an axiom likely originated from a Japanese term often used in martial arts.

Good technology design that accomplishes minimal effort and maximal efficiency comes from designers understanding the task, the user, and the user environment. Designers of technology have a variety of tools to analyze their design.
Task analysis - understanding what the task actually entails so that the human and the machine can accomplish the task together.
Cognitive task analysis - involves studying experts at the task, and their cognitive steps that lead to task competency. Cognitive task analysis is often used to create training programs.
Cognitive work analysis was developed specifically for complex, hi tech, teamwork work domains (includes work enviroments of ICUs, operating room, L&D teams, and nuclear power plants) and investigates how work is actually done by actual users.

when a nurse user implements a human-tech interface design, a critical nurse user will identify problems, and those problems could lead to frustration and use of some choice words. The doctorally prepared nurse informatics specialist on a design team will recognize that identification, evaluation, and correction of problems is part of the design process.

Ub 1988, Donald Norman described principles of design
1. Design for both the environment and the user and most importantly for how the environment and the user relate to each other
2. mapping is a design principle that describes how facts are presented by information displays, such as how an ICU monitor maps heart rate and rhythm
3. the principle of simplifying recognizes that fewer steps or screens to complete a task is better. why have 30 clicks to prescribe an Ambien, as in the ZDogg video, when you could use two?
4. Constraints exist - recognize them and design around them. constraints can include that humans have to turn our heads to see to the side, or that organizational policies constrain tasks.
5. my favorite - mistakes happen. design for error. tech should eliminate predictable errors, but there will always be unpredictable errors, so tech should be flexible to allow users to identify and recover from inevitable unpredictable errors.
6. Standardize means that systems work better when everything is standard and can interface iwth everything else, for example, imagine if we had a standard computer (not mac vs windows) or a standard phone charge (not iphone vs android)
7. When you make things visible, you eliminate the Gulf of execution, meaning the gap between knowing the goal (programming the PCA pump) and seeing how to do it on the machine.
Jakob Nielsen worked with Don Norman
https://www.youtube.com/watch?v=hWc0Fd2AS3s

Link to Video: https://www.youtube.com/watch?v=hWc0Fd2AS3s

example - nursing and EHR
Survey nurses to assess preferences in EHR design, menu, icons, layout

Focus groups of nurses so that designers could better udnerstnad nurses responses to charting and what content is meaningful and valuable

Cognitive walkthrough means using a working prototype to test a completed interface with typical tasks to help designers better understand the users -nurses and the tasks of patient care and charting

Usability tests means designers observing actual nurses using the interface to accomplish real world tasks, for example, using a MAR.

Field studies means using a prototype in the actual work setting of patient care before general release so that workflow and needed modifications can be identified. This is the most expensive kind of evaluation and the least used.
A heuristic evaluation advantages - easy to do and economical. typically uses 10 or fewer experts who evaluate the degree to which the design complies with recognized principles of design who can identify problems before implementation. One way to remember the meaning of heuristic is that it is a big word that means a mental shortcut.
FITT (Ammenwerth, Iller and Mahler (2006) model is
Fit between Individuals, Tasks, and Technology

User and technology
Task and technology
User and task

Adapt the tech to the user and the task, don’t just expect the user to adapt to the tech.

Summary. We have a long way to go in HTI improvement. Doctorally prepared nurse practitioners need to understand these principles of design, analysis, safety issues, because NPs have the education and the clinical wisdom to transform health care. Technology is so integrated into health care that whatever we do, we will be using technology in our transformative work. Butterfly symbolizes transformation
The design industry has many helpful tools for analysis, design and evaluation that hsould be used in all phases of health care tech devleopment life cycle.

Interface between humans and tech is a significant source of either errors or safety. When engineers and clinicians collaborate, as in anesthesiology, patient safety increases. Vicent, 2004, descibed how anestheisa-related deaths decreased from 2 in 20,000 to 1 in 200.000 as a result of interface improvements. One practical example is changing hoses and ports so that the wrong hose can't be plugged into the wrong port. Many such interace improvements are needed with increasing use of technolgy that health care workers interface with.