Toward a More Usable Home-Based Video Telemedicine System: A Heuristic Evaluation of the Clinician User Interfaces of Home-Based Video Telemedicine Systems

The effect of telepractice on vocal turn-taking between a provider, children with cochlear implants, and caregivers: A preliminary report

OBJECTIVES

To examine the effect of telepractice on vocal turn-taking between one clinical provider and children with cochlear implants and their caregivers during child-centered auditory rehabilitation intervention.

METHODS

Seven dyads of children with cochlear implants (mean age 4:11 years) and their hearing mothers and one speech-language pathologist participated together in a telepractice session and an in-person intervention session. Dependent variables were vocalization rate, turn taking rate, rate of speech overlap per second, and between-speaker pause duration.

RESULTS

The speech-language pathologist and children had lower rates of vocalization in the telepractice session than the in-person session. However, maternal vocalization rate was higher in the telepractice than in-person session. The rate of turn-taking between the provider and children was lower in telepractice than in-person sessions but the rate of turn taking between mothers and children was higher in telepractice than in-person sessions. Between-speaker pause duration between children and the provider and between mothers and children was longer in telepractice than in-person sessions. Rate of speech overlap did not vary significantly by session type.

DISCUSSION

The quantity and temporal characteristics of vocal turn-taking were impacted by remote communication during tele-intervention suggesting a potential increase in the cognitive effort required of participants.

A machine learning and blockchain based secure and cost-effective framework for minor medical consultations

With the ever-increasing awareness among people regarding their health, visiting a doctor has become quite common. However, with the onset of the COVID-19 pandemic, home-based consultations are gaining popularity. Nevertheless, the worries over privacy and the lack of willingness to assist patients by the medical professionals in the online consultation process have made current models ineffective. In this paper, we present an advanced protected blockchain-based consultation model for minor medical conditions. Our model not only ensures users’ privacy but by incorporating a calculation model, it also offers an opportunity for consulting end-users to voluntarily take part in the consultation process. Our work proposes a smart contract based on machine learning to be implemented for the prediction of a score of a professional who consults based on various prioritized parameters. This is done by using word2vec and TF-IDF weighting to classify the question and cosine similarity scores for detailed orientation analysis. Based on this score, the patient is charged, and simultaneously, the responder is awarded ether. An incentivized method leads to more accessible healthcare while reducing the cost itself.

Usability of Telemedicine Mobile Applications during COVID-19 in Saudi Arabia: A Heuristic Evaluation of Patient User Interfaces

The coronavirus disease 2019 (COVID-19) pandemic has impacted the use of telemedicine application (apps), which has seen an uprise. This study evaluated the usability of the user interface design of telemedicine apps deployed during the COVID-19 pandemic in Saudi Arabia. It also explored changes to the apps’ usability based on the pandemic timeline. Methods: We screened ten mHealth apps published by the National Digital Transformation Unit and selected three telemedicine apps: (1) governmental “Seha”^® app, (2) stand-alone “Cura”^® app, and (3) private “Dr. Sulaiman Alhabib”^®app. We conducted the evaluations in April 2020 and in June 2021 by identifying positive app features, using Nielsen’s ten usability heuristics with a five-point severity rating scale, and documenting redesign recommendations. Results: We identified 54 user interface usability issues during both evaluation periods: 18 issues in “Seha” 14 issues in “Cura”, and 22 issues in “Dr. Sulaiman Alhabib”. The two most heuristic items violated in “Seha”, were “user control and freedom” and “recognition rather than recall”. In “Cura”, the three most heuristic items violated were “consistency and adherence to standards”, “esthetic and minimalist design”, and “help and documentation” In “Dr. Sulaiman Alhabib” the most heuristic item violated was “error prevention”. Ten out of the thirty usability issues identified from our first evaluation were no longer identified during our second evaluation. Conclusions: our findings indicate that all three apps have a room for improving their user interface designs to improve the overall user experience and to ensure the continuity of these services beyond the pandemic.

An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care

Telemedicine implementation in ambulances can reduce time to treatment for stroke patients, which is important as "time is brain" for these patients. Limited research has explored the demands placed on acute stroke caregivers in a telemedicine-integrated ambulance system. This study investigates the impact of telemedicine on workload, teamwork, workflow, and communication of geographically distributed caregivers delivering stroke care in ambulance-based telemedicine and usability of the system. Simulated stroke sessions were conducted with 27 caregivers, who subsequently completed a survey measuring workload, usability, and teamwork. Follow-up interviews with each caregiver ascertained how telemedicine affected workflow and demands which were analyzed for barriers and facilitators to using telemedicine. Caregivers experienced moderate workload and rated team effectiveness and usability high. Barriers included frustration with equipment and with the training of caregivers increasing demands, the loss of personal connection of the neurologists with the patients, and physical constraints in the ambulance. Facilitators were more common with live visual communication increasing teamwork and efficiency, the ease of access to neurologist, increased flexibility, and high overall satisfaction and usability. Future research should focus on eliminating these barriers and supporting the distributed cognition of caregivers.

Evaluation is Key: Providing Appropriate Evaluation Measures for Participatory and User-Centred Design Processes of Healthcare IT

INTRODUCTION

The increasing availability of healthcare IT has the potential to improve the integration of health services. Existing projects developing healthcare IT mostly disregard the potential and importance of incorporating user feedback and proper evaluation measures to gain user feedback throughout the development process. We therefore provide methodological guidance for evaluation in a stepwise user-centred design process.

METHODS

Based on a literature review we propose adequate methods for data collection in each phase of participatory and user-centred healthcare IT development. In order to provide an orientation within the plethora of development processes used in practice, we consolidate a generic blueprint process from the literature review. The applicability of our methodological guidance is shown in three diverse use cases from the field of integrated care.

RESULTS

From 14 literature items, we identified common evaluation methods including, among others, interviews, focus groups, and surveys. These methods can be associated to six typical development phases that could be derived from research: State of the Art Research, Requirement Analysis, Conceptual Prototype, Preliminary Prototype, Full Prototype, Full Application. The use cases demonstrate the value of qualitative methods and mixed methods designs.

DISCUSSION

Our methodological guidance has proven applicable for designing healthcare IT solutions from scratch - both for patient and professional settings - and to develop a platform for combining existing component-based solutions. In integrated care settings, where a wide range of stakeholders with multiple needs exist, we thus provide methodological guidance on how to involve users in the development process.

CONCLUSION

Our stepwise methodological guidance helps to design and properly evaluate healthcare IT solutions, which meet the user needs and requirements, for integrated care settings.

Automated Computer Vision Assessment of Hypomimia in Parkinson Disease: Proof-of-Principle Pilot Study

BACKGROUND

Facial expressions require the complex coordination of 43 different facial muscles. Parkinson disease (PD) affects facial musculature leading to "hypomimia" or "masked facies."

OBJECTIVE

We aimed to determine whether modern computer vision techniques can be applied to detect masked facies and quantify drug states in PD.

METHODS

We trained a convolutional neural network on images extracted from videos of 107 self-identified people with PD, along with 1595 videos of controls, in order to detect PD hypomimia cues. This trained model was applied to clinical interviews of 35 PD patients in their on and off drug motor states, and seven journalist interviews of the actor Alan Alda obtained before and after he was diagnosed with PD.

RESULTS

The algorithm achieved a test set area under the receiver operating characteristic curve of 0.71 on 54 subjects to detect PD hypomimia, compared to a value of 0.75 for trained neurologists using the United Parkinson Disease Rating Scale-III Facial Expression score. Additionally, the model accuracy to classify the on and off drug states in the clinical samples was 63% (22/35), in contrast to an accuracy of 46% (16/35) when using clinical rater scores. Finally, each of Alan Alda's seven interviews were successfully classified as occurring before (versus after) his diagnosis, with 100% accuracy (7/7).

CONCLUSIONS

This proof-of-principle pilot study demonstrated that computer vision holds promise as a valuable tool for PD hypomimia and for monitoring a patient's motor state in an objective and noninvasive way, particularly given the increasing importance of telemedicine.

Leveraging health system telehealth and informatics infrastructure to create a continuum of services for COVID-19 screening, testing, and treatment

Objectives

We describe our approach in using health information technology to provide a continuum of services during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 challenges and needs required health systems to rapidly redesign the delivery of care.

Materials and Methods

Our health system deployed 4 COVID-19 telehealth programs and 4 biomedical informatics innovations to screen and care for COVID-19 patients. Using programmatic and electronic health record data, we describe the implementation and initial utilization.

Results

Through collaboration across multidisciplinary teams and strategic planning, 4 telehealth program initiatives have been deployed in response to COVID-19: virtual urgent care screening, remote patient monitoring for COVID-19–positive patients, continuous virtual monitoring to reduce workforce risk and utilization of personal protective equipment, and the transition of outpatient care to telehealth. Biomedical informatics was integral to our institutional response in supporting clinical care through new and reconfigured technologies. Through linking the telehealth systems and the electronic health record, we have the ability to monitor and track patients through a continuum of COVID-19 services.

Discussion

COVID-19 has facilitated the rapid expansion and utilization of telehealth and health informatics services. We anticipate that patients and providers will view enhanced telehealth services as an essential aspect of the healthcare system. Continuation of telehealth payment models at the federal and private levels will be a key factor in whether this new uptake is sustained.

Conclusions

There are substantial benefits in utilizing telehealth during the COVID-19, including the ability to rapidly scale the number of patients being screened and providing continuity of care.

An empirical study investigating the user acceptance of a virtual conversational agent interface for family health history collection among the geriatric population

Critical for the early diagnosis of genetic disorders, a Family Health History (FHx) can be collected in several ways including electronic FHx tools, which aid easy editing and sharing by linking with other information management portals. The user acceptance of such systems is critical, especially among older adults experiencing motor and cognitive issues. This study investigated two types of FHx interfaces, standard and Virtual Conversational Agent (VCA), using 30 young (between 18 and 30) and 24 older participants (over 60). Workload, usability and performance data were collected. Even though participants required less time to complete three of five tasks on the standard interface, the VCA interface performed better in terms of subjective workload and usability. Additionally, 67% of the older adults preferred the VCA interface since it provided context-based guidance during the data collection process. The results from this study have implications for the use of virtual assistants in FHx and other areas of data collection.

Asking the Right Questions-Human Factors Considerations for Telemedicine Design

Purpose of Review

The goal of this paper was to provide a narrative review of human factors considerations for telemedicine. It also sought to provide readers a foundation of human factors thinking and methods that could be employed within their own practice.

Recent Findings

There are only a handful of articles that discuss the importance of user-centered design and human factors principles in relation to telemedicine systems.

Summary

Most articles come to the conclusion that design flaws could have been avoided by involving stakeholders in the design and implementation of telemedicine. However, many of them lack the guidance for those who find themselves having to choose, implement, or use unwieldy systems. With this in mind, this paper provides a series of human factors principles, real-world questions, methods, and resources for those who may find themselves considering, implementing, sustaining, or using telemedicine in their own healthcare settings.

Evaluation of rural public libraries to address telemedicine inequities

Access to home-based telemedicine is inequitably distributed in the United States due to the limited reach of fixed broadband in rural areas. Public libraries typically offer patrons free access to broadband. Libraries, particularly those in rural regions, need to be evaluated as sites for patients to connect to a health care provider over a video visit. The purpose of this research was to evaluate the technological readiness of public libraries to provide telemedicine support and to determine differences in readiness between rural and urban public libraries. We distributed a survey to Virginia librarians to evaluate technological readiness of their libraries to support telemedicine. Respondents from 39 libraries completed the survey, approximately one third of which were in rural or small urban areas. All reported fixed broadband, at least four computers, and staff to assist with technology. Eighty-five percent of surveyed libraries reported sufficient broadband speed and a private room available to patrons. There were no significant differences between rural and urban status for any of the library characteristics. Virginia public libraries may have infrastructure necessary to support patrons connecting to telemedicine. Libraries may benefit from systematic guidelines for collaborating with health providers to support telemedicine implementation across geographic and socioeconomically diverse areas.

Family health history collected by virtual conversational agents: An empirical study to investigate the efficacy of this approach

Family health history (FHx) is one of the simplest and most cost-effective and efficient ways to collect health information that could help diagnose and treat genetic diseases at an early stage. This study evaluated the efficacy of collecting such family health histories through a virtual conversational agent (VCA) interface, a new method for collecting this information. Standard and VCA interfaces for FHx collection were investigated with 50 participants, recruited via email and word of mouth, using a within-subject experimental design with the order of the interfaces randomized and counterbalanced. Interface workload, usability, preference, and satisfaction were assessed using the NASA Task Load Index workload instrument, the IBM Computer System Usability Questionnaire, and a brief questionnaire derived from the Technology Acceptance Model. The researchers also recorded the number of errors and the total task completion time. It was found that the completion times for 2 of the 5 tasks were shorter for the VCA interface than for the standard one, but the overall completion time was longer (17 min 44 s vs. 16 min 51 s, p = .019). We also found the overall workload to be significantly lower (34.32 vs. 42.64, p = .003) for the VCA interface, and usability metrics including overall satisfaction (5.62 vs. 4.72, p < .001), system usefulness (5.76 vs. 4.84, p = .001), information quality (5.43 vs. 4.62, p < .001), and interface quality (5.66 vs. 4.64, p < .001) to be significantly higher for this interface as well. Approximately 3 out of 4 participants preferred the VCA interface to the standard one. Although the overall time taken was slightly longer than with standard interface, the VCA interface was rated significantly better across all other measures and was preferred by the participants. These findings demonstrate the advantages of an innovative VCA interface for collecting FHx, validating the efficacy of using VCAs to collect complex patient-specific data in health care.

The Association Between Willingness of Frontline Care Providers' to Adaptively Use Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study

Background

Telehealth technology can create a disruptive communication environment for frontline care providers who mediate virtual communication with specialists in electronic consultations. As providers are dealing with various technology features when communicating with specialists, their flexible attitude and behaviors to use various telehealth-related technology features can change the outcome of virtual care service.

Objective

The objective of this study is to examine frontline care providers’ technology adaptation behaviors in the electronic consultation context. From the perspective of frontline care providers, we reapply and retest a theoretical model, reflecting a mechanism through which technology users’ personal characteristics and technology adaptation behavior enhance virtual service performance, which is an important performance enabler in this online meeting context. In provider-to-provider communication, particularly, we explore the association among providers’ information technology (IT)–related personal characteristics, adaptive telehealth technology use, and virtual service performance.

Methods

An online survey was administered to collect individual providers’ personal traits, IT adaptation, and perception on virtual service performance. Partial least squares-structural equation modeling was used to estimate our predictive model of personal traits—IT adaptation, such as exploitative use (use the telehealth technology in a standard way), and exploratory use (use the telehealth technology as innovative way)—and virtual service performance.

Results

We collected 147 responses from graduate nursing students who were training to be nurse practitioners in their master’s program, resulting in 121 valid responses from the cross-section online survey. Our theoretical model explained 60.0% of the variance in exploitative use of telehealth technology, 44% of the variance in exploratory use of telehealth technology, and 66% of the variance in virtual service performance. We found that exploitative IT use is an important driver to increase virtual service performance (β=0.762, P<.001), and personal characteristics such as habit are positively associated with both exploitative (β=0.293, P=.008) and exploratory use behaviors (β=0.414, P=.006), while computer self-efficacy is positively associated with exploitative use of telehealth technology (β=0.311, P=.047).

Conclusions

This study discusses the unique role of frontline care providers in a virtual care service context and highlights the importance of their telehealth adaptation behavior in provider-to-provider communication. We showed that providers perceive that telehealth technologies should function as intended, otherwise it may create frustration or avoidance of the telehealth technology. Moreover, providers’ habitual use of various technologies in daily lives also motivates them to adaptively use telehealth technology for improving virtual care service. Understanding providers’ technology habit and adaptation can inform health care policy and further provide a better view of the design of telehealth technology for online communication.

An investigation of the effect of anecdotal information on the choice of a healthcare facility

This article includes two studies investigating the impact of anecdotal healthcare information from the Internet on healthcare decisions. The availability of anecdotal information on the Internet through social media and peer support groups has increased the risk of the dissemination of misleading information. The first study investigated the effect of demographics, quality of life, health status and public reports usage on the use of anecdotal healthcare information from the Internet. The second employed a 2 (anecdotal information presented as videos supporting and contradicting public report information) * 2 (phase of introduction of anecdotal information: early, late) between-subjects experimental design to investigate the consumer's choice between two health facilities, the level of confidence in the decision, the knowledge acquired and the workload experienced. The results from the first study found that age, gender, educational level, health status and public report usage were significant predictors of consumer use of anecdotal information on the Internet. The results from the second suggest that the probability of making the optimal choice was reduced by more than half when contradicting rather than supporting anecdotal information was presented first. The data from anecdotal information became the anchor points for developing an understanding of the healthcare situation, meaning initial perceptions did not change after the presentation of the more reliable public reports. Because of comprehension issues related to public reports, consumers may give more weight to anecdotal information found online. Thus, new approaches are needed to ensure the former is engaging for a wide range of healthcare consumers.

An investigation of the efficacy of collaborative virtual reality systems for moderated remote usability testing

Collaborative virtual reality-based systems have integrated high fidelity voice-based communication, immersive audio and screen-sharing tools into virtual environments. Such three-dimensional collaborative virtual environments can mirror the collaboration among usability test participants and facilitators when they are physically collocated, potentially enabling moderated usability tests to be conducted effectively when the facilitator and participant are located in different places. We developed a virtual collaborative three-dimensional remote moderated usability testing laboratory and employed it in a controlled study to evaluate the effectiveness of moderated usability testing in a collaborative virtual reality-based environment with two other moderated usability testing methods: the traditional lab approach and Cisco WebEx, a web-based conferencing and screen sharing approach. Using a mixed methods experimental design, 36 test participants and 12 test facilitators were asked to complete representative tasks on a simulated online shopping website. The dependent variables included the time taken to complete the tasks; the usability defects identified and their severity; and the subjective ratings on the workload index, presence and satisfaction questionnaires. Remote moderated usability testing methodology using a collaborative virtual reality system performed similarly in terms of the total number of defects identified, the number of high severity defects identified and the time taken to complete the tasks with the other two methodologies. The overall workload experienced by the test participants and facilitators was the least with the traditional lab condition. No significant differences were identified for the workload experienced with the virtual reality and the WebEx conditions. However, test participants experienced greater involvement and a more immersive experience in the virtual environment than in the WebEx condition. The ratings for the virtual environment condition were not significantly different from those for the traditional lab condition. The results of this study suggest that participants were productive and enjoyed the virtual lab condition, indicating the potential of a virtual world based approach as an alternative to conventional approaches for synchronous usability testing.

Designing Home-Based Telemedicine Systems for the Geriatric Population: An Empirical Study

Background and Introduction: Telemedicine, the process of providing healthcare remotely using communication devices, has the potential to be useful for the geriatric population when specifically designed for this age group. This study explored the design of four video telemedicine systems currently available and outlined issues with these systems that impact usability among the geriatric population. Based on the results, design suggestions were developed to improve telemedicine systems for this population.

MATERIALS AND METHODS

Using a between-subjects experimental design, the study considered four telemedicine systems used in Medical University of South Carolina. The study was conducted at a local retirement home. The participant pool consisted of 40 adults, 60 years or older. The dependent measures used were the mean times for telemedicine session initiation and video session, mean number of errors, post-test satisfaction ratings, the NASA-Task Load Index (NASA-TLX) workload measures, and the IBM-Computer Systems Usability Questionnaire measures.

RESULTS

Statistical significance was found among the telemedicine systems' initiation times. The analysis of the qualitative data revealed several issues, including lengthy e-mail content, icon placement, and chat box design, which affect the usability of these systems for the geriatric population.

DISCUSSION

Human factor-based design modifications, including short, precise e-mail content, appropriately placed icons, and the inclusion of instructions, are recommended to address the issues found in the qualitative study.