|Abstract or Summary
- Although electronic medical records systems (EMR) present promising benefits, they have not yet been widely adopted. A problem facing many EMR are that they are disruptive technologies; their complex hardware and software are not designed to account for the clinicians' characteristics and needs, thus, demanding a steep learning curve and diverted attention while being used. As a result, encounter time increases; clinicians' stress and discomfort arise from the interaction with disruptive technologies affecting doctor-patient communication and technologies are not adopted for further use. The objectives of this study were to apply the human-machine systems engineering (HMSE) and person-environment congruence theory to design and test a minimally disruptive device to improve the documentation of the medical exam. The focus of this project was 1) to reduce the interference that new technologies sometimes provoke during the medical encounter and affect the physician's routine and communication with the patient; and 2) promote interaction between physicians and patients by reducing the attention dedicated to interaction with technological systems. The design concept combines the capabilities of an electronic stethoscope, otoscope, ophthalmoscope, and a digital camera. It uses existing technologies to capture patient data from the physical examination and save it in the patient's EMR in real time. It aims to eliminate data acquisition time, entry errors, avoid instrument loss or damage and facilitate communication with patients. Seventy-five requirements were developed based on the results of task analysis, failure mode and effects analysis (FMEA), review of literature and the incorporation of user centered, and display design principles. Jordan's hierarchy model was used as a framework to organize and categorize these requirements. Based on the design criteria, a design concept of a multipurpose medical instrument (allscope) and its interaction with the EMR (iPad application Graphic User Interface) was developed. Physical and digital models created using a 3D printer machine, and a software prototyping application were used to test the concept. Seven medical clinicians interacted with the models following a scripted scenario. A combination of quantitative survey and qualitative interview was used to evaluate the subjects' perceptions of their experience with the concept and verify requirements. Major findings from the case study were that the system fits overall user characteristics and needs, and that it was not perceived as a cause of interference of doctor-patient relationship but on the contrary as a communication facilitator. It is expected that the design solution will improve the documentation and analysis of the physical examination findings, minimize the interference with clinicians' interaction with patients and routine, and increase user satisfaction and adoption of new technologies. On the other hand, efficiency, a major concern in the medical community, could not be evaluated because of the use of a non-functional model. In this way, future studies should involve objective performance measurements using a fully functional prototype. Usability and emotional issues not previously considered were identified; half of the 18 requirements tested were verified. The requirements verified were related to usability, psychological and physiological pleasure. For example that the system presents useful functions, displays are clearly visible, displays presents information useful to achieve the correct diagnosis, and the device feels good in the hand. New requirements were created based on the study findings and its incorporation on a new design iteration would provide a system that fits users needs more accurately, enabling the enjoyment of the benefits that nowadays technologies can provide.