Designing User Interfaces for Smart-Applications for Operating Rooms and Intensive Care UnitsWorking Conditions in ORs and ICUsStress and Habituation EffectsUsers in Healthcare as a ChallengeDecision Support in Medical Devices SystemsDesigning Smart ApplicationsAnaesthesia Display "SmartPilot"Diagnosis DisplayConclusion from the Case StudiesDesigning Working Conditions Instead of Optimizing DevicesReferencesT. Gross et al. (Eds.): INTERACT 2009, Part II, LNCS 5727, pp. 684–695, 2009. © IFIP International Federation for Information Processing 2009 Designing User Interfaces for Smart-Applications for Operating Rooms and Intensive Care Units Martin Christof Kindsmüller1, Maral Haar2, Hannes Schulz3, and Michael Herczeg1 1 University of Lübeck, Institute for Multimedia & Interactive Systems, Ratzeburger Allee 160, D-23538 Lübeck, Germany 2 Drägerwerk AG, Moislinger Allee 53-55, 23542 Lübeck 3 Dräger Medical AG & Co. KG, Moislinger Allee 53-55, 23542 Lübeck {mck,herczeg}@imis.uni-luebeck.de, {maral.haar,hannes.schulz}@draeger.com Abstract. Today’s physicians and nurses working in operating rooms and in-tensive care units have to deal with an ever increasing amount of data. More and more medical devices are delivering information, which has to be perceived and interpreted in regard to patient status and the necessity to adjust therapy. The combination of high information load and insufficient usability creates a severe challenge for the health personnel with respect to proper monitoring of these devices respective to acknowledging alarms and timely reaction to critical incidents. Smart Applications are a new kind of decision support systems that incorporate medical expertise in order to help health personnel in regard to di-agnosis and therapy. By means of a User Centered Design process of two Smart Applications (anaesthesia monitor display, diagnosis display), we illustrate which approach should be followed and which processes and methods have been successfully applied in fostering the design of usable medical devices. Keywords: Smart-Applications, Safety Critical Systems, Healthcare, User In-terface, OR, ICU. 1 Working Conditions in ORs and ICUs Backhaus and Friesdorf ([1], p.45, translation by the authors) describe the “megalopo-lis” intensive care unit (ICU) “as an unmanageable set of hoses, cables and wires interconnected with at least an equal amount of sensors, instruments, devices or any other technical equipment. Right in the middle, the »patient« agonisingly made stationary by the equipment that is required to keep him alive” (Fig. 1). These circum-stances describe both the situation in ICUs and in operating rooms (ORs). The assem-bled multitude of technical support systems creates highly complex and highly dynamic working conditions for the attending physicians and nurses (in the following summarized as health personnel). As a general rule, patient monitors are the central constituent of this environment. They measure and log vital signs (e.g. heartbeat, blood pressure, breathing and anaes-thetic gas concentration levels), and thus form the basis of a reliable monitoring of the patient. Patient monitors are used for anesthetized patients in ORs and ICUs as wellDesigning User Interfaces for Smart-Applications 685 Fig. 1. Patient embedded between technical equipment on a modern ICU as for conscious patients in general wards and allow health personnel to quickly diag-nose and react on critical patient conditions. The interaction with medical devices is often difficult and cannot be effective without a huge amount of previous knowledge. Furthermore the medical devices from different manufacturers often vary in their operating philosophy. Patient monitors for example often have different controls/keys with a different layout. Thus nurses often have to adapt to a different handling while going from one patient to another or interacting with various devices (e.g. ventilator, patient monitor and syringe pump) at one patient. Obradovich and Woods [2] and Wears and Cook [3] show that these devices often suffer from bad usability. This deficiency is of particular importance because the workload of many users in the medical domain does not give them enough time to carry out in-depth examinations of these technical devices [4]. Health personnel often refuse to change visual settings of devices because they fear that they could end up with an even worse layout and not being able to change it back. But even if every specific device would be ergonomically designed, numerous problems will only manifest themselves in the interaction with other devices in a certain working context. Some of the problems emerge from divergent design princi-ples. In addition, there is insufficient interconnection and integration within the vari-ous devices compiling the patient monitoring system assembly (Fig. 1). This forces users to type in identical data into different devices, or to read a measurement at one device and type it into at another device. Taking these situations into account, the lack of acceptance for these devices is hardly surprising. 1.1 Stress and Habituation Effects Numerous studies (cf. [5] for a review) document that the cognitive system of humans is generally not well adapted to monitoring activities. The errors occurring in monitor-ing tasks are mostly a consequence of the high attentional load, caused by the enormous amount of information and the large number of signals that have to be proc-essed. In the case of health personnel using monitoring devices, Coiera et al. [6] found evidence for the following three possible types of errors: (1) Users see the information686 M.C. Kindsmüller et al. on a monitor, but they are not interpreting it. (2) Users concentrate on a very small amount of the data and ignore relevant information. (3) If users are tied up with per-forming a complex task, they avoid spontaneously addressing themselves to another task. Thus severe problems are sometimes detected too late. It has been shown however that an adequately designed device can support the human information processing considerably in relation to monitoring tasks. Parasura-man et al. [5] emphasise the possibility of exploring the system behaviour, whereas Norman [7], recommends that the system should communicate its internal control decisions to the user. 1.2 Users in Healthcare as a Challenge As in every design task that needs to incorporate the wide