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Human–Computer Interaction

Gregory L. Alexander

INTRODUCTION

Human–Computer Interaction (HCI) is broadly defined as an intellectually rich and highly impactful phenomenon influenced by four disciplines: (1) Human Factors and Ergonomics, (2) Information Systems, (3) Computer Science, and (4) Library and Information Science (Grudin, 2012). Aspirations of fledgling HCI researchers and practitioners, over the past few decades, were to develop better menus, enhance use of graphical user interfaces, advance input devices, construct effective control panels, and improve information comprehension (Waterson & Catchpole, 2016). There are few fields, like HCI, which can claim such a rapid expansion and strong influence on the design of ubiquitous technologies including desktops, Web, and mobile devices used by at least 5 billion users around the world (Shneiderman, 2012). In healthcare specifically, digital technologies that are rapidly becoming important in HCI domains are listed in Table 9.1 (Gulliksen, 2017).

This chapter provides important information for nurses engaged in HCI efforts to improve healthcare systems and processes. The purpose of this chapter is to elevate nurses’ understanding of theoretical underpinnings for HCI approaches used to evaluate clinical technologies; to infuse HCI concepts by identifying important HCI approaches, during this time of rapid and continuous change; and finally, to describe how HCI evaluation can lead to improved performance and outcomes in nurse-led systems (Nelson, 2018).

HUMAN FACTORS: A BUILDING BLOCK FOR HUMAN–COMPUTER INTERACTION

Human factors is a discipline that tries to optimize relationships between technology and people (Kantowitz & Sorkin, 1983; McCormick & Sanders, 1982). Human factors have been defined in a number of ways by a number of experts (Table 9.2). Human factors experts apply information about human characteristics and behavior to determine optimal design specifications for tools people use, such as technology, in their daily life (Johnson & Barach, 2007). The goal of a human factors approach in nurse-led systems is to optimize the interactions between nurses and the tools they use to perform their jobs, minimize error, and maximize efficiency, optimize well-being, and improve quality of life.

HCI, concerned with interactions between people and computers, is an area of study concentrated on by human factors experts (Staggers, 2002). HCI is defined as the study of how people design, implement, and evaluate interactive computer systems in the context of users’ tasks and work (Nelson & Staggers, 2014). HCI emerged in the 1980s as an interdisciplinary field incorporating ideals of computer science, cognitive science, and human factors engineering, but since has grown into a science incorporating concepts and approaches from many other disciplines. An excellent history of HCI written by Grudin can be found in Human Computer Interaction Handbook (Grudin, 2012). Some critics believe current descriptions of HCI require broader definitions. Critics suggest that current definitions do not reflect ubiquitous, pervasive, social, embedded, and invisible user-oriented technologies (Shneiderman, 2012). Further, some HCI critics want to move beyond computer use to emphasize other components of HCI including “… user experience, interaction design, emotional impact, aesthetics, social engagement, empathetic interactions, trust building, and human responsibility” (Shneiderman, 2012).

FRAMEWORKS FOR HCI NURSING RESEARCH

Early pioneers in nursing informatics set the stage for development of nursing information systems and their use in storing information, knowledge development, and development of technology in caregiving activities (Graves & Corcoran, 1989; Schwirian, 1986; Turley, 1996; Werley & Grier, 1981). These early models had several limitations including a lack of environmental and task-oriented elements, conceptual differences across frameworks, and a lack of time dimensions; subsequently, nursing frameworks were proposed to illustrate dynamic interactions occurring between nurses, computers, and enabling elements that optimize a user’s ability to process information via computers (Staggers & Parks, 1993). These became the early foundations for incorporating human factors approaches into the design of information technologies used by nurses. However, there were still limitations identified in these early models because they did not explicitly make the patient part of the model and they didn’t define the context or include all elements of nursing’s metaparadigm (Effken, 2003). Effken (2003) proposed the Informatics Research Organizing Model, which emphasized all elements of nursing’s metaparadigm including the system, nurse, patient, and health. Later, Alexander’s Nurse—Patient Trajectory Framework was proposed (Alexander, 2007). Alexander’s framework utilizes nursing process theory, human factors, and nursing and patient trajectories as components of a framework that can be used to evaluate patient care systems. The midrange framework specifically emphasizes the use of human factors, including HCI, approaches to link patient care processes, nurse and patient trajectories, and nursing and patient outcomes (Fig. 9.1). Examples of HCI design and research focused on user experiences (UX) will be used to achieve the objectives.

• FIGURE 9.1. Alexander’s Nurse-Patient Trajectory Framework. (From Alexander G.L. (2007). The nurse-patient trajectory framework. Studies in Health Technology and Informatics, 129(2), 910-914. Reproduced with permission from Gregory L. Alexander, PhD.)

DESIGNING FOR HCI

The discipline of HCI incorporates proponents of interaction design. Interaction designers are concerned withshaping digital things for people’s use to maximize efficiency and minimize error (Lowgren, 2013). Concepts proposed by HCI experts in healthcare have significant implications for design of pervasive technologies that are being developed and adopted by healthcare providers and patients (Staggers, Elias, Makar, & Alexander, 2018). Interaction designers are characterized as shaping and transforming processes through the use of digital devices; they consider all possible futures for a digital design space; designers frame a problem at the same time they are creating a solution; and finally, designers address instrumental and technical aspects of digital media, but also recognize aesthetical and ethical aspects of designs (Lowgren, 2013).

USER EXPERIENCE (UX) IN HCI

UX encompasses all aspects of the end-user experience (Norman & Nielsen, 2019). Current UX pain points in nursing that are impacting clinical practice include health IT design/usability, IT fit to workflow, excessive documentation, interoperability, and lack of information to support care processes (Staggers et al., 2018). These UX pain points among others can be assessed using methods available for designers to assess the usefulness of a piece of medical technology. Table 9.3 provides a comparison of HCI methods that can be used by interested readers for capturing end-user experiences.

HEALTH IT DESIGN/USABILITY IN HCI

Usability evaluation determines the extent that a technology is easy and pleasurable to use by determining if it is well adapted to users, their tasks, and that negative outcomes are minimized as a result of use (Bastien, 2010). Usability evaluation has been a staple of HCI researchers for the past 30 years and continues to grow in prominence as technology advances have been made around the world. HCI designers have proposed that usability is inherently measureable in all electronic technologies, that usability evaluation determines if an interactive system is usable, and if a system is usable, then usability evaluation can determine the extent of usability using hardy usability metrics, and finally, that usability evaluation is an accessible form of analysis and easy enough to learn about in HCI literature (Cockton, 2013).

Contextual Inquiry

Contextual inquiry is qualitative in nature. This methodology is derived from ethnography, which focuses on scientific descriptions and illustrations of social groups and systems. Contextual inquiry is usually conducted in the field using extensive, well-designed, systematic observations to capture how people interact with technology in real-world settings. Through this method the researcher becomes immersed in the group or system to understand how interactions take place. This method provides rich data that can be voluminous depending on number of settings involved, time spent in the settings, and the number of observations captured in the setting. Typically, sample subjects are key informants who have specialized knowledge, status, or skills which are of interest to the researcher. Oftentimes one, two, or more subjects can be observed individually or in dyads over periods of time to understand how interactions take place or how technology may influence interactions. Decisions about the sample and settings also have impacts on costs of conducting contextual inquiry research, which can be high. Researchers using contextual inquiry methods use their interpretations of observations as a source to answer important questions about social groups or systems. In many studies, other methods are used concurrently with contextual inquiry, such as focus groups in order to validate researchers’ interpretations of phenomenon observed in the field.

Cognitive Task Analysis

Cognitive research is used to describe psychological processes associated with the acquisition, organization, and use of knowledge (Hollnagel & Hollnagel, 2003). Cognitive processes in human–machine interactions are complex and involve continuous exchanges of information between operators and the machines they use, which is a type of shared cognition. For example, nurses and physicians work in tandem to deliver optimal care for each patient. The design of human– machine interfaces such as nursing and physician interfaces used for documentation and medical record review must consider the nature of interdisciplinary work. Unfortunately, studies typical of evaluating nursing workflow disruption have not been a focus in similar studies assessing physician workflow; for instance, investigating how nursing roles and activities are affected by physician orders when implementing a clinical information system would provide valuable design input for electronic medical record designs (Lee & McElmurry, 2010). Medical devices are also an important human–machine interface, which are sometimes shared and need to be tested collaboratively by interdisciplinary healthcare teams, but these evaluations are limited. For example, evaluations of computerized provider order entry for pharmacy and medication administration systems should include both pharmacists and nurses. Joint interdisciplinary studies might ensure safer execution of orders and delivery of medications as a result of agreed upon design considerations that benefit both disciplines (Alexander & Staggers, 2009).

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