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Thesis Milanski

John Milanski
John Milanski

This document describes a research project to address information loss in rehabilitation therapy. Therapists have difficulty recording important details from therapy sessions because they cannot take notes during sessions. The project uses human-centered design principles to understand therapists' work processes and information needs. This includes observing therapists to identify challenges and testing prototype devices. The proposed solution is a wearable voice transcription device called "Say What?" that allows therapists to record, tag, and share session notes and photos in real-time.

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Research and Demonstration Project Institute of Design Say What? H e l p i n g r e h a b i l i t a t i o n p r o f e s s i o n a l s r e m e m b e r p a t i e n t c o n v e r s a t i o n s Therapists are reluctant to take notes during the therapy session, relying on memory to make progress notes days later. Such instances of "Information Loss" the inability to gather, communicate, and access information contribute to the high cost of therapy. O B S E R V A T I O N S I N F O R M AT I O N L O S S Rehabilitation is a hands-on profession that requires a high level of mobility and patient interaction. This means that therapists are generally unable to take notes during the therapy session, relying on memory to record patient progress notes long afterward. This is one example of "Information Loss" that occurs during the daily activities of therapists. Therapists daily activities fall into three categories: access, gather, and communicate (see Figure 2). Each category has its own examples of Information Loss: Access Therapists spend a lot of time searching for patient information. It is often trapped in private files or checked out by another caregiver. Gather Information gathered during the patient session is often lost before it can be recorded because therapists cannot or will not take notes during the session. Communicate Health providers tend to communicate through the patient rather than with each other directly. This practice results in poor communication and expensive, lower quality care. P R O B L E M E X P E N S I V E , Q U A L I T A T I V E T H E R A P Y Why is Information Loss a problem? Rehabilitation is under great pressure from managed care to reduce costs, document procedures, and quantify patient improvement. The information needed to do this already exists, but it cannot be used because it is forgotten before it is written down, difficult to decipher, or impossible to access. Therapists need a device that will prevent Information Loss by helping them gather, access, and communicate information to the rest of the patient care team. With such a device, therapists can then quantify their procedures and increase the quality of patient care. S O L U T I O N S A Y W H A T ? Say What? is a watch-sized computer that provides real-time digital transcription of patient-therapist conversations. Say What? allows the therapist to tag important parts of the record with the touch of a button, supplement it with digital photos, and transmit the data into the hospital data network. Qualitative information gathered during these sessions patient condition, medical history, treatment efficacy can then become instantly available to the rest of the medical team. Figure 1. Therapist-patient conversation. Figure 2. Activity revolves around the therapy session. John Milanski G a t h e rA c c e s s C o m m u n i c a t e
Research and Demonstration Project Institute of Design John Milanski System Solution A w e a r a b l e t r a n s c r i p t i o n d e v i c e f o r r e h a b i l i t a t i o n p r o f e s s i o n a l s Display watch Records and displays indexed transcript. Also functions as a normal watch and a viewfinder for camera. curved 2" by 2" touch-sensitive, graphic display directional microphone wide, rubberized wrist strap mode button message buzzer battery compartment random access memory voice recognition software 2 attachment ports for camera, transmitter, and/or flash memory units Flash memory unit Stores indexed transcript and up to 24 snapshots (6 per session). Useful when not in range of a wireless network. 12 megabyte flash memory chip attachment port (I/O and power) RF transmitter unit Instantly sends transcript and pictures to hospital wireless network, keeping everyone informed of patient progress. spread spectrum wireless network card (transmitter/receiver) short range antenna (<500 feet) attachment port (I/O and power) Digital camera unit Allows therapist to document progress and create visual exercise plans for patients. 1/3" CCD detector 1" lens shutter button on/off light attachment port (I/O and power) Watch interface Color coding is used to separate the therapist and patients portions of the transcript. green text (therapist) black text (patient or other) red text (system-generated such as index tags, picture tags, and time stamps) Say What? allows therapists to automatically capture and distribute information during therapy sessions.
Research and Demonstration Project Institute of Design John Milanski Scenario of Use T h e r a p i s t s b e n e f i t f r o m u s i n g S a y W h a t ? G A T H E R Who am I seeing this morning? Don, a physical therapist at a large hospital, is running late. He doesnt have time to read through the patients file before his first session. But since the hospital replaced his beeper with a Say What? watch, Don always his the big facts with him: name, age, and diagnosis. Walking into the gym, Don sees that his first patient has already started her program. Hi, Mrs. Morrison! Before he had Say What?, Don had a hard time remembering every patients name. He taps the Say What? screen twice to start recording a new session. As they talk, the Say What? transcript scrolls down the screen. That will be useful later when he writes up the progress notes. When did these sores on your feet show up? Don taps the screen of the watch to "tag" that portion of the transcript; hell want to remember that later. Don takes a snapshot for Mrs. Morrisons home exercise program using the built-in camera. He also takes one of her foot. The pictures are transmitted into her patient record. C O M M U N I C AT E A vibration from his watch alerts Don of an incoming message. Gone are the days of those annoying intercom messages pagers. Mrs. Morrisons doctor has already seen the picture of the sore foot and would like to discuss it with Don between sessions. As she finishes her program, Mrs. Morrison asks if shell be getting a wheelchair when she goes home next week. Don taps his watch to remind himself and heads upstairs to treat a patient at bedside. Hey, Don! Hold up a second! Its Mrs. Morrisons doctor. Hes a little concerned about that foot. They review the audio transcript taken during the morning session using Say What?, jumping to the tag about her sore foot. Maybe an anti- inflammatory would help. Good idea, says Don as he taps the watch three times to record the last 10 seconds of this ad- hoc conversation. Don continues on his morning rounds. A C C E S S By 5pm Don has had a long day. After 6 patient sessions and 3 meetings, he sits down at his desk to write patient progress notes; he still doesnt have a personal computer. Mrs. Morrison 9 am. What did he promise her? Say What? comes to the rescue. Switching the display from watch mode to review mode, Don jumps to Mrs. Morrisons session. He jumps through the record tags, making notes on the things he marked during the session. A red tag near the bottom of the record reminds him. Right... I promised her a wheelchair! I cant believe I used to rely on my memory to make progress notes. Now what did her doctor ask me to do... Therapists do not need to worry about forgetting facts from the session. No more difficulty finding patient files. Making progress notes long after the session is much easier.
Research and Demonstration Project Institute of Design John Milanski C O N T E X T : S E C O N D A R Y R E S E A R C H To create products or systems that people want, you must fully understand the people who will use them. I started by reading, studying the history of therapy, trends in the field, and technologies that could be used to help therapists. Then I talked with therapists, administrators, patients, and doctors. Human-centered Development Process Traditional product development focuses only on how to make a product the artifact. This approach often results in things no one wants. Marketing research goes further, asking users what they want in order to generate better ideas. But what people say and what they do can be very different. Human-centered Design (HCD) looks at what people do. Watching people in the context of their environment results in better insights and user-centered rather than designer-centered ideas. By focusing on behavior, HCD produces consistently better artifacts things that customers will buy. I N S I G H T : F I E L D O B S E R V A T I O N S Human-centered designers immerse themselves in the users environment. Simple observations can reveal major problems. I observed therapists at two sites: the Bowman Center for the Elderly and the University of Illinois Chicago Medical Center. Using video ethnography and analysis techniques, I began to see a major problem "Information Loss." I D E A : S K E T C H I N G Designers will always create based on their personal experience what they know. Behavioral observation ensures that solutions are based on user needs, not just designer whims. Dozens of ideas environmental, product, and system were sketched during the course of the project. Scenarios were also created to convey the concepts during presentations. A R T I FA C T : B E H AV I O R A L P R O T O T Y P E S Youll never know if an idea works until you try it. Human- centered designers create behavioral (works-like) and conceptual (looks-like) prototypes and ask users to work with them. One set of behavioral prototypes tested various display sizes. Therapists wore them as they did their jobs. C O N C E P T U A L P R O T O T Y P E S Looks-like models are especially useful to determine form and size. But they must be made quickly and iterated upon. In one iteration, I tested how a display, transmitter, and camera might come together in the final design. What to make?Why make it? How to make it?Who is it for?

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Thesis Milanski

  • 1. Research and Demonstration Project Institute of Design Say What? H e l p i n g r e h a b i l i t a t i o n p r o f e s s i o n a l s r e m e m b e r p a t i e n t c o n v e r s a t i o n s Therapists are reluctant to take notes during the therapy session, relying on memory to make progress notes days later. Such instances of "Information Loss" the inability to gather, communicate, and access information contribute to the high cost of therapy. O B S E R V A T I O N S I N F O R M AT I O N L O S S Rehabilitation is a hands-on profession that requires a high level of mobility and patient interaction. This means that therapists are generally unable to take notes during the therapy session, relying on memory to record patient progress notes long afterward. This is one example of "Information Loss" that occurs during the daily activities of therapists. Therapists daily activities fall into three categories: access, gather, and communicate (see Figure 2). Each category has its own examples of Information Loss: Access Therapists spend a lot of time searching for patient information. It is often trapped in private files or checked out by another caregiver. Gather Information gathered during the patient session is often lost before it can be recorded because therapists cannot or will not take notes during the session. Communicate Health providers tend to communicate through the patient rather than with each other directly. This practice results in poor communication and expensive, lower quality care. P R O B L E M E X P E N S I V E , Q U A L I T A T I V E T H E R A P Y Why is Information Loss a problem? Rehabilitation is under great pressure from managed care to reduce costs, document procedures, and quantify patient improvement. The information needed to do this already exists, but it cannot be used because it is forgotten before it is written down, difficult to decipher, or impossible to access. Therapists need a device that will prevent Information Loss by helping them gather, access, and communicate information to the rest of the patient care team. With such a device, therapists can then quantify their procedures and increase the quality of patient care. S O L U T I O N S A Y W H A T ? Say What? is a watch-sized computer that provides real-time digital transcription of patient-therapist conversations. Say What? allows the therapist to tag important parts of the record with the touch of a button, supplement it with digital photos, and transmit the data into the hospital data network. Qualitative information gathered during these sessions patient condition, medical history, treatment efficacy can then become instantly available to the rest of the medical team. Figure 1. Therapist-patient conversation. Figure 2. Activity revolves around the therapy session. John Milanski G a t h e rA c c e s s C o m m u n i c a t e
  • 2. Research and Demonstration Project Institute of Design John Milanski System Solution A w e a r a b l e t r a n s c r i p t i o n d e v i c e f o r r e h a b i l i t a t i o n p r o f e s s i o n a l s Display watch Records and displays indexed transcript. Also functions as a normal watch and a viewfinder for camera. curved 2" by 2" touch-sensitive, graphic display directional microphone wide, rubberized wrist strap mode button message buzzer battery compartment random access memory voice recognition software 2 attachment ports for camera, transmitter, and/or flash memory units Flash memory unit Stores indexed transcript and up to 24 snapshots (6 per session). Useful when not in range of a wireless network. 12 megabyte flash memory chip attachment port (I/O and power) RF transmitter unit Instantly sends transcript and pictures to hospital wireless network, keeping everyone informed of patient progress. spread spectrum wireless network card (transmitter/receiver) short range antenna (<500 feet) attachment port (I/O and power) Digital camera unit Allows therapist to document progress and create visual exercise plans for patients. 1/3" CCD detector 1" lens shutter button on/off light attachment port (I/O and power) Watch interface Color coding is used to separate the therapist and patients portions of the transcript. green text (therapist) black text (patient or other) red text (system-generated such as index tags, picture tags, and time stamps) Say What? allows therapists to automatically capture and distribute information during therapy sessions.
  • 3. Research and Demonstration Project Institute of Design John Milanski Scenario of Use T h e r a p i s t s b e n e f i t f r o m u s i n g S a y W h a t ? G A T H E R Who am I seeing this morning? Don, a physical therapist at a large hospital, is running late. He doesnt have time to read through the patients file before his first session. But since the hospital replaced his beeper with a Say What? watch, Don always his the big facts with him: name, age, and diagnosis. Walking into the gym, Don sees that his first patient has already started her program. Hi, Mrs. Morrison! Before he had Say What?, Don had a hard time remembering every patients name. He taps the Say What? screen twice to start recording a new session. As they talk, the Say What? transcript scrolls down the screen. That will be useful later when he writes up the progress notes. When did these sores on your feet show up? Don taps the screen of the watch to "tag" that portion of the transcript; hell want to remember that later. Don takes a snapshot for Mrs. Morrisons home exercise program using the built-in camera. He also takes one of her foot. The pictures are transmitted into her patient record. C O M M U N I C AT E A vibration from his watch alerts Don of an incoming message. Gone are the days of those annoying intercom messages pagers. Mrs. Morrisons doctor has already seen the picture of the sore foot and would like to discuss it with Don between sessions. As she finishes her program, Mrs. Morrison asks if shell be getting a wheelchair when she goes home next week. Don taps his watch to remind himself and heads upstairs to treat a patient at bedside. Hey, Don! Hold up a second! Its Mrs. Morrisons doctor. Hes a little concerned about that foot. They review the audio transcript taken during the morning session using Say What?, jumping to the tag about her sore foot. Maybe an anti- inflammatory would help. Good idea, says Don as he taps the watch three times to record the last 10 seconds of this ad- hoc conversation. Don continues on his morning rounds. A C C E S S By 5pm Don has had a long day. After 6 patient sessions and 3 meetings, he sits down at his desk to write patient progress notes; he still doesnt have a personal computer. Mrs. Morrison 9 am. What did he promise her? Say What? comes to the rescue. Switching the display from watch mode to review mode, Don jumps to Mrs. Morrisons session. He jumps through the record tags, making notes on the things he marked during the session. A red tag near the bottom of the record reminds him. Right... I promised her a wheelchair! I cant believe I used to rely on my memory to make progress notes. Now what did her doctor ask me to do... Therapists do not need to worry about forgetting facts from the session. No more difficulty finding patient files. Making progress notes long after the session is much easier.
  • 4. Research and Demonstration Project Institute of Design John Milanski C O N T E X T : S E C O N D A R Y R E S E A R C H To create products or systems that people want, you must fully understand the people who will use them. I started by reading, studying the history of therapy, trends in the field, and technologies that could be used to help therapists. Then I talked with therapists, administrators, patients, and doctors. Human-centered Development Process Traditional product development focuses only on how to make a product the artifact. This approach often results in things no one wants. Marketing research goes further, asking users what they want in order to generate better ideas. But what people say and what they do can be very different. Human-centered Design (HCD) looks at what people do. Watching people in the context of their environment results in better insights and user-centered rather than designer-centered ideas. By focusing on behavior, HCD produces consistently better artifacts things that customers will buy. I N S I G H T : F I E L D O B S E R V A T I O N S Human-centered designers immerse themselves in the users environment. Simple observations can reveal major problems. I observed therapists at two sites: the Bowman Center for the Elderly and the University of Illinois Chicago Medical Center. Using video ethnography and analysis techniques, I began to see a major problem "Information Loss." I D E A : S K E T C H I N G Designers will always create based on their personal experience what they know. Behavioral observation ensures that solutions are based on user needs, not just designer whims. Dozens of ideas environmental, product, and system were sketched during the course of the project. Scenarios were also created to convey the concepts during presentations. A R T I FA C T : B E H AV I O R A L P R O T O T Y P E S Youll never know if an idea works until you try it. Human- centered designers create behavioral (works-like) and conceptual (looks-like) prototypes and ask users to work with them. One set of behavioral prototypes tested various display sizes. Therapists wore them as they did their jobs. C O N C E P T U A L P R O T O T Y P E S Looks-like models are especially useful to determine form and size. But they must be made quickly and iterated upon. In one iteration, I tested how a display, transmitter, and camera might come together in the final design. What to make?Why make it? How to make it?Who is it for?