A wearable e-ink task manager and alert system for nurses that improves communication of doctor orders
BraceAlert was produced as part of a design sprint during the first week of MHCI+D, in collaboration with two other members of my cohort, Will Wang and Eclair Junchaya. We were given the unusual task of using e-ink technology to solve any problem in the real world, and we had just four days to do so. There was one proviso - when we considered the feasibility, viability, and desirability of the product, we could essentially ignore the cost of e-ink and only worry about other associated costs.
Our goal was to improve communication of doctor orders and order changes to nurses and the efficiency with which they are carried out. BraceAlert allows nurses to bypass repeat logins to the hospital information system (HIS) by providing them with crucial information on their patients. We attempted to keep this information as secure as possible by:
Not allowing direct changes to the system via the bracelet
Using RFID technology for logins and a motion sensor that deactivates the display when it isn’t raised
The concept was motivated mainly by our discovery that communication is one of the biggest issues faced by hospital personnel, and can lead to errors in administering medications, unnecessary costs, and delays in transplants and other surgeries. Given our time constraints, we sought a solution that could reduce errors due to miscommunication without making significant changes to nurses’ workflows or to the design of the hospital information system.
How it works
The top display shows a list of a nurse's assigned patients. Only one name is shown to preserve patient confidentiality. Nurses must tap on a name to view any more information. This is also where emergency notifications appear. The middle display, separating top from bottom, shows time and date by default and changes to function as a pager, showing non-patient-specific notifications.
Note: all 3D renderings by Will Wang
The bottom display, underneath the wrist, shows patient information normally printed on the bracelets issued to patients on admittance, as well as specific doctor's orders. Patient info is prioritized to show crucial stats nurses need to know before they reach their patients, such as blood type, allergies, and contagions. A large part of the display functions as a task manager for doctors' orders.
- Finding a space -
We first had to find a problem space where we could apply e-ink technology to develop a solution, so we began secondary research by looking at current products that utilize e-ink to get an idea of what kinds of things it's useful for.
e.g., Kindle Paperwhite
Our attention was drawn to an existing solution called PhutureMed, which introduced e-ink technology to pharmaceutical packaging to monitor the quality of medication and display its status. We were surprised that there weren’t more healthcare-related solutions on the market, considering how ubiquitous both paper and labeling are in hospitals. So we decided to find a place for e-ink in the hospital space.
- Finding a Problem -
For our primary research, we conducted interviews with a range of healthcare professionals because we wanted to get a better understanding of problems faced within the hospital space. We focused on common interactions, how technology currently plays a role in their daily tasks, and where problems exist in either.
This guided our secondary research into communication channels between hospital personnel, the benefits of technological innovations in hospital spaces, and the potential concerns regarding security and the hospital information system.
- Key Findings -
Nurses are in need of improved communication with doctors
- The introduction of information management technology into hospitals has helped to increase overall efficiency, but it has reduced direct communication between doctors and nurses.
- Doctors are sometimes unable to tell nurses about order changes, so for nurses to find out about new orders or order changes, they must log in to the HIS and check their patients’ files.
- Miscommunication often leads to complications for patients, such as medication errors and delays in transplants and other surgeries, which leads to unnecessary costs for the hospital.
In order for hospitals to adopt new technology it must be secure, cost-efficient, relatively easy to learn, and not disrupt normal workflow
- Smart devices are being used more and more in hospitals to achieve tasks like patient monitoring and inventory logging more efficiently.
- New technology should be easy to use to avoid training costs...
- And secure enough to implement into current healthcare systems and routines to avoid administrative or legislative barriers.
Our concepts overall sought to improve communication of patient information. The most common element we kept coming back to was some sort of wearable that wasn’t invasive to nurses and that they could use to quickly access patient information.
For example, one idea (Concept 3) replaced the typical patient bracelet with an RFID-enabled e-ink sticker that displayed basic medical information at a glance when activated by a nurse’s RFID-enabled badge. Another used a bracelet instead that also offered more transparency for patients on their status, and the concept we eventually settled on (Concept 4) brought the bracelet concept to nurses, allowing them to communicate with one another and view patient information.
Digital illustrations by Eclair Junchaya
Because we couldn’t set up prototype testing with nurses, I thought of ways we could test a similar concept. I proposed transforming the nurses’ bracelet into a wearable task manager for students that we could test on fellow members of our cohort. We couldn't recreate the high-stakes context of a nurse's workflow, but giving our participants similar goals allowed us to gain an understanding of (1) how the bracelet would fit into a busy workflow, and (2) how people would interact with such a concept.
- Findings -
The dual-display with differing orientations was met with mixed reviews by 4 participants.
Having two displays with different orientations was met with mixed reviews by our 4 participants. However, when told the unusual orientation was designed to accommodate more important information, participants said it was something they could grow comfortable with.
Because of the unfamiliar form factor, some interactions were not as intuitive as we'd hoped they'd be.
In some cases, scrolling, expanding, and flipping to display more were not discoverable.
We incorporated much of the feedback we'd gotten from testing into the final interface design. The only feedback not taken into account was the differing orientations of the dual displays. After in-depth discussion with each other and some of our interview participants about what information was crucial for nurses, we decided the benefits of having larger screen width to display potentially complex information outweighed the unfamiliar interaction.
As a final measure to ensure the validity of our concept, we ran our idea by some of our interview participants to ensure there was nothing that would totally compromise the (hypothetical) viable use of BraceAlert in hospitals. Our participants had some concerns with patient confidentiality but overall feedback was positive, the general opinion being that BraceAlert could improve nurses' workflows. They especially liked that it didn't attempt to replace any part of a current typical nurse workflow. If we had more time, here are some of the considerations I would take into account when designing a thorough user research study:
For unfamiliar and complex spaces such as hospitals, I believe observational research, e.g., ethnographic studies, is one of the most valuable methods for understanding how people operate and where their pain points are. Sometimes it's not enough to just be told that an issue exists and it becomes necessary to observe the issue's context in order to make judgments about why it exists and how to solve it. Though this kind of research is extremely difficult to conduct in hospitals, if I were conducting a more thorough healthcare-related project, I would probably push the hardest for these kinds of insights.
Certainly something that could be made clearer through observational research, but also something we'd learn about with more in-depth interviews and testing. After our participants expressed concern over displaying patients' names, I realized a simple fix would be to only show location (room number) instead.
Hospital personnel already use smartphones in their daily routines, so mobile integration could be a way to increase functionality and confidentiality while preserving the non-disruptive benefits of a wearable.
BraceAlert improves communication of doctors' orders to nurses, but how well does it (or can it) improve overall communication between doctors and nurses? More research into the relationship and interactions between doctors and nurses would be crucial in informing the design of a fully-integrated product within the hospital space.