Targeting the Seniors

Mobile Health at “Home”

Polun Chang, PhD International Committee Member, TIGER

Chair, 12th International Congress on Nursing Informatics

Consultant and Founder, Taiwan Nursing Informatics Association

Consultant, China Medical Informatics Association NI WG

Adjunct Professor, UMN Nursing School

Director, Integrative Health Care Research Center

Professor, Institute of bioMedical Informatics,

National Yang-Ming University, Taiwan/ROC

Auditorium, SNU 9/3/2013

WEB CHI

AI WEB CHI

Mobile Computing

No More PC Thinking Desktop with good interactive capability Walking and multitasking?

What Do We See? 4” …

6”… Any Better?

One Inch Difference? 7”

23”…: Different Story

23”…What Do You See?

10

Dolphins?

HD CHI

HD

HD DSS

IC WEB DE

DSS

HD

DE EHR

EHR

HD DSS

CH

CH

HD DSS

AI

EHR

VBA DSS

WEB DSS

VBA DSS

VR HD

VR DSS

WEB DSS

PS

EUC

SMS

DSS

HD RFID DSS

SA

DE WEB CHI

EUC

EUC VBA

SA

HIS DSS

VR CRM

VR CHI

EUC VBA

AI WEB CHI

EUC VBA

EUC

HD CHI

EUC VBA

HD CHI

HD DSS

CH CH

VBA DSS

EUC VBA

EUC

AI: Artificial Intelligence CH: Consumer Health CHI: Computer Human Interaction DE: Data Exchange DSS: Decision Support System EHR: Electronic Health Record EUC: End User Computing HD: Handheld Device HIS: Hospital Information System

PS: Privacy & Security SA: Statistical Analysis SMS: Short Message Service VBA: Visual Basic for Applications VR: Voice Recognition

B. TraumaticSymptoms

A3

A. Basic Data

A6

A2 A5

A1 A4

B3

B6

B2

B5

B1

B4

C4

C8

C3

C7

C2

C6

C1

C5

E4

D7 D3

D6 D2

D5 D1

D4

F1

E8

E3

E7

E2

E6

E1

E5

C. Non-traumaticSymptoms

D. Evaluation/Diagnosis

E. Treatment

F. Vital Sign

Usability is the Key

What We Have Learned

1) Usability of Mobile Care Solutions Can

be Assured with Right Interface Design

Principles

1st Generation

GM

BHN

CIO

DJP

EKQ

FLR

2 34 5 6

A1

A

1

Layer 1: main category of evaluation questions

Layer 2: subcategory

Layer 3: panel of evaluation questions

Menu

Working main- and sub-category items

Layer +1: to supplementary data-entry screen

G

M

B

H

N

C

I

O

D

J

P

E

K

Q

F

L

R

2 3

4 5 6

A

1

Layer 1 (4 rows x 6 items/row): main category of evaluation questions

Layer 2 (3 rows x 3 items/row ): subcategory

Layer 3 (9 rows): panel of evaluation questions

Toolbar (1 row)

Working main- and sub-category items

Layer +1: click to the other supplementary screen

S T U V W X

7 8 9

A1

2nd Generation

What We Have Learned

1) Usability of Mobile Care Solutions Can

be Assured with Right Interface Design

Principles

2) Display and Device Size does matter

• Barcode Reader Integrated

• Sterilizable

• Pocket-sized

• One-hand Handheld

• Lightweight

• Hand Strip Hole

• Feature Hand Strip

• 6” Pad

PDAPAD

2008

2009

2011

Easy navigation

Layer 2

Layer 1

Layer 3

Quick Data Entry

Size Do Matter

What We Have Learned

1) Usability of Mobile Care Solutions Can

be Assured with Right Interface Design

Principles

2) Display and Device Size does matter

3) Mobile Solutions can be Right for

Healthcare Professionals

Chinese MDS-

HC 2.0: a 21-

page tool

24

Comprehensive

Geriatric Assessment

2013/9/3 25

滿意

MDS+

PAD系

統的螢

幕大小

滿意

MDS+

PAD系

統的字

體大小

滿意

MDS+

PAD系

統的畫

面整體

配置

滿意

MDS+

PAD系

統的反

應速度

滿意

MDS+

PAD系

統的尋

找評估

內容項

目

滿意

MDS+

PAD系

統的資

料輸入

滿意對

MDS+

PAD系

統的縮

寫文句

意義理

解

滿意可

用酒精

或飄白

水消毒

MDS+

PAD系

統

滿意

MDS+

PAD系

統的攜

帶方便

性

滿意

MDS+

PAD系

統提供

的可設

計快捷

建(音量

控制鍵)

滿意使

用腕帶

固定

MDS+

PAD系

統以防

滑落

滿意

MDS+

PAD系

統的易

手持(好

拿)

滿意

MDS+

PAD系

統的操

作說明

滿意

MDS+

PAD系

統的教

育訓練

滿意

MDS+

PAD系

統的整

體使用

經驗

Pre 1.684 1.684 1.722 1.895 1.947 1.947 1.947 1.667 1.895 1.833 2.000 1.842 1.895 1.947 2.105

Post 1.684 1.632 1.778 2.368 2.474 2.474 2.474 1.833 2.368 2.500 2.158 2.368 2.474 2.000 2.368

P value 1.000 0.749 0.790 0.107 0.056 0.047 0.047 0.331 0.046 0.029 0.380 0.096 0.053 0.772 0.367

1

2

3

4

5

mean

MDS+ PAD 滿意度-聯醫_同一人比較 Satisfaction

2013/9/3 26

MDS+

PAD系統_

字型大小

易閱讀

MDS+

PAD系統

螢幕大小

合所需

MDS+

PAD系統_

欄位分配

易使用

MDS+

PAD系統_

畫面整體

配置易使

用

MDS+

PAD系統_

點選輸入

易使用

MDS+

PAD系統_

手寫輸入

易使用

MDS+

PAD系統_

易學習操

作

與MDS+

PAD系統_

互動清楚

容易

MDS+

PAD系統_

反應速度

可接收

MDS+

PAD系統_

更易切換

到所要的

評估工作

資料蒐集

畫面

MDS+

PAD系統_

更輕易找

到要尋找

的內容

MDS+

PAD系統_

可讓

MDS+評

估工作更

容易掌握

個案整體

情況

MDS+

PAD系統_

更能提高

MDS+評

估工作完

整性

Pre 1.500 1.500 1.667 1.722 1.667 1.778 1.944 1.944 1.778 1.833 1.833 1.722 1.722

Post 1.833 1.611 2.000 1.944 2.111 2.056 1.944 2.167 2.167 2.222 2.167 2.167 2.278

P value 0.138 0.607 0.111 0.298 0.134 0.368 1.000 0.466 0.168 0.233 0.269 0.134 0.066

1

2

3

4

5

mean

MDS+ PAD Ease of Use -聯醫_同一人比較

非常同意

Ease to Use

2013/9/3 27

MDS+ PAD系統_

讓我更快速輕易

完成MDS+評估

工作

MDS+ PAD系統_

讓我更容易掌握

MDS+評估工作

的內容細項

MDS+ PAD系統_

減少更多MDS+

評估工作資料整

理時間

MDS+ PAD系統_

增加我與個案評

估時互動

MDS+ PAD系統_

更提升整理評估

的工作績效

整體而言,MDS+

PAD系統_讓我執

行MDS+評估工

作很有幫助

Pre 2.000 1.778 1.611 1.944 2.000 1.778

Post 2.111 2.167 2.444 2.444 2.611 2.389

P value 0.542 0.185 0.012 0.058 0.012 0.045

1

2

3

4

5

mean

MDS+ PAD Usefulness-聯醫_同一人比較

非常同意

Usefulness

Nursing Tasks

What’s Right?

Chemotherapy

Medication

Administration

Reengineering

Evaluation Overall：3.83(out of 4)

» Job Simplification » Decision Support » Easy to Learn and for Training

» No More Manual Calculation » Large Font Size

1

2

3

4 有用性

易用性

易學性 接受度

滿意度

3.95

3.70 3.78

3.80 3.95

Usefulness

Ease of Use Satisfaction

Learning Acceptance

Loading Released

ICU of Teaching Medical Center in Taiwan

Important Part of EMR

What We Have Learned

1) Usability of Mobile Care Solutions Can

be Assured with Right Interface Design

Principles

2) Display and Device Size does matter

3) Mobile Solutions can be Right for

Healthcare Professionals

4) Mobile Health Solutions are Feasible

for “Consumers”

Challenge 1: Feasible for

All Groups? --The Seniors

Challenge 2: Where Does

Telemedicine Take Place?

Challenge 3:What Does

mHealth Imply?

(CDC, 2003)

Challenge 1: Feasible for

All Groups? --The Seniors

Challenge 2: Where Does

Telemedicine Take Place?

Challenge 3:What Does

mHealth Imply?

(CDC, 2003)

The Seniors

• Unfamiliar with the tech – Aged Society in 2020 for Taiwan (>14% aged over

65)

(Fox & Duggan, 2012)

• Functions decay: Motion, Cognition, Vision, Sense of Touch, etc.

• So, are they 1) OK w/ mHealth (use mobile devices, Smartphone,

to bridge the “missing half”)?

2) willing to use?

3) competent of using it?

1) Yes, they are OK

115/325 Items Can be Answered…

But with Large Display Size 6”,

Not 3.7” (2011)

3.7 too

small to see

and out of

sight, out of

mind

Device Feasible in 2013

US$350

• If, help them in some ways

• easy to Use

For example, Community-based

Integrated Screening Service

App (2013, Working Draft)

1) Yes, they are OK

From

ECRS 步驟

刪除 1項(18表單回收:1.回收篩檢表2.回收並填完整，4人)

合併 4項(2領取表單，2人、3篩檢項目登記，2人、4填單區，6人、17問卷區:1.「失智量評估」及「慢性病防治問卷」，3人)

重排 (2領取表單與4填單區）

簡化 1(4填單區)

And Confusing Flow

To App

Common Seniors

2) Yes, they are interested

(Course of Teaching Students to Serve Seniors, since 2011)

Motivated…

But…

Not too serious at the

beginning…

Dumb Apps to Begin w/…

• Need Lasting Support

• Starting from Simplicity

• Related to Part of Their Daily Lives

• or Dumb Apps like

3) Are they competent?

http://www.geekinsider.com/2013/04/03

/top-10-smartphone-apps-for-the-elderly/

Successful Aging by Away From

Home (ICQmH)(NSC:2011-2014)

“Wander Around, Health Watch 24/7, Doc & Nurses Around, Happy Long Life.”

Intelligent

Comprehensive

Quality

Mobile

Health

Project Map

Competency Scale 1. Basic Skills and Knowledge

2. Phone Calls

3. Short Messages

4. 聯絡人功能操作

4.21 能夠在手機中建立一筆新的聯絡人資料

4.22 能夠修改手機中的某一筆聯絡人資料

4.23 能夠刪除手機中一筆聯絡人資料

5. 相機功能操作

4.24 能夠用智慧型手機拍照

4.25 能夠用智慧型手機錄影

4.26 能從圖片庫中瀏覽手機內的圖片、照片及影片

4.27 能夠刪除手機內的照片或影片

6. 桌面功能操作

6.28 能夠新增一個應用程式捷徑到桌面，或從桌面上移除一個捷徑

6.29 能新增或移除一個桌面小工具

6.30 能操作使用桌面上的小工具

7. 應用程式操作

7.31 能透過手機行動網路(3G)上網

7.32 能使用【PLAY商店】在網路上搜尋並下載應用程式

7.33 能開啟或關閉【衛星定位(GPS)】

7.34 了解網路使用流量，並能在流量快超過時關閉行動網路

64

4. Correspondence

5. Picture Taking

6. Desk Top Management

7. App Download and Run

Training Plan

Leaning Map & Menu

Smartphone with 4” Display Size

A3 Size

w/ Color

Format

Test and Follow-ups

• Operation 13 tasks on their own

• Phone Follow-ups

Preliminary Results

• Subjects (60% Never Used Smartphone)

• All Competency Items Were Significantly Improved after Training

WWW.NI2014.ORG

Submission Deadline: 9/30/2013

Comments polunchang@gmail.com