User optimized design of hand held medical devices - applications and casing

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User optimized design of hand held medical devices -

applications and casing

Marike Brunberg

June 26, 2010

Master’s Thesis in Interaction Technology and Design, 30 credits Supervisor at Applied Physics and Electronics-UmU: H˚ akan Gulliksson

Supervisor at Advantech Co. Ltd: Lydia Cheng Examiner: Per Kvarnbrink

Ume˚ a University

Department of Computing Science SE-901 87 UME˚ A

SWEDEN

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Abstract

The health care industry has with enthusiasm and bright vision adopted mobile computing technology. Physicians support the innovation of using mobile devices to access and view information at the point of care. Hand held computers is a step in the right direction to create a more efficient health care where information such as patient medical records, test results and patient data can be accessed, modified and used at the right time and place. A hospital providing efficient solutions to increase health care quality will affect patients in a positive way. Physicians will be able to decrease their workload and save both money and time.

This paper will describe how a hand held computer in a hospital environment, a so called Mobile Clinical Assistant (MCA), can be optimized with respect to HCI (Human-Computer Interaction) in different aspects, in software applications as well as casing and graphic icon design. The hand held computer is a MCA developed by Advantech, a Taiwanese Industrial PC platform company. It is one of their Point-of-Care Computing devices with the specialty to streamline medication using administration and the latest technology to provide the “five rights” of patient care; right patient, right time, right medication, right dosage and right route.

My thesis work resulted in several different improvement projects, covering both software and casing design. Software applications were developed as specially designed Advantech utilities for their MCA. Two applications were developed, one camera interface to control the camera functionality and the second one to gather all functions in a dashboard for easy access by the physician. Casing of one MCA got more user-friendly with improved keyboard design.

A unified graphic icon design was developed for all Point-of-Care products in Advantech’s Medical Computers family line.

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List of Figures

4.1 The camera utility at its draft design stage. All necessary function buttons and option tabs are arrange. . . 19 4.2 The Resolution tab in the camera interface is opened and the option “640x480

@10fps” is marked. . . 19 4.3 The camera function is in use, a mode indicating icon is shown in the corner

and the camera button is highlighted. . . 20 4.4 The picture shows a computer desktop with the “MICA Camera” desktop

icon in the left corner. . . 20 4.5 By double clicking on the desktop icon, the camera utility will start up with

its front camera chosen. . . 21 4.6 The Sound tab is opened and the option “Sound2” is marked and highlighted. 21 4.7 The Resolution tab is opened and the option “1280x960 @8fps” is marked

and highlighted. . . 21 4.8 The LED light is off and is marked by a red line across the Light icon. . . 22 4.9 The appearance of the Front/Back switching button when the back camera

is chosen. . . 22 4.10 The interface shows that the front camera is chosen and the camera function

is in use by highlighted color changes of the buttons. A camera icon is shown in the left corner of the picture panel to indicate the camera mode is in use. . 22 4.11 The front camera is chosen and the recording function is in use. A recording

icon is shown in the corner to indicate that the recording mode is chosen.

The Front and the Record button is highlighted with color changes. . . 23 4.12 All files will be stored in the folder MyMICA. When a user clicks on the

button MyMICA to find photos or movies, the button will be lighted up with bright blue color. . . 23 4.13 The camera utility was developed according to this system description. . . 23 4.14 The picture shows the camera interface pixel sizes. . . 24 5.1 Early design suggestions for the dashboard appearance. Different color com-

binations, menu shapes and transparent design was tried and discussed. . . . 27 5.2 Early design suggestion for the brightness function. . . 27

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vi LIST OF FIGURES

5.3 This is a picture of the dashboard start up menu with its seven function buttons. 28 5.4 The battery status function provides an interface with information about the

remaining time and percent of the battery. The information is shown with large clear numbers to make it easy for the user to quickly view the battery

status information. . . 28

5.5 The interface for the brightness function consists of an adjustable bar and an indicating brightness diagram. . . 28

5.6 The screen rotation interface consists of two buttons, one to rotate the screen 90 to the right, and the other to rotate the screen 90 to the left. . . 29

5.7 To start using the touch screen the user needs to calibrate the screen. De- pending on which technique the user wants to use both the pen and finger calibration software can be found at the touch utility function button. . . 29

5.8 The users may change the path way of three programmable buttons; P1, P2 and P3. This is made by pushing the browse button and then set a new function path. . . 29

5.9 This is interface of the Barcode function. It has four different options for the user to choose how to store and separate scanned barcodes; by an Enter, a space or tab character. Default settings let the barcodes stores as a text string without any space in-between. . . 30

7.1 The power button icons. . . 34

7.2 The touch screen icons. . . 34

7.3 The reading light icons. . . 34

7.4 The audio control icons. . . 35

7.5 The brightness control icons. . . 35

7.6 The RFID reader icon. . . 35

7.7 The alarm clock icon. . . 35

7.8 The wireless LAN icon. . . 35

7.9 The barcode scanner icon. . . 36

7.10 Three ways to create a disable function icon; by marking an icon with a cross or by diagonal lines in two different directions. . . 36

7.11 This is the first icon map of the final design result after improvements of icons on the first icon map. . . 37

7.12 This is the second icon map showing improvements and the final result of the icon design. . . 38

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Chapter 1

Introduction

1.1 Purpose

1.1.1 An aging world in need of health care

Today the world population is aging. Especially in the western world there is a high average age and increasing elderly population due to high living standard and low natality. A world full of people that is getting older and older is leading to an increasing need of health care services. High-quality health care is crucial for treating and managing illnesses of people.

But providing health care also brings an important disadvantage, rising health care costs around the world. One way to improve health care services is by introducing technical support solutions where it has not been used before. This can decrease the work load for nurses and hospital personnel and also give them a more comfortable and efficient work environment. Finally, we have the patients as receivers of care and they will (if success of modern technology) also be positively affected. Several visions talk about connecting people to medical care systems and storing the information using available technology of today. The goal is to apply a more actively consumer focused thinking work to improve care, taking health care services to the next level of quality and functionality.

1.1.2 Health care market and actors

By optimizing technology with the aim to enhance and effective health care in hospitals a new market is explored. The suppliers fight for making technology better fitted to medical applications. Hand held computers and PDAs are examples of equipment that enables more mobile applications in health care solutions. This new kind of health care devices is supposed to distinctly increase the health care service at a systematical level. The idea is to design technical solutions to improve and make the health care more effective in order to reduce costs, give some more time for personal care, and solve other challenges health care is facing today. The health care market is shared between producers of medical technical equipment and other groups of suppliers like personal computer and PDA suppliers. Formerly, the market consisted of a large selection of established companies. They were less computerized, providing a wide range of self contained technical functions, not providing larger connected system services or system solutions. Today, the new players on the market are the ones stimulating the use of these kinds of products. These actors are technology based companies specialized in a specific high technology area with a high level of industrial computer and

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2 Chapter 1. Introduction

communication background. They develop cheaper and better products to attract people by producing electronic components and electronics solutions with expertise in a narrow technology field of knowledge. Some of these companies are interested in the medical sector and wants to get into that new market. Intel is one of the new actors on the market. As a component supplier, they are producing computer circuits that are widely used all over the world.

1.2 Advantech Co. Ltd.

Another new actor on the health care market is Advantech Corporation Ltd. It is a company with industrial computer platform background. Intel has made an initiative for reference platforms. Several Embedded PC companies have followed this initiative and one such company is Advantech that is developing mother cards and apparatus/embedded PC cards and systems. Now, Advantech wants to sell more products, where their MCA is one solution designed with Intel core inside. By using Intel’s MCA reference architecture, Advantech has been able to develop a more optimized MCA model.

1.3 Report outline

To give a better understanding and overview of the thesis’ structure, this is the content of each chapter:

Chapter 2 - Problem Description This chapter is describing the challenge of designing hand held computers for health care and how this thesis work was a contribution in development and design of software application and casing design aspect at Advantech Co.

Ltd.

Chapter 3 - Design process The methods and equipment used during the design process are presented in this chapter. Interviews and field studies have been used as the main sources go gather data in how to proceed the work.

Chapter 4 - Interface for camera This chapter is presenting the first software application developed for the Mobile Clinical Assistant MICA-101, the camera utility. The camera utility is to help the user to take photos and record movies.

Chapter 5 - Interface for dashboard This chapter is describing the second software application developed for MICA-101. The dashboard utility helps the user to find common used functions faster by gather them in a easily accessed menu panel.

Chapter 6 - Keyboard and casing design Keyboard and casing design were enhanced and designed for the second generation MCA. The chapter is bringing up the design process and final work covering the shaping and improved design of the keyboard and finger print reader used on the device.

Chapter 7 - Graphical symbol design An initiative was taken to gather all common icons and symbols on different products in the medical product family line. This chapter is describing the goal and result of finding the most suitable unique icon and/or symbol for each function in accordance with the profile of Advantech and what would be easy interpret by the user.

Chapter 8 - Summary The summary is the part of the thesis work summarizing and describing what goals were reached and what parts that were not satisfied done. Success and failures with the work performance is discussed and analyzed.

Chapter 9 - Discussion The last chapter is bringing up the company culture where the work was performed, limitations with the work and thoughts about future work within the

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1.4. Definitions and acronyms 3

area of hand held computers for health care. The work is finally tied together in a conclusion part.

1.4 Definitions and acronyms

HCI: Human Computer Interaction

MCD: Advantech Medical Computing Division MCA: Mobile Clinical Assistant

MICA-101: The first generation MCA MCA 5.7: The second generation MCA MPIP: Medical Product Identity Project

Camera Utility: MICA-101 Software application Dashboard Utility: MICA-101 Software application NTUH: National Taiwan University Hospital

POC: Point-of-Care

EMR: Electronic medical record

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4 Chapter 1. Introduction

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Chapter 2

Problem Description

2.1 The challenge

The latest trend that hospitals using advanced technology are facing today is the “real time, paperless and film-free” patient monitoring and nursing care [33]. The technology and products of today are now capable of networking and deeply integrated with all other systems. This also enables high quality image displays which make it possible for the medical personnel to take advantage of digital technology instead of old-fashion films and documents and apply it in their daily work in hospital environments. Given an awareness of a multi functional computer would not be able to be compared to the doctor-patient relationship; computers have been adopted and accepted in many different areas of medical care. The latest technology can assist nurses and doctors in their daily work with enhance to collect information, analyze data and help medical professionals making correct treatment decisions. Advanced trustful health care technology is clearing the way to enhance the quality in delivering patient care.

Nowadays, mobile hand held computers are used in hospital environment by nurses and doctors. The Taiwanese company Advantech’s Mobile Clinical Assistant (MCA) is one of the products on this new market [13]. The MCA is a product used in making clinical documentation in real time. It is based on the Intel MCA reference architecture which integrates technologies that support the “five rights” of patient care: right patient, right time, right medication, right dosage, and right route [33]. Mobile computing solution for health care solution in this new category has been supported and appreciated by clinicians and nursing staff world wide. The MCA can quickly access information in databases and provide patient education.

2.2 My mission

The master’s thesis was performed at the company Advantech Co., Ltd. in Taipei, Taiwan.

I was working at the head quarter of Advantech Co. Ltd., for their Medical Computing Division. My project was to optimize the HCI of their next product generation in their Mobile Clinical Assistant series. The thesis work was performed with skills and abilities learned and practiced during my education program, a Master of Science Degree in Inter- action Technology and Design Engineering at Ume˚a University in Sweden. By applying my knowledge in an industrial practice in a foreign company, I got highly valuable experience on

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6 Chapter 2. Problem Description

how it is to be working for a company in real projects and how it is to work in a foreign work culture. In this kind of situation adoption to the working process and company culture in a flexible way is necessary. At Advantech, when my thesis work started, Human-Computer Interaction was not a well known area. Initially, I was asked to educate the personnel by holding presentations in Interaction Design where I presented theories and models from Human-Computer Interaction Design and how it could profit and gain Advantech.

A better understanding for Interaction Design while developing products and integrating this knowledge in the design process will give a better focus on the product, the user and the interaction in between. A user-friendly product is a device developed by a team that involved the user in the design process, from the beginning to the end. To contribute with my knowledge and skills in Interaction Design to the Medical Computing Division team and influence their way of working was a great profitable experience. I was warmly welcomed by the Medical Computing Division as they realized the benefit and advantages that I could help them with. The project team appreciated the new innovative strategy to focus more on the user and its need which gave me a lot of courage.

2.2.1 Aim and work

The challenge was to enhance Advantech’s Medical Clinical Assistant products in their Medical Computing Platforms series. My work resulted in several different improvement projects, covering both product casing and software design:

1. The product casing design project was to join the development of the second generation Mobile Clinical Assistant (MCA) product, MCA 5.7. It is a 5.7” LCD Medical Tablet PC based on the Intel MCA reference architecture. My task was to improve the user friendliness and usability of the MCA 5.7 by improving the appearance of the keyboard design and the fingerprint reader.

2. The first software application project consisted of developing their two first Advan- tech Software Utilities. My interaction design expertise helped the project team in developing and designing a camera and a dashboard application for their MICA-101.

3. The second software project was to evaluate existing health care software that the MCD was considering taking into use. It was a patient journal system developed by students from National Taiwan University. Due to secrecy, the result of the system design and description may not be revealed and published in this report.

4. The forth and last part of my thesis work was the Medical Product Identity Project.

The aim of the project was to unify hardware icon and symbols for all POC products in Advantech’s Medical Computers product line.

2.2.2 Related work

There are a lot of studies made with hand held computers in health care. The hand held computer used in hospitals has changed its appearance through out the years. What is in field studies described as a hand held computer has developed from a PDA with simple functions to a nowadays hand held computer special designed for health care usage, the mobile clinical assistant. Mobile Clinical Assistant Platform Prototype [14] is one of the latest clinical field studies made by the Intel Digital Health group. The study brings up the value and features of the mobile clinical assistant prototype, such as the RFID-based user log-in and authentication, bar code and RFID readers for patient identification and

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2.2. My mission 7

integrated digital camera for wound documentation. Intel Digital Health group has made another study to evaluate the use of the MCA by physicians in an emergency care environment. The result of a MCA as Mobile Point-of-Care technology is documented in the paper Mobile Point-of-Care Technology in Emergency Care - Changi General Hospital, Singapore [21].

Mobile computing

For this thesis work the main research within mobile computing has been about hand held computers suitable for the health care sector. Hand held computers in critical care [24] is evaluating the role of hand held computing technology for managing patient data and access medical reference information with help from a Palm III series hand held device. Physicians perceived benefits of hand held computers and personals factors creating barriers to hand held computer use are discussed in Doctors’ experience with hand held computers in clinical practice: qualitative study [28]. In Nurses’ and nurse students’ demands of functions and usability in a PDA [2] it is clarified what functions and information is wanted. Different type of information is categories in information about patients and knowledgebase for nurses and functions for daily work.

Product design

In contextual design a product design approach involving the context is described [3]. It is said that the designer needs to understand how the customer works in order to produce great product ideas. The most optimal way of working is when the designer in involved in col- lecting and interpreting customer data and is aware of what the real users need. Affordance has an important role in the interaction design for physical products. In “Applications of affordance and semantics in product design” [40] suggests three design dimensions to deal with in physical interaction design: affordance, perceptual information and symbol. Affor- dance is regarded as the potential of a product in supporting actions of a user, without requiring users’ memory or interpretation. This is a useful concept, especially in hospital environments where the users may be working stressed under time pressure. A product should not be designed in a way that requires too much of the user if the context is full of factors that may obstruct the user in using his or her mind to its fullest potential.

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8 Chapter 2. Problem Description

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Chapter 3

Design constraints

To better understand how I was to accomplish my work and who I was about to work for, interviews and field studies were used to understand what customers Advantech’s medical computing division were working for, where their products are used and by who. By talking to employees, making field studies at a hospital were their MCA is taken into use, I got new knowledge within an area where my earlier experience was limited. I needed the background knowledge in order to understand the environment where the products are developed for, how a developing process looks like at Advantech’s MCD and how I will collaborate with the employees. This was important to later create useful design suggestions and base my motives base on a stable ground. This chapter will talk about the process in understanding how the type of product I was about to work with is used, what it is used for, who is using it and where it is being used. I was interested in get to know more about strengths and difficulties of using it and possible challenges and guidelines in improving the device, both from external (casing design) and internal (software application design) perspectives.

3.1 Involved participants, products and methods

I have been working together with the Medical Computing Department at Advantech as their first Interaction Designer. People that have been involved in the projects are colleagues from the Mechanical-, Marketing, and Engineering Department. We have been working together in a continuous design process.

I was working close to the project managers in the MCD team. For the improvement of the MCA 5.7 enclosure design mechanical and electrical engineers were involved in the design process. While developing the two software applications for the MICA-101 the marketing managers, engineers and a designer were collaborating together. The software engineers at Advantech developed a working application for one of the produced design proposal. The second application was still in at its final design phase when I had to leave Advantech.

The software applications were designed for the MICA-101 but with the goal that if it worked successfully, it would be used also for other products in the same product family.

I was mainly working with the project manager and some engineers in contributing to the evaluation, design process and the implementation of ideas and taken decisions. To describe and present my design idea I drew system descriptions and scenarios. This made it easier to present my ideas during meetings and the project team could easily follow my thoughts while designing and how a real case scenario could look like.

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10 Chapter 3. Design constraints

The Medical Product Identity Project was sponsored by the government after an initiative by the design company Union Design & Development Corporation in collaboration with Advantech MCD. We used sketches, meetings and presentations to unify medical computers icon and symbols.

To find out what the market and context of use looks like, a market survey and some hospital work flow studies had to be made. To detect requirements, needs and resources visits at National Taiwan University Hospital (NTUH) and a clinic were made by me together with colleagues. NTUH is the best hospital in Taiwan, providing patient care and highest quality service to the people. To get a good understanding for whom and what environment we are designing for a profile picture of the user was made. By interviews and consultations with health care professionals at NTUH, information was gathered to better understand who the users of a hand held device in hospitals were, and how it was to be used.

3.2 User studies

To get new knowledge and understand the projects from a wider perspective interviews and field studies were used. An interface design for medical interfaces has to follow certain rules and guidelines suitable for its users and use of context. The users, nurses and hospital professionals may be in critical or stressful situations during the working day and be in need of software application supporting and helping them in their work. The personnel might need to be focusing on different tasks at the same time and in this situation it’s important than the computer based system is helping the nurses to decrease their work load, instead of increasing stress by being another attentive disturbing task in their work flow.

An application designed for a portable computer in hospital environments is recom- mended to follow certain guidelines in designing symbols and icons [15]. There need to be a survey about what are the accepted and easy recognized symbols and icons for the specific context where it will be used. A well designed interface, a design considering these guidelines, would in this case help the personnel at hospitals and clinics to easier interpret how to get started with a new software application and feel familiar using it.

There are some specific guidelines to follow regarding color combinations and symbol use adapted to the context of use. Valid warning symbols usually have the appearance of a warning triangle. In most countries an equilateral triangle is used as a traffic warning sign to indicate hazard and that the driver need to be careful. This symbol also applied in interface design to warn the user. When it comes to color, red color usage should be done carefully. Red color is effective in attracting the attention of people to indicate danger and emergency. Within medical services, red marked information text should be used with cautious, and is normally interpreted as an error by the personnel. When a system error is the case, red marked text may advantageously be used.

There is a practical example in a Swedish hospital [32]. When a patient arrived to the hospital the nurse or doctor will ask the patient about their health condition. Based on the answers the doctor will decide where the patient will be placed in the waiting queue.

Each patient is given a color in the computer system; green, yellow, orange or red to let the doctors know the patient’s state, need of nursing care and for how long time they are able to wait for care. The red color indicates that immediate care is needed, orange labeled patients can wait for a while (up to 20 minutes), yellow can wait one hour and green can wait a couple of hours.

A design criterion for a computer based system should be easily accepted and taken into use by hospital professionals in that the user was once involved in the design process.

The team developing and designing a system have the user’s different computer skills in

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3.2. User studies 11

mind and try to picture themselves as the users with different background knowledge and contexts. To handle user’s different computer experiences it is important to design the user interface as user-friendly as possible. When a new function or module is developed a good idea is to let the not so experienced users try it out.

There are some general rules that all journal systems should follow. First of all, patient security should be taken into consideration. Logging and traceability of information should be provided. Systems should be safe, which means that none unauthorized can access information. Authorization of users is solved by password, signature login, or smart cards.

Smart card is a credit card with a smart inside. It has the size of any pocket-sized card and contains an embedded microprocessor situate under a metallic pad. This smart chip process input data and can be used for strong security authentication. Traditionally login to computer system was made by the user’s identity and corresponding password where the input data and password is compared by the system. A security hole is that a plain-text stored password can of course by mistake change hands and the account can from that moment be overtaken by someone unknown. Nowadays there are safer, less expensive and more efficient ways of login to computer systems. Smart card is a cheaper, more portable and with a larger cryptographic capacity solution [7]. These advantages have made smart cards popular as new authentication technology.

If a hospital wants to take a wireless device into use, it is their IT department’s re- sponsibility to install the network and also to handle any existing encryption requirements on wireless networks. There are not only encrypted networks; some information in system databases may be encrypted too. There are not many disadvantages using wireless computers in a dynamic environment like in hospitals but there is one important disadvantage that needs to be considered. When using wireless computers compared to stationary ones there is a risk of loosing data because of wireless communication. To only let appropriate people use the systems, each hospital decides who has authority or not, in general the nurses and doctors. This means the authority can be established later on to decided what parts respective user may access. Skilled health care system designers develop systems that are supporting hospital in authority configuration on a quite detailed level. The possibility to establish the user’s rights to access a certain type of information is then given to the hospital [15].

There are some aspects regarding development of health care systems that is less tech- nically oriented and more user communication intensive [6]. Symbol and menu design for the interface are two such type of cases. The symbols used both for interface and hardware needs to follow an, for the supposed user, easy acceptable and well established design. Sys- tems in a critical environment should provide easy to use basic functions. A user should be able to use and have easy access to no matter how the user’s earlier computer skills. There is no particularly difference in the security settings for communication with mobile health care computers compared to a standard PC.

Nurses and doctors may be stressful in critical situation. An interaction designer may think of when designing for hospital environment. The toughest challenges and problems be discuss further in this text. It is a crucial issue for the designers because they have to keep in mind that the users will often be in need of focusing on different things at the same time in such a dynamic environment. There are three main topics within this area while designing health care systems, user-friendliness, compatibility of application and how to decrease data error.

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3.2.1 User friendliness

A way to convince the user that the system is easy to use is by design with the motivation in mind: why use a Mobile Clinical Assistant when the paper is faster? Faster in this case means that it is faster access (since they at the time how the paper system works, and they got no experience of hand held supportive tool like the MCA), it is what the personnel are used to work with and believe learning a new system would take longer time to understand then stick to the old way of paper use, which means give them a feeling that it is faster.

There is always a question about time, money and patience to take a new system into use and get used to a new work flow, but the if the time and costs is spread over the time where the system is accepted and is fulfilling its expected efficiency then the resources spend may be decently invested. At the time the user is interacting with the interface it should only be showing the meaningful data and records that matter at the time. In many cases the computer screen is full of data that is not necessary at the time, which will just give the user an information overload and limit the readability of the other data that matters [29]. By only showing appropriate data, provide larger fonts where it is needed and design records with space to easy fill in information or just check mark questions, the nurse will feel less confused working with the system.

3.2.2 Compatibility of applications

Another challenge is to handle the compatibility of applications running on different platforms [29]. The common used screen size of 19” has a lot of space to have all data available.

The smaller screen the less space is it for all data to be shown. Many applications were designed years ago and have since that time been growing, which means a application meant to be used on a common used screen size like 19” needs to be redesigned to be able to work on a 10” mobile screen, the application developers need to shrink the resolution down to a lower resolution if they want to use the same application again. I most cases the mobile applications needs to be redesigned.

3.2.3 Decreasing data errors

Human make mistake by nature and sometimes a data error is made. There are methods to decrease the possibility of data errors by using the mobile device when the data is entered as close as possible to where the data source. It is better to directly type the information into any recording document in digital form, e.g. patient record, instead of letting the nurse daily first write it down on paper records and then bring this to the work station at the nursing desk. The possibility of making data error will be reduced by decreasing the number of tasks needed for this action.

3.2.4 Context of use

To develop a product for health care, the context of use needs to be taken into consideration.

There are performance requirements of the device from the environment and the user. The device needs to be reliable and secure and at the same time help the user to access the information when and where they need it, at the point of care. To explore the interest about using mobile technologies and the benefits of taking a hand held computer into use in hospital environments a visit at National Taiwan University Hospital (NTUH) were made in Taipei, Taiwan. NTUH is a hospital educating and training students, physicians and biomedical scholars. As the hospital with the highest service quality in Taiwan, they are

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3.2. User studies 13

providing comprehensive knowledge, research and patient care [16]. NTUH has already taken the latest mobile clinical assistants into use and adopted the hand held computers in their daily work routines. To take part of valuable user experience and opinions of using it, interviews with three doctors were made at NTUH. Doctors from the three different hospital divisions; Dermatology, Emergency, Internal Medicine and Department where represented at the meetings. According to the strengths and weaknesses that were brought up during the interviews the interview data showed what the user wants, needs and expects of using a hand held computer in their work. With this kind of facts it was possible to summarize what is important for the user when it comes to product expression and context awareness.

3.2.5 Product expression

Nowadays products are not only given a design for its functionality, they are also designed to express their function. The user should be able to understand how to use it by looking at it, in other words its affordance [30]. With a hand held computer that is supposed to suit all hospital professionals need to consider that the design suits the user, no matter the person’s length or strength. One doctor was questioning the hand held computers advantages in hospital. Sometimes the product design can play an important role in convincing the user that it is reliable, supportive and secure, only by looking at it. But of course, the products software performance at the point of care has to speak the same product language, express similar attributes as the outer hardware design. If not, the user might get disappointed of the unit as a whole. The goal with focusing on a product expression is to convince the physicians that this product is something they need and want in their daily work. The strength with a mobile device is that it is, exactly, mobile. There came up a request during the meetings of possibilities of installing the computer on the wall. This is a decision need to by taken by people working at the hospital and it would technical not be a big problem.

There is a cradle that can be put on the wall and act as the holder. Nevertheless, the interesting part here is if the device would not loose its largest benefit of being mobile when all the other computer and medical devices are stationary and too heavy to carry around?

If the user would like to carry around the device to different work stations or patients it is good if there are no loose parts. The suited pen for the touch screen is fixed on the backside of the computer. If the pen once is lost you can’t user the touch utility, which is a pity. On idea is to instead of providing only one pen suitable for the screen, a durable plastic screen cover would available more kind of pens [39]. If the option is to provide only one Stylus Pen, it should not be too tight fixed on the back of the computer. There was also a comment about the sensitivity of the touch screen; a doctor felt it was not sensitive enough [39]. If characteristics like above are fulfilled and expressed by its design, then there is a strong motivation for a mobile clinical assistant’s advantages and why a nurse would adopt it as a natural tool in their work.

3.2.6 Context awareness

What is special with a hospital environment? What to think of when it comes to the hardware design. Should it follow the same style as other equipment in the hospital? There are also network issues about a mobile product requiring a wireless network to work appropriate all over the hospital. IT-people at the hospital are the one responsible of organizing the wireless infrastructure. The wireless local area network needs to cover any area where the nurse might want to use the computer. The biggest use of MICA was to easily connect to the Hospital Information System (HIS) while visiting a patient. One doctor commented the

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need of a MCA. This doctor was not convinced about the benefits with this kind of product. The need of a MCA was questioned; what would the MCA do better then a regular personal computer does today [39]? This doctor said that memorizing the patients’ information also works and prefer to use the hospital cart instead of a mobile hand held device.

There are concerns about the computers battery life and temperature after long time use.

There were questions about the computer if it will be over heated. If that happens, what are the consequences? The MICA is constructed to be used a couple of hours at the time without getting over heated. To charge it there is a battery station where four batteries can be charged at the same time. Only one battery is used at the time. Using the RFID function for authority identification was highly appreciated and could be used with hospital identification cards with RFID tag to login. It is clear that there is no single solution that will fit all users. First of all, the environment is different from one department at a hospital to another. Second of all, depending on the user’s role, their need and requirement may differ. There will always be different opinion of what is useful, necessary and important to fulfill a specific users needs and to suit the hospital environment. But by putting enough resources into detect critical situations where a hand held computer could help the user in their work, this scenarios could later on be used as subjects to motivate why a MCA could be helpful in a nurse work flow.

3.2.7 Field study at Far Eastern Poly-clinic, Taipei, Taiwan

To understand more how to integrate a new system in a hospital environments a meeting were held with the Information Technology personnel at Far Eastern Poly-clinic in Taipei, Taiwan. When designing a new software for helping the nurse or doctor in performing a specific task, there designers need to keep in mind the time pressure the personnel are often working under and how to educate and adopt this new software in the environment [36].

The time pressure requires that the user easy can access the data when they need it and a user-friendly interface to make it easy to navigate to the right function in a short time.

A more task specific and dedicated software would be preferred for any examination in the work flow [36]. Especially education of a new system when taking new software into use is also mentioned discussed in other research papers. The current topic is how to educate the users of a new software system in an efficient way. Hospitals would appreciate if vendors are not only providing health care systems but also resources in educating new users [36].

3.2.8 An interaction architects’ point of view

Cambio is today on of Sweden’s largest supplier of Health care Systems with nearly 50 000 uses at emergency- and university hospitals, clinics and specialist units [35]. Cambio Health care Systems has since 1993 been focusing with their competence and capacity in realizing the vision of a functional, flexible, integrated system for the health care. At Cambio they have Interaction Architects working. An interaction architect’s job is about the communication and interaction between human and artificial systems. Even though they are designing for system of large sizes, they are experts when it comes to design system being used in health care. To take part of interview material on their web page with two of their IA employees gave the development of the projects’ utility application some appreciated guidelines in what to think of in preceding the work. A smaller application should be imprinted by the same thinking since the context and the users may be the same as someone responsible for handling health care systems. One interaction architect is describing the challenge as design a module to a unique environment that is in a hospital.

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3.3. Other design issues 15

There is also a zero tolerance for unnecessary waiting time because of slow computers. The users need to feel comfortable and secure while using the systems. At Cambio each project starts with asking the question “Why?” By repeating the same question over and over again the user’s needs are easier to detect. Then it is easier to identify a new perspective that can be used in the project work.

In developing applications it is clear that is should provide the right information at the right time in order to let the user feel stressful because of slacking program. However, a small application can’t be compared to a health care systems since is not using at all as much memory and computer power, but it a good point to think of in any project developing software for a time critical context. The interaction architects at Cambio are also describing the health care’s condition as constantly changing. That is a good reason why systems also should be designed to easy adopt environment and condition changes.

This was something interesting to keep in mind while developing the utilities. Both the dashboard and the camera utilities will be given a design that suits the users need at the time they are developed. In the future, when other functions will be available, it is preferred that the applications easily can update changes or release new versions, to always suit the user in the way they and where they would like to use it.

3.3 Other design issues

The biggest challenge in developing interface for medical computers is how to make them as user-friendly as possible. It is an important aspect because there are many users that should feel comfortable using the system. Software developed for health care will meet an uneven maturity of computer usage. The users might have difference backgrounds and earlier computer experience and all this need to be considered in the design process. Another challenge is how to meet the requirements in saving paper costs. In some countries there is an initiative of “paperless” hospitals where they are pushed to save paper cost. That would imply more and more documents stored digitally in databases [29]. One an important issue within mobile computing in health care is how to decrease data errors. Introducing electronic medical records (EMR), is a big effort from the European committee and local governments.

There have been a lot of controversies about this where the patients are protesting against having their Medical Records on the “street” [29]. The two main issues in this discussion are data security and access control, where the access control is determining who has access and what information details may be accessed.

3.3.1 Investigation of the environment

To integrate this kind of equipment, there are several restrictions and requirements that has an impact on the usage. These are mentioned below. These are areas not to be concerned in this thesis work but is important in the total picture of adopting a MCA into hospitals.

There is different systems that the customer may use on the product, they can access the central system for patient informatics where nurse information system.

Hospitals have special requirements on the journal systems development process. The IT departments got often and/or wish that systems should have safe data storage, which means they are using reliable and secure relational databases containing transaction handling. It is common that IT departments also raise questions about systems developed with modern architecture structure. Today a Service-Oriented Architectures (SOA) is preferred and even sometimes a demand. SOA is a modern system management approach and a way to organize a distributed IT system. The approach is a way to manage the various servers, storage

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and different network devices a system may contain into a structure of communicating services [37]. There are also requirements on a legal level. National or regional regulatory requirements are controlling electromagnetic compatibility, chemicals and safety. There are security and authorization requirements handled by RFID technology and biometric smart cards and functions handling log out after a certain time. Depending on the user and its authority different functions will be enabled and data able to be accessed. Other patient data regulatory legislation and legal issues need also to be considered. There are options for data input. Methods are using regular keyboard or on screen keyboard where a pen special designed for the touch screen may be used.

The focus on the report is on the user, the product and the environment. By looking into the context where the user, product and patient are interaction, a lot of interesting information can come out in order to support the design team in developing a user friendly product.

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Chapter 4

Interface for camera

This chapter will describe the work done developing Advantech’s first medical software application, the camera utility. In this chapter the design process will be described from start to the final result. There will be a motivation for why a camera interface was needed, how the interface was design and why, and how the software application is used. Pictures of the prototype application design will be shown at the end of the chapter.

Advantech MCD developing team had been thinking about how it would be to develop software application specified for the functionalities of mobile clinical assistant MICA-101.

One useful function of the MICA-101 is that the user can take pictures with the integrated cameras. The hand held computer provides two cameras, one on the front- and one on the back side. The idea of a software application started to grow at the time when employees were taking pictures with one of the cameras and wanted to view them later on. It was shown that it was easy to take a picture, but to find the picture taken was more complicated because the picture was stored in a folder at a not very self-evident location. Even employees at MCD had problems finding the picture. Discussions started about how this could be done in a better way with a user-friendly interface providing all options a user would need in taking a picture, save it and view it. A project group was set up in order to start developing a user- friendly camera interface as the first software utility for Advantech’s medical computers.

The goal for the project was to develop an interface in order to make the user feel more comfortable and safe while using the cameras on MICA-101.

4.1 Camera Utility

To solve the problem using the camera, the project team started to discuss a new way to handle the camera utility. The user may not only want to take pictures, they may want to record movies too. The idea started of an interface handling both the camera and video recording functions. Previous research and gathering of interview data supported the development process with useful information and guidelines on how to design software applications especially for medical environments. The camera utility was about to be the first software application with the aim to be as user friendly as possible and suit the context of use. With knowledge and guideline that came out from the research, the project team started to discuss functionalities of the camera interface. Crucial questions to answer were for what situations will this application be used for, and what functions was needed? The user wants of course to take pictures, record and store them somewhere safe. But is there also a need of sending the picture to another physician that is far away for observation and

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18 Chapter 4. Interface for camera

maybe receive expertise comments? During discussion it got clear that due to patient’s integrity, no function for sending picture was allowed. The pictures should only be stored and accessed by the hospital database by people with authority. After discussion considering the functionality range of the application the conclusion was that the application should be as simple as possible but fulfilling the basic requirements from the user. The application had to provide a user-friendly interface for:

1. Choosing camera, front- or back camera 2. Take a photo

3. Record a movie 4. Store file 5. Find file

The first draft design had two tabs on the top of the picture for Sound and Resolu- tion options. The sound tab consisted of different sounds to let the user choose the most preferable one to indicate that a photo is taken. The user could in the prototype design choose from two different sounds or set as mute. The already existing camera software had a simple bar underneath the picture where the resolution of the picture could be changed.

That functionality and data were kept but merged into a Resolution tab in the new camera interface design. The user could choose from four different pixel resolutions.

To take a photo the user may choose between two cameras. On the MICA-101 there are one on the back and one on the front side of the device. The back camera takes a photo in a similar way as users would take a picture with their digital camera. The front camera is normally used as a web camera, but could also if the user wants act as a camera. To record a movie AMCap is used. AMCap is a simple tool that is used to capture video from a webcam. After each photo captured or when movie recording stopped the file is stored in the folder MyMICA. In the MyMICA folder both movie files and photos will be stored at the same locations, but in the current solution it is set to that a new folder is created after 200 files have been saved.

The user may choose what function they want to use, the camera or the recording function. To indicate what function is in use there will be an icon displayed in the left corner of the picture panel. To indicate the camera mode a simplified camera icon will be shown, and for the recording mode an icon of a motion camera will appear in the corner.

An early design idea of indicating the recording mode was with a round red dot. That idea got overruled because it was too similar to the kind of recording icon that is used in media players. To indicate a function is in use, the button will be shadowed in a way to make it look like it has been pushed. A challenge was to design an icon for the button of changing the cameras from one camera to another. There were a lot of different design ideas of creating an icon. It could also have been done only by text, only with icons or a combination of these two ways. The last-mentioned suggestion was used in the prototype design because it was the easiest interpretable design. On the right side of the Resolution tab there is a button for the LED light. This light is disabled by pushing it and enabled by pushing it a second time. The LED light will however only be changed when the camera is in its Back position because there is no light for the front camera.

The early stage design of the camera interface had seven buttons, four in the right side of the panel and three on the top of the picture panel. A suitable camera application icon was about to be created and placed with the software name in the left corner of the window

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4.2. Result 19

panel. There was also a preliminary default decision taken for all functions. Once the user starts the utility the default settings will be set to back camera, LED light on and MyMICA folder as the default folder.

4.2 Result

Following pictures shows the draft of the camera interface. The pictures are demonstrating the draft design of the software application in three scenarios; when a user starts the software application, when a user clicks on a tap and how it looks like when the camera mode is in use.

Figure 4.1: The camera utility at its draft design stage. All necessary function buttons and option tabs are arrange.

Figure 4.2: The Resolution tab in the camera interface is opened and the option “640x480

@10fps” is marked.

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Figure 4.3: The camera function is in use, a mode indicating icon is shown in the corner and the camera button is highlighted.

The camera interface draft design was revised with changes such as adding the latest design of the icons, and the function- and tab buttons. All buttons were given a unified design of both text and icon to be as clear as possible for the users. The “Open” button got its name changed into “MyMICA” instead to easier let the user know that “MyMICA”

is the folder where all media files can be found. This is the result of the final design. The pictures show the appearance of the camera utility desktop icon and the interface for the different functions and the menu options for each tab.

Figure 4.4: The picture shows a computer desktop with the “MICA Camera” desktop icon in the left corner.

Once the prototype design for the camera interface was ready all the material needed to implement the camera application was handed over from MCD to the software engineering division at Advantech. Among other important documents a system description and interface pixel size data was included in the delivery.

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4.2. Result 21

Figure 4.5: By double clicking on the desktop icon, the camera utility will start up with its front camera chosen.

Figure 4.6: The Sound tab is opened and the option “Sound2” is marked and highlighted.

Figure 4.7: The Resolution tab is opened and the option “1280x960 @8fps” is marked and highlighted.

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Figure 4.8: The LED light is off and is marked by a red line across the Light icon.

Figure 4.9: The appearance of the Front/Back switching button when the back camera is chosen.

Figure 4.10: The interface shows that the front camera is chosen and the camera function is in use by highlighted color changes of the buttons. A camera icon is shown in the left corner of the picture panel to indicate the camera mode is in use.

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4.2. Result 23

Figure 4.11: The front camera is chosen and the recording function is in use. A recording icon is shown in the corner to indicate that the recording mode is chosen. The Front and the Record button is highlighted with color changes.

Figure 4.12: All files will be stored in the folder MyMICA. When a user clicks on the button MyMICA to find photos or movies, the button will be lighted up with bright blue color.

Figure 4.13: The camera utility was developed according to this system description.

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Figure 4.14: The picture shows the camera interface pixel sizes.

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Chapter 5

Interface for dashboard

The camera interface prototype, described in the previous section, was favorably received at the MCD. After considering the feedback from employees at the division testing the camera interface prototype, the project team was given green light to continue developing a second Advantech utility application, the dashboard utility. The development process of the camera interface was special in one way because there was more or less an urgent need of it at the project start. The MICA-101 had more functions then the previous platform that needed to be, for the user, easily used and found. While discussing the functionality, the idea of developing a dashboard interface started to grow. The idea was to design a software application to gather some functions at the same place, a dashboard utility. The dashboard interface was supposed to provide a platform for the mostly used functions that the user may want to access fast and often, helping them in their daily route at work and clearly speaking functionality by appropriate icons. The dashboard design is inspired by the appearance of the iPhone menu design [22].

5.1 Dashboard utility

The development process of the dashboard utility started with discussions about what functions could be most suitable for the dashboard. Requirements were saying that the size of the dashboard was not supposed to be too big and it should primary be composed of functions that could be helpful for the physician in their daily job. Functions that were brought up during brainstorming were the RFID reader, barcode scanner, finger print reader, webcam, battery status, on-screen keyboard, brightness, Wi-Fi, Bluetooth, touch utility and handwriting application. At an early stage, it became clear that these functions needed to be prioritized by their usefulness and with options possible to modify by the user. The purpose of choosing a function and options necessary had to be motivated and discussed.

To give the dashboard a suitable size and shape, there was a decision taken to give space to seven function buttons and a close button. The seven chosen function that qualified for the dashboard were the following functions:

1. Battery status 2. Brightness 3. Screen rotation

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26 Chapter 5. Interface for dashboard

4. Touch Utility 5. Bluetooth

6. Programmable buttons 7. Barcode

Each button works as a short cut to the function represented by an icon on the button.

The user can, depending on the function of interest, easily access status information and/or modify settings. By gathering these common used functions in a dashboard the user does not need to search for them in the operation system’s start menu anymore. The user navigates to one function by double clicking on the icon button. The chosen function will take over most of the space in a new function window but all the other icons will still be represented in a lower bar underneath. This is to enhance the feeling of where the user is in the menu and remind the user what more functions that are available. To go to the next function, the user just needs to click on one of the smaller function buttons in the lower bar. If the user wants to shut down the dashboard, they click on the close button.

Below follows a description of each dashboard options, what information they provide and what options that can be modified.

1. Battery Status The battery status provides information about the remaining battery time and battery percent. The information is presented with a large font size on a battery illustration.

2. Brightness The brightness function provides the option for the user to set appropriated brightness of the screen. By dragging the adjustment bar, the brightness of the screen can be decreased (by moving the bar to the left) or increased (by moving the bar to the right), according to the user’s wish.

3. Screen Rotation The screen rotation function lets the user to rotate the screen 90^◦ degrees to the right or to the left. This is useful in situations where the physician does not want to feel limited by either bad availability or the screen direction of the computer.

4. Touch Utility The touch utility is the digitizer of the dashboard. To use the touch screen, at first the user has to calibrate a touch pen or a finger. This is made by activating the calibration software. Two calibration softwares, one for the pen and one for the finger calibration can be found at this touch utility function button.

5. Bluetooth The Bluetooth function is a Microsoft shortcut to ”My Bluetooth Places”

where the user can add and view Bluetooth devices.

6. Programmable buttons On the MICA-101 there are three programmable buttons; P1, P2 and P3. They allow the users to set these buttons into paths that they personally found useful. Each programmable button has a browse button and a text bar showing the path of the current function. By pushing the browse button the user may find a function that could be set as a button path.

7. Barcode The barcode function is created to let the user choose how to store scanned barcodes. The current solution of scanning barcodes stores them sequentially as a text string. That will make it difficult to handle the data because it is hard to know where a barcode starts and ends. To solve this problem the barcode function provides three

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5.2. Result 27

additive solutions, beyond the standard solution, that the user may choose from to separate scanned barcodes. The first way is by adding an enter character after each barcode, the second way by using a space character and the third option is by using tab character to separate the barcodes. This will make it easier to handle the data and for instance store a single barcode in a text box in a patient medical record. The forth and default option is to store the barcodes without any separating character.

5.2 Result

The following pictures show the dashboard interface design. The two first pictures show the dashboard design at its early trial and error stage. Different color combinations and transparency were tested on a desktop background in order to find the most suitable design.

Figure 5.1: Early design suggestions for the dashboard appearance. Different color combinations, menu shapes and transparent design was tried and discussed.

Figure 5.2: Early design suggestion for the brightness function.

The picture to the left shows a simplified dashboard start menu and the right picture shows the interface window after double clicking on the brightness function button. The brightness of the screen can be changed by clicking on the arrows to increase (right arrow) or decrease (left arrow).

The seven function buttons on the dashboard are for battery status, brightness settings, screen rotation, touch utility, Bluetooth shortcut, programmable buttons and the barcode

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Figure 5.3: This is a picture of the dashboard start up menu with its seven function buttons.

settings. The eighth button is for shutting down the dashboard.

Figure 5.4: The battery status function provides an interface with information about the remaining time and percent of the battery. The information is shown with large clear numbers to make it easy for the user to quickly view the battery status information.

Figure 5.5: The interface for the brightness function consists of an adjustable bar and an indicating brightness diagram.

To change the brightness of the screen the user has to adjust the bar horizontally. By dragging the bar to the right, the brightness will increase, and by dragging the bar to the left, the brightness will decrease.

While designing the programmable buttons there was a suggestion about providing an inactivating function for each button in order to guarantee a button would not be pushed without attention. But because the need of an inactivation function was not big enough, the idea was not implemented. In the beginning of the project the camera interface utility was supposed to be situated on the dashboard as well. But because of its importance and

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5.2. Result 29

Figure 5.6: The screen rotation interface consists of two buttons, one to rotate the screen 90 to the right, and the other to rotate the screen 90 to the left.

Figure 5.7: To start using the touch screen the user needs to calibrate the screen. Depending on which technique the user wants to use both the pen and finger calibration software can be found at the touch utility function button.

Figure 5.8: The users may change the path way of three programmable buttons; P1, P2 and P3. This is made by pushing the browse button and then set a new function path.

range, it was given its own desktop shortcut. The dashboard and camera utility developed by Advantech are both applications run on Windows XP. Adequate drivers are necessary for the finger print reader, Bluetooth, RFID reader, webcam, integrated camera and the barcode scanner.

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Figure 5.9: This is interface of the Barcode function. It has four different options for the user to choose how to store and separate scanned barcodes; by an Enter, a space or tab character.

Default settings let the barcodes stores as a text string without any space in-between.

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Chapter 6

Keyboard and casing design

Due to confidential agreements following chapter is not publishable and suitable for public distribution.

6.1 Second generation Mobile Clinical Assistant 6.2 Design process

6.3 Buttons and system indicator lamps 6.4 Keyboard design

6.5 Finger print reader 6.6 Result

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32 Chapter 6. Keyboard and casing design

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Chapter 7

Graphical icon design

The Medical Computing Division at Advantech develops and categories products in their medical product family line as Point-of-Care Terminals, Slim Point-of-Care Terminals, Mo- bile Clinical Assistants and Medical Tablets. Even though products belong to different categories, the symbols and icons used on the products should be alike. This is to make it easier for the user by knowing one product in the product family to feel familiar and easily start using another product in the same product line. Another reason is that by giving all medical products the same design the user or customer can easily recognize the product as a typical Advantech medical product. An initiative was taken to gather all common icons and symbols for a specific function on all different products in the same medical product line. The goal was to find the most suitable unique icon or symbol for each function in accordance with the profile of Advantech and what would be perceived as easily interpreted by the users.

7.1 Icon and symbols

A product may have a great design, it’s attractive, ergonomically, functional and maybe got everything that the user needs. However, if the icon and/or symbols on the product are not speaking the same language as the overall design the product may be perceived as hard to understand and use. At the time there was no unified language for demonstrating the meaning of functions in Advantech’s medical product line. To solve this problem a government sponsored project was created, the Medical Product Identity Project and it was a collaboration between Advantech’s Medical Computing Division and the design company Union Design & Development Corporation.

The medical computers were analyzed and all existing symbols and icons were gathered into a document to give an overview in understanding how many different designs were used for the same function. This made it even more obvious that some icons where not intuitive enough and hard to interpret, even for the project group members themselves. Earlier at Advantech MCD, there had been too many designers involved in generations of products but now the project team felt the limit of design freedom was reached. The major importance of the project was to put together guidelines in how to design icon and symbols for Advantech’s medical computers.

The following symbols are a selection of the most common used functions where the design had to be unified and revised to find out the best design for each function. Below follows a description for each function, in many cases with more then one icon used on other

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User optimized design of hand held medical devices - applications and casing