Merlin.net Remote Care System: A Human Factors Approach to Understanding Workflow

1. Merlin.net Remote Care System: A Human Factors Approach to Understanding Workflow Joy Hamerman Matsumoto

2. Introduction • St Jude Medical Cardiac Rhythm Management Division manufactures implantable cardiac devices • Pacemakers • Implanted defibrillators • Many newer devices are capable of remote communication between the device and a web-based data base • Clinicians perform both review of remote care data and in-clinic patient follow ups

3. St. Jude Medical Cardiac Rhythm Management Division focus on devices and platforms that diagnose and treat heart disease 3

4. Merlin.net remote care system • St Jude deploys a web-based system, Merlin.net, for remote follow ups • Patient devices communicate through a transmitter in their home to the web portal • Clinicians use Merlin.net to enroll patients in remote care, to schedule remote care “appointments” and to review patient data • Clinicians log into Merlin.net on a regular basis to assess patient and device status

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6. Expand our knowledge • Management recognized that users work with multiple computer systems to perform their work • Our understanding of the workflow that defines remote care of patients was limited to our product in isolation • To better integrate our product into the overall workflow, we needed to gain an understanding of users’ tasks and system interactions as it relates to remote care

7. Value of the research • Most clinicians use multiple software systems to manage their patients • Scheduling programs • Electronic medical records • Device manufacturers web-based programs • Systems are not integrated and do not share information • The addition of these multiple systems has impacted the workflow for clinicians • What can we do to improve users’ workload and impact user satisfaction?

8. Roles and definitions • Teams of Human Factors and Clinical Systems Engineers conducted all research • Human Factors Engineers • Trained in cognitive psychology, interface design and studying human behavior • Use these principles to guide design of equipment and systems • Knowledgeable in structuring research and analyzing results • Clinical Systems Engineers • Partners in working with our users • Knowledge of clinical applications and practices • Biomedical engineering background

9. How did we collect data? • Used a contextual inquiry approach • Puts the researcher in the users’ environments • User-centered design method that enables collection of detailed work practices through observation and interview • Used to understand how and why tasks are done • Visited 13 clinics in the U.S. and 7 clinics in Europe • Total of 28 participants • Summarized data to detail tasks, time, obstacles

10. What are clinicians doing? • Enrollment • Enter patient information so the patient can perform remote transmissions • Scheduling • Arranging each patient’s schedule for remote follow ups and in-clinic appointments • Reviewing Transmissions • Patient data recorded on the device is available for review • Patient Management • Follow up to ensure patients are complying, answering patient questions, reminders for appointments

11. Q: Do you perform these tasks? Percentage of people interviewed who answered yes

12. Enrollment Workflow Patient Chart is completed Receive Chart Retrieve Patient Info Enrollment system Log-in to Remote Care System Update EHR; Update Schedule Schedule next follow-up Print patient reminder Deliver letter to mail outbox

13. Schedule Workflow Access RC site Check transmission Manage transmission Determine next date Access RC site Resource page Transmissions page Schedule page Edit Schedule page Modify schedule Update Schedule(s) EHR • Scheduling is the most frequent task in remote care • Multiple system interactions are necessary to schedule

14. General Findings • Proliferation of electronic records and software systems have mixed results • Some tasks are easier and less error prone • Different user interfaces and need for multiple passwords causes frustration • Users learn multiple methods of accomplishing similar tasks (little transfer of knowledge) • Clinicians are wary of Electronic health records – lack of integration; multiple data entry points

15. Differences between Europe and U.S. users and systems

16. Localization challenges • Difficult to accommodate text expansion on certain screens – technical constraints / character limitations • Support for locales in IVR format only – no written support for language • Dynamic web interface – ownership of content varies by placement of content (regulatory versus marketing) • Adequate review of content by local subject matter experts (Chinese champion reviews the Simplified Chinese GUI for correct usage)

17. Conclusions • Items identified as issues in the study are prioritized for implementation • Many concerns addressed in the current development plan • Positioned Human Factors team to be included earlier in development planning • Identify key customer issues • Design, iterate and evaluate changes to the user interface • Maintain awareness of customer workflow in a broader sense to improve the experience and reduce inefficiencies

18. Thank you