Emerging Needs and Opportunities for Human Factors Research (1995) / Chapter Skim
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4 Health Care
4 Health Care
Pages 131-157
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gross national product; new developments have consequences for the quality and duration of many lives. Even a small change in the effectiveness of workers, medical devices, or care-giving environments can translate into a large impact on costs and human comfort.
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We first discuss some general technological and societal trends that are likely to have an impact on medical practices in the future and consider the human factors implications of these trends. We then describe, in more detail, several broad areas that are likely to raise specific issues for human factors research: enhanced understanding of risk factors and its impact on programs for behavioral change and disease prevention, advances in medical information technology, technological advances in medical instrumentation, and ergonomic issues that
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Although new health care needs may arise independently from technology -- for example, through demographic or social trends or through new understanding of requirements for device design -- responses to these needs increasingly reflect today's highly computerized environment. NEW TRENDS IN HEALTH CARE A number of trends in medicine indicate ample opportunities for contributions from human factors research in the coming decade.
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The trend toward increasing patient participation in medical decision making raises many important questions: How can we inform patients about risk factors, preventive measures, and treatment options? How can we aid their decisions?
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RISK ASSESSMENT AND PREVENTIVE PRACTICES In both the United States and abroad, individuals are increasingly seeking control of health care practices. This reflects a growing knowledge of risk factors and greater interest in taking preventive steps.
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. Communication of Risk Factors An approach known as "health risk appraisal" began some two decades ago in an effort to make use of risk information (for a general review, see Health Services Research, 1987)
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, along with attendant recommendations for behavioral change, will increasingly be part of the American health scene. Prevention Programs in the Workplace and Community Once people are informed of risk factors, preventive practices may take various forms, including controlling toxic substances, designing environments that reduce local exposure, and promoting risk-reducing behaviors.
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Human Factors Challenges Related to Risk Assessment and Preventive Practices There is a clear need for further human factors research on how information about risk and its reduction should be communicated and how these communications are interpreted. Risk communication is complex, as a recent National Research Council publication attests (National Research Council, 1989)
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Computer programs variously known as knowledge-based systems, decision aids, and expert systems are meant to facilitate the many medical decisions that must be made by both medical workers and patients. Whether these programs succeed depends in part on how well they are tailored to the humans who use them.
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Commercially available shells, which specify a format for the knowledge base and provide an inference engine, are intended to simplify the development of new systems. Computerized decision aids are attractive in part because of evidence that human decision making is far from ideal.
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• Medical training. Medical schools do not currently include extensive training in medical informatics in their curricula, although efforts to increase such training are under way (Ball and Douglas, 1990)
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suggests that the psychological impact of breast cancer diagnosis and treatment may be as threatening as the disease itself. Human factors researchers could address such questions as the effects of stress on decision making in this context and the potential role of automated data retrieval and decision aids.
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. Bioinstruments include, for example, biomedical imaging systems that take advantage of the computer for gathering, enhancing, and displaying data; electrochemical sensors that incorporate whole living cells in their construction; artificial sensing devices such as tactile sensors based on force-sensitive polymers; and transducers such as cochlear implants.
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, a digital workstation that will allow physicians to call up and display stored images. The 1990 meeting on medical imaging of the International Society for Optical Engineering had 15 paper sessions and a poster session devoted to PACS (Dwyer and Jost, 1990)
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For decades, diabetics have done home glucose monitoring by using visual assessment of color changes on reagent strips dipped in urine or blood. These methods have a high potential for error, and, particularly with urine testing, there is considerable temporal lag between a change in blood glucose and the ability to detect it.
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Human Factors Challenges Related to Medical Instrumentation The contributions that human factors researchers can make to the development and use of medical imaging seem enormous. New techniques for acquiring, displaying, and evaluating images call for increased interaction between the human user and the computer.
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In evaluating the instructional materials provided with blood glucose monitors, most diabetes educators judged them inadequate and believed that additional instruction was necessary. User error was identified in nearly three-fourths of reported problems.
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The case of the blood glucose monitor serves to emphasize the need for human factors research related to home use of medical devices. Whereas blood glucose monitors are simple devices and have been designed for patient use, other devices that are sent to the home may be far more complex and may have been designed for hospital use only (e.g., for ventilators, see Health Devices, 1988)
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. The HPP can then be compared with that of healthy persons of equivalent age, sex, and work category in order to determine functional capacity.
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The current biomechanical models are quite basic at best and cannot adequately deal with the complicated structures of the musculoskeletal system. Three-dimensional biomechanical models that include, for instance, the effects of soft tissue and the individual muscle tension generated in performing typical patient handling could provide important insights into handling methods and design of work areas and equipment to minimize the stresses on the spine.
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Particularly important research goals noted in this chapter are the following: • to identify and eliminate sources of error arising from the medical workplace and medical devices; • to design health-promoting environments for the aged; • to identify health risks in the workplace; • to determine techniques for effective risk communication; • to develop health risk reduction and illness prevention programs for groups; • to design user-appropriate interfaces for new medical devices, such as decision aids, imaging systems, and biosensors; • to identify ways to facilitate access to health information by medical personnel; • to identify barriers to effective use of medical devices in the home and to redesign devices and home environments so as to promote effective home care; • to identify and eliminate sources of biomechanical stress on the musculoskeletal system from health care practices; • to develop techniques for measuring functional capacity of candidates for rehabilitation; and • to develop biomechanical models to assist in determining potential health hazards. As we indicated at the outset, the research needs that are reviewed here are far from exhaustive, and new technological developments are likely to expand the list.
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Janz 1987 Behavioral science perspectives on health hazard/health risk appraisal. Health Services Research 22(4)
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Mulvihill 1989 Projecting individualized probabilities of developing breast cancer for white fe males who are being examined annually. Journal of the National Cancer Institute 81:1879-1886.
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Kozlowski, and E Menngola 1990 Human Factors in Self-Monitoring of Blood Glucose.
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Schiffrin, and A.M. Albisser 1987 Stabilizing blood glucose with a novel medical expert system.
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Chantelau 1990 Short-term evaluation of an electro-chemical system (ExacTech) for blood glucose monitoring.
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1986 Analysis of Lifting Tasks in the Health Care Industry. Paper presented at the University of Washington Symposium on Occupational Hazards to Health Care Workers.
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