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ASSESSING USABILITY OF ICONIC & NON-ICONIC INTERFACES IN HOSPITAL EMERGENCY SERVICE SOFTWARE FOR TABLET PC BY HCI YÜCEL BATU SALMAN JANUARY 2006 ASSESSING USABILITY OF ICONIC & NON-ICONIC INTERFACES IN HOSPITAL EMERGENCY SERVICE SOFTWARE FOR TABLET PC BY HCI A THESIS SUBMITTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY of BAHCESEHIR BY YÜCEL BATU SALMAN IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN THE DEPARTMENT OF COMPUTER ENGINEERING JANUARY 2006 ii Approval of the Graduate School of (Name of the Graduate School) (Title and Name) Director I certify that this thesis satisfies all the requirements as a thesis for the degree of Master of Science (Title and Name) Head of Department This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Master of Science. (Title and Name) (Title and Name) Co-Supervisor Supervisor Examining Committee Members iii ABSTRACT ASSESSING USABILITY OF ICONIC & NON-ICONIC INTERFACES IN HOSPITAL EMERGENCY SERVICE SOFTWARE FOR TABLET PC BY HCI Salman, Yücel Batu M.S. Department of Computer Engineering Supervisor: Asst. Prof. Dr. Adem Karahoca January 2006 Despite rapid advances in all facets of the technology, the software industry is still struggling with the formidable task of developing software applications that meet quality standards, time pressure, and budget constraints. Cost and time elements are quantitative and therefore can be measured and evaluated. On the other hand, the cause of having many dimensions and factors, the term quality has many different yet related definitions. In this thesis study, the test results are based on the one of the most important software quality metrics; usability. In medical information systems, data quality is crucial. Getting the correct data efficiently in a short period of time is a must in real-life situations for an emergency service of any hospital. Instead of using complex forms to keep track of records efficiently and rapidly, settling such software system can provide long-term solutions. Usable graphical user interfaces are designed and evaluated via implementation of the user oriented development process methodologies. In this study, two software prototypes are (MESS and MESSI) developed for the emergency service data flow for Tablet PCs via Wi-Fi mobile network, which are tested in Acibadem Hospital in Istanbul, Turkey. Both prototypes are designed and developed according to the rapid application prototyping methodology. The prototypes are designed by considering user centered development methodology and usability evaluation activities with HCI techniques such as heuristic evaluation and cognitive walkthrough. The aim of this study is to find out distinctions between MESS and MESSI from the point of usability approach, which is directly related with software quality. In additionally, the impact of software process improvement methodology such as ISO is investigated on software usability with observations. As a conclusion, it can be defended that usability and perception of the web-based applications can be increased with visual iconic components especially in hospital information interfaces. Keywords: GUI design, usability engineering, HCI, cognitive science, usability, software quality assurance, ISO 9241, software process improvement, human factors engineering. iv ÖZET Salman, Yücel Batu Tez Yöneticisi: Yrd. Doç. Dr. Adem Karahoca Ocak 2006 Bu sonuçlar i hastane acil servisleri için etmek bir zorunluluktur. saklamak sahip zümler üretmektedir. acil servisleri için Wi-Fi mobil test edildi. gereksinimleri de sistem ve gereksinim analizi sürecinde dikkate. rneklere ait edilmesi ve bunun de rle, Anahtar Kelimeler: O 9241, v To My Parents vi ACKNOWLEDGMENTS This thesis is dedicated to my parents for their patience and understanding during my master s study and the writing of this thesis. I would like to express my gratitude to Asst. Prof. Dr. Adem Karahoca, for not only being such a great supervisor but also encouraging and challenging me throughout my academic program. vii TABLE OF CONTENTS TABLE OF CONTENTS...VIII LIST OF TABLES... IX LIST OF FIGURES... X LIST OF ABBREVIATIONS... XI 1 INTRODUCTION METHODS HYPOTHESIS SOFTWARE QUALITY SOFTWARE QUALITY FACTORS SOFTWARE USABILITY USER CENTERED DEVELOPMENT FOR MESS AND MESSI ISO 9001 AND ISO Software Usability on ISO Software Usability on ISO Difference between ISO 9126 & ISO USER AND TASK ANALYSIS GUI DIFFERENCES BETWEEN MESS AND MESSI TEST RESULTS EVALUATION TESTS FOR MESS EVALUATION TESTS FOR MESSI SOFTWARE USABILITY MEASUREMENT INVENTORY RESULTS MESS VERSUS MESSI ON USABILITY FOR ISO STANDARDS CONCLUSION REFERENCES viii LIST OF TABLES TABLE 2.1 SOFTWARE QUALITY FACTORS TABLE 2.2 USABILITY FACTORS TABLE 2.3 DIFFERENCES BETWEEN ISO 9126 AND ISO 9241 FOR USABILITY TABLE 2.4 NURSES TASK SEQUENCE FOR MESS TABLE 2.5 NURSES TASK SEQUENCE FOR MESSI TABLE 2.6 PHYSICIANS' TASK SEQUENCE FOR MESS & MESSI TABLE 2.7 JAKOB NIELSEN'S TEN HEURISTICS TABLE 3.1THE AVERAGE INFORMATION ENTRY RATE OF SIX NURSES TO FILL FORMS IN THE SECOND TESTS TABLE 3.2 USER EVALUATIONS FOR THE SOFTWARE PROTOTYPE TABLE 3.3 USER MOTIVATION SURVEY RESULTS TABLE 3.4AVERAGE TIME RATE OF NURSES TO COMPLETE ALL TASKS TABLE 3.5 USER EVALUATIONS FOR ICONIC-BASED GUIS TABLE 3.6 MESS VERSUS MESSI ON USABILITY BY ISO ix LIST OF FIGURES FIGURE 2.1 USER CENTERED DEVELOPMENT FIGURE 2.2 QUALITY ON ISO STANDARDS FIGURE 2.3 USABILITY ON ISO FIGURE 2.4 USABILITY ON ISO FIGURE 2.5 NURSE MENU SYSTEM FOR MESS FIGURE 2.6 NURSE MENU SYSTEM FOR MESSI FIGURE 2.7 SOAP MENU SYSTEM FIGURE 2.8 PHYSICIAN MENU SYSTEM IN MESS FIGURE 2.9 PHYSICIAN MAIN MENU SYSTEM ON MESSI FIGURE 2.10 THE HCI DESIGN METHODOLOGY FIGURE 2.11 USABILITY ENGINEERING & COGNITIVE SCIENCE METHODOLOGY MAP FIGURE 2.12CURVE SHOWING THE PROPORTION OF USABILITY PROBLEMS IN AN INTERFACE FOUND BY HEURISTIC EVALUATION FIGURE 2.13 LOGIN SCREEN FOR MESS FIGURE 2.14 LOGIN SCREEN FOR MESSI FIGURE 2.15 ADDICTIONS MENU FOR MESS AND MESSI FIGURE 2.16 STILL USED MEDICINE FORM OF MESS AND MESSI FIGURE 2.17 PREVIOUS DISEASES FORM OF MESS AND MESSI FIGURE 2.18 FAMILY PAST INFORMATION FORM OF MESS AND MESSI FIGURE 2.19 ARRIVAL VITAL SYMPTOMS FORM OF MESS AND MESSI FIGURE 3.1 NURSE LEARNING CURVE FOR LAST TWO DATA ENTRY TESTS FIGURE 3.2 WORST PERFORMANCE AND ITS MATURITY FOR THE NURSE x LIST OF ABBREVIATIONS EHRs Electronic Healthcare Records GSEP Good Software Engineering Practices HCI Human Computer Interaction ISO International Organization for Standardization SUMI Software Usability Measurement Inverntory xi 1 INTRODUCTION When it is based on the usability definitions as quality in use (ISO/IEC ,1999), it can be clearly understood that usability has recently become a key software quality factor. From the view of (Abran et. al,2003), usability refers to a set of multiple concepts, such as execution time, performance, user satisfaction and ease of learning. On the other hand, usability has some different categories such as product effectiveness which includes output and the satisfaction at the time of use of the product; product attributes such as interfaces, capability of the organization and process used to develop the product(abran et. al, 2003). Additionaly, (Kushniruk et al., 1997) defines usability of a computer system as the capacity of the system to allow users to carry out the required tasks safely, effectively, efficiently and enjoyably. Such as (Schneidermann, 1998), (Nielsen, 1993) defines usability by giving five quality components; learnability, effeciency, memorability, errors and satisfaction. Also, (Jones, 1997) defines usability as the total effort required to learn, operate and use software or hardware. Designing a well-organized system for every fields of the industry is very important for effective productivity and quality assurance to provide long term solutions (Ashrafi, 2003). Developing a good software system is a very complex task. Organizations understand the importance of integrating new software technologies and methodologies to increase and improve the productivity, quality, security for fundamental problems in managing the software process (Anderson, 2001). It is defended that system complexity measurement plays a vital role in controlling and managing software quality because it generally affects the software quality attributes like software reliability, software testability and software maintainability. Thus, software quality assurance (SQA) needs to be addressed keeping in 1 view the new strategies, tool, methodologies and techniques applicable to software development life cycle. SQA can be classified into six classes such as pre-project components, components of project life cycle activities assessment, components of infrastructure error prevention and improvement, components of software quality management, components of standardization, certification, and SQA system assessment, and finally, organizing for SQA human components. Software companies must use the software process improvement (SPI) methodologies such as ISO 9000 standards which is esspecially used in Europe and Japan. (Paulk et al., 1993). The usability software quality factor existance and role are observed in both ISO 9241 which defines usability as the achieving goals, objectives with effectiveness, efficiency, satisfaction of a product for the chosen users and ISO 9126 states usability as one of the six different factors in a quality model which has two different roles; product and process oriented. In product oriented role, usability is a part of a detailed software development activity and in process oriented role it provides a matching between the product and the user expectations. There are some aspects of software development process that affect software quality management process which includes software reliability measurement, ISO approach applicable to software quality and some other aspects are related with software testing improvement. Software testing and evaluation methods or tools do not guarantee effective testing and ensure high quality. The way to improve the effectiveness of testing is to improve the attitude of software developers toward testing. Continuity of medical information systems mostly depends on correct and reliable storage of medical information extracted from hospital processes. Health information systems that 2 support high quality electronic health records should be considered as a part of hospital information systems. Efficient user interfaces will provide more reliable data which is used to improve quality of electronic health records (Kushniruk et al., 1997). In the field of medical informatic, issues of usability have become to the fore, with the ultimate acceptance and rejection of systems such as computerized patient records depending to a large extent on their degree of usability.(rubin et al, 1994) also defends to cope with the challenge of designing systems that provide desired functionality, and that are easy to learn and use, a variety of techniques from the study of human-computer interaction have emerged and become key in the general software industry. Development of advanced health systems that conform to basic standards, security and integrating of mobile devices to medical information systems, no doubt, has an important role in providing modern and faultless health service. So, hospital authorities tend to adapt solutions that support mobile data input for increasing the data quality and accessibility. In addition to instant acccess, mobile devices are also significant for their ability to integrate with decision support systems (Lippoff, 2001). For efficient use of mobile devices, their screen features should be considered during application interface design where human factors engineering methods that are used in usability engineering can be employeed. The fact that the mobile devices are focused in this situation is to provide faster input and querying of data as defended in the studies of (Buchauer et. al, 1999) and (Chen et. al, 2002). Information system specialists are facing difficulties in convincing medical doctors to use mobile devices instead of desktop computers. 3 Authorities should develop strategies to simplify the integration phase of mobile devices to existing medical information systems. Applications developed for these mobile devices should use special interfaces designed using object oriented methods, which will produce a usable, efficient, and user-friendly interfaces for Tablet PC if user oriented processes are used implemented (Chan, 2002). In this thesis study, the primarly target is to prove the great role of developing more usable software to decrease the error rate made by end-users while entering data in Tablet-PCs. Instead of having to persuade resistant clinicians to use desktop computers, information system specialists are reporting that clinicians are independently adopting mobile devices to assist them in treating patients (Terry, 2002). Provider institutions must learn how to integrate such devices into their information systems. In the parallel of these reasons, an application have to be developed that has special user interfaces created according to the user centric methodology to run on a table personnal computer, which depends on user centered development processes. Usable software interfaces enhance data entry ratio of correct data are considered by mobile and portable devices. Why did we prefer to use Tablet PC instead of PDA in this study? (Carroll, 2002) and (Wilcox, 2001) detemine the disadvantages of PDA as the limited software support and the small screen size for text intensive electronic data records, so data entrance becomes more suitable, faster and reliable than PDAs. On the other hand, according to (Landro, 2003), Tablet PC supports the most commonly used operating systems and thus any PC supported software applications can be installed easily. Not like PDA, is has A4 sized display, which allows entering any data like in PCs with virtual keyboard. 4 In addition to the usability evaluations based on ISO 9000 standards, walkthroughs are involved in detailed review of a sequence of actions described in the study of (Dix et. al, 2004). Cognitive walkthrough methodology is used to inspect the simplest way to follow the process for the users. A defined taskis broken into sub task hierarchy to create action sequence tree. Shortly, cognitive walkthrough is benefited in the early design stage to evaluate defined scenarios and menu structure hierarchy. Particulary, heuristic approach is used to check appropriateness of the menu structures of prototypes which is a variation of usability inspection where usability specialists judge whether each element of a user interface follows established usability principles. The aim of this study is developing two different prototypes named MESS and MESSI for the use of emergency service of Acibadem Hospital in Istanbul, Turkey and evaluating, comparing the usability for both systems by the help of cognitive walkthrough and heuristic approach. This study includes the design of the software as well as the requirement and evaluation analysis of the software that will support the tablet PC usage in the emergency service of Acibadem Hospital with an initial start in system analysis and script derivation work. The interfaces of both prototypes are modeled by using the inputs taken from the physicians and nurses according to the printed forms which have already used in emergency service. The first user interface tests are performed on not only the emergency service staff yet also various physicians and nurses from the other departments in the hospital. MESS and MESSI has both the same functionality yet the interface designs are different such MESSI has iconic based GUIs which icons are decided to be used for related medical terms by making some tests over healthcare staff in Acibadem Hospital. These tests are including the terms related with the forms of the software product and each term represents each form. It is asked to draw a figure for each medical terms and mostly drawn figures are considered as the icons 5 for the GUIs. This test is applied on 43 physicians and 34 nurses. Finally, the usability comparison between MESS and MESSI from the point of ISO 9241 and ISO 9124 is completed and results are reported in conclusion part of this thesis study. The targets of this thesis study are preparing special and different interfaces for each prototypes for Tablet PC environment, testing Tablet PC usage in a healthcare environment to get the user responses to access patient information more efficiently and finally, arranging a new tool for hospital emergency service for providing database and Tablet PC usage in the Wi-Fi supported network. In addition to the reactions and motivation of the staff to a new technology, the effectiveness of the user on the new system is measured. In the existing system the information is writtten manually on the printed emergency service forms or is textually saved to the system in local area environment. The printed forms which are long and detailed can also include test orders as stated in (Ying, 2003) causes info-phobia. The methods, infrastructure investments, and improvement of the existing system provisions were analyzed. The existing investments were done without considering the user reactions that cause unexpected troubles. In this case either the existing system is revised or new systems are purchased one by one. This results in a huge increase in the system costs. The proposed model considers the results of the user reaction tests by the pilot studies in the emergency services to minimize the costs. Since the mobile patient record systems are quite new, it is difficult to show a complete example. For every patient, averagely entries are filled in minimum 24 separate main forms starting from the admission and ending with the discharge of the patient. Making errors 6 for each prototype is inevitable in this huge information entry. Proposed system suggests an interface that will use pop-up menus and checkboxes that will save time and minimize typing errors by asking questions one after and other. However, this must be tested against the average staff behavior and accordingly the system should be structured. 7 2 METHODS 2.1 Hypothesis In this thesis study, general purpose is keeping patient records efficiently, properly and fast for both two prototypes. Also there are some sub intensions such as developing interfaces which are suitable for Tablet PCs, evaluating the usability of Tablet PCs from the point of healthcare staff in any hospital, finally searching the success rate of efficient use of Wi-Fi network supported Tablet PCs in an emergency service. As a supplementary, this study includes the following concepts; 1- In an emergency service edifice, how much of patient diagnosis, treatment and persecution processes can be carried out electronic environment? 2- How can these processes be supported by the help of visual programming languages? While designing the interfaces, what kind of screen components can be used? 3- Can be the forms created according to all data gathered in requirement analysis stage? 4- What can be done to improve efficiently of virtual keyboard use? These questions are answered in the conclusion part of the thesis clearly. 2.2 Software Quality When thinking of software, it is imagined an accumulation of programming language instructions and statements or development tool instructions, that together form a program or software package. The structure is based on the code but it is not enough to deal with the code in order to assure that quality of the services provided by the software program. There are some additional elements which are necessary to assure the quality for each. 8 Not like othe
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