Exploring medical device design and use through layers of Distributed Cognition: How a glucometer is coupled with its context

Abstract

Medical devices are becoming more interconnected and complex, and are increasingly supported by fragmented organizational systems, e.g. through different processes, committees, supporting staff and training regimes. Distributed Cognition has been proposed as a framework for understanding the design and use of medical devices. However, it is not clear that it has the analytic apparatus to support the investigation of such complexities. This paper proposes a framework that introduces concentric layers to DiCoT, a method that facilitates the application of Distributed Cognition theory. We use this to explore how an inpatient blood glucose meter is coupled with its context. The analysis is based on an observational study of clinicians using a newly introduced glucometer on an oncology ward over approximately 150h (11days and 4 nights). Using the framework we describe the basic mechanics of the system, incremental design considerations, and larger design considerations. The DiCoT concentric layers (DiCoT-CL) framework shows promise for analyzing the design and use of medical devices, and how they are coupled with their context.

A Staged Feasibility Study of a Novel Vaginal Bowel Control System for the Treatment of Accidental Bowel Leakage in Adult Women

“…Blanford et al (2014) noted that challenges in device usability are minimized before market introduction to patients when incorporating the concept of "work as done" rather than "work as imagined" models of medical device design (fitness for purpose) [19] . In a case study reported by Furniss et al (2015) on the usability of a glucometer, the authors noted that feedback and insight that impacted incremental and non-incremental design decisions came from multiple sources, including traditional verbal reports by users, as well as observations of users [20].…”

“…Prior to that pivotal study, research was conducted to understand the feasibility of the concept of a vaginal bowel control system. Medical device development involves multiple stages of evolution driven by patient and clinician feedback derived from investigational trial use and standard care delivery [19][20][21]. Feasibility studies are intended to provide initial information about the safety, effectiveness, and acceptance by both patients and clinicians of a new therapy in a small, sample population.…”

Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff

“…In the homecare environment this could involve customising the device to make it look discreet (O'Kane et al, 2015). In the hospital context equipment could be modified beyond the original design intent, as per accounts relating to barcoding systems (Koppel et al, 2008), alarm settings (Watson et al, 2004), physiological monitors (Cook and Woods, 1996) infusion pumps (Obradovich and Woods, 1996) and glucometers (Furniss et al, 2015).…”

Interruptions in the wild: portraying the handling of interruptions in manufacturing from a distributed cognition lens

“…However, DiCoT has been proven to facilitate the learning of applying the DCog framework (Berndt et al 2014), and recently, a lot of work has been performed in healthcare using the DiCoT methodology (e.g. Furniss et al 2014Furniss et al , 2015Rajkomar and Blandford 2012).…”