Icon and user interface design for emergency medical information systems: A case study
Highlights
► Task analysis of an emergency medical service. ► Emergency personnel participated in the icon design for the medical information system. ► Understandability of the developed icons were tested by a second group of physicians and nurses. ► Final user interface was decided and installed after assessing two prototypes.
Introduction
Many end users of medical input systems encounter usability problems such as learnability, flexibility and robustness with the interfaces of computer applications [1]. Such systems must support quick and precise operation, especially in emergencies. Well-designed and usable interfaces for emergency medical information systems would allow more efficient and reliable data entry [2].
A graphical user interface (GUI), employing icons, provides an easy and friendly interaction method with systems. Iconic interfaces serve to reduce system complexity and so the mental workload of end users when the icons are designed properly [3], [4]. If icons are not designed to be meaningful and identifiable, they may cause unexpected menu selection errors, resulting in serious problems in an emergency medical information systems.
Icons have been widely used in many applications because they can be recognized and remembered easily [5], have more universal recognition than textual information [3], provide better cognitive affordance [6], and end users prefer iconic interfaces to textual interfaces [7]. However, icons can deliver ambiguous meanings, making the system inefficient or ineffective, if they are carelessly designed or based on inadequate research [2], [8], [9]. Researchers have suggested guidelines to aid designers in developing more understandable and meaningful icons [4], [10], [11]. Four critical factors are recommended for consideration in icon design: styling quality, message quality, meaningfulness, and metaphor [12], as well as factors related to the icons being identifiable, meaningful, concise, associable, eye-catching, and symbolic [13].
Four characteristics of icons, concreteness, complexity, semantic distance, and familiarity, have been examined widely [14]. Concreteness refers to the depiction of real objects, while complexity relates the amount of details presented. Semantic distance refers to the closeness of the relationships, while familiarity relates the extent of experience or acquaintance with an object. For medical icons familiarity is most important as these icons are often employed by well-trained users [15]. Concreteness and semantic distance can affect the initial understanding of the icons if systems are newly installed [14], [15].
Many icons are still designed such that they cannot be understood easily, nor correctly [8], [9]. The main objective of this study was to design a usable iconic medical information system by including users and emergency medical personnel in the icon design procedure. We used the participatory icon design process, a procedural design alternative, for its effectiveness in developing our medical information system based on task completion time and accuracy [16]. Our approach included (1) conducting task and user analysis by observing and interviewing the emergency service staff, (2) a questionnaire about proper icon design, completed by seventy eight medical personnel, (3) selection of initial icon designs based on the results of a survey, expert advice, and design guidelines, (4) installation of the iconic medical information system with the selected icons by using a professional design team, and (5) final icon design after its understandability was evaluated by twenty eight medical personnel.
Healthcare personnel of Acibadem Hospital and Ismail Akgun State Hospital, bothlocated in Istanbul, Turkey, took part in the study. Acibadem Hospital is one of the Turkey's leading health institutions, with over 6000 employees in twenty different locations. The hospital consists of a network of six general hospitals, medical centers, outpatient clinics, ophthalmology center, and laboratories. Acibadem has been accepted as a member of the European Foundation for Quality Management (EFQM) and Kalder. Acibadem Central Sterilization Units have received ISO 9001 certification. Ismail Akgun State Hospital has 39 experienced doctors and has a capacity of 75 patient rooms.
Section snippets
System design and development
A system must be efficient in solving the problems faced by their users, in a manner that is satisfying to them [17]. Although user requirements are the most significant basis for system development [18], satisfying user requirements is not enough to develop a usable system. A user-oriented procedure is essential in developing satisfactory and usable information systems [19].
The purposes of the medical information system in this study are to input, store, retrieve, monitor, and modify the data
Task analysis
Emergency medical service must allow for quick and accurate information processing by nurses and physicians who must enter new data and monitor the required information of a patient.
We first observed several emergency cases, without interacting with the on-site staff, to better understand their medical emergency environment. Emergency healthcare personnel were interviewed to identify the tasks performed for emergency patients. The paper form in use was also examined to understand the medical
Work site survey
The objective of the work site meeting was to introduce the study to the personnel, confirm task analysis results, and ask staff to suggest icons for the medical system. Emergency personnel were invited to participate in the work site meeting and cooperate on the medical system project by their hospital directors.
A brief project introduction was given to each staff member, with the tasks explained by use of the photos taken from the previously observed emergency treatments. After the meeting,
Understandability test
After the initial icon designs were selected, a second survey was undertaken to explore their degree of understandability. Twenty-eight medical personnel, who did not participate in the previous worksite survey, were selected from the hospitals to test the icon designs. 65% of the participants were physicians with the remainder nurses (10 males and 18 females). Participant ranged in age from 34 to 61 (M = 44.5, SD = 6.5). All reported having computer experience and being familiar with GUI systems.
A
User interface design
Two prototypes, having different interface designs that reflected the most commonly used layouts, were developed. Twenty physicians assessed the prototypes to determine the most suitable design (Table 4). A web-based emergency medical information system was then developed using Microsoft .NET and ORACLE database, as a stand-alone PC based program. Working prototypes, having limited functionality, were given to the participants.
70% of the physicians preferred Layout 1. The snapshot of the final
Discussion
Designers and engineers need to understand the tasks, cultural context, and interaction between medical staff and a system to design improved emergency medical information systems [22]. We observed and interviewed medical personnel to understand procedures and work context. Physicians and nurses suggested, and evaluated, icon and layout design for the system. A user-centered, participatory design, process was applied to create an improved emergency medical system.
We found the participatory
Authors’ contributions
Y. Batu Salman designed the study, conducted the work site survey and task analysis, and drafted the manuscript. Hong-In Cheng designed the study, organized the analysis, and revised the manuscript. Patrick E. Patterson provided topic expertise and revised the final manuscript.
Conflict of interest
There's no conflict of interest.
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