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Research Projects Telemedicine and Home
Care: Cognitive Evaluation: IDEATel. (Funded By
Cooperative Agreement Centers for Medicare and Medicaid Services.
Informatics, Telemedicine and Education Demonstration Project. PI: Steve Shea) The Informatics for Diabetes Education and
Telemedicine (IDEATel) project is a demonstration project funded by the
Centers for Medicare and Medicaid Services with the goals of evaluating the
technical feasibility, acceptability, clinical efficacy and cost
effectiveness of telemedicine in the management of older adults with
diabetes. Kaufman and colleagues
(2003a,b) conducted field usability testing of the
Home Telemedicine Unit (HTU) in New York City (NYC) area and in Upstate New
York. Subjects were asked a series of questions about their use of computers
and experience with diabetes. We then asked them to perform a series of tasks
including: measuring blood pressure, uploading results, accessing the
Diabetes Manager, web page, reviewing patient data, and generating and
interpreting a table of blood glucose results. Subjects were asked to think
aloud throughout the task and offer comments on each screen (and screen
transition). Whenever the subjects experienced difficulty, the experimenter
provided as much guidance as necessary. The entire procedure took about 60
minutes on average. All sessions were audio and video taped. The
testing revealed a range of both cognitive and noncognitive
barriers. These subjects routinely used the glucose and blood pressure
monitoring devices without difficulty and were rather satisfied with the
video-visit component. However, we observed a range of problems in their use
of the web components. Many of these problems can be subsumed by three
categories: 1) perceptual-motoric skills, especially in relation to the use of
the mouse, 2) mental models which
refer to a basic understanding of system navigation, and 3) health literacy, including basic
literacy and numeracy. The results of the study
contributed to iterative design of the system and a training program. (Funded By NIH/NLM Training. PI: David
Kaufman) Partly on the basis of the usability research, we
initiated a training program and made design changes to the system. The
training program is still ongoing. Although it contributed positively to
patients’ use of the system, there were still enduring problems with a
segment of the user population, particularly in their use of the web. We
conducted a training experiment to characterize aspects of the encounter that
contributed to successful outcomes (e.g., use of the system) and identify
enduring problems. The study included
16 participants of the IDEATel telemedicine and diabetes education program
living in New York City. The subjects were trained on the component tasks of
the IDEATel system and the sessions were video and audio taped. The goal of the training sessions was for patients
to develop a level of proficiency as reflected in their ability to
autonomously perform certain tasks. Eight of the sixteen participants were
able to realize that goal within the first two sessions. Perceptual/motoric skills presented significant difficulties for
most of the participants on the initial visits. Older adults do improve in
their use of a mouse and we witnessed such improvements in almost all
subjects. However, it is reasonable to assert that a mouse is a suboptimal
pointing device for many elderly participants. Unfamiliarity with a keyboard
and limited dexterity also presented challenges for patients to logon
(entering their IDs and passwords) on to the system. Although several of the
participants were haltingly slow in using the keyboard, all of them were able
to login eventually. Mental models also remained a significant issue with
certain participants experiencing enduring problems related to their use of a
web browser, especially in relation to navigation. (Research Team: Justin Starreen,
Charlyn Hilliman, Jenia Peuznoe) |
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