Scenarios [Dictation]Cogs 160 Final Presentation

Jenny Chang, Jingwei Li, Samantha Tse

June 2, 2011

Key

• Blue= interruption

• Green = hassle

• Red= breakdown

• Bolded text in diagrams = specific scenario focus

These arrows indicate time These arrows

indicate causation

Dictaphone

Talk Station

Record button used most often (only button used)

Both the optic mouse and scroll bar not used because not precise

These four programmable buttons are not used at all

OverviewNight shift: resident does pre-lim in IBOX (PACS).

Morning shift: resident opens up PACS and pre-dictatesstudies using IBOX as a guide.

Pre- dictation goes to the attending.

Attending signs off on dictation.

Attending sends pre-dictation back to resident to dictate again. It is not correct or insufficient information.

Dictation is finalizedand goes back to whoever ordered it (dictation will have attending’s name on it).

Overview Scenario• Resident radiologist is dictating a case from a ER patient.

• Notices that he must get a hold of the attending radiologist immediately because this patient’s condition is critical.

• Must get a hold of the attending to sign off on the dictation before the results can go back to the ER physician who ordered the scan.

• Radiologist phones attending but there is no answer.

• Radiologist phones other radiologists to see where the attending may be or how to get a hold of the attending.

• Calls older radiologist to see what call should be made.

• The whole process has come to a halt because attending cannot be reached.

• Tension with the ER as they pressure radiologists to expedite the process. ER wants it done fast, RADS want it done thoroughly.

Talk Tech Error Scenario• Radiologist is dictating a study (Dictaphone in hand, thumb on record

button, eyes are on images).

• He dictates the word “pachyperitonitis”.

• Lets go of the recording button.

• Right after dictates that word, takes eyes of images and looks at talk station screen to double check that word was correctly dictated.

• Notices that the word has not been dictated.

• Presses record and speaks into the microphone “pachyperitonitis”.

• Sees the software did not recognize the word again.

• Dictates the word into microphone. Word is not recognized again.

• He puts down the Dictaphone on the desk.

• He uses his mouse to click where the word should be dictated.

• He starts typing the word “pachyperitonitis”.

• He picks up his Dictaphone again and continues dictating the rest of his study.

Dictating

• Get up and move body

• Time loss

• Tension

• Forgets place in dictation

• Phone calls

Interruptions Noise• Sound from others’

workstation (phone, music)

• Sound from others dictating

• Room conversations (phone and in person)

Dictating & Noise Scenario• Radiologist 1 is dictating a study.

• Radiologist 2 is listening in on a phone conference on speaker phone at his station in the same room.

• Radiologist 1 looks to see where the noise is coming from and continues dictating.

• Radiologist 1 is finally annoyed by the noise and stops dictating.

• Radiologist 1 gets up out of his chair and walks over to Radiologist 2.

• Rad 2 notices Rad 1 wants to talk to him and stops his work.

• Rad 1 asks Rad 2 to please turn down the volume. Rad 2 complies.

• Rad 1 walks back over to his station, sits down, and continues dictating his study.

Dictating

• Get up and move body

• Time loss

• Tension

• Forgets place in dictation

• Phone calls

Interruptions Artifacts• Taking notes on

paper helps with remember place if there is an interruption

• Paper notes help with guiding dictation

• Time consuming

• For work arounds

Using Paper Scenario • Radiologist is dictating a study.

• Radiologist uses several pieces of paper to write down what he observes on the images (does not record with Dictaphone).

• Phone rings and interrupts and stops radiologist from note taking. Picks up phone.

• He listens to the content over the phone and hangs up.

• Radiologist looks back at his notes. Easily finds his place where he left off.

• Continues with dictation (taking notes).

• When finished with taking all notes, starts using Dictaphone and records words in talk station.

• Looks at notes to help guide his recording.

Dictating

Interruptions

Advice/Discussion

Agents:

• Physicians (in person)

• Physicians (phone)

• Other radiologists

Social Interaction• Human interaction

• Personal contact

Doing a Reading Together Scenario• Radiologist is sitting at his station dictating a study.

• There is a knock at the door.

• He stops dictating by putting down the Dictaphone.

• He gets up from his chair to walk over to open the door.

• A bunch of physicians come in asking for advice and more information about a particular study.

• Radiologist stops his current study by closing it.

• He opens that particular study through PACS.

• Physicians come in and huddle behind radiologist.

• The radiologist uses the mouse to explain his observations while talking/discussing with physicians.

• Physicians point a lot. But only radiologist uses mouse to point.

• The physicians thank him and they exit he room.

• Radiologist resumes his previous study by opening it in PACS.

Dictation 1 (Study 1)

Interruptions: agents, phone calls, noise, talk tech errors (software), posture

Dealing with interruptions

(workarounds):

• Time loss

• Loses place in dictation

• Tension

• Social interaction

• Use of artifacts

Dictation 2 (Study 2)

Overall Workflow Model

Design Ideas

• Padding for wrists and elbows as part of the desk

• Adjustable table heights, distance (monitor and person)

• Adjustable monitors

• Foot rests

• Chairs that align spine

• Partitions/ curtains

• Ambient lighting

• Designing for better acoustics (dampen noise)

• Multiple mice? Or have a way of accurate pointing to images.

• Some type of better integration of mouse and Dictaphone (less going picking up and putting down and switching between these two)

• Portable Dictaphone, either on clothes, workstation (bluetooth?)

Questions?