Joy Hamerman Matsumoto
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St Jude Medical Cardiac Rhythm Management
Division manufactures implantable cardiac
devices
◦ Pacemakers
◦ Implanted defibrillators
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Many newer devices are capable of remote
communication between the device and a
web-based data base
Clinicians perform both review of remote care
data and in-clinic patient follow ups
Cardiac Rhythm Management Division focus on devices
and platforms that diagnose and treat heart disease
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St Jude deploys a web-based system,
Merlin.net, for remote follow ups
Patient devices communicate through a
transmitter in their home to the web portal
Clinicians use Merlin.net to enroll patients in
remote care, to schedule remote care
“appointments” and to review patient data
Clinicians log into Merlin.net on a regular
basis to assess patient and device status
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Management recognized that users work with
multiple computer systems to perform their
work
Our understanding of the workflow that
defines remote care of patients was limited to
our product in isolation
To better integrate our product into the
overall workflow, we needed to gain an
understanding of users’ tasks and system
interactions as it relates to remote care
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Most clinicians use multiple software systems
to manage their patients
◦ Scheduling programs
◦ Electronic medical records
◦ Device manufacturers web-based programs
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Systems are not integrated and do not share
information
The addition of these multiple systems has
impacted the workflow for clinicians
What can we do to improve users’ workload
and impact user satisfaction?
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Teams of Human Factors and Clinical Systems
Engineers conducted all research
Human Factors Engineers
◦ Trained in cognitive psychology, interface design
and studying human behavior
◦ Use these principles to guide design of equipment
and systems
◦ Knowledgeable in structuring research and
analyzing results
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Clinical Systems Engineers
◦ Partners in working with our users
◦ Knowledge of clinical applications and practices
◦ Biomedical engineering background
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Used a contextual inquiry approach
◦ Puts the researcher in the users’ environments
◦ User-centered design method that enables
collection of detailed work practices through
observation and interview
◦ Used to understand how and why tasks are done
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Visited 13 clinics in the U.S. and 7 clinics in
Europe
◦ Total of 28 participants
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Summarized data to detail tasks, time,
obstacles
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Enrollment
◦ Enter patient information so the patient can perform remote
transmissions
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Scheduling
◦ Arranging each patient’s schedule for remote follow ups
and in-clinic appointments
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Reviewing Transmissions
◦ Patient data recorded on the device is available for review
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Patient Management
◦ Follow up to ensure patients are complying, answering
patient questions, reminders for appointments
Percentage of people interviewed who answered yes
100%
80%
60%
96%
40%
86%
89%
75%
68%
46%
20%
0%
Enrollment
Scheduling
Reviewing
Transmissions
Alert Management
Billing
Documentation
In-clinic *
Patient Chart is
completed
Receive Chart
Retrieve Patient Info
Log-in to Remote
Care System
Update EHR; Update
Schedule
Schedule next
follow-up
Print patient
reminder
Deliver letter to mail
outbox
Enrollment system
Access RC site
Check
transmission
Manage
transmission
Determine next
date
Access RC site
Resource page
Transmissions page
Schedule page
Edit Schedule page
Modify schedule
Update Schedule(s) EHR
 Scheduling is the most frequent task in remote care
 Multiple system interactions are necessary to schedule
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Proliferation of electronic records and
software systems have mixed results
◦ Some tasks are easier and less error prone
◦ Different user interfaces and need for multiple
passwords causes frustration
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Users learn multiple methods of
accomplishing similar tasks (little transfer of
knowledge)
Clinicians are wary of Electronic health
records – lack of integration; multiple data
entry points
Europe
U.S.
More integrated electronic health
records
Slow adoption of electronic health
records
Physicians use our system with
little help from SJM personnel
SJM personnel often available to
provide on-site assistance to
support physician
IVR systems are used and the
translations are not optimal
IVR systems are used; some
messages are confusing
Transmitters paired and given to
patients in clinic
Transmitters mailed to patients’
homes (this has recently changed)
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Difficult to accommodate text expansion on
certain screens – technical constraints /
character limitations
Support for locales in IVR format only – no
written support for language
Dynamic web interface – ownership of
content varies by placement of content
(regulatory versus marketing)
Adequate review of content by local subject
matter experts (Chinese champion reviews
the Simplified Chinese GUI for correct usage)
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Items identified as issues in the study are
prioritized for implementation
◦ Many concerns addressed in the current
development plan
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Positioned Human Factors team to be
included earlier in development planning
◦ Identify key customer issues
◦ Design, iterate and evaluate changes to the user
interface
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Maintain awareness of customer workflow in
a broader sense to improve the experience
and reduce inefficiencies