Development of a user needs-based telepresence robot for consultation

Abstract

BACKGROUND:

An assessment of needs to develop a system that provides consultations using a telepresence robot and education for health professionals was conducted. The absence of a structured methodology for user-needs analysis has been identified as a problem.

OBJECTIVE:

To use a telepresence robot for medical consultation in future usability testing, the robot has been developed by analyzing end-user needs in a multifaceted manner.

METHODS:

In designing the telepresence robot for consultation, required functions and forms were defined based on the results of a user-needs survey. The robot was implemented based on specifications of needs. The prototype robot was developed and after repeated internal tests, the final version was completed.

CONCLUSIONS:

Keywords

Robotics point-of-care systems needs assessment remote consultation telemedicine

1. Introduction

Tele-health refers to providing remote healthcare services using information communication technology (ICT). Tele-health has been introduced to reduce costs, improve efficiency, and provide better access to healthcare services [1]. Among the various types of robots, those that apply telepresence technology help to closely connect users on both ends who apart from each other [2]. A telepresence robot allows health professionals to remotely move, look around, talk, and participate in decision-making [3]. This research team conducted an assessment of needs through a questionnaire survey and interviews to develop a system that provides consultations using a telepresence robot and education for health professionals [4].

An end-user-needs analysis is widely recognized as a key element in user-centered design (UCD) [5, 6]. However, it is difficult to identify user needs in the early design phase of a new technology, because developers and designers tend to perceive development as a process essentially centered around technology and regard user needs as trivial problems [5]. Thus, the absence of a structured methodology for user-needs analysis has been identified as a problem. In addition, since users have not experienced a new technology in development, users might not be able to imagine or express how the technology will function and be applied [7]. In other words, users may find it difficult to sense or communicate that a technology is innovative and helpful for users. In general, users tend to talk about needs for technologies and services that they are familiar with and understand well. In the early design process of a new technology, however, it is important to investigate users’ unmet needs [8]. Without clear encouragement to consider such needs, it would be difficult address users’ practical needs until development has progressed quite significantly and the technology has materialized. Prototyping can help in identifying user needs and in exploring ideas by visually presenting practical forms and functions. In this regard, we would like to analyze end-user needs in a multifaceted manner, develop a telepresence robot for medical consultation, and use it in future usability testing.

Table 1
Summary of service specifications

Categories	User needs specification
		Requirement	Keyword
Remote control/ screen sharing	I&S	When offsite healthcare provider views images of a medical record using a PACS (picture archiving and communication system), the program should be remotely controlled	Remotely controlled program
	I&S	Multi-site screening sharing with operating room monitor (including pointer functionality)	Pointer
	I&S	Transmission of additionally required clinical data during communication	Clinical data transmiss- ion
	I	Loading of programs should be minimal in case of remote control	Loading minimization
	S	Wireless system	Wireless system
Consultation/	I&S	Real-time communication via videoconferencing	Telepresence function
training functions	I	Diversification of laser pointer functionality (for brief instruction, continuous instruction, etc.)	Pointer
	I&S	Vital signs (blood pressure and pulse) should be measured regularly at pre-scheduled times and the values be saved	Clinical data transm- ission
	I&S	The functionality for offsite healthcare provider to zoom in on a specific area in an imaging study	High-resolution photo image transmission
	I	For ease of use, transmission speed should be fast for imaging data such as MRI and CT.	Fast data transmission
	I	There should be consultation templates for the data required by the consulted department.	Development of tem- plates suitable to a variety of consultation
	I	Image quality is most critical	High image quality
	S	Videotaping or sound recording	Videotaping or sound recording
Conversation/ communication	I&S	The user should be able to operate the robot in an operating room or even when support staff is not available	Voice command
	I	Microphone functionality should be high enough for offsite healthcare provider to ask a patient questions	Telepresence function – sound transmission
	I&S	A backup method should be available in case clear communication is not possible due to noise at hospital	Chatting window
	I	Diversification of communication channels to use depending on the purpose of the conversation	Option to use a head- phone or earphone set
	I	UI/UX of programs should be multilingually designed for healthcare provider from various countries	Multilingual service
Appearance	I	Usability is better if the robot is as small as possible	Size with the environ- ment taken into consideration
	I	Appearance to minimize anxiety in patients	Stable appearance
Mobility function	I&S	Autonomous driving should be optional for safety	Various mobility modes
	I&S	Functionality for the robot to autonomously move from storage space (charging station) to where it is used	Automatic charge
	I&S	Safety functionality such as auto-stop function or other alternatives to prevent collision	Collision prevention
Monitor	I	Monitor should be large enough for viewing imaging data while it is not too difficult to move it	Adequate monitor size
	I	An offsite user should be able to have face-to-face conversation with healthcare provider	Telepresence
	I	A monitor for videoconferencing and a monitor to output clinical data	Multiple monitors
	S	Touch screen interface	Touch screen interface

Table 1, continued
Categories	User needs specification
		Requirement	Keyword
Others	I	Functionality to allow offsite healthcare provider to immediately perform consultation in any place	Tablet PC program
	I	It should be easy to clean and disinfect to prevent infection	Infection prevention
	I	Maneuverability should be as simple as possible	Simple maneuverability
	S	Onscreen messages to notify the user of such conditions as loss of far end video, incomplete or dropped connections, mute, etc.	Notification of problems

I: Interview, S: Survey.

Figure 1.

Mapping of the robot’s requirements and function/hardware components.

2. Description

2.1 Robot design

The present study is a methodological study that applies user-centered design to the development of a robot. In designing a telepresence robot for medical consultation, its required functions and form were defined based on the results of a user-needs survey conducted in a previous study [4], and these needs were expressed so as to better communicate with developers. In addition, various situations were considered in developing the robot so that it could respond to them.

In designing the telepresence robot for consultation, required functions and forms were defined based on the results of a user-needs survey. To better communicate with developers, requirements and keywords describing them were specified as in Table 1. To implement such specifications, we had multiple meetings with the development team and mapped them as shown in Fig. 1.

2.2 Robot implementation

The robot was implemented based on specifications of needs. The prototype robot was developed in June 2018. After repeated internal tests and several development meetings, the final version was completed in January 2019. The final version of the robot was 179 cm tall, weighed 88 kg, and covered a 47 $\times$ 47 cm floor area. Its maximum speed was 2.7 km/h under free motion and 4.5 km/h under operation and control, which is similar to or slower than an adult male’s walking speed. It was operated with front-wheel drive by using a joystick controller, which allows the user to steer it from behind. Furthermore, the robot included a microphone, three types of cameras, and two monitors (1920 $\times$ 1080 mm and 1024 $\times$ 768 mm, respectively). To avoid collisions, 7 ultrasonic sensors – 3 in the front and 2 on each side – were attached to the robot, which allows it to detect objects around 2 cm to 300 cm away.

The operating system displayed at the bottom of the screen was Windows, and C++ was used as a system programming language. Figure 2 shows a screen of the consultation program. In Fig. 2, the program’s functions consist of the “video,” “document,” and “motion” tabs in the upper left corner of the first screen that appears when the user signs in. The user can touch each tab and switch the screen and mode. Under the video tab, the user can have a video or audio teleconference, and the left screen displays video recorded by the robot’s pan-tilt-zoom (PTZ) camera, 360-degree camera, or web camera. Under the document tab, health professionals can share images or document files during the teleconsultation and immediately open them or take notes. Under the motion tab, the user can control the robot’s movements and the cameras’ angle or zoom.

Figure 2.

Layout of telepresence robot for consultation program.

3. Discussion

UCD highlights a system’s purpose is to serve users, rather than solely employing a particular technology or creating a visually pleasing program. User needs should drive the interface design, and it should in turn lead the design of the rest of the system [9]. In addition, UCD is an iterative process that aims to develop a useful system through the participation of potential users in the system design [10] and a process that focuses on usability throughout the entire development process and the life cycle of the system [11]. The present study applied UCD’s key principles – active user involvement, evolutionary systems development, simple design representations, prototyping, and evaluations of use in context—and developed a prototype telepresence robot for medical consultation that addressed the essential functions and needs identified from a user-needs survey.

The present study involved the designing and developing a prototype based on user needs, which can be regarded as an extension of the continuous and repeated analysis of user needs aimed at increasing health professionals’ acceptance of telepresence robots for consultation. Prototypes are one of the most powerful tools that allow users to express their what they need from a technology that they have never experienced before [5]. The biggest advantage of employing a prototype for user-needs analysis is that it can specifically and physically represent the function, form, and interactive features of a system. Such specificity may help the user and the developer to better understand and communicate the developer’s intention and the user’s needs [12]. Hence, prototypes can help in discussing a new technology’s functions and encourage users to express needs that have not yet been identified. The present study also found that prototyping is an efficient method for communicating and exploring various possible design ideas and solutions.

The present study holds significance as it systemized user needs, applied them to a new medical technology’s components and functions, and provided a technology development process that could improve usability. In the early design phase of a technology, the developer or designer tends to not properly understand user needs and to think of development mainly based on technology, which highlights the need for a structured methodology user-needs analysis. In the present study, health professionals, who not only understood consultation situations involving robots but also were very experienced in medical equipment maintenance, participated in the development process. In the future, a usability test of the prototype might help to collect ideas on various scenarios applicable to this technology. Furthermore, highly usable healthcare ICT could be developed based on the findings of the present study. The usability of the telepresence robot for consultation developed in the present study would need to be repeatedly tested and the effects of robot-based consultations assessed in further studies.

Footnotes

Acknowledgments

This research was supported by the Ministry of Trade, Industry and Energy (MOTIE) of Korea under Industrial Technology Innovation Program (No. 10063098, Telepresence robot system development for the support of point-of-care service associated with ICT technology).

Conflict of interest

None to report.

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