Telemedicine and e-Health

This paper presents the results of experiments examining the performance of a telesurgeon and an assistant local to the patient performing simulated laparoscopic tasks under a variety of time-delay conditions. Of particular interest is a comparison between the surgeon provided with audio/video and force feedbck synchronously with various time delays, and the surgeon performing asynchronously, where video is delayed relative to force feedback. These conditions are relevant since current telecommunication systems have limited bandwidth, and video signals must be compressed for efficient transmission. This produces a time lag between the video camera and the surgeon’s monitor, Force feedback and position commands from a surgical teleoperator require much lower bandwidth, and can be transmitted in near-real time. In the first of two series of experiments, two laparoscopic training tasks were performed under different time-delay conditions, with force and video feedback delayed by equal amounts. In the second series, using the same tasks, the force feedback was more immediate, while the video delay lagged by the time required for compression and decompression. In both experiments, there were various role assignments in terms of whether the telesurgeon or the assistant controlled the laparoscope and/or the various surgical tools required. The three most striking results are that (1) nontrivial time delays significantly degraded the performance of the surgical tasks, (2) asynchronous force feedback resulted in significantly faster task-performance than did synchronous performance when the surgeon operated the laparoscopic tools, and (3) there was no difference between synchrony and asynchrony when the remote surgeon operated the laparoscope and gave commands while the local assistant operated the surgical tools.

Problems associated with telemedicine systems include high telecommunications costs, lack of physician interest, and failure to build evaluation into the design process from the onset of the telemedicine project. An overview of the human-factors engineering approach to systems design and how it can be applied to the development of telemedicine systems is described. Design of an interface is based on an analysis of user capabilities, tasks, and work environment. Task analyses are performed to understand and document the interaction between a user’s work activities and a system. Two characteristics of a human factors approach that are important for telemedicine are: (1) defining and measuring user performance, and (2) involving users in the design and testing of a system. Usability goals are operationally defined and tracked to quantify performance. Having users participate in the design, testing, and critique of a system also increases the likelihood that the system will be accepted and used after it is released.

Human factors engineering and system design are critical elements in the newly developing field of telerehabilitation. Telerehabilitation is the remote delivery of rehabilitative services such as monitoring, training, and long-term care of persons with disabilities using telecommunications technology. This paper describes projects at the Rehabilitation Engineering Research Center (RERC) on Telerehabilitation in the context of three conceptual models: telecounseling and training, telemonitoring and assessment, and teletherapy. Issues pertaining to human factors engineering design are identified, and ongoing challenges are discussed.

A low-cost usability engineering methodology (heuristic evaluation combined with small-scale expert assessment) is examined in the context of the design and development of a Web-based telemedicine system. Six experts - three human-computer interaction (HCI) experts and three medical-content experts - examined the Spacebridge to Russia Web site for usability. The HCI experts identified 52 interface problems using a set of ten usability criteria or heuristics; these problems ranged in severity from cosmetic to a major failure. The content experts completed a series of six simple tasks while describing their actions. The usage difficulties were related to the HCI problems identified and were primarily characterized by a mismatch of the designer model and the content expert model. This heuristic/usage methodology can provide an incremental benefit in a variety of other design activities. It is suggested herein that the combined heuristic/usage methodology should be included as a standard design component of dynamic telemedicine systems.

The Interactive Surrogate Travel (IST) system is based on the super-miniaturized system of virtual technology, Cave Automatic Virtual Environment (CAVE). Using bilateral virtual reality (VR-to-VR) communications, IST enables the testing of subjects via interactive communications. It appears that IST will find practical applications in the near future. We examined the utility of IST in medical treatment and psychiatric tests. Psychiatric symptoms reflect human pathos, which in turn are greatly influenced by culture. If these culture-bound symptoms can be adequately communicated between providers and clients of different cultures, we can develop effective telepsychiatric services across different societies and cultures. IST requires high-speed transmission and gigabyte circuits. A pilot project tested the utility of IST(through the use of optical fiber communications on earth) as a basis for experiments via the Gigabit satellite, to be launched in the year 2002.

When a student is away from school for an extended time due to illness, he/she is provided with a tutor or access to in-hospital classrooms to keep up with his/her studies. This isolates the child from normal classroom experiences. A remote-control videoconferencing system (VCS), P.E.B.B.L.E.S.™ (Providing Education by Bringing Learning Environments to Students), was developed to allow a student access to his/her regular classroom from the hospital. Remote control is provided by a game pad, which allows the student to direct the system. The first iteration, P.E.B.B.L.E.S. I, tested feasibility. The design of P.E.B.B.L.E.S. II provides an integrated version of the system with user interface aimed at children. Four studies examined its efficacy in allowing a student to participate in typical classroom activities and in providing him/her a sense of presence in the classroom. Results indicate that the system can be used with relatively few errors when set to perform the majority of required activities. The study-participants reported positive experiences using the system, and remote users appeared to have a sense of presence in the classroom.

This paper describes a conceptual framework and human factors evaluation for usability assessment of commercially available telemedicine technology. Four criteria of human factors evaluation are utilized:(1) technical acceptability; (2) operational effectiveness; (3) clinical appropriateness; and (4) equipment selection. These criteria were applied to commercially available video-otoscope systems for otological evaluations.