Interaction Design

Enhance the Usability of Touch Screen for

Intensive Care Ventilators

Chong You Le
chongyoule@gmail.com
Interaction Design Programme - MA1
Autumn Term
Table of Content 1. Project Overview 2

2. Approaches and Methodology 3

3. Chaotic Environment in Intensive Care Unit 4

4. Problem Identification 5

5. Interation Between Human and Machines 6

6. Physical Interfaces and Vitual Interfaces Analysis 7

7. Design Solutions 11

8. Summary 15

9. Acknowledgements 15

10. References 16

Project My aim with this project is to enhance the usability of ventilators

touch screen display through problem solving approaches.
Overview
I utilize human sensory systems into my studies and designs
which are inspired by the Sensorial Quality Assessment Method
(SEQUAM)
(L. Bonapace, 2002.) The sensory systems are vision, hearing,
somatic sensation (touch), taste and olfaction (smell) as
feedback or response to the users. On the other hand, I also
explore the functional potential of a ventilators touch screen
display beyond its existing functions especially for the used in
the Intensive Care Units.

The proposed design is focusing on the primary users, the

medical personnel who operate the ventilators in the Intensive
Care Unit yet taking into consideration of the comfort of the
secondary users who are the patients and the family members.
Ultimately, this could help to draw a closer the relationship
between the primary and secondary users rather than being
separated by the machine.

You Le, Chong Interaction Design Programme - MA1

Approaches This project had been divided into 2 major session. In the first
phase of the project, the project approaches were to obtain a
and Methodology deeper understanding of an Intensive Care Ventilator and the
man-machine interaction in it. On the second part of the
projects, each individual selected their own focus and dive in
to another research phase, which is Research 02.

Research 01
Collect Information
Analysis

Identify Project
Scope In the first part of the project, to obtain a deeper understanding
Analysis of an Intensive Care Ventilators, we had gone through some
brochures from Maquet, browsing through internet about other
existing ventilators, and also trying out a few ventilators in the
hospital. We had implemented the Heuristic Evaluation in our
Research 02 analysis.
Collect Information
Analysis
On the other hand, we had visited the Noorlands
Universitisjukhus, Intensive Care Units and interviewed a few
nurses there to get an overview of the working environment
in Intensive Care Units. Observations are also carried out in the
Initial Design
Ideation
same time.
User Testing
In this project, emphasis is also put on the users themselves.
There are more than one user involved in this product. There are
primary user, who operated the machines and the secondary
Final Design users who are the patients and the family members. A few
Design Refinement interviews had been carried out to obtain the users experience
with the products.

In the second phase of the research, each of us had selected

a certain area to zoom in and I had decided to approache
this project through enhancing the usability of touch screen
in ventilator. In my studies, I had utilised the Sensorial Quality
Assesement Methods (SEQUAM), by L. Bonapace 2002 to
analyse the feedback of physical interfaces and virtual
interfaces.

I had carried out a few observations on users manipulating

physical interfaces and virtual interfaces in different products
and situations. Through these studies, I had manage to identify
the pros and cons about touch screens. A few users testing had
been carried out to verify the usability of touch screens too.

You Le, Chong Interaction Design Programme - MA1

Chaotic Intensive Care Medicine or critical care medicine is a branch of
medicine concerned with the provision of life support or organ
Environment support systems in patients who are critically ill who usually
In Intensive also require intensive monitoring. It Is a 24 hours operating
Care Unit environment. Some ICUs allow family members to visit 24 hours
a day and some do not. The operating system in each ICU
depends on each hospital organisation.

Family members who visited the ICU usually were terrified by the
atmosphere. They are exposed to information which they are
not familiar with and accepting the fact that, their loved one
are in danger. Instead of giving the family members or friends a
peaceful and quiet environment, ICU often seems chaotic with
lots of medical personnel, machines, equipments, tubes, cables
and other patients.

Most patients in ICU are separated with curtains due to space

constrained and the medical personnel often need to tidy up
or create a space for the family members and the patient.

You Le, Chong Interaction Design Programme - MA1

 Problem There are various problems that were identified during our
studies. From this point, I have decided to focus in the following
Identification areas:

1. Primary Users – the trust of using touch screen

a. Touch Screen Limitations
i. Lack of sensitivity and accuracy
ii. Slow reaction
iii. No feedback
iv. Not as good as the physical button especially
the knob

2. Chaotic Environment In Intensive Care Unit

The relationship between Medical personnel, Family
members, Patients , and Machines
i. Alarms and discussions disturb the patients and
family members
ii. Crowded ICU

refering to both patient

professional and the screen while do-
no obvious or beginner ing medical check up semantic looks of the
grouping technology or machine - rather show
not technology recovering but show how
different user serious the patient are
spacing in between all groups
displayed info & settings no instructions
Medical
personnel alarms of the machine
disturbing the patients
Display
some data are Patient
way too small

too much information need

to be displayed in the same time
touchscreen
feedbacks are too mild
no obvious feedback
no clear display
lack of sensitivity
on touchscreen
Users
Screens &
Displays semantic looks of the
machine - rather show
recovering but show how
serious the patient are
Family &
Settings Problem friends
Identification
some felt uncomfortable
with the machine around
not knowing how the ma- them or their loved ones
chine works can be scary
Transportation

Environment

Hard to Scary limited space

manouver machines & crowded too many machines

ICU looks scary with all messy family members & friends
needed some private time with
the machine surrounding
too heavy the patient
the patients
* needed 2 people to
move the ventilators around

The cables & tubes
are hanging all over the patients
and lie on the floor of the ICU
task needed to be done by the nurses, be-
fore allowing the patient into the ICU
1. Clear the patients room
2. Put some chairs for them
3. Close the curtains

Problem Identification

You Le, Chong Interaction Design Programme - MA1

Interaction The second part of the research approache is inspired and
influenced by Sensorial Quality Assessment Method (SEQUAM),
Between by L. Bonapace 2002. In her studies, she mentioned about
Man human perceptions in products design and I have adopted the
and same thinking and implemented into my studies.
Machine

Interaction between Man - Machine

The five senses that I am referring to are hearing, touching,

seeing, tasting, and smelling. In this part of the studies, I try
to identify the differences in both physical and virtual (touch
screen) interfaces and how users perceived them while using
them. The most frequent senses that are perceived in user
interfaces are touch, vision and hearing. Touch Sensory is one
of the important senses, users experience more than just tactile
senses, but also biomechanics strength and thermal senses
through it.

For example:

10 10

9 9

8 8

7 7
6 6
5 5
4 4
3 3

10

7
6

the finger felt the travel

5
4

fingers feeling the

3

distance when the but- the smell of

buttons coffee
ton is pressed.

the button lights up

the sound of
indicating the machine
boiling water
is working

the user hears the

mechanical “tak” sound
generated by the button
when it was pressed.

You Le, Chong Interaction Design Programme - MA1

Physical
Interfaces
Analysis
Heater Knob Action Effect
The knob is turning with the
pointer

Feel the knob turning When it reaches maximum

temperature, it cannot be turned.

Mobile Phone
Keypad
The keypad looks like it is The screen displayed and
depressed and released highlight selected items
accordingly
Feel the button depressed and
released

Hear both mechanical and

keytone from the phone

Kettle
The toggle switch was push When the power On the switch
downwards lights up

The displacement of fingers

before and after switching On

When the switch hit on the

toggle, it stop and generated a
“TAK” sound.

Laptop wireless switch

The On/Off switch seems The Wireless Icon LED lights up
depressed and released

Feel the switch depressed and

released

Hear both mechanical sound

from the buttons

Stove
The knob turn accordingly The LED lights up
following the hand motion

Feel the knob rotating

accordingly and the frictions
against it

Hear some mechanical sound

You Le, Chong Interaction Design Programme - MA1

 Significant differences between Physical Buttons and Touch
Screen:

1. Biomechanics Strength Feedbacks

• The need of apply pressure onto a physical buttons.
• Newton’s Third Law of Motion - For every action there
is an equal and opposite reaction.

2. Tactile Feedbacks
• The friction between the user’s finger and the button
(e.g. laptop touch pad)

3. Speed of Feedbacks
• The immediate feedbacks in terms of visual and
auditory.
• There is no delay compare to Touch Screen

4. Three (3) senses feedbacks on every event

• Visual feedback
• Auditory feedback
• Tactile or Biomechanics Feedbacks

Physical Visual feedback

Interfaces • Physical buttons (e.g. depress and release)
• Indicators lights (e.g. Power On LED)
Feedbacks
• LCD display (e.g. Highlighted selected items)

Auditory Feedback
• The mechanical sound from the buttons when the user
clicks
• The artificial sound from the speaker to indicate the
confirmation of clicking (e.g. mobile phone dialing
keypad)

Tactile or Biomechanics Feedbacks

• The travel distance before and after the button was
pressed. (e.g. depress and release)
• The friction between the finger and the surface
(e.g. touchpad)
• The force to push the button down
• The bounce back reactions from the buttons
• The feeling of turning the knob.

You Le, Chong Interaction Design Programme - MA1

Virtual Touch Screens are widely used in various products as Input
devices to replace physical buttons. It can be operated
Interfaces directly using fingers or with a stylus.
Analysis

TouchScreen Keyboard During Done

The virtual keyboard seems Alphabets appeared accordingly
depressed and released on the screen

No feedback

No feedback

Selection
The button highlighted

No feedback

No feedback

Key in Number
The button highlighted Numbers appeared accordingly
on the screen

The phone vibrates each time

the user key in a new digit

Hear keytone each time the user

key in a new digit

Key in using Stylus

The keyboard is highlighted Alphabets appeared accordingly
when the user press on it. on the screen

No feedback

No feedback

You Le, Chong Interaction Design Programme - MA1

 Studies had shown that touch screens had very significant
advantages and disadvantages

Advantanges • Programmable interface allows for greater diversity

• Utilizes natural abilities of user
• Requires no additional desk space
• Durability
• Direct manipulation of objects or cursor
• Cost efficiency

Disadvantanges • Slower alphanumeric data entry

• Less accuracy (more errors)
• Finger may obstruct view of object on screen
• Fatigue
• Sitting/Standing position: The user has to sit/stand close to the
screen.
• Dirt: The screen gets dirty from finger prints.
• Screen coverage: The user’s hand, the finger or the pen may
obscure parts of the screen.
• Activation: Usually direct activation of the selected function,
when the screen is touched; there is no special “activation”
button as with a light pen or a mouse.

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You Le, Chong Interaction Design Programme - MA1

Design Servo-Tablet, a detachable and portable Touch Screen display
for Intensive Care Ventilator. It allows users to move freely
Solutions and yet keep track on their responsibilities. Built-in Bluetooth™
allowed Servo-Tablets to be cloned into multiple screens and
enhance information sharing among different users.

Servo-Tablet

New Technology By incorporating the Immersion and 3M MicroTouch Capacitive

TouchSense System (Tactile Feedback Enhancement System) into
the product and implementing the SEQUAM design approaches,
Servo-tablets went beyond ordinary tablets, and successfully
increased the reliability and trust of touch screens in every user.

Immersion and 3M introduced the MicroTouch Capacitive

TouchSense System with Tactile Feedback using integrated with 4
actuators on the screen.

When the user touches the screen, a signal is sent to the

touchscreen controller, which supplies information on the precise
screen location where contact was made. This location
information is sent to the host application, which commands the
TouchSense controller to play a specified tactile effect.

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You Le, Chong Interaction Design Programme - MA1

 The TouchSense® system can be integrated into most touchscreen
designs to provide tactile feedback using these elements:

• Electromagnetic actuators, which are attached to the
touchscreen carrier during assembly
• Touchscreen carrier design guidelines, to ensure
maximum energy transfer from the actuators
• Tactile feedback controller, with serial or USB
communications
• Software development kit, for fast integration of tactile
feedback into your application software

References :
http://solutions.3m.com/wps/portal/3M/en_US/
3MTouchSystems/TS/News-Events/PressReleases/
?PC_7_0_3R53_assetId=1114310734448
(14.11.2006)

Status Indicators Light

Power Off
Power On
Light Sensor Alarm/ Alert

Front View Back View

Display &
Touch Screeen Active Area Speakers

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You Le, Chong Interaction Design Programme - MA1

Servo Tablet Design Considerations

User Interface 1. Same colours usage in graphs, figures and buttons indicate
relativity between them.
2. Contrast Colours for better viewing.
3. “Dim off” inactive buttons to avoid confusions
4. High Contrast in line thickness, font sizes, and colours are for
better viewing.
5. Using the Knob to insert the value.
6. Giving signals and alerts in terms of visual and auditory feed-
back on limits settings and error.
7. All buttons design simulate physical buttons being press
down and also incorporating auditory feedbacks and tactile
enhancement system to better usability.

Admit
A Status
Mode Of Ventilation Automode P
Patient Nebulizer

40 cmH2O

Ppeak (cmH20)

Pmean
24 40

(cmH20) 11
PEEP 5
(cmH20)

70 l/min RR (b/min)

15 30
5
O2 (%)

-70 l/min
I:E
39 1:2:0
45
35

700 ml

MVe (l/min)

VTi
7.0 40.0
5.0

(ml) 450
VTe 465
(ml)

Additional
settings
5
cmH2O
30b/min
39 %
5
ml
PEEP Resp. Rate O2 Conc Tidal Volume

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You Le, Chong Interaction Design Programme - MA1

Design
Solution
(Scenarios)

The screen can be placed

regularly like the existing
ventilators, but this time,
with a 17” touch screen
that is integrated with the
built-in Touch Sense System .

The screen can be detached

from the ventilators for easy
viewing. With this function, the
medical personnel can view at
both patients and the screen in
the same time.

The Touch Screens also function

as a portable module that can be
used among medical personnel
to view all functioning machines,
by selecting the patient name
and the data to be viewed. By
doing so, most discussion can be
carried outside the room or away
from the patient.

When the patients’ family

members or friends visited them,
they would had their own private
place, with the curtain closed.
Now, with this portable screen,
the medical personnel can still
monitor the patients’ through the
Bluetooth paired screen.

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You Le, Chong Interaction Design Programme - MA1

Summary Working with 5 senses in usability design had given me a brand
new perspective in interfaces design. I’ve learn not only how
each users perceived through their senses but also learn that,
by mimicking the physical interfaces feedbacks help to im-
proved the usabilty.

Since users can experience product in their true senses, it

opened out more opportunities for us to improve the usability of
virtual interfaces. Maybe, feedbacks on virtual interfaces can
go beyond the 3 senses, but also through smell and taste.

This approach might also help to enhance usability for the

handicaps who had lost some of their senses. But, when, where
and what are the appropriate feedbacks to be implemented
still need lots of explorations and studies.

Acknowledgements I would like to thank Maquet for providing us this golden op-
portunities to carry out this project. Special thanks for Karin
Blomquist, Kent Lindberg, Johan Bergvall, Nils Eric, Niklas Ander-
son, Mike Scott, Annelise Muller and the other technical person-
nel from MTI who had given myself and the class such a won-
derful tutoring and guidance.

Nevertheless, I would like to give a special mention to all my

coursemates and the student of umea who had participated
during the project giving constant feedbacks and making this
project a very enjoyable experience.

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You Le, Chong Interaction Design Programme - MA1

References Videos
http://www.youtube.com/watch?v=FQIVv4b2jOI (10.11.2006)
http://www.youtube.com/watch?v=rFU2Z3k9w0Q (10.11.2006)
http://www.youtube.com/watch?v=qQjPEslrR0E (10.11.2006)

Books
Pleasure with Products: Beyond Usability by William s. Green and Patrick W. Jordan
2002, Chapter 15, Sensorial Quality Assessment Method (SEQUAM) (L. Bonapace
2002)

Webpages
http://psychology.wichita.edu/surl/usabilitynews/2w/touchscreen.htm
http://www.sapdesignguild.org/resources/TSDesignGL/Index.htm
http://solutions.3m.com/wps/portal/3M/en_US/3MTouchSystems/TS/News-Events/
PressReleases/?PC_7_0_3R53_assetId=1114310734448 (14.11.2006)
http://solutions.3m.com/wps/portal/3M/en_US/3MTouchSystems/TS/News-Events/
PressReleases/?PC_7_0_3R53_assetId=1114310734448 (14.11.2006)

Pictures
http://www.whitememorial.com/content/images/rebuilding/move/ICU-transfer.jpg
http://www.hidakagh.gobo.wakayama.jp/kangobu/ICU-11.jpg
www.nabcoentrances.com/pricu2_092005.cfm
http://www.whitememorial.com/content/rebuilding/move_photos.asp
http://healthlawblog.blogspot.com/uploaded_images/icu-736088.jpg
http://www.o6u.edu.eg/hospital/my%20webs/oct/Hospital%20images/icu.jpg
http://www.asada-hp.or.jp/byouin/setsubi/image/ICU.jpg
http://www.nankodo.co.jp/yomimono/kenshui/kabeya/icu.JPG
http://www.mcg.edu/sah/pt/philosophy.html
http://www.med.kyushu-u.ac.jp/ericu/index.php?plugin=ref&page=TOP&src=%B2%E8
%C1%FC-ICU%B6%E1%C0%DC2.JPG
http://www.russmed.com/icu.jpg
http://www.pref.saitama.lg.jp/A80/BA01/scrc/comedical/nurse/icu.htm
http://www.nabcoentrances.com/pricu2_092005.cfm
http://www.infocroatia.com/blog/wp-content/images/ICU-doctors.jpg
http://www.ncvc.go.jp/hsp/kango/icu/images/icu_002.jpg

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You Le, Chong Interaction Design Programme - MA1