Ubiquitous computing to support co-located clinical teams: Using the semiotics of physical objects in system design

Abstract

Objectives

Co-located teams often use material objects to communicate messages in collaboration. Modern desktop computing systems with abstract graphical user interface (GUIs) fail to support this material dimension of inter-personal communication. The aim of this study is to investigate how tangible user interfaces can be used in computer systems to better support collaborative routines among co-located clinical teams.

Methods

The semiotics of physical objects used in team collaboration was analyzed from data collected during 1 month of observations at an emergency room. The resulting set of communication patterns was used as a framework when designing an experimental system. Following the principles of augmented reality, physical objects were mapped into a physical user interface with the goal of maintaining the symbolic value of those objects.

Results

NOSTOS is an experimental ubiquitous computing environment that takes advantage of interaction devices integrated into the traditional clinical environment, including digital pens, walk-up displays, and a digital desk. The design uses familiar workplace tools to function as user interfaces to the computer in order to exploit established cognitive and collaborative routines.

Conclusion

Paper-based tangible user interfaces and digital desks are promising technologies for co-located clinical teams. A key issue that needs to be solved before employing such solutions in practice is associated with limited feedback from the passive paper interfaces.

Introduction

Several researchers have concluded that physical objects are used supportively when co-located professionals perform everyday cognitive tasks and join forces to solve problems [1], [2], [3]. For instance, paper folders are arranged in the office so that they serve as memory structures and representations that preserve task states [4]. Sticky notes function as flexible reminders [5] that draw attention to important information and tasks, and, similarly, making annotations and underlining text can serve to highlight the significant contents in a document and in this way facilitate re-reading [6]. Arrangements of this type facilitate interpersonal communication because several modalities can be used to achieve interaction and mutual understanding, i.e., in addition to speech, gesture, and gaze [7], [8], [9], [10]; also physical manipulations of the objects. From this perspective, the present desktop computing paradigm has several limitations, e.g., by that the tangibility and flexibility of physical objects are difficult to replicate in the graphical user interfaces (GUIs) [11]. Lack of these properties is, therefore, an obstacle to the development of systems that optimally can support co-located teamwork [12]. Moreover, the relatively small computer screen along with a standard keyboard and mouse are designed to be used by one person at a time, which makes it difficult for several people to simultaneously view, discuss, and interact with the systems [13].

An ultimate consequence of “overvirtualized” desktop computing-based workplaces is thus that users are deprived of their resources and natural strategies to offload cognitive demanding tasks to the environment, as well as their means to use physical social cues to facilitate collaborations [9], [14]. The aim of this study is to investigate how tangible user interfaces can be used to support collaborative routines among co-located clinical teams. For this purpose, we develop an alternative user interface design for clinical computer systems that also takes advantage of the semiotic value of the physical objects used in everyday cognitive tasks among these teams. The reasons for the disappointing adoption rate for present electronic patient record systems may be found in decisions made already early in the design of these systems, and which today are taken for granted. For example, the graphical user interface that is employed today is a direct descendant of the Rank Xerox ‘Star’ system interface of the late 1970s and early 1980s [11]. The Star interface was developed with office tasks in mind and it also replicates tools of a physical office. For example, the semiotics used in the system refer to the office environment (e.g., ‘desktop’ and ‘folder’). Researchers have criticized this interaction model for not effectively supporting co-located teamwork; the screen of a desktop system is small, which makes it difficult for several users to work simultaneously, and it is impossible to quickly hand over a document to share information. This interaction paradigm, therefore, imposes unnecessary tasks on closely collaborating personnel, e.g., clinical teams managing patients in serious conditions.