Computer systems are increasingly being used in healthcare, however a mismatch between the technology and the clinical work has frequently been identified as a source of concern for clinicians and system designers. We identified design principles for interactive healthcare computer systems that take in consideration the mismatch between technology and clinical work. Four phases were carried out:

  1. ethnographic investigation;
  2. initial design principle identification and mapping;
  3. exploratory prototyping; and 
  4. experimental prototyping.  

Consistent with evidence from the literature, an ethnographic study of nurses who provide care for patients with wounds in Vancouver’s home and community healthcare (n=36, 120 hours), indicates that they create and use workarounds in wound documentation. It is possible that this is a manifestation of unsuccessful adoption of an implemented wound documentation system.  

To study further, a user-centred design process was created to identify design principles for such interactive systems. This work used an adapted model from the literature to identify the most common workaround situations and their attributes such as tasks, actors, resources, and outcomes. These most common workaround situations were validated using a questionnaire given to homecare nurses (n=58). This mapping used measures developed for applications of the technology acceptance model in healthcare, to identify a fit for the workaround situations to a dimension of usefulness or ease of use. The dimensions of usefulness include items such as increased productivity, and saved time, and the dimensions of ease of use include items such as lowered mental/physical effort, and ease of remembering tasks.  

The mapped design principles were evaluated and refined in iterations of exploratory prototyping for a low fidelity prototype (n=15), and experimental prototyping for a medium and high fidelity prototype (n=12) called SuperNurse. The set of 9 design principles were used to create features for an interactive mobile wound documentation prototype. The SuperNurse prototype used interactive features such as speech recognition and wearable technology, as well a smart mobile device. 

Results of qualitative data analysis (n=27) and completed questionnaires (n=11) by the participants of the prototyping sessions indicated that they perceived the prototype to be useful, easy to use, and a good task-technology fit. Especially they perceived the prototype to be useful to their job, easy to learn, beneficial, and they predict that they would use it. Identification of workarounds and using them to inform design as a new approach resulted in innovative technology that fit the circumstances of homecare nurses’ work, and the evaluation of it in user study sessions showed that the design informed by homecare nurses workarounds addresses key aspects of technology acceptance.