WARD: an exploratory study of an affective sociotechnical framework for addressing medical errors

ABSTRACT

Aiming to reduce medical errors by 50% by 2010, the Institute of Medicine (IOM) has identified information technology (IT) as an important tool. One potential application of IT would be communicating with clinicians using affective multimodal interfaces. In this paper, we propose an Augmented Cognition (AugCog) related framework, Wearable Avatar Risk Display (WARD), for addressing medical errors. WARD is a dynamic, adaptive, and mobile display system that aims for delivering critical and contextual information meaningfully to clinicians based on their affective states. WARD is based on sociotechnical systems theory and serves two purposes: (1) To guide the development of a test bed for investigating effective and meaningful communication methods using avatars with lifelike behaviors (affective avatars) and (2) To investigate the interplay of affects, stress, and decision-making ability when interacting with affective avatars. Through a small exploratory study, we found that participants did not benefit from our avatars at this point. However, findings and suggestions from participants revealed that there is potential for affective avatars in critical or emergency situations.

REFERENCES

• 1: Adolphs, R. Trust in the Brain, Nature Neuroscience, 5(3), 2002, 192--193.
• 2: Abu-Saad, H. & Hamers, J. Decision-Making and Paediatric Pain: A Review, Journal of Advanced Nursing, 26, 1997, 946--952.
• 3: Eva Brandt , Erling Björgvinsson , Per-Anders Hillgren , Viktor Bergqvist , Marcus Emilson, PDA's, barcodes and video-films for continuous learning at an intensive care unit, Proceedings of the second Nordic conference on Human-computer interaction, October 19-23, 2002, Aarhus, Denmark [doi>10.1145/572020.572070]
• 4: Bradburn, N. The Structure of Psychological Well-Being, Walter de Gruyter, Inc., 1969.
• 5: Chan, A., Martins, S., Coleman, R., Bosworth, H., Oddone, E., Shlipak, M, Tu, S., Musen, M., Hoffman, B., & Goldstein, M. Post-Fielding Surveillance of a Guidelinebased Decision Support System. Advances in Patient Safety: From Research to Implementation, 1, AHRQ Publication Nos. 050021 (1-4), 2005, Agency for Healthcare Research and Quality, http://www.ahrq.gov/qual/advances/, accessed 05/27/2005.
• 6: Chin, T. Doctors Pull Plug on Paperless System. American Medical News, 2003, http://www.amaassn.org/amednews/2003/02/17/bil20217.htm, accessed 05/27/2005.
• 7: Conzola, V. and Wogalter, M. A Communication-Human Information Processing (C-HIP) Approach to Warning Effectiveness in the Workplace. Journal of Risk Research, 4(4), 2001, 309--322.
• 8: Cohen, M., O'Brien-Pallas, L., Copplestone, C., Wall, R., Porter, J., & Rose, K. Nursing Workload Associated with Adverse Events in the Postanesthesia Care Unit. Anesthesiology, 91(6), 1999, 1882--1890.
• 9: Conati, C. Probabilistic Assessment of User's Emotions in Educational Games. Journal of Applied Artifical Intelligence, Special Issue on Merging Cognition and Affect in HCI, 16, 2002, 555--575
• 10: Coomber, S., Todd, C., Park, G., Baxter, P., Firth-Cozens, J., & Shore, S. Stress in UK Intensive Care Unit Doctors. British Journal of Anaesthesia, 89(6), 2002, 873--881.
• 11: Andrew J. Cowell , Kay M. Stanney, Manipulation of non-verbal interaction style and demographic embodiment to increase anthropomorphic computer character credibility, International Journal of Human-Computer Studies, v.62 n.2, p.281-306, February 2005 [doi>10.1016/j.ijhcs.2004.11.008]
• 12: Darves, C., Oviatt, S., & Coulston, R. The Impact of Auditory Embodiment on Animated Character Design. In Proceedings of the 1st Internation Joint Conference on Autonomous Agents and Multiagent Systems, Bologna, Italy, 2002.
• 13: Ekman, P., Levenson, R., & Friesen, W. Autonomic Nervous System Activity Distinguishes among Emotions. Science, 221(4616), 1983, 1208--1210.
• 14: Erlen, J, & Sereika, S. Critical Care Nurses, Ethical Decision--Making and Stress. Journal of Advanced Nursing, 26, 1997, 953--961.
• 15: Gross, J. & Levenson, R. Hiding Feelings: The Acute Effects of Inhibiting Negative and Positive Emotion. Journal of Abnormal Psychology, 106(1), 1997, 95--103.
• 16: Gutteling, J. & Kuttschreuter, M. The Role of Expertise in Risk Communication: Laypeople's and Expert's Perception of the Millennium Bug Risk in The Netherlands. Journal of Risk Research, 5(1), 2002, 35--47.
• 17: Hamann, S. & Canli, T. Individual Differences in Emotion Processing. Current Opinion in Neurobiology, 14(2), 2004, 233--238.
• 18: Healey, J. & Picard, R. Detecting Stress During Real-World Driving Tasks Using Physiological Sensors. IEEE Transcations on Intelligent Transporation Systems, 6(2), 2005, 156--166.
• 19: Hillel, G. & Vincente, K. Nursing Interruptions in a Post-Anesthetic Care Unit: A Field Study. In Proceedings of the 47th Annual Meeting of the Human Factors and Ergonomics Society, Denver, 2003, 1443--1447.
• 20: John, G. & Langley, P. Estimating Continuous Distributions in Bayesian Classifiers. In Proceedings of the 11th, Conference on Uncertainty in Artificial Intelligence, San Francisco, 1995, 338--345.
• 21: Kohn, L., Corrigan, J., & Donaldson, M. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 1999.
• 22: Lamberg, L. Mind-Body Medicine Explored at APA Meeting. Journal of American Medical Association, 288(4), 2002, 435--439.
• 23: Leape, L. Institute of Medicine Medical Error Figures Are Not Exaggerated, Journal of American Medical Association, 284(1), 2000, 95--97.
• 24: Leape, L. & Berwirk, D. Five Years After To Err Is Human: What Have We Learned? Journal of American Medical Association, 293(19), 2005, 2384--2390.
• 25: Mier, D., Back, A., & Morrison, R. The Inner Life of Physicians and Care of the Seriously Ill, Journal of American Medical Association, 286(23), 2001, 3007--3014.
• 26: Bonnie M. Muir, Trust between humans and machines, and the design of decision aids, International Journal of Man-Machine Studies, v.27 n.5-6, p.527-539, Nov/Dec 1987 [doi>10.1016/S0020-7373(87)80013-5]
• 27: Oertel K., Schultz, R., Blech, M., Herbort, O., Voskamp, J., & Urban, B. EmoTetris for Recognition of Affective States, 2005
• 28: Helmut Prendinger , Junichiro Mori , Mitsuru Ishizuka, Using human physiology to evaluate subtle expressivity of a virtual quizmaster in a mathematical game, International Journal of Human-Computer Studies, v.62 n.2, p.231-245, February 2005 [doi>10.1016/j.ijhcs.2004.11.009]
• 29: Per Persson, Exms: an animated and avatar-based messaging system for expressive peer communication, Proceedings of the 2003 international ACM SIGGROUP conference on Supporting group work, November 09-12, 2003, Sanibel Island, Florida, USA [doi>10.1145/958160.958166]
• 30: Reason, J. Human Error. Cambridge, England: Cambridge University Press, 1990.
• 31: Rosalind W. Picard, Affective computing, MIT Press, Cambridge, MA, 1997
• 32: Fiorella de Rosis , Catherine Pelachaud , Isabella Poggi , Valeria Carofiglio , Berardina De Carolis, From Greta's mind to her face: modelling the dynamics of affective states in a conversational embodied agent, International Journal of Human-Computer Studies, v.59 n.1-2, p.81-118, July 2003 [doi>10.1016/S1071-5819(03)00020-X]
• 33: Sexton, J., Thomas, E., & Helmreich, R. Error, Stress, and Teamwork in Medicine and Aviation: Cross Sectional Surveys. British Medical Journal, 320(7237), 2000, 745--749.
• 34: Slovic, P. Perception of Risk. Science, 236(4799), 1987, 280--285.
• 35: Slovic, P. The Perception of Risk. London: Earthscan Publications Ltd, 2000.
• 36: Williams, S., Zainuba, M., & Jackson, R. Affective Influences on Risk Perceptions and Risk Intention. Journal of Managerial Psychology, 18(2), 2003, 126--137.
• 37: Zhai, J. & Barreto, A. Concurrent Analysis of Physiologic Variables for the Assessment of the Affective State of a Computer User, 2005.

INDEX TERMS

Primary Classification:
  H. Information Systems
  H.1 MODELS AND PRINCIPLES
      H.1.2 User/Machine Systems

General Terms:
Design, Experimentation, Human Factors, Performance

Keywords:
affective computing, emotions, human factors, medical errors