title: The employment of an iterative design process to develop a pulmonary graphical display.
abstract: OBJECTIVE
  Data representations on today's medical monitors need to be improved to advance clinical awareness and prevent data vigilance errors. Simply building graphical displays does not ensure an improvement in clinical performance because displays have to be consistent with the user's clinical processes and mental models. In this report, the development of an original pulmonary graphical display for anesthesia is used as an example to show an iterative design process with built-in usability testing.
  
  
  METHODS
  The process reported here is rapid, inexpensive, and requires a minimal number of subjects per development cycle. Three paper-based tests evaluated the anatomic, variable mapping, and graphical diagnostic meaning of the pulmonary display.
  
  
  METHODS
  A confusion matrix compared the designer's intended answer with the subject's chosen answer. Considering deviations off the diagonal of the confusion matrix as design weaknesses, the pulmonary display was modified and retested. The iterative cycle continued until the anatomic and variable mapping cumulative test scores for a chosen design scored above 90% and the graphical diagnostic meaning test scored above 75%.
  
  
  RESULTS
  The iterative development test resulted in five design iterations. The final graphical pulmonary display improved the overall intuitiveness by 18%. The display was tested in three categories: anatomic features, variable mapping, and diagnostic accuracy. The anatomic intuitiveness increased by 25%, variable mapping intuitiveness increased by 34%, and diagnostic accuracy decreased slightly by 4%.
  
  
  CONCLUSIONS
  With this rapid iterative development process, an intuitive graphical display can be developed inexpensively prior to formal testing in an experimental setting.
authors.affiliation: Medical Inforamtics, University of Utah, Department of Anesthesiology, 3C444 SOM, 30 North 1900 East, Salt Lake City, UT 84132-2304, USA. blake@relia.net
authors.forename: S Blake
authors.initials: SB
authors.lastname: Wachter
authors.forename: Jim
authors.initials: J
authors.lastname: Agutter
authors.forename: Noah
authors.initials: N
authors.lastname: Syroid
authors.forename: Frank
authors.initials: F
authors.lastname: Drews
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Weinger
authors.forename: Dwayne
authors.initials: D
authors.lastname: Westenskow
mesh_terms: D000768:Anesthesia, General; D003196:Computer Graphics; D003198:Computer Simulation; D006801:Humans; D008168:Lung / Q000033:anatomy & histology* / Q000502:physiology*; D008954:Models, Biological; D012119:Respiration