title: Exploring medical device design and use through layers of distributed cognition: how a glucometer is coupled with its context.
abstract: Medical devices are becoming more interconnected and complex, and are increasingly supported by fragmented organizational systems, e.g. through different processes, committees, supporting staff and training regimes. Distributed Cognition has been proposed as a framework for understanding the design and use of medical devices. However, it is not clear that it has the analytic apparatus to support the investigation of such complexities. This paper proposes a framework that introduces concentric layers to DiCoT, a method that facilitates the application of Distributed Cognition theory. We use this to explore how an inpatient blood glucose meter is coupled with its context. The analysis is based on an observational study of clinicians using a newly introduced glucometer on an oncology ward over approximately 150h (11days and 4 nights). Using the framework we describe the basic mechanics of the system, incremental design considerations, and larger design considerations. The DiCoT concentric layers (DiCoT-CL) framework shows promise for analyzing the design and use of medical devices, and how they are coupled with their context.
authors.affiliation: UCL Interaction Centre (UCLIC), MPEB 8th Floor, University College London, Gower Street, London WC1E 6BT, UK. Electronic address: d.furniss@ucl.ac.uk.
authors.forename: Dominic
authors.initials: D
authors.lastname: Furniss
authors.affiliation: School of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Masci
authors.affiliation: School of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Curzon
authors.affiliation: Royal Free London NHS Foundation Trust, Department of Oncology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
authors.forename: Astrid
authors.initials: A
authors.lastname: Mayer
authors.affiliation: UCL Interaction Centre (UCLIC), MPEB 8th Floor, University College London, Gower Street, London WC1E 6BT, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Blandford
mesh_terms: D000465:Algorithms; D016477:Artifacts; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D002173:Cancer Care Facilities; D003071:Cognition; D003625:Data Collection; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis; D004867:Equipment Design; D004864:Equipment and Supplies; D008490:Medical Informatics; D008495:Medical Oncology / Q000458:organization & administration; D012107:Research Design; D012984:Software
chemical_list: D001786:Blood Glucose
keywords: Blood glucose meter; Distributed Cognition; Ethnography; Glucometer; Human–computer interaction; Socio-technical system