title: Usability in telemedicine systems-A literature survey.
abstract: The rapid development of sensors and communication technologies enable the growth of new innovative services in healthcare, such as Telemedicine. An essential ingredient in the development of a telemedicine system and its final acceptance by end users are usability studies. The principles of usability engineering, evaluations and telemedicine are well established, and it may contribute to the adoption and eventually deployment of such systems and services. An in-depth usability analysis, including performance and attitude measures, requires knowledge about available usability techniques, and is depending on the amount of resources. Therefore it is worth investigating how usability methods are applied in developing telemedicine systems. Our hypothesis is: with increasing research and development of telemedicine systems, we expect that various usability methods are more equally employed for different end-user groups and applications.
  
  
  
  A literature survey was conducted to find telemedicine systems that have been evaluated for usability or ease of use. The elements of the PICO framework were used as a basis for the selection criteria in the literature search. The search was not limited by year. Two independent reviewers screened all search results first by title, and then by abstract for inclusion. Articles were included up to May 2015.
  
  
  
  In total, 127 publications were included in this survey. The number of publications on telemedicine systems significantly increased after 2008. Older adults and end-users with cardiovascular conditions were among largest target end-user groups. Remote monitoring systems were found the most, in 90 publications. Questionnaires are the most common means for evaluating telemedicine systems, and were found in 88 publications. Questionnaires are used frequently in studies focusing on cardiovascular diseases, Parkinson's disease and older adult conditions. Interviews are found the most in publications related to stroke. In total 71% of the publications were trial-orientated and the remaining process orientated. An increase in telemedicine research, development and applications is found worldwide, with the majority of publications conducted in America.
  
  
  
  Monitoring patients in their homes can lead to better healthcare at lower costs which implies an increased demand of new healthcare strategies like telemedicine. We expected that with the increase in telemedicine research and development, a greater range of usability methods would also be employed in the included publications. This is not the case. Researchers employed questionnaires as a preferred usability method for each type of telemedicine system and most end-users. However, in process-orientated studies a greater range of usability evaluations were applied, with fewer differences found in the amount of publications for each evaluation method. Questionnaires enable researchers to evaluate a system quickly on end users, as it requires less expertise on the evaluation method compared to the other methods. They are easily distributed and are customizable. The use of questionnaires is therefore an evaluation method of choice for a variety of telemedicine systems and end-users.
authors.affiliation: Biomedical Signals And Systems group, University of Twente, Enschede, The Netherlands; Centre for Telematics and Information Technology, University of Twente, The Netherlands. Electronic address: b.klaassen@utwente.nl.
authors.forename: B
authors.initials: B
authors.lastname: Klaassen
authors.affiliation: Biomedical Signals And Systems group, University of Twente, Enschede, The Netherlands; Centre for Telematics and Information Technology, University of Twente, The Netherlands.
authors.forename: B J F
authors.initials: BJ
authors.lastname: van Beijnum
authors.affiliation: Biomedical Signals And Systems group, University of Twente, Enschede, The Netherlands; Centre for Telematics and Information Technology, University of Twente, The Netherlands; Roessingh Research and Development, Roessingh Rehabilitation Hospital, The Netherlands. Electronic address: jacsedit@facs.org.
authors.forename: H J
authors.initials: HJ
authors.lastname: Hermens
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data*; D014584:User-Computer Interface
keywords: Evaluation; Healthcare; Telecare; Telemedicine; Usability