Hello, my name is Simon Kimmel and on behalf\h of Vanessa Cobus, Wilko Heuten and myself\h\h
I'm presenting our research with\h the title "opticARe - Development\h\h
of an Augmented Reality Application for\h Patient Monitoring in Intensive Care Units".\h\h
Our work was motivated by the tremendous\h challenges that the German healthcare system\h\h
is facing at the moment. In Germany, hospitals are\h struggling to fill all nursing and critical care\h\h
vacancies. As you can see on the right-hand side\h this results in one German nurse having to care\h\h
for 13 patients on average. The main reasons\h behind this situation are on the one hand the\h\h
demographic change in the German population\h as well as the physically and psychologically\h\h
demanding working conditions of nurses in\h general and critical care nurses in particular.\h\h
Experts agree that technological innovation\h might be able to contribute to overcoming these\h\h
challenges by entailing extensive improvements for\h the working conditions of ICU nurses. In relation\h\h
to this objective particularly augmented reality\h is considered a very promising innovation. This\h\h
also becomes evident when looking at the research\h already conducted in the field of AR in nursing.\h\h
Prilla and colleagues developed an AR prototype\h for supporting professional and unprofessional\h\h
caretakers for instance by providing instructions.\h Klinker et al. on the other hand used a Microsoft\h\h
Hololens to support the wound documentation\h process in hospitals. Furthermore, Wueller and\h\h
colleagues identified that overall only little\h research has been conducted in relation to AR\h\h
in nursing with the more predominant use cases\h being education and instruction giving. One use\h\h
case that was overlooked by the research community\h up to now is patient monitoring in nursing.\h\h
Patient monitoring is the continuous observation\h of a patient's condition via his or her measured\h\h
biosignals. While this task is fundamental to\h the critical care nursing profession research\h\h
has proven that the employed equipment is often\h not well designed from a user's perspective. Even\h\h
though AR systems have been successfully applied\h to patient monitoring in other medical domains it\h\h
has not yet been researched whether AR could also\h prove beneficial for monitoring tasks in critical\h\h
care. Therefore this is what we researched in our\h project "opticARe". As a starting point of our\h\h
research, we conducted a context of use as well as\h a requirement analysis by performing a shadowing\h\h
observation in an ICU, by conducting several\h semi-structured interviews with ICU nurses,\h\h
and by collecting stakeholder views of\h former hospital patients and their visitors.\h\h
With this multi-method approach, we identified\h that especially patient monitoring in mobile\h\h
monitoring scenarios - present for instance during\h transportation of patients - could benefit from\h\h
the application of AR. Today mobile monitoring\h is performed by using these transport trolleys\h\h
seen here on the right, which were described\h by our participants as being bulky and heavy.\h\h
Our participants stated that using AR\h in this scenario could decrease weight,\h\h
eliminate interfering cables, and could thereby\h facilitate the transport of patients. Beyond the\h\h
specification of the context of use, we were\h also able to compile a variety of requirements\h\h
from our results. Among other ones, these included\h the device to be operable in a hands-free manner\h\h
and to emit visual and auditory alarms.\h While it was furthermore agreed upon that\h\h
the device is supposed to visualize the required\h information in a clear and well-organized manner\h\h
the participants were quite indecisive about what\h an optimal representation would look like. Some\h\h
participants stated that a large representation\h format, which was designed in correspondence to\h\h
the traditional monitoring equipment, would\h be preferred as it would foster consistency.\h\h
Another group of participants preferred a smaller\h representation of the data as it would prevent\h\h
one's view from being crowded during transport. A\h final group of participants stated that the device\h\h
should be able to switch the presentation format\h from a traditional to a smaller illustration\h\h
format and back depending on the context that the\h nurse and his or her patient is in. As a means to\h\h
resolve this ambivalence, we decided to develop\h all three described representation formats and\h\h
to compare them in a user evaluation. To develop\h our prototypes we used the game engine unity and\h\h
the vuforia augmented reality SDK and deployed our\h application onto a Microsoft Hololens version 1.\h\h
The resulting prototypes looked like this: The\h prototype displaying the large format presented\h\h
parameter names, values, and alarm thresholds\h as well as a historic curve representation.\h\h
The small format prototype just presented\h parameter values, names, and alarm thresholds. In\h\h
case of an emergency, which was triggered when\h an alarm threshold was over or undershot by a\h\h
parameter value, both the large and the small\h format would emit visual and auditory alarms.\h\h
This alarm system was also used by the\h context-dependent format prototype,\h\h
which displayed the small format while all\h parameter values were in a normal condition\h\h
and displayed the larger format in case\h of an alarm value being over or undershot.\h\h
A short video of the context-dependent\h representation format is presented in the\h\h
following. Here you can see that the parameter\h values are fixed in their location at the\h\h
rear end of the patient bed and that they're\h unrelated to the head movement of the nurse.
Due to the pandemic, we performed an online\h questionnaire for the user's evaluation,\h\h
in which 45 critical care nurses participated.\h In this questionnaire, we presented videos of\h\h
the three prototypes in a counterbalance\h randomized order and had our participants\h\h
rate the UX of each prototype with regards\h to its pragmatic quality, hedonic quality,\h\h
and attractiveness. Additionally to these UX\h measures the participants were instructed to\h\h
rank each representation format with regard to\h their preference and to give qualitative feedback.\h\h
With this study design, we intended to\h examine the following main hypotheses:\h\h
the abstractness of the prototype does influence\h the perceived user experience of the prototype\h\h
in terms of PQ, HQ, and ATT. And: the abstractness\h of the prototype does influence the preference\h\h
rankings of the prototype. In order to evaluate\h these hypotheses, we first performed a statistical\h\h
analysis of the data of all three measured UX\h scores. As visible in these box plots, over all\h\h
scores the context-dependent format was rated best\h with regard to its median value. The inferential\h\h
statistical analysis identified differences\h among all scores with posthoc analysis revealing\h\h
the context-dependent format and the large format\h differing significantly with regards to all three\h\h
UX scores and the context-dependent and the small\h format additionally being significantly distinct\h\h
with regards to their ATT score. The evaluation of\h the preference rankings painted a similar picture\h\h
with a median rank of 1, the context-dependent\h format was ranked as preferred most often\h\h
and scored a significantly different rank\h when compared to the other two prototypes.\h\h
Overall, these results entail that both of\h our hypotheses put forward can be accepted.
The preference for the context-dependent\h format was also highlighted by the feedback\h\h
gained via the open question\h items. The context-dependent format\h\h
integrated and increased navigability when\h patients' vital signs were within the normal\h\h
range while providing the required information for\h a professional assessment in case of an emergency.
The participants additionally provided suggestions\h for improvement. In particular, they called for\h\h
more possibilities to individualize the display\h for instance by adjusting display colors and they\h\h
wished for ways to use the device for remote\h monitoring of patients. Overall, the results\h\h
revealed that the context-dependent representation\h format provides a preferable representation of\h\h
information with best possible UX. Furthermore, we\h conclude that the concept of applying AR devices\h\h
for patient monitoring - particularly during\h transport - remains a highly promising one as it\h\h
presents potential benefits. The empirical results\h reported, however, need to be considered in light\h\h
of several limitations: In our view, the greatest\h limitation is the chosen remote-based study format\h\h
as due to it some of the usability issues\h identified in previous research, such as small\h\h
field of view, could not be adequately illuminated\h in the context of this research. In summary,\h\h
this research identified mobile patient monitoring\h scenarios as a potential application of AR in\h\h
nursing and revealed the benefits of applying\h a context-dependent representation format.\h\h
Overall, we believe this research was able to\h illustrate that AR can provide benefits for\h\h
patient monitoring in critical care and beyond.\h Future research should therefore focus on the\h\h
evaluation of suitable interaction techniques\h and on contrasting the emerging AR systems\h\h
with traditional monitoring equipment. The\h pursuit of these and other research projects\h\h
will not be sufficient on their own to tackle\h the challenges that the german healthcare sector\h\h
is currently encountering. Nevertheless, the\h further development of aiding innovations,\h\h
such as the one presented in the course of this\h paper, may one day be capable of contributing to\h\h
overcoming these issues. Thank you for joining\h my talk today. Please read our paper or send us\h\h
an email, if you want more information\h on our research. Thank you very much.