april 18, 2007med-e-tel 2007, luxembourg etsi workshop 1 etsi user experience design guidelines for...

April 18, 2007 Med-e-Tel 2007, LuxembourgETSI Workshop

1

ETSI User Experience Design Guidelines for Telecare Services

Bruno von Niman vonniman consulting and ITS (Sweden)ETSI TC Human Factors Vice Chairman

ETSI STF 299 [email protected]

&

Steve J. Brown BT, Plc.

ETSI STF 299 Expert

April 18, 2007Med-e-Tel 2007, Luxembourg

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Agenda

ETSI Benefits of standardization ETSI TC Human Factors

Telecare and eHealth STF 299

User experience guidelines (under development)

ETSI’s eHealth activities and future plans


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What is ETSI?

A European standards organization Officially recognized by the EU & EFTA Setting globally-applicable standards for

Telecommunications, in general Radio communications, especially mobile Broadcasting, and Related topics

Active in all areas of ICT An independent, non-profit organization,

created in 1988 Offering direct participation of all members We have more than 15,000 publications

→ available for free!

http://www.etsi.orghttp://portal.etsi.org


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ETSI

The home of the GSM™ standards…

… and of a lot of others, e.g. ISDN, DECT, DAB, DVB …


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ETSI

……and a founding Partner in

The 3rd Generation Partnership Project


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PartnershipsPartnerships

ETSI partnerships

ITU-TITU-T ITU-RITU-R JTC1JTC1

GTSC

GRSC

• WIMAX forum• NENA• CITEL• CCSA• DVB Project• EBU• GSMA• IEEE• IPv6 Forum• TETRA MoU• (70 altogether)

Internationalbodies

InterregionalCo-operation

CENELECCENELECCENEurope

InterregionalCo-operation

Europe


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Global Standards Collaboration

Interregional collaboration on selected standardization subjects between:

ISACC (Canada)

ATIS (USA)

TIA (USA)

ITU(International)

TTC(Japan)

TTA(Korea)

ACIF(Australia)

ARIB(Japan)

(China)


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Why standards?


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Standardization is

Load sharing

Cost saving

Interoperability

Close co-operation of competitors

Reduction of solutions to a minimum: preferably → one!

Creation of a critical mass

Bringing about economy of scale

A fight against technical barriers to trade

Enabling development and use of common infrastructures


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Open process

Open meetings: All stakeholders may participate in the standards development process

Consensus: All interests are discussed and agreement found

Due process: Balloting and appeal process may be used to find resolution

Open IPR: IPR holders must identify themselves during standards development process

Open access: Open access to all deliverables Open World: Same standard for the same function

world-wide Open interfaces: Allow additional functions, public or

proprietary Open markets: Interoperability, users are not locked in

with one supplier or service provider


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TC EEEnvironmental

Engineering

TC ERMEMC and

Radio Spectrum Matters

Status: 2006-04-28

TC HFHuman Factors

JTC BroadcastEBU/CENELEC/ETSI

ECMATC32Standardizing information &

communication systems

TC TISPANTelecoms & Internet

converged Services & Protocols for

Advanced Networks

TC SESSatellite Earth Stations

& Systems

TC MTSMethods for Testing &

Specification

TC ESIElectronic Signatures

& Infrastructures

TC TETRATerrestrial

Trunked RADIO

TC DECTDigital Enhanced

CordlessTelecommunication

Technical Committees

TC SCPSmart Card Platform

TC ATAccess and Terminals

TC MSGMobile Standards Group

TC RTRailway

Telecommunications

TC TMTransmission

and Multiplexing

TC LILawful Interception

TC PLTPowerLine

Telecommunications

TC SafetyTelecommunications

Equipment Safety

TC STQSpeech processing

Transmission & Quality

TC BRANBroadband Radio Access Networks

TC healtheHealth and

Telecare in prep


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ETSI TC Human Factors

Responsible for human factors issues in all areas of telecommunications and ICT Responsibility to ensure ETSI takes account of the needs of all users- generic, older, young, disabled, etc. Produces standards, guidelines and reports that set the criteria necessary to ensure the best possible user experience Chairman: Stephen Furner (BT, UK) Vice Chairmen: Bruno von Niman (ITS, Sweden)

Lutz Groh (BenQ, Germany)


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TC HF Major activities/deliverables

New wave technologies Children’s use of ICT Telecare Real time communications

Fixed mobile convergence Minimum HCI for mobiles User profiles Enterprise wide systems

Accessibility and inclusion Textphone access to IP text services Symbols for access to digital TV Multicultural interfaces

Deliverables Around 100 deliverables published so far by ETSI

human factors committees Project Teams/STFs

31 have completed work to date; 5 are in preparation; more on the way!


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ETSI HF Specialist Task Forces

- Requirements for assistive technology devices in ICT

- Generic spoken command vocabulary for ICT devices and services

- Guidelines on the multimodality of icons, symbols and pictograms

- Guidelines for ICT products and services: Design for All

- Access to ICT by children; Issues and guidelines

- Alphanumeric characters in European languages: sorting orders and assignment to the 12-key telephone keypad

- Human Factors of work in call centers

- Multimodal interaction, communication and navigation

- Maximizing the usability of UCI based systems

- Guidelines for generic UI elements of mobile terminals and services

- Telecare in and outside of intelligent homes

- User profile management

- Guidelines for the design and use of ICT by children

- Duplex universal speech and text communication

- Multicultural aspects of ICT

- Etc.


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e-Health and Telecare services

Thanks to the smarter home, home help is required only twice a year… to adjust the clock!


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Demography changes

Western societies are aging 40% of the European population foreseen to be 65+ in 2051

Public health care spending is on the increase- OECD figures as % of GDP: 1970: 5 % 1990: 7% 2004: 8 % already exceeds 10 % in Germany, Sweden, Switzerland and the USA

OECD recommends actions including: the introduction of automated health‑data systems; strategies making use of new technologies; and improved quality of care through better information.

Better health care services are required on a global level Costs and expenses not allowed to continuously increase

without a collapse of the system in the aging Western world)


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Health & Social care models and costs

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Support Ratio 1 UK Long TermHealthcare Cost 2

1. Office for National Statistics, 2002.2. Royal Commission Report into Long Term Care, 1999.


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Telecare is…

ICT-enabled delivery of health and social care services to individuals within the home or a wider area, involving clients, carers and coordination agents.

A Business-to-Consumer (B2C) service model, including: information and communication services; safety and security monitoring; personal monitoring; electronic assistive technologies.

NOT telemedicine, a service offered to and used by healthcare professionals! a Business- to-Business (B2B) service model


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A historical perspective (pre-e-Infrastructures)

Medical care until the mid‑1900s provided by trained physicians in the client's home; family and neighbours acting as nursing and supportive staff

This healthcare model has changed dramatically Medical care is now care unit‑centric, requiring advanced equipment; A GP or MD's visit to the client's home has become an unusual service.

Telemedicine was introduced in the 1960s as isolated, stand alone efforts to overcome distances

Social care services supported by ICT since the 1990s Through call centre services, home equipment for social alarms, etc. Enabled by the underlying technology and availability of services .

The more widespread deployment of telecare was held back by the: lack of reliable telecommunication networks and devices; unavailability of hardware and software at reasonable costs; lack of on‑line connectivity; relatively stable demographics and lack of political support; lack of client trust, acceptability and client expectations and habits; resistance from healthcare professionals

• social patterns take generations to change


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A historical perspective: e-Infrastructures as enablers

Users were not ready yet, nor were the prerequisites technology, society, technical infrastructure, practitioners,

procedures, budgets, etc The proliferation of fixed and mobile broadband services (in

and outside the home) is opening up opportunities for convenient and reliable delivery of telecare services

Thereby- the demand for end user (client) centric human factors guidelines addressing design, development, deployment, use and

maintenance of telecare services is on the increase At present, demographic changes, limited resources, high

user expectations, globalization and technology are transforming medical and social care systems in many countries


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Evolution of Telecare Services 1st Generation

Social alarms - dispersed panic alarm with pendant and pull cords

Addition of passive sensors for auto alerts An existing care intervention package

2nd Generation Telecare systems - adaptive, personalised but event

driven Exhibits aspects of reasoning An emerging care intervention package

3rd Generation Well-being analysis - pre-emptive, long term trend

analysis Migrates Telecare from a crisis safety net to an

assessment tool Will enable intervention outcome measures and

optimisation


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The EU policy framework

European Commission encourages EU Member States to: provide better care services at the same or a lower cost; be compliant to standards;

"e‑Health is today's tool for substantial productivity gains, while providing tomorrow's instrument for a restructured, citizen‑centred health system

and, at the same time, respecting the diversity of Europe's multi‑cultural, multi‑lingual health care traditions".

Telecare identified as strategic enabler of the provision of independent living to older people

e‑Health Action Plan- steps to build the "European e‑Health area": Basic level 2004: a European Health Identity Card (EHIC) shall be introduced; National level 2005: National and regional e‑Health Member State strategies

developed Interoperability level 2006: national healthcare networks should be well

advanced in their efforts to exchange information, including client identifiers; Networked level 2008: health information and services (e.g. e‑prescription and

telecare services) to become commonplace, accessible over fixed and mobile broadband networks.

FP7 strategic focus area EC eHealth ICT Standardization Mandate M/403 EN (March 6, 2007)


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ETSI activities in e-Health and telecare

Technical Report (prestudy) TR 102 415: User aspects ETSI Guide (under development) DEG 202 487: User

experience guidelines eHealth Starter Group

Foreseen to become a new Technical Committee ETSI Project (EP) established, first meeting held on April

12, 2007• Welcome to join!

Special Report SR 002 564 published (will be updated as a Technical Report)


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Human factors- a wide and complex area

Human factors of telecare services non-exhaustively involves: human confidence and decision making; user education; device setup, configuration, calibration and maintenance; data collection, transmission and communication with diagnostic

systems and carers; user procedures; cultural issues (e.g. use of language and illustrations); the organization of the care provisioning process; accessibility issues; usability aspects relating to the specifics of mobile environments;

Used by young and older people, impaired, disabled or temporarily ill people should therefore be designed, deployed and maintained thereafter!


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Rationale for our work

Telecare must move from the research labs to the real world; technology is there; still need to consider:

Intuitive and simple user interfaces Reliability Security and privacy issues Interoperability Business models

A user centred approach is a pre-requisite to a successful uptake!


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User centred integration of telecare services

TELECARE INTEGRATED MODEL

METHODOLOGICAL APPROACH

PROVIDED SERVICES

ElectronicAssistive

Technologies

Home Safety &Security

Monitoring

USERSDisabled peopleElderly people

Carers

InformationProvisioning

PersonalMonitoring

Design for All Independent Living Ethics

PolicyMakers

StandardDevelopers

InfrastructureProviders

ServiceProviders

Device andApplicationDevelopers

EquipmentSuppliers

Sustainability

UNIFIED ACCESS POINTS ASSESMENT COORDINATION

Ref: Barlow, Bayer, Curry, 2003


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The “Usability Gap”

“Featurism” - product complexity increasing Range of ICT users broadening – children, older, disabled

people


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Address the needs of all users


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ETSI TR 102 415 STF 264 “Telecare- user aspects”

Contribute to meeting the demand for care services enabled by narrow- and broadband, fixed and mobile technologies

Support EC policy framework give vulnerable customers greater access to an independent

life within the wider community; and reduce the need for institutional care.

Not exclusively services for older community members young people who need care at home, permanent heart monitor wearers, pregnant women, etc.

Identifies key issues, potential solutions, and provide recommendations for actions be taken in this area

Facilitate the development of European and international standards


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Structure and content of TR 102 415

Foreword and Introduction Scope References, definitions, et cetera Introduction to telecare Characteristics of telecare solutions Drivers, enablers and obstacles Stakeholders’ requirements and goals Human Factors recommendations for telecare solutions Conclusions and recommendations


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Characteristics of telecare solutions (I)

Users

Availability Appropriateness:

Accessibility, according to:• Human abilities• Awareness of potential users• Geographical and temporal barriers

Safety and security of operation Effectiveness: Assessment of real user needs Affordability: Complex business models

Ethics and non-intrusiveness: Respect users’ privacy Avoidance of technical language Takes informal carers into account Appropriate visual impact Presents telecare as self-empowerment tool


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Characteristics of telecare solutions (II)

Technology

Providers

Interoperability Integration capability Maintenance Pull and push modes Adequate response time Optimization of power consumption

Service

Providers

Efficiency: outcome benefits Scalability Service portfolio flexibility


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ETSI Draft EG 202 487 (STF299):“User experience guidelines for telecare

services”

New, follow-up work started in February 2006 Funded by EC, EFTA and ETSI ITS/vonniman consulting, BT, Telenor, AENOR/E.T.S.I./DIA/UNED Will develop an ETSI Guide EG, ready in September 2007

addressing a subset of previously mentioned issues providing guidelines for development and deployment

Published and freely available in December 2007 (matter of ETSI member’s approval)

Portal, Reference Group end email Newsletter http://portal.etsi.org/stfs/STF_HomePages/STF299/STF299.asp


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Standards- starting with the user experience!


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Life-cycles and stakeholders

Life-cycles phases: Research, Design and Development Service provisioning

Stakeholders: Users: Clients, carers (professional and informal) Care service providers Buyers and procurers Developers Communication access providers etc


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Guideline themes

Trust – trust is only established when the user believes issues relating to the security of information have been dealt with appropriately, and that the system can deliver what is expected of it.

User interaction - Interfaces should be designed with the needs of all end users in mind, requiring high degrees of flexibility and a sound knowledge of the end users abilities and preferences.

Service aspects – this theme is mainly concerned with the internal workings of the system developers and service providers, ensuring that any issues which might arise here are dealt with appropriately so that the service can be delivered.


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Approach and structure

Trust

1. Privacy and confidentiality;

2. Ethics;

3. Legal aspects;

4. Availability and reliability;

5. Integrity;

6. Safety. User interaction

1. Usability and accessibility;

2. Localization, customization and personalization;

3. User education. Service aspects

1. Organisational aspects;

2. Servicing and maintenance;

3. Interoperability and roaming;

4. Development process and testing.


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Guidelines across the innovation continuum and service lifecycle


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Structure of the EG and the guidelines

Clause 5 provides a number of high-level, context-independent, common user experience design principles or meta-guidelines, not specific for any area but applying in general to most of them. These are generic to the widest possible extent and applicable to a large

variety of user interface design, user interaction and accessibility aspects.

By applying these common user experience principles across the elements and lifecycles of telecare services, combined with a user-centered development process (see clause 18 for details), the human factors of telecare services will be properly addressed.

The specific design guidelines provided in the following clauses of this document should be applied, in order to optimize the user experience of telecare services and its elements. The first six sections can be grouped under the theme of "Trust", while

the next three sections are grouped under the theme of ‘User interaction'.

The lastfour sections are grouped under the theme of ‘Service aspects':


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Bob and his Mobile Telecare Assistant

Telecare network

Telecare network

Telecare service provider


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Telecare network

Telecare network


Ambulance


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Telecare network

Telecare network


Ambulance


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Telecare network

Telecare network


Ambulance

Cardiologist


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Clause 5: Meta-guidelines

Provides common user experience design principles (meta-guidelines).

generic to the widest possible extent and applicable to a large variety of user interface design, user interaction and user experience areas in ICT.

Further guidelines can be found in their source documents [1- 2x].

By applying these common user experience principles across the elements and lifecycles of telecare services, combined with a user centred development process (see clause 19 for details), the human factors of telecare services and its elements will be well optimized.


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Clause 6: Privacy & confidentiality

Privacy - the ability of an individual or group to keep their lives and personal affairs out of public view, or to control the flow of information about themselves.

Confidentiality - the responsibility of individuals, companies or organisations who may collect and store such information on others, and the need to ensure that only authorised individuals are allowed access to that information.

We may classify privacy as the right of the client and confidentiality as the duty of the service provider.


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Guidelines: Privacy and confidentiality (2/4)

Telecare network

Telecare network

HomeTelecare service provider

RoamingTelecare service provider

Record

Log

Record

Log


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Guidelines: Privacy and confidentiality (3/4)

Telecare network

Telecare network



Record

Log

Record

Log


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Guidelines: Privacy & confidentiality

(PRV-G) 1. Clients have a right to control access to and disclosure of their own health information by giving withholding or withdrawing consent.

(PRV-G) 2. The telecare service provider then has a duty of confidentiality towards that client.


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Clause 7: Ethics

Ethics can be considered in terms of two basic principles:

Care - the universal duty of good care i.e. the use of expertise to protect the well-being of clients.

Respect - the universal duty to respect the autonomy of the client.

These basic principles often create an ethical dilemma.


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Guidelines: Ethics

(E-G) 7.1.1 Telecare systems should protect the well-being of the client in terms of their physical health, mental health and social interaction, with the aim of supporting or improving the independence of the client.

(E-G) 7.1.2 Telecare systems should respect the client's autonomy: their decisions, dignity, integrity and preferences.


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Clause 8: Legal aspects (1/3)

Guidelines are based upon the legal requirements associated with providing health and social care to individuals.

As with all of the guidelines within this document the wording has been chosen to convey a sense of good advice rather than compulsory instructions.

However, stakeholders should bear in mind that because these guidelines are based on current legislation it may be unwise to consider them as optional.

The legal aspects considered here are: laws, liability and contracts.

Most of the laws relating specifically to privacy, ethics and safety are considered within other sections (clause 6 Privacy and Confidentiality, clause 7 Ethics, clause 11 Safety).

Stakeholders are encouraged to read all of these sections together with this section in order to develop a good understanding of the legal aspects associated with the development and provision of telecare services.


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Guidelines: Legal aspects (3/3)

Telecare network

Telecare network




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Clause 9: Availability & reliability

Availability - the degree to which a system can be expected to function when it is required to be set into operation.

Reliability - the ability of a system to function, both in routine use and in case of unexpected, adverse circumstances.


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Guidelines: Availability & reliability

(A&R-G) 9.1.1 Telecare systems should be designed and operated such that the availability of the service is appropriate to the needs of the end user, and provides an acceptable user experience.

(A&R-G) 9.1.2 Telecare systems should be designed and operated such that the reliability of the service is appropriate to the needs of the end user, and provides an acceptable user experience.


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Guidelines: Availability and reliability (3/5)

Telecare network

Telecare network

HomeTelecare service providerCardiologist


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Guidelines: Availability and reliability (4/5)

Telecare network

Telecare network

HomeTelecare service providerCardiologist



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Clause 10: Integrity

Integrity in this document is related to the confidence that can be had that data is not tampered with or accidentally changed.

This is again related to data consistency, repeatability of measurements and security of data against errors or attacks [ISO 17799-05].

The integrity guidelines should be applied not only to the technical parts of the system, but also to its human counterparts insofar as they have an influence on system behavior and data.


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Guidelines: Integrity

(I-G) 10.1.1 Telecare systems should be designed and operated such that data and information within the system are maintained unchanged during transfer.

(I-G) 10.1.2 Telecare systems should be designed and operated such that data and information within the system are maintained unchanged during storage.

(I-G) 10.1.3 Telecare systems should be designed and operated such that data and information within the system are maintained unchanged during retrieval.


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Clause 11: Safety

Safety is here taken to mean "non-harmfulness". In that context, the guidelines presented below have two different purposes. The first is to make the equipment safe in routine use by minimizing the chances of user errors or minimizing the adverse consequences of any error.

The second is to help the user make the right decisions and takes the right corrective actions when something goes wrong and the equipment becomes potentially unsafe. Safety aspects related to user perception (color, sound, tactile feedback etc) can be found in the chapter on user interaction.

An overview of designing for safety in medical devices is given in 111. For a general and comprehensive introduction to the design of user interface see 112.


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Clause 12: Usability and accessibility (1/6)

Usability and accessibility aspects considered in this clause are applicable to users who will directly interact with the Telecare equipment, namely clients and carers.

It must be stressed that users falling in any of these stakeholder categories may face problems to make an efficient and satisfactory use of telecare equipment, either because of a limited ICT proficiency, or because of limited physical, cognitive or sensory abilities.

Hence, telecare services should satisfy users' generic needs for utilizing ICT equipment.


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Quality in user interaction has to be addressed in every stage of the telecare lifecycle.

Design, development and manufacturing stages should finally produce telecare systems that have in-built capabilities to communicate appropriately with users and their assistive technologies.

During service provision, technology has to be put in place, and this includes optimization of interaction according to the specific user and context of use.

Targeted users and contexts of use should have also been considered initially during the research stage, when ethnographic, social and cultural issues need to be addressed.


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User interaction will be affected by the emerging trend to provide telecare services through different types of generic ICT gadgets: fixed and mobile phones, TV sets and their remote controls, personal computers, laptops, PDA's, etc.

In addition to generic ICT devices, other specific pieces of equipment (e.g. medical or biometrics devices) will be part of the telecare systems.

These ICT gadgets' user interfaces, as well as the procedures to make use of them, will constitute a relevant component of user interaction with telecare and affect quality in user interaction.

Emerging pervasiveness of computers will cause a proliferation of computing enabled objects that are part of our everyday life, which will also be part of telecare services. Derived from these facts and trends, it is foreseen that combinations of interaction devices and telecare services belonging to different generations will co-exist: Traditional interaction devices being used to access to new services (e.g. a TV set being

used for a televisit to a practitioner). New devices being used to access to services that previously existed (e.g. phone call to an

emergency service through the hand-free modality of a wearable Telealarm system). New interaction devices being used to access new services (e.g. an automatic vocal

interaction system embedded in the living room supporting an older person while doing some rehabilitation exercises).

Traditional interaction devices being used to access to traditional telecare services (e.g. phone call to an emergency service).


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New schemas in user interaction will appear in forthcoming generations of telecare systems, with potential implications in accessibility and usability of these services and products: Telecare equipment may react based on an implicit

communication with the user, rather than on a traditional explicit human-machine dialogue. Systems, for instance, may automatically change some features of their user interface according to context or to person's habits or preferences, in order to improve the quality of user interaction.

Communication with users will build on new modalities, such us semi-natural speech, gesture recognition, etc.

Increasing ubiquitous access telecare services will bring up many different contexts where the person-system communication may take place, such us home use, mobile use, etc. Variety of contexts implies the potential existence of ambient conditions that may affect user interaction (noise, inadequate lighting, low temperatures, etc.).


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Guidelines: Usability and accessibility (5/6)

(ITR-G) 1. Users must be able to perceive the information presented by the Telecare equipment and services.

(ITR-G) 2. Users must be able to operate the Telecare equipment efficiently.

(ITR-G) 3. Telecare operation must be understandable by users.

(ITR-G) 4. Assistive technologies must be usable in conjunction with Telecare equipment. Users must be able to use the Telecare equipment either directly or by means of assistive technologies.


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Guidelines: Usability and accessibility (6/6)

Simple activation of service request The service activation has to be very simple and intuitive,

and provide acoustic feedback.

Clear, visual-acoustic, notification of: Mobile phone is switched on/off Existence/non existence of cellular phone coverage. Progress report on the communication with the cardiology

service. Low battery in mobile phone or sensor.

Bob was happy to update to himself to the new smartphone, as it has been able to install a screen reader to have access to all its functionalities


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Clause 13: Localization, translation management, customization and personalization (1/5)

According to [17], localization refers to the provision of product and user-guide variants for different markets, taking into account market specific, local linguistic and cultural differences. In some markets, product localization is required by regulations. In addition, a reasonable degree of localization is recommended, as users expect to be informed about their products in their own, native or other preferred language.

As the costs for localizing products and services are considerable [17], most manufacturers and service providers restrict their localization efforts to offering a limited set of language versions of the user interface (in particular in the menus) and of the user guides. The use of icon-based menus in mobile devices is an attempt to internationalise aspects of the user interface. Other relevant aspects such as the use of colours or referent objects depicted in icons are usually not varied, even though they are likely to carry different connotations in different cultures.


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A main challenge related to localizing user guides [17] is that as user guides are being completed fairly late in the development process, the localization efforts of user guides comes after completion of master draft, i.e. at a very late stage.

Relevant aspects of localization include: Dialect variants of particular languages (e.g. German in Switzerland, Austria

and in Germany); The fact that certain languages that are written from left to right, while others

right to left; Visual content (illustrations, icons, pictures, images) may need to be adopted

for local cultures; Use of formal addressing: in some cultures, it is appropriate to address the

user in the user interface and the user guide using formal language ("Vous", "Sie", "U", etc.), while in others an informal addressing ("Tu", "Du", "Jij", etc.) may be expected;

There are cultural differences concerning perceived sexism (e.g. German requires the use of male and female terms describing a person in order to circumvent sexism - the "useresse and the user" - while some Anglo-Saxon cultures consider this sexist and require both males and females to be addressed with the male term only);

English terms might be accepted in some languages, but not in others.


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Translation management and validation: according to [17], most ICT products are produced for a global market and are be translated into many languages.

As English is the most frequently used foreign language and it is usually easy to find translators who work with translations from English into their native language, the master text is written in English by most producers.

Common writing rules have to be agreed upon and style guides have to be written and used, both in the source and in the target language..

It is important to ensure that the style and terminology of a translated text/term correspond to the style and terminology used in the local market and within the company. This can be accomplished by having people who know the local markets and the industry, review the translations (and illustrations). The reviewers can give advice and comments on the choice of terminology and the overall translation to the translators. For detailed guidelines, see [17].


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Customization: telecare service providers will offer customized services that may include the menu tree, service provider-specific service portals and contact numbers, terminology, logotypes, illustrations, user interface strings (help texts etc. in the display of the equipment), functionality, control keys, icons, reference to the service provider's call centres and Web pages, services provided by the service provider, information about costs and cost-transparency for the services provided, colours or login and identity validation mechanisms [17].


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Personalization: In the mobile ICT environment, it is not uncommon that users personalize their experience through configuration, that may relate to the terminal, the network or the service. The optimal approach to support the users achieving this is through user profiles, defined in [20] as "…the total set of user related rules and settings which affect the way in which a user experiences terminals, devices and services".

According to [20], several aspects of a service or device may be personalized, depending on:

characteristics of the service and device; specific goals of the service provider or manufacturer; categories of users who will use the device/service; existing user profile data that can be used to set initial values for new device or service start-

up. Service developers and manufacturers have a considerable influence on in what

way personalization can take place, which parts of the service are candidates for personalization and available settings.

In order to decide the best way to deliver the device or service to the intended users, service developers will need to obtain information about those users. Prior to the launch of a product, a number of methods can be employed to obtain such information:

market surveys; feedback from users about previous versions of the device or service; usability and focus group testing of prototypes of the new device or service; users may define which aspects are relevant, or they may become clear from the way the

individual uses the service.


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Clause 14: User education (1/3)

Telecare users should be provided adequate information concerning the availability and functionality of the telecare service offering.

Information can be provided through several channels, such as national centres for the dissemination of social and telecare services and community equipment, healthcare centres, through the Internet or direct approaches (e.g. a one-stop-shop for information and advice about health and social services).

In order to be able to make proper use of deployed services, users should be able to understand how to access and make use of the offered capabilities in a reliable way.

The provision of user education for telecare services is a necessity, as these services are often complex, have inadequate input and output devices, provide an increasing number and range of functions and can sometimes be difficult to understand and use. User education can play an important role not only in the discovery of a service offering, explaining how the service will benefit the user and providing further details and guidance including the ordering and use of a telecare service.


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Clause 14: User education (2/3)

Current difficulties with user education for telecare services includes the difficulty to find information about available services, the explanations of how to use a telecare service, incomplete user guide, information perception difficulties and product/service version incompatibilities.

[17] provides a clear set of guidelines on how user instructions ought to be provided, taking into account the requirement of different user groups (e.g. young and older people, disabled and less literate users) and the possibilities offered by different media. In addition, [17] provides generic guidelines that can help increase the uptake and usage of telecare services: an improved user education will help users to discover, understand and make a better use of the available services.

In order to be able to access and use a telecare services, most often some kind of ICT equipment is necessary. This will involve a variety of generic ICT usability and accessibility requirements to be met. Furthermore, as the clients are often older people, issues of vision, sight, hearing and cognitive capacities are raised. In other cases, less literate users may experience considerable difficulties.


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Guidelines: User education (3/3)

Bob and Eva received the necessary training at the cardiology service of the hospital, while the service was installed.

They received a detailed insight about the service’s functionality, reliability, international roaming features.

The whole process took less than half a day. There exists a 24 hours help-desk service available .


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Clause 15: Organizational aspects

Health and social care organisations employ telecare solutions to help with their objectives of dealing with increasing workloads, maintaining or improving service quality, and containing costs.

In order for a telecare system to be effective in helping with these objectives, changes to existing working practices within the organisation may be required. Indeed it is reasonable to assume that the aim of introducing telecare is to change (or improve) existing working practices in order to meet the stated objectives.

In some cases change to working practices may result in the need to change an organisation's structure, all of which can be very disruptive. If the organisational disruption caused from introducing a telecare system becomes excessive, or is deemed unnecessary by the service provider employees and their clients, the credibility of that system may suffer.

When designing or implementing a telecare system it is important to understand how its introduction and use may affect existing organisational structures and working practices.

The guidelines are aimed at helping designers and service providers avoid or minimise the negative effects associated with these necessary changes.


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Clause 16: Servicing and maintenance (1/2)

NOTE 1: Some of the maintenance guidelines within this section that are aimed at improving or maintaining the availability or reliability of the system are found in the "Availability and reliability" section.

NOTE 2: Any installation guidelines within this section which relate specifically to installing equipment in a way which ensures it's usability to the client (e.g. fixing an alarm panel at the correct height so that it can be used by a person in a wheel chair) are found in the "Usability and accessibility" section.

NOTE 3: Guidelines relating to installation, setup, configuration and maintenance AND which address issues of cost, keeping clients informed or keeping any reduction in client disturbance to a minimum are found within this clause.


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Clause 16: Servicing and maintenance (2/2)

Installation, setup, configuration and maintenance are needed to ensure that the behaviour of the telecare system is in accordance to the required functional, usability and trust requirements during the whole period of service provision.

More specifically, these activities aim to: Customise the generic functionality of the service to the actual

needs of the client. Adapt the user interface of the service to specific clients'

preferences and abilities, as well as to the concrete context of use. Ensure that clients' privacy right is protected during service

provision. Ensure that the system functioning is within the required levels of

availability, reliability and safety.


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Clause 17: Interoperability and roaming (1/2)

The European Commission's eHealth Action Plan [30] identified and set up the practical steps required to build a "European e-Health area".

by 2006, national healthcare networks should be well advanced in their efforts to exchange information, including client identifiers.

By 2008, health information and services such as e-prescription, e-referral, telemonitoring and telecare services are to become commonplace, accessible over both fixed and mobile broadband networks across the Member states of the European Union.

In order to support client mobility across the EU, interoperability and coding standards need to be harmonised between national care record systems. In order to achieve such harmonisation cultural differences between health and social care providers within countries will have to be addressed in addition to cross border differences. These issues are addressed by the CEN/ISSS e-Health Standardization Focus Group [36].

As described in [1], on the level of the health care providers, several initiatives throughout Europe try to integrate the different information databases and the different bodies that together are involved in the care of a person, at home or in an institution.

On the level of the communications infrastructure, the proliferation of ubiquitous, digital, always‑on, wireless communication channels, like GPRS for the mobile user, WI-Fi in‑house or in targeted public zones, as well as UMTS and the emerging Wi-Max technologies, open the possibility for continuous health care irrespective of time and place.


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Clause 17: Interoperability and roaming (2/2)

The Technical Committee for Medical Informatics, TC251 of the European Committee for Standardization (CEN), established a project team (CEN/TC251/PT5-021) to standardize the representation of digitized biomedical signals, measurements, events and alarms, called vital signs in this context. The intended application areas of this standard proposal are found in the

equipment used in intensive care, anesthesia, neurophysiologic measurement laboratories, sleep laboratories etc.

The goal in this work was to enable interoperability between the real time computer systems of different manufacturers also in time critical applications in hospitals, e.g. plug and play. A pre-standard was published in 2000. The main content of this CEN pre-standard has been distributed into the globally harmonized ISO/IEEE 11073-series [34], covering all point-of-care medical device communications [34] and [35]. Standards for data exchange between devices, and definitions and support of ontologies between services [35] should be further developed.

This is a complex situation. Given the scope of the present document, the guidelines provided

below focus on the user experience of interoperable telecare services, even if it is difficult to disregard from the technical aspects necessary to enable such services.


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Clause 18: Development process and testing (1/9)

The adequate addressing of human factors in the creation and provision of Telecare services and products will constitute a key factor in the success of their effective adoption as support elements for the independent living of people with functional limitations.

The adoption, within the engineering process, of specific design processes and phases of methodological evaluation of human factors aspects, such as accessibility, usability, personalization, respect for ethical principles, security of operation, privacy, etc. will allow to detect and solve deficiencies in time, increasing the quality perceived by the potential clients of the these services.


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User centered development processes The application of the principles of Human (or User)-

Centered design have high payoffs, according to [19]: reduced costs: the overall development times and costs can be

reduced by avoiding re-design and reducing the number of changes required late in design;

reduced support costs: systems which are easier to use require less training, less user support and less;

subsequent maintenance; reduced costs in use: systems better matched to user needs

improve productivity and the quality of actions; and decisions; improved product quality: Human-centered design results in

products which have a higher quality of use and are more competitive in a market which is demanding easier to use systems.


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All these benefits are obtained taking on account the total life-cycle costs of the product, not only those of the development, but also the set-up phase

and the maintenance phase. The initial costs of human-centered design activities are compensated by all the benefits that produce at the end. In spite of being so important benefits, they are seldom expressed in economic terms.

ISO standard ISO 13407 [33], "Human centered design processes for interactive systems", provides guidance on human centered design activities throughout the life cycle of computer-based interactive systems. The standard is targeted to people who manage design processes. According to ISO 13407 [33], human centered design consists of four different types of design activities:

Understand and specify the context of use; Specify the user and organizational requirements; Produce draft (pilot) design solutions; Evaluate design against requirements.

The overall general methodological framework for developing telecare solutions should be mainly inspired of the Design for All philosophy. Related user-centered design methodologies propose iterative processes where user requirements are matched against the results achieved at different stages of the product life cycle.


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After assessing the appropriateness of intermediary or final results according to the initial set of users' requirements, proposal for changes would be reported by evaluators. In the case of conflicts caused by incompatibility between technical issues and user requirements, or even between different user requirements, the initial set of requirements should be modified, and the resulting modifications in product expected features reported. (see USERFIT methodology [104]).

Apart from the generic approach provided by user-centered methodologies, some work has been carried out on assessing different aspects of human factors of telecare solutions.

In [105], a cognitive engineering approach to the study of human-computer interaction for telecare services is proposed. The research is predicated on a two-pronged methodological approach to the study of human-computer interaction. The first component consists of a cognitive task analysis of the system carried out by the team of investigators. The second part of this work involves field usability testing of patients performing a series of tasks using the system.


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According to the Guide published by the “The Care Services Improvement Partnership (CSIP)” of the UK Department of Health [103], evaluation of services is critical as it helps to demonstrate the benefits (and problems) of telecare to users and other stakeholders, and helps support informed procurement and strategic decisions.

However, there has been no truly rigorous evaluation of telecare services

There exists a long list of references with methodologies for evaluating different aspects of telemedicine solutions, but this is not the case for telecare services, where non-professional users are involved.

Using telecare systems can present some difficulties for health and social care professionals, and these difficulties may be harder for chronic care patients, typically older and with low technological skills.

A particular problem that has to be overcome is that telecare interventions affect to a very diverse user population, the conditions to manage are too diffuse and the surrounding environmental context too varied.


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According to CSIP, the evaluation of a telecare system by a service provider should cover: Management and partnership arrangements; Commissioning and funding aspects; Performance issues; Technical and other barriers; Availability of new products; Environment in which equipment is used; Service development; User and practitioner views, ethical considerations; Service functionality; and Future arrangements.


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No comprehensive methodology for evaluating user aspects of telecare services, several approaches and references are applicable.

Jacob Nielsen has produced sets of guidelines relevant for usability evaluation, including heuristic techniques [106], Web interfaces and users' groups, applicable to evaluation with users [107].

Several EU funded projects proposed methodologies for evaluating different characteristics of Smart Home solutions: The NJORD-TIDE project, where several purposes of assessment

methodologies for domotic systems were issued [108]; The HEPHAISTOS-TIDE project, where an evaluation methodology was

proposed for evaluating a demonstrator of a multimodal system of environment control, for users with different functional profiles.

Generic evaluation techniques for the evaluation of telecommunication equipment are also available and most often applicable to telecare equipment (after possible adaptations).


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ETSI ETR 095, "Human Factors (HF); Guide for usability evaluations of telecommunications systems and services", [5] supports the usability evaluation of telecommunications systems and services by improving communication by providing an agreed terminology; facilitating our understanding and comparison of test results; and supporting planning and carrying out of usability evaluations.

ETSI EG 201 472 [19] provides the basis for the use of a common methodology when performing usability evaluations and provides guidance on the Human-Centered Design (HCD) Process (also providing arguments against the idea of usability evaluation as " "final test").


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According to [19], the usability goals are the desired end states which should be met for the system or service be judged as usable across the main dimensions of usability including effectiveness, efficiency, satisfaction, learnability and flexibility and accessibility.

These goals should be particularized in measurable criteria, either absolute (e.g., the minimum level the system or service should meet), or relative (in comparison with previous systems or prototypes).

It is important to specify how the validity of these measures going to be analyzed, this is, up to what extent the measures being taken will relate to the global measure of the system.

It is essential to apply relevant sampling methodologies to ensure a representative selection of the users who will participate in the evaluation and testing programmes.


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Establishment a new ETSI Project

eHealth Starter Group in 2006 Pre-study performed, Special Report SR 002 564

published Will be updated into a Technical Report

Preparing the foundations ETSI Project (EP) established First meeting held on April 12, 2007

Welcome to join and shape future standards! For more information, please contact:Gaby LenhartETSI eHealth Project [email protected]


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Future human factors issues to address

The need for an over-arching Telecare standard? Acceptability of telecare services

Non-intrusiveness Interoperability and portability between service providers Consistency of user interfaces between services Accessibility issues in more detail

embrace the design-for-all approach Complementary assistive technologies

User understanding and confidence in systems would a standards based approach help to eliminate misunderstanding?

Interoperability with other ICT devices and services adaptability between solutions for different chronic diseases; integrity of solutions within complex RF environments.

Addressing the needs of all user groups: older people, children, others as clients; carers needs across the age spectrum; coordinators needs.

Guidelines for usability testing etc


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Join us at near-future events

Med-e-Tel 2007 Workshop in Luxembourg (April 18, 2007, http://www.medetel.lu/index.php)

DRT4ALL 2007 Workshop in Madrid, Spain (April 20, 2007, http://www.drt4all.org/drt/en/2007/)

HCI International 2007 Presentation and Poster (July 22- 27, Beijing, China, http://www.hcii2007.org/)

Electronic working- public review of drafts and provision of your comments

etc

April 18, 2007 Med-e-Tel 2007, LuxembourgETSI Workshop

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Thank you!

Your input and comments are WELCOME!

For more information:

http://portal.etsi.org/STFs/HF/STF299.asp

To work with us:[email protected]

(STF Leader)

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