wheelchase: to find wheelchairs in hospitals
DESCRIPTION
WheelChase is a service that enables users to locate a wheelchair within their vicinity based upon the chairs availability. Hidden wheelchairs cannot help patients. Enabling staff to locate available wheelchairs quickly and easily resolves this issue by making availability and location available to anyone who needs a wheelchair. This not only reduces the hoarding of wheelchairs, but also reduces the time it takes to locate a wheelchair and return it to a patient who needs it. Also, by keeping track of a wheelchair’s location theft levels may reduce as well. The average cost for a standard, hospital wheelchair is from two hundred to five hundred dollars per chair, depending on the type of chair desired. Interviews with nurses and hospital administrators indicate wheelchair theft is more common than people think.TRANSCRIPT
INFO-I 564 Indiana University Indianapolis
WheelChase Saving Time and Money for Healthcare
Michael Downey Steven Entezari 5/6/2011
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CONTENTS
Introduction and Vision ........................................................................................................................................................ 3
Functional Design Concepts ................................................................................................................................................ 4
Web Application/Smartphone ...................................................................................................................................... 4
SMS/Pager ............................................................................................................................................................................. 5
Voice Phone ........................................................................................................................................................................... 6
Early Ideation and Prototypes ........................................................................................................................................... 7
Informal Walkthroughs ....................................................................................................................................................... 10
Medium-Fidelity Prototypes ............................................................................................................................................. 13
Prototype Usability Tests ................................................................................................................................................... 14
Potential Improvements ................................................................................................................................................ 16
Lessons Learned and Implications of Use ................................................................................................................... 18
Appendix A: Mobile Web Prototype Screens ............................................................................................................. 20
Appendix B: Web Application Prototype Screens .................................................................................................... 31
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INTRODUCTION AND VISION
In hospitals, wheelchairs are just as commonplace as patients. Unfortunately, due to budget
and space concerns, there are not enough wheelchairs for each patient. This means wheelchairs are
used only during patient transport, then made available to anyone once no longer utilized. In an
ideal world, this method works perfectly. However, since the supply is low while demand is high,
wheelchairs are constantly being pushed around to different parts of a hospital; making it difficult
to immediately locate one when needed. In addition, hospital workers adopt a behavior where they
attempt to plan for upcoming needs, leading to wheelchair hoarding and hiding as a common
occurrence.
WheelChase is a service that enables users to locate a wheelchair within their vicinity based
upon the chairs availability. Hidden wheelchairs cannot help patients. Enabling staff to locate
available wheelchairs quickly and easily resolves this issue by making availability and location
available to anyone who needs a wheelchair. This not only reduces the hoarding of wheelchairs, but
also reduces the time it takes to locate a wheelchair and return it to a patient who needs it. Also, by
keeping track of a wheelchair’s location theft levels may reduce as well. The average cost for a
standard, hospital wheelchair is from two hundred to five hundred dollars per chair, depending on
the type of chair desired. Interviews with nurses and hospital administrators indicate wheelchair
theft is more common than people think.
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FUNCTIONAL DESIGN CONCEPTS
WheelChase utilizes multiple Wi-Fi access points from around the hospital to triangulate its
location. All wheelchairs will be fitted with Wi-Fi transmitters, with unique identifiers, to allow a
backend database to keep track of properties relating to the wheelchair, such as type, availability,
status, maintenance dates, cleaning dates, and more. The service will be made accessible via
smartphone, web application, SMS/pagers, and voice phones. The web application will allow for
administrative users to see more than simple type and status (availability), enabling them to
maintain wheelchairs.
WheelChase is designed around a hospital’s current set of wheelchairs and existing Wi-Fi
network. Current wheelchairs would be retrofitted with a spring-loaded weight sensor to
determine if someone is sitting in that chair, which would indicate its availability (or lack thereof).
For instance, if a wheelchair has over twenty-five pounds of weight on it, a signal will be sent via the
Wi-Fi transmitter to notify the database that the wheelchair is no longer available. This sensor
would be placed beneath the seat of the wheelchair, not affecting the comfort of the seated patient.
If necessary, an additional sensor could be placed on the back of the wheelchair, to enhance the
validity of the availability status.
WEB APPLICATION/SMARTPHONE
The smartphone and web application will be hosted on a secure server, requiring proper
authentication to access its resources. The interface allows users to identify what type of chair they
need (adult, child, wide, tall, etc.), what floor you wish to locate a chair on, and for the web-app
specifically, the ability to query all chairs for any property. More specific examples of these
interfaces will be shown later in this paper.
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SMS/PAGER
Users will be able to ping the location of a wheelchair using the SMS protocol on their
phones or two-way pagers. In the initial text, a location is provided, along with any type of filters
one may desire to include (such as the specific type of wheelchair requested). Given that the
location can be matched to the back end database, the closest wheelchairs to that location are
returned to the user via an SMS response. A more specific flowchart of an SMS scenario is located
below, in Figure 1.
FIGURE 1 - SMS FLOWCHART
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VOICE PHONE
Users need not have a smartphone or text-service to locate a wheelchair. Using a hospital
phone, users can locate a wheelchair closest to them by simply dialing a number specific to that
hospital. The backend database will match the extension of the hospital phone with the closest
wheelchairs in its proximity. If the user is not using a hospital phone, then a step will be added to
enable the user to provide a location to the service (either specific room number or landmark like
Cafeteria or Waiting Room). A more specific flowchart of a voice phone scenario is located below.
FIGURE 2 - VOICE PHONE FLOWCHART
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EARLY IDEATION AND PROTOTYPES
In our phases of early ideation, we focused heavily on the physical possibility of this service
even being designed. Before we began sketching the interfaces that would be utilized, we sketched
how the device would be physically implemented into the wheelchair. For the majority of
wheelchairs that have rubber handles, we designed a device that simply fit right into the hollow
rubber handle, as shown in Figure 3.
FIGURE 3 - WHEELCHAIR HANDLE
As we sketched the initial prototypes of our mobile web interface, our goal was to ensure
that the interface menus were as easy to navigate as possible. People in hospitals are extremely
busy and have absolutely no time to fight poor system design. Early sketches also gave insight to
how we envisioned the chairs being located. At first, we considered a navigational system that
would tell people how far away the wheelchairs were and guide them to that destination. However,
as we discussed alternative usage scenarios, we eventually favored a map interface would allow
easy distinction of the wheelchairs location in relation to the users -- our assumption being that
users may not necessarily want to find the wheelchairs closest to where they were at that moment,
but rather where they might be in the near future. Further, landmarks on the map would enable
users to locate the closest chair with greater ease.
Wi-Fi Transmitter
RFID Transmitter
Battery
Rubber Handle
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We developed a video to describe this potential mobile usage. It is available online at
YouTube: http://www.youtube.com/watch?v=R1itQQ2Rlpg
Figures 4 through 6 are indicative of some of our early concepts.
FIGURE 4 - EASY TO NAVIGATE MENUS
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FIGURE 5 - CONSISTENCY AMONGST MENUS
FIGURE 6 – MAPS
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INFORMAL WALKTHROUGHS
We conducted several informal cognitive walkthroughs of our initial prototypes.
Fortunately, both designers had some domain expertise, with one of us having been a hospital
volunteer and one of us having spent extensive time in hospitals as a child due to his parents'
employment there. Thus, we were able to interrogate each other to ensure validity of our ideas. We
also asked several people familiar with hospitals, either as patients or health care professionals,
about their ideas of the project.
Everyone we spoke with had experienced "orphaned" wheelchairs in random places around
hospitals, such as shown in Figure 7, although those without professional experience in the hospital
environment did not have first-hand understanding of the problem finding wheelchairs. However,
when we explained the problem space to them, they immediately understood the value a
technology-based system could provide.
FIGURE 7 – ORPHANED WHEELCHAIR
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We first set about validating our ideas on the onboard tracking unit. Although this was not
our primary design objective, we needed to understand its potential capabilities in order to design a
human interface around it. Based on concerns expressed about potential wheelchair theft, we
decided the unit should be somewhat covert. We also confirmed through both discussions and in-
person visits that hospitals with Wi-Fi networks have many access points throughout the hospital,
making a good "grid" of location receivers. Charging could happen via a small solar panel on the top
of the handlebar grip, since hospital corridors are always lit.
At first, we had intended to only design a web-based system for mobile phones. However, as
our discussions were conducted, we realized that different hospital personnel have different means
of accessing information. Many of those people are still using two-way pagers, for example. We also
discovered that many nurses work at a stationary nurses station with PC's. (Additionally, we had
not planned for a system to manage wheelchair inventory and add them to the tracking system via
the mobile application.) It was also possible, we found, that personnel might need to find a
wheelchair unexpectedly, and without any other method, may want to pick up a phone to find one.
Thus, we went back to sketch out some early conceptual models of these modes, as is shown in
Figure 8.
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FIGURE 8 – SUBSEQUENT IDEATION FOR MULTIPLE MODES
With those additional scenarios confirmed, we set out to design additional modes to answer
the same question: "Where are the available wheelchairs nearest to me?"
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MEDIUM-FIDELITY PROTOTYPES
We built fully designed (in terms of functionality) medium-fidelity (in terms of visual
design) prototypes of not only the mobile web application, but also a traditional web app, using
Balsamiq Mockups. Testing, described in the following section, was conducted using a combination
of clickable PDF documents and paper printouts of these prototypes. For our SMS/pager mode and
our voice mode, we designed detailed flowcharts describing how these applications would work,
since we would test them via actual SMS or a voice-only "Wizard of Oz" technique.
Appendices A and B, at the end of this document, show a selection of the mobile web app
and traditional web app screens. The diagrams of the SMS and voice modalities are included under
"Functional Design Concepts".
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PROTOTYPE USABILITY TESTS
We conducted usability testing for all four modes with four users, resulting in 16 tests.
Participants were stratified in an attempt to capture a wide variety of potential backgrounds who
might use the system in a hospital:
1. User A: Female, age 23, college-educated and working in marketing
2. User B: Female, age 64, a retired hospital secretary
3. User C: Male, age 18, a soon-to-graduate high school student
4. User D: Female, age 21, a college student
The user was provided a background on the usage of the system and the problem space. They
were then presented the four modes in random order:
The web application was tested using the prototype images, and the user given scenarios
for both a “normal” user as well as an administrator with a separate “account” (two
separate sub-tasks).
The mobile application web tested using the prototype images as well, and the user
instructed to share his or her location with the system when prompted.
The SMS application was tested by sending and receiving actual SMS messages with the
user, as the test conductor followed the flowchart.
The voice application was tested using the “Wizard of Oz” technique, while the user, holding
a mobile phone, spoke to the “system”. The test conductor responded based on the
flowchart.
Interestingly, tests did not uncover any major stumbling points in the applications'
functionality. All users were able to complete the tasks successfully without assistance. This
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relatively unusual situation is likely due to the simplicity of the system's goal -- providing the user
with the location and number of wheelchairs closest to him or her.
Despite the unimpaired success of our users, they did provide interesting and valuable feedback
for us, confirming some of our expectations and raising some new questions. Some of the feedback
we received at the conclusion of testing included:
"So how exactly does this know where the wheelchairs are?" This question indicates
something we overlooked, that users may not necessarily understand how the system
works and that the wheelchairs’ locations are updated automatically by the handlebar units.
In-application descriptions or help screens could provide this context, particularly
important for new users.
"This would be a lot faster than walking around the hospital to look for wheelchairs."
This comment vindicated our design ideation that a system such as WheelChase would save
time, and hopefully would be indicative of all users of the system.
"If I don’t know where I'm located on this map, how would I know what is closest to me?
It wouldn't be as useful." This comment suggested a hypothetical scenario where the user
may be using the traditional web application, but may not understand her physical location
in the hospital. This could be a possibility in the real world, depending on how the system is
used. For example, someone could log on to a computer in a different work area and not
instantly recognize their location on the map in order to find the closest wheelchairs. The
map could be revised to help recover from this scenario.
"I like that I could just send a quick text message instead of messing around with a
computer." With this comment, we were happy to see that we did go about designing the
other modes, as it would appear that people have personal preferences about which
interface style to use.
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"So if I use this system all day, what else is it tracking about me?" This question seems to
refer to the prompt in the mobile web site about sharing location with the application, and
probably represents a larger concern by computer users about location-based services. It is
important to be sensitive to these concerns, particularly when one's employer is the one
asking for location information: users may not be comfortable telling their "boss" where
they are at any given moment.
POTENTIAL IMPROVEMENTS
Based on these comments, we would suggest the following minor adjustments to the product:
1. Provide text labels on the web map representing major landmarks. Our prototype did not
include any text on the map, and doing so could help orient the user, particularly for the
traditional web application, as that user does not have the added assistance of Wi-Fi and
GPS location such as the mobile user, or the location lookup concept of the voice user.
2. Add additional (but short) voice cues to the beginning of the voice system's introduction. If
voice users are not accustomed to using WheelChase, they may not recall what they need to
say in order to activate the system. Another possibility is that people may reach the number
incorrectly. We would suggest something like "This is WheelChase, helping you find
wheelchairs at Niles Memorial Hospital. Where do you need a wheelchair?"
3. Help screens should be developed to describe the system's functionality at a basic level and
how their location is used (and not used).
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DESIGN WISHLIST
The possibilities and potential of Wheelchase will grow with more time and resources.
During discussions, brainstorming episodes, and drafting exercises ideas were derived that were
outside of the scope for this particular project but beneficial for future research. A few of the ideas
are noted below:
1. Patient Monitoring with Wheelchair a. During the use of a wheelchair, there are three main stakeholders; patient,
wheelchair-pusher, and wheelchair. In the event that the patient and wheelchair are
separated from their designated hospital wheelchair-pusher, a system could be
utilized that monitors patients via RFID tags in their hospital bracelets, matched
with the wheelchairs Wheelchase RFID and Wi-Fi system, to locate the patient.
Episodes like this, while not terribly common, can be beneficial for the instances
that a patient is unable to move for a pre-determined amount of time. A hospital
worker will be able to locate the individuals last location to the wheelchair and
provide any assistance needed.
2. Wheelchair Route Planning a. Users who need a wheelchair may not need one in their current location. For
instance, if a nurse is going from the second floor, west wing to pick up a patient
from the fourth floor, east wing, a wheelchair along the route to the fourth floor, or
on the fourth floor, may be the best option for speed and efficiency.
3. Wheelchair Delivery Service a. In bigger hospitals, there may be a bigger volunteer base. Many hospitals currently
have a volunteer position solely responsible for transporting patients from one
location of the hospital to another in a wheelchair. An addition to our current
interface would be the ability to schedule this process via a smart phone or any
other modality listed in this report.
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LESSONS LEARNED AND IMPLICATIONS OF USE
As demonstrated, WheelChase would enhance current hospital protocols and reduce
undesired behaviors such as wheelchair hoarding and hiding. When you take away the problem of
being able to find a wheelchair, you take away the adaptations to that problem, such as the
behaviors mentioned before. However, as to be expected with paradigm shifts via automating
portions of previously manual tasks, some unforeseen and even undesired consequences were
noted.
If a nurse needs a wheelchair today, before the implementation of WheelChase, the nurse
must first look in the immediate area, then begin walking around the hospital, searching for
available wheelchairs. Since this is a common occurrence, a predefined path, or usual path, may be
established in one’s mind based upon where one has found wheelchairs in the past. Along the route
the nurse may take, other instances may occur that the nurse can either help with or utilize for help
in another situation. An example of this could be noticing that the west wing is overcrowded, that
there is a spill on the floor, or that over half of a unit is filled with patients suffering from a similar
condition to that of that nurse’s patient.
Related to the “usual path” problem listed above, we also identified a breakdown in the
social structure of the hospital environment. Looking for a wheelchair may prove to be a two-fold
benefit to someone looking for one. In one case, it helps them find the wheelchair. In another, it
allows them a chance to get away and socialize with other hospital employees. In hospitals, nurses
are usually assigned a station and a set of patients. While there is some interaction amongst nurses
during the day for practical purposes, there aren’t that many chances for them to socialize with one
another. At times, when a nurse may want to get away and go for a walk, an excuse they may use is
that they went to “look for a wheelchair”. While this is not efficiently great, it might possibly be a
huge morale component that reduces stress levels on a twelve hour shift.
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Also, individuals may be skeptical at the idea of tracking wheelchairs throughout a hospital.
While no patient information will be recorded via WheelChase, the stigma of knowing others can
pinpoint your location may induce a sense of fear. Public education and training on the WheelChase
system as well as scripted dialogue training for nurses may help reduce the anxiety surrounding the
location tracking of the wheelchairs.
Ultimately, these unexpected and unintended consequences may not be fully realized and
understood until a real-life test could be conducted in an actual hospital. Such a test should include
the capture of user feedback, to ensure that the system is not only working as intended by making
the wheelchair process more efficient, but also not reducing employee or volunteer morale in other
ways. We believe WheelChase is an interesting and technically viable concept with a significant
chance of commercial success. Further research is required, of course, to bring our conceptual
model to a phase ready for commercialization. However, the information and tests presented here
should serve as a starting point for those wishing to explore these ideas in greater detail, and work
to ultimately reduce the cost of healthcare by increasing efficiency.
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APPENDIX A: MOBILE WEB PROTOTYPE SCREENS
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APPENDIX B: WEB APPLICATION PROTOTYPE SCREENS
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