1. Usability and Human Factors
Input and Selection Methods
Welcome to Usability and Human Factors, Input and Selection Methods.
In this unit we will be discussing input and selection methods. This unit will focus on how to select an appropriate technology input methods given different technology uses, user populations and contexts.
This material (Comp 15 Unit 11) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC This material was updated by The University of Texas Health Science Center at Houston under Award Number 90WT0006.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit
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2. Input and Selection Methods Lecture – Learning Objectives
Provide a rationale as to why input methods are an important consideration in the design process for health technology
Compare and contrast technology input methods
Select appropriate technology input methods given different technology uses, user populations and contexts
By the end of this unit learners will be able to:
1. Provide a rationale as to why input methods are an important consideration in the design process for health technology
2. Compare and contrast technology input methods
3. Select appropriate technology input methods given different technology uses, user populations and contexts

3. Significance
All CIS depend on accuracy and dependability of data entered into them
Input methods vary in speed, accuracy, suitability to different users and conditions
Technology selection and assessment before deployment is important for success
All clinical information systems are only as good as the data entered into them. Input methods are therefore of great importance in assuring accuracy, safety, sufficient speed and efficiency to be useful, and fit of the technology to the work environment. Careful assessment of input methods and matching them to the task, user, and environment are important before deployment.
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4. Different input methods
Light pen
Pen & touchscreen
Mouse
Trackball
Voice recognition
Bar codes,
Special-purpose keyboards
Device touch pads with LCD screens
Gesture-recognition systems
Haptic control
Usually in conjunction with keyboard
Input selection must be done with:
a view to context (physical, cognitive)
Task
User population
Other variables
Some methods are light pen, pen and touch screen (as we see with palmtop devices), mouse, trackball, voice recognition, and bar codes (which can be used in situations where transactions related to physical objects must be tracked, such as use in medication administration systems). There are special-purpose keyboards and device touch pads. Gestural interfaces are becoming increasing common in gaming and in certain very specific environments such as public restrooms. Haptic (touch sense) controls are controls in which the user may wear a device that provides tactile feedback or approximated tactile feedback, such as making a click sound on key press. Most of these interfaces still involve a microprocessor in some way and often are still used in conjunction with a keyboard.
Context is important in selecting input methods. The physical and cognitive attributes of the task and user should be considered. For example, some hospital environments are noisy, must be disinfected frequently, may have illiterate users, and so forth. Other tasks may require fine motor control. Examples are training simulations or games for surgeons, or precise device manipulation controls.
(Sittig, 2010)

5. Keyboard/Mouse
Experienced users up to 15 keystrokes/second (150 words/min)
Beginners <1 keystroke/second (12 words/min)
Most common method of input, but requires training, differences in skill level
Poor method for healthcare, such as hands-on bedside nursing
Excessive use or improper ergonomic conditions can result in to repetitive strain injuries:
Severe injury/permanent loss of hand/arm function
Risk increases above 300 minutes/day
Proper deployment required
Paper and pen still used for clinical recording
Transfer to other systems --> potential errors, duplication of effort
The most common input device is the keyboard and mouse. Experienced users can achieve very high speeds, up to 150 words per minute. On the other hand, beginners may type at 12 words per minute. The differences in skill level and need for training and practice mean it can be an obstacle to adoption of clinical information systems, or a cause of suboptimal use. In addition, some clinicians may dislike a perceived association with clerical work. Some institutions find that younger clinicians are skilled and are used to using keyboarding, so that dictation and similar input methods are declining.
Keyboards are unsuitable for many healthcare contexts that may not have horizontal platforms on which the keyboard could be put, or requires both hands free (such as hands-on bedside nursing). Thus paper and pen are still used for much clinical recording, particularly of patient data such as vital signs and nursing records. These are later transferred to other systems, giving a potential for error introduction and duplication of effort.
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6. Voice Input/Speech Recognition
Requires adequate hardware and software, including headset microphones or handheld voice recorders
Software improves as it is used more and acquires more data about the individual user’s voice
Initial use requires a training exercise consisting of reading passages aloud
Specialized vocabularies for medicine, specific specialties
Voice recognition requires specific approved hardware, such as desktop PCs or laptops with sufficient RAM and chip speed; most current models have this. Systems also require microphones that are certified as conforming to the specifications of the software vendor, incorporated into headsets so that the microphone can be precisely positioned near the mouth, or in handheld voice recorders.
Voice recognition software makes use of machine learning algorithms that store user speech data every time the software is used, and detects patterns specific to that user’s voice. Thus the software becomes more accurate with use. Caution must be used in initial evaluation of the accuracy of software packages for this reason; since initial statistics may not reflect later accuracy and speed when trained.
Initial use requires training by the user, which usually involves reading a passage aloud, until the software has a large enough speech sample that it is able to recognize most of the user’s speech accurately. This may take from a few to 30 minutes. There are specialized packages designed for medicine (and other fields, such as law) and specific modules for specialties.
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7. Speech Recognition: Advantages
Natural
Requires little training except software-specific training
Rapid input
Handheld recorders; upload for interpretation and transcription
Turnaround in hours; user can correct transcript immediately
Hands-free
Speaker-independent applications good where commands are limited
Easy to convert from sending dictation recordings to outside transcription house
In-house speech recognition stations controlled by medical transcriptionists
But: interruptions make it less efficient than expected in practice
Advantages of speech recognition include the fact that it is natural, requires little training aside from training the software and perhaps specific commands for manipulating the computer interface. It can achieve very rapid input for ordinary users, around 150 words/minute.
Workflow can involve handheld recorders with a system of upload to an interpretation and transcription service. Turnaround can be in hours or minutes instead of days, and the user can correct the transcript immediately. Operation can be hands-free (as with desktop directional microphone). Conversion from external dictation services to in-house speech recognition is generally smooth.
Some studies show that while speech recognition is faster than other methods, interruptions in the work environment can lead to decreased overall efficiency.
Voice recognition can be speaker-independent, that is, it will recognize almost any voice. These applications generally can only recognize a limited set of commands; an example is the voice recognition used in automated telephone systems where the user is instructed to say ‘reservations’ to reach the reservations department, ‘billing’ for billing, and so on. These may be good for specific situations where commands are limited but hands-free operation is an advantage.
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8. Speech Recognition: Disadvantages
Requires microphones within certain configuration of face (newer distance desktop microphones are being developed)
Misinterpretations by software can lead to uncaught errors
Difficult to use in noisy environments; confidentiality may be compromised
Software may not fit highly structured forms; compatibility with existing medical records may be a problem
Accents or individual speech patterns may require extra training
Disadvantages of speech recognition include requiring microphones / headsets close to the face. Misinterpretations by software could lead to uncaught errors, and it is difficult to use in noisy environments, such as hospital wards. Confidentiality may be compromised. Dictation into highly structured forms is available but may not suit all situations or clinical information systems. Recognition of accents and unique individual speech patterns may require extra training (though accent-specific regional software has been developed).
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9. Research Zick & Olsen, 2001 McGurk et al., 2014
Voice recognition faster (avg 3.65min turnaround) v. transcription (39.6min)
Transcription more accurate (99.7% v 98.5% for voice)
McGurk et al., 2014
More errors in noisy environments
More errors when users did not speak English as their first language
Zick and Olsen compared voice recognition and traditional transcription services for Emergency Department (ED) charts, and found voice recognition to be much faster (a 3.65 minutes turnaround time versus 39.6 minutes for transcription. However, transcription was more accurate (99.6% versus 98.5%).
McGurk and colleagues studied radiologist reports and also found that traditional transcription was more accurate than voice recognition. Their research showed that more errors occurred in noisy areas and when the radiologists did not speak English as their first language.
Technology in this area continues to improve so testing for decision-making should be done on the basis of the most current versions.

10. Tablets Examples: Apple iPad, Microsoft Surface
Form factor and light weight; suitable for some applications
Many medical applications already developed
Meets many requirements for healthcare tablet:
WiFi,
Dust/liquid resistant
Fingerprint authentication
Barcode scanning
Integrated camera
Scoble, R. (2010).
Tablets, including very thin lightweight tablets with limited ports and restricted functionality, are common. While not designed for healthcare, the small form factor and light- weight can be appealing in a healthcare context, and are reminiscent of the clipboards people are used to carrying. Depending on the particular configuration, tablets may meet many of the requirements of a healthcare environment, including connection to wireless Internet, (Wi-Fi) barcode scanning, biometric authentication, integrated cameras, robust construction, tolerance to dust and cleaning. However, some models may be fragile, easily dropped or misplaced, and specialized tablets for particular institutions have been developed to meet healthcare needs.

11. Ideal Features for Tablets
Ruggedization:
Liquid & crash resistance
Cleanable & disinfectable
Gloves should work on it
Long battery life
Swappable battery
Multitasking
Barcode scanning
Camera (telemedicine, photography of conditions and transmission to consultants)
Ability to accommodate various websites and video
Tablets used in healthcare environments must have some degree of resistance to dirt, rugged construction, ability to be disinfected, as well as technical capabilities (high enough speed), long battery life, and perhaps specialized additions such as barcode scanners.
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12. Touchscreen Input as Part of a Pharmacy Dispensing Unit
This is a photo of a touch screen incorporated as part of a pharmacy-dispensing unit.
Lester, K. (2009).

13. Pen Input
Handwriting recognition: conversion of text in user-drawn image into digital form
Difficult in practice
Gestural alphabets (palmtops, cell phones) differ by brand
Digitizer tablets: learn user’s handwriting; uses samples to train for accuracy
Digital pen and special paper capture and recognize motion sequence
Slower than keyboard input, virtual keyboards replacing it
Pen input is increasingly common, particularly with small tablets and handheld devices. Gestural alphabets turn users’ writing into digitized form. This form of input is slower than keyboard input, and so is being replaced in handhelds by virtual pop-up keyboards.

14. Tablets/Pen Input Advantages Disadvantages
Can be efficient in structured form formats, lightweight devices, tablets have adequate screen space, easy to learn
Disadvantages
Screen reading may be difficult in certain lighting conditions, populations (e.g. elderly)
Fragility, weight difficult in bedside practice
Newer, lighter tablets may overcome this
Small PDAs, cell phones have limited screen space, virtual keyboard input methods which may be slow, inaccurate
Advantages and disadvantages of tablets with pen input include the fact that tablets can be very efficient in structured forms, and easy to learn. Screen reading may be difficult in certain lighting conditions, or by certain populations (e.g. the elderly, if resolution or screen sizes are inadequate). Tablets may be fragile, excessively weighty for bedside care in which clinicians walk around a lot. Small devices can overcome this, but may have slow input methods such as virtual keyboard input.
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15. Pie Menus Faster than linear menus
Depend on direction rather than distance
Circular menu slices large in size, near pointer for fast interaction (Fitt’s law: ease of target acquisition is proportional to size and inversely proportional to distance)
Ideally 3-12 items; 8 or fewer is best
Muscle memory: experienced users need not look
Can be nested for many options & pop-up linear menus
Shows available options, unlike mouse gestures
Pie menus are commonly found in video games; they are faster and more reliable for selection than linear menus, since they depend on direction rather than distance. Human ability to detect differences in degrees of angle is very acute. When the circular menu slices are large in size, and because the pointer is near them, selection is fast. Fitt’s law states that the ease of target acquisition is directly proportional to the size of the target and inversely proportional to the distance from the cursor.
The most effective pie menus have 3-12 items, and are easiest to use with 8 or fewer.
One reason pie menus can be fast is because with practice the user can retain the direction of menu items in muscle memory, so that they need not even look at the menu, and the menu need not even have popped up on the screen. Multiple nested items can be selected in rapid sequence.
Microsoft clipart

16. Pie Menus (Cont’d – 1)
Useful for actions with logical grouping choices
Linear menus useful for dynamic large menus without logical groups
Self-revealing gestural interface
Easy to ‘mark ahead’ because of memory without menu even showing
Eases transition from novice to expert since every use rehearses actions which go into muscle memory & item location unconsciously memorized
Disadvantage: not often available as standard interface widgets (except in games)
Pie menus are most useful for actions with logical grouping choices, with limited numbers of items. They constitute a self-revealing gestural interface, and because of memory it can become easy to ‘mark ahead’, increasing speed of interaction. The menus can increase the transition from novice to expert since every use rehearses the action and forms muscle memory in which the item locations are unconsciously memorized. One disadvantage is that outside of games this type of menu is not often available in software.

17. Marking Menus
Similar to pie menus but menu need not appear, multiple actions in chain can select desired item very fast, without need for menu to pop up visibly
Combine pie menus with gestures
Marking menus combine the advantages of pie menus and gestures.

18. Contextual Menus (Popup Menus)
Appears on user interaction, in specific context
Limited choices pertaining to current state
Solution to need for rapid selection; also requires little memorization of location
Problems:
Options available only in the context may be confusing & not let user know of availability
Screen edge interactions may be different
Contextual menus are very common, particularly in the Windows operating system. They are launched by a specific user interaction, such as a right-click of the mouse. Contextual menus offer a set of limited choices pertaining to the current state of the system; usually these pertain to an object selected by the mouse action. It is fairly rapid and also requires little memorization of item locations. Some applications may only make options available in some contexts; this can cause problems in letting users know that the options are available, or cause confusion. Screen edge interactions may be different than those when the object is located in the center of the screen.
Screenshot from dropdown menu in Microsoft Office Word, 2012

19. Yen (2005) Digital Pen/Paper
Pen contains camera; records writing pattern on digital paper with 0.3mm dots
Camera uses dots to track pen location, creating digital representation in memory
Information transferred to computer; creates digital & paper copies
Study: initial excitement gave way to use interchangeable with regular pens; preference for conventional pens due to bulk, distraction, not fitting in pockets
Nurses saw potential, but physical execution needed improvement
Yen studied the use of digital pen and paper by nurses. The digital pen and paper consisted of a pen with a camera, which uses the pattern of 0.3mm dots on special paper to track the pen location and create a digital representation in memory. This information is later transferred to a computer, and dual digital and paper copies are created simultaneously. In Yen’s study, initial excitement gave way to nurses’ using them interchangeably with regular pens (often they would just choose whatever was most handy). The digital pens were bulkier than regular pens and could not fit in pockets. Nurses saw the potential of these but in execution the system required more development.
Image from Sony:
Image: Sony

20. Gestural Interfaces Examples:
‘Magic Wall’ election night interface
Wii
iPhone
no physical contact required; body only input device
Need to create discoverable vocabulary, metaphors
Physically-oriented applications easy
e.g. Wii for tennis - mapping is directly spatial
Fuller use of human body; not just eyes/fingers
Pinch to zoom on iPhone
Direct spatial relationship
Immediate feedback
Gestural interfaces are a new development that can be seen in everyday life, such as the ‘Magic Wall’ used in the news in recent elections. Other examples are the Wii or iPhone. In these interfaces the body may be the only input device. There is a need to discover vocabulary and metaphors for these types of interfaces. Physically-oriented actions are easier to coordinate since the mapping is directly spatial, as with Wii sports applications or ‘pinch to zoom’ on the iPhone, which involve direct spatial relationships between the user’s action and the output response. These interfaces make fuller use of the human body than just the eyes and fingers used in usual keyboard and mouse interactions, and could provide a far greater range of possible types of input.
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21. Gestural Interfaces (Cont’d – 1)
Multitouch -> 1 point of contact
Gestural commands less obvious, and less obvious than current GUIs
May involve gloves, sensors, multiple cameras, LCD arrays used as pinhole cameras
Output can be of multiple forms: music, video, device control
Examples:
Interfaces can be almost invisible
Gestural components for other applications may be less than obvious, and more indirect. An example is the clapper interface for turning off lights – the user must somehow be notified that this capability exists. Multitouch likewise has more than one point of contact between the user’s body and the screen, and this must be told to the user.
Some gestural interfaces may involve other devices such as gloves, sensors, multiple cameras, LCD arrays used as pinhole cameras, and so on. Output can be of many different forms, such as music, video, device movement or other types of control, or digital manipulation. Examples can be seen by visiting the URL,
Some gestural interfaces can be almost invisible, such as the sensors, which detect movement near a sink and turn on the water, commonly found in public restrooms. This context has become a site for use of gestural interfaces because of people’s desire not to touch anything and the need for infection control and decreasing waste of water and paper.

22. Mechanics: Touch Screens, Gestural Controllers (Saffer, 2009)
Sensor
Detects environmental changes
Size, sensitivity, must be suitable for the purpose, gestures
Comparator
Usually a microprocessor
Compares current to previous state or goal
Makes decisions
Actuator
Receives decisions from comparator as a command
Implements action
Physical, e.g, flushing, or
Digital, e.g. changing iPhone display orientation when tilted
All gestural interfaces have 3 parts: a sensor, a comparator, and an actuator (which can consist of a single physical component or multiple components). A sensor detects environmental changes and/or user actions (such as a change in pressure, proximity, light, sound, tilt, motion, orientation of the device, or acceleration). The size and sensitivity of the sensor must be suitable for the purpose and context, or it may be irritating or disruptive to users, (for example, devices that use fingers to key in data must present buttons suitable to a range of finger sizes, and allow smooth operation). Devices that use a clapping sound to turn lights on or off must accommodate a range of sound that is not so sensitive that it picks up noises of daily living.
After the sensor detects a stimulus, it passes information about it to the comparator, which is usually a microprocessor. This compares the new information to the previous state or goal, and makes decisions about what is to be done. These decisions are passed to the actuator, which receives the decisions from the comparator as a command, and implements an action (which may be physical, such as flushing a toilet), or digital, such as changing an iPhone display orientation when the device is tilted.
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23. Gestural Interfaces: Use and Appraisal
Consider reason for use?
e.g. public restrooms; people don’t want to touch things, infection control
Bad for:
Heavy/rapid data input (touchscreen keyboards)
Visual-only feedback (e.g. for visually impaired users)
Reliance on physical (for those with physical limitations
Environment (e.g. wearing gloves), subtle movements for those with large hands
Contexts where privacy, embarrassment may be issues
In designing gestural interfaces it is important to consider the reason for their use, and how they would fit the context. We have already given the example of this type of interface being used in public restrooms for infection control.
These types of interfaces may be bad for circumstances where rapid or heavy data entry is required (touch screen keyboards are not as efficient as physical keyboards), or where there is visual-only feedback unsuitable when users are visually impaired. Reliance on physical motions may be unsuitable for situations in which the users may have physical limitations, as may be common among patients. The environment may mandate actions such as wearing gloves, which may also make a gestural interface unsuitable. Subtle movements for those with large hands or lack of coordination could also be a problem.
It is also important to consider the social context and avoid gestural interfaces in situations where privacy and embarrassment may be issues.
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24. Gestural Interfaces: Advantages
Good for:
Natural interactions
Less cumbersome/visible hardware
Flexibility
Non-touchscreen gestures: huge number of possible gestures
Subtlety, nuance (as with common communication hand and facial gestures)
Fun, games, play, exploration, teaching
Advantages of gestural interfaces include that they involve natural actions, often less cumbersome or visible hardware, have great flexibility in the types of interfaces and gestures that can be used. For example, since touch screens do not involve physical buttons there is great design flexibility in how many buttons can be used, their design, position, colors, and so on. This means more controls can be accommodated in a small space. There are a huge number of possible non-touch screen gestures, increasing flexibility. Subtlety and nuances can be incorporated, as with common hand and facial gestures involved in daily communication. Finally, gestures can be used to incorporate fun, games, play, exploration and teaching into the interface.
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25. Gestural Interfaces: Characteristics of Good Design
Discoverability
How does one find out the screen is touchable?
How does one discover an environment or device is interactive?
e.g. New York subway has large hand + “Touch, start” on ticket vending machines (attraction affordance)
Trustworthiness
Must convey lack of danger, privacy
Responsiveness
Feedback
System state,
Correct level of sensitivity
Aesthetically pleasing
Respect for dignity (don’t make users appear foolish in public)
Some of the characteristics of good design for gestural interfaces are discoverability, trustworthiness, and responsiveness. Discoverability means whether or not a new user can discover the capabilities of the interface, including the fact that it is an interface responsive to gestures. Sometimes this may have to be conveyed explicitly via and attraction affordance’, that is, a sign, diagram, or other means of telling people unfamiliar with it that this is an interface. An example is the New York subway ticket vending machines, which are touch screens. A large hand and the word ‘Touch’ and ‘Start’ show inexperienced users that this is a touch screen and how to start interacting. Airline self-ticketing kiosks have similar affordances.
Trustworthiness and privacy are other issues; the system must appear legitimate, and that it will not cause injury (physical or financial, for example).
Responsiveness is another consideration; feedback to the user (who may be using the system for the first or only time), clear indication of the system state (e.g. notifying the user that a transaction has gone through), the correct level of sensitivity, aesthetically pleasing and clear design, are all important in interfaces which address the general public and users who may have to operate the device without any prior training. In addition, it is important to design gestural interfaces that do not make users appear foolish in public, or compromise their dignity.
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26. Technology/Input Method Selection
Should be based on consideration of the task, user, and environment
Current technologies (such as voice input) may progress rapidly, so outdated studies and statistics should not be used
Users may have a learning curve; comparison of two different methods should allow for training time (e.g. Kotani: study of pen-tablet v. mouse showed initial mouse superiority; then users became more efficient with pen-tablet
See Mobile Devices for Nursing: a Human Factors Evaluation (McCurdie, T., Chagpar, A., Cafazzo, J.A., 2009)
Input method selection should be based on consideration of the task, user and environment, keeping in mind that current technologies can progress rapidly, so that outdated studies and statistics should not be used. Users may have a learning curve, which can affect initial comparisons of two different methods, so allowance should be made for training time. In some cases study of two different methods showed one to be faster than the other initially, then with training or experience the situation was reversed. Speed and accuracy of voice recognition increases with the use of the software, so initial measurements can be misleading.

27. Appraisal of Input Methods
Some research on these comes from the field of experimental psychology
Variables measured may include speed of interaction, speed of data entry, accuracy, muscular and cognitive involvement, long-term, short-term and muscle memory, hand-eye coordination
Results can vary from experimental laboratory to in-situ; try to test in the setting in which it will be used, with typical users
Considerations such as size and weight can have significant consequences for whether item will be used, despite sophisticated software or other features
Selection of input methods must depend on knowledge about their efficiency; some of the research on this comes from the field of experimental psychology. Variables measured may include the speed of interaction (taking into account different types of users and their experience and training), the potential and actual common speeds of data entry, accuracy, muscular and cognitive involvement and limitations, long-term, short-term and muscle memory, and hand-eye coordination.
Results can vary from the experimental laboratory to field conditions, so it is also important to test methods in the setting in which they may be used, with typical users. The presence of noise, for example, can affect accuracy and risk of injury.
Size, weight and similar considerations can have consequences for whether an item will be used in practice, despite the presence of sophisticated software or other desirable features. This may be especially true for such clinical roles as bedside nursing in which carrying large devices is incompatible with other duties.

28. Questions to Ask in Input Method Selection
Does the method require a device?
Is fine motor control required?
How much training is required?
How much practice is required?
How much motor intelligence is required? (e.g. typing requires at least weeks of skilled training)
Does the user require both hands to operate it?
Is furniture/surface required (e.g. table for keyboard)
What speed of data entry is required?
Is speed an important consideration?
How critical would an inaccuracy be?
How easily correctable are mistakes?
How easily detectable are mistakes?
How many others see the product? (error detection)
Design of systems requires consideration of many factors; the following are some questions to ask in selecting input methods:
Does the method require a device?
Is fine motor control required?
How much training is required?
How much practice is required?
How much motor intelligence is required? (e.g. typing requires at least weeks of skilled training)
Does the user require both hands to operate it?
Is furniture/surface required (e.g. table for keyboard)?
What speed of data entry is required?
Is speed an important consideration?
How critical would an inaccuracy be?
How easily correctable are mistakes?
How easily detectable are mistakes?
How many others see the product? (This can affect error detection)
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29. More Questions
Does the method have characteristics that make it unacceptable to potential users (e.g. perceptions of rudeness, clerical work… )?
Does the input feed into other complex systems (such as a clinical information system, pharmacy order) ?
Is structured data required?
Is the method going to be used in an ambulatory manner (e.g. by a clinician walking around)?
Is disinfection required? To what degree? (e.g. ordinary hospital or clinic v. operating room)
Will frequent cleaning/solvents be required?
Does the environment require special provisions in setup (e.g. wall or partition separating equipment to protect it from dirt, noise?)
Does the required setup create distance from other clinicians, affecting communication patterns?
Some more questions:
Does the method have characteristics that make it unacceptable to potential users (e.g. perceptions of rudeness, clerical work…)?
Does the input feed into other complex systems (such as a clinical information system, pharmacy order)?
Is structured data required?
Is the method going to be used in an ambulatory manner (e.g. by a clinician walking around)?
Is disinfection required? To what degree? (e.g. ordinary hospital or clinic v. operating room)
Will frequent cleaning/solvents be required?
Does the environment require special provisions in setup (e.g. wall or partition separating equipment to protect it from dirt, noise?)
Does the required setup create distance from other clinicians, affecting communication patterns?
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30. Input and Selection Methods Summary
Input methods are an evolving field; standard methods (such as keyboard) will likely persist, but become device-independent
New methods require research, but open up avenues of control useful in medicine.
Gestural non-touch methods may be useful in situations where infection control, freedom of movement, lack of physical devices are key (e.g. ED, OR, pediatrics…)
Matching the input method with senses and modalities involved in other parts of the task is more successful
This concludes Usability and Human Factors, Input and Selection Methods.
In conclusion, input methods are constantly evolving and improving. Standard methods such as the keyboard and mouse will likely persist, but become device-independent (so that they are used on many mobile and other devices). New input methods require research, but can open up avenues of control useful in medicine where requirements such as hands-free or non-touch use can be particularly important for user satisfaction, safety, infection control, and so on. Matching the input method to the senses and modalities involved in other parts of the task is most likely to be successful in the long run.

31. Input and Selection Methods References
Sittig, D, Ash J. Clinical Information Systems: Overcoming Adverse Consequences. Jones and Bartlett, Sudbury MA, 2010.
Zick.R.G., Olsen, J. (2001). Voice recognition software versus a traditional transcription service for physician charting in the ED. American Journal of Emergency Medicine, vol.19 (4). P
Yen, Po-Yin, Gorman PN. (2005). Usability Testing of a Digital Pen and Paper system in Nursing Documentation. AMIA Proceedings 2005, p
Saffer, D. (2009). Designing Gestural Interfaces Touchscreens and Interactive Devices. O;Reilly Media. Canada. Retrieved on October 4th, 2010 from .
Gestural Interfaces. - A collection of gestural interfaces shown on video Retrieved on October 5th, 2010 from
McCurdie, T., Chagpar, A., Cafazzo, J.A. (2009). Mobile devices for nursing: a comparative factors evaluation. Retrieved on October 5th, 2010 from .
McGurk 2014: McGurk, S., Brauer, K., Macfarlane, T. V., & Duncan, K. A. (2014). The effect of voice recognition software on comparative error rates in radiology reports. The British Journal of Radiology.
Buxton, W. Issues in Manual Input. User Centered System Design: New Perspective. (Paperback). by Donald A. Norman, Stephen W. Draper Chapter 15, p
Betriebsraum, B. 2009). Extremely Efficient Menu Selection: Marking Menus for the Flash Platform.Retrieved on September 3rd, 2010 from
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32. Input and Selection Methods References (Cont’d – 1)
Image:
Slide 11: Scoble, R. (2010). Retrieved on November 10th, 2010 from
Slide 11: Retreived June 28th, 2016 from
Slide 12: Lester, K. (2009). Retrieved on November 10th, 2010 from
Slide 16: Microsoft- Clipart image, public domain.
Slide 17: Senathirajah, Y. (2010). Screen-shot of Microsoft word personal computer. Department of Biomedical Informatics, Columbia University Medical Center, New York, NY.
Slide 19: Screenshot from dropdown menu in Microsoft Office Word, 2012.
Slide 20: Retreived June 28th, 2016 from
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33. Usability and Human Factors Input and Selection Methods
This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC This material was updated by The University of Texas Health Science Center at Houston under Award Number 90WT0006.
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