The visible and the invisible: Distributed Cognition for medical devices

Abstract

Many interactive medical devices are less easy to use than
they might be, and do not fit as well as they could in their
contexts of use. Occasionally, the deficiencies lead to
serious incidents; more often, they have a less visible effect
on the resilience and efficiency of healthcare systems.
These issues remain largely invisible as they are not
reported and have rarely been studied. In this paper, we
report on the use of DiCoT as an approach to representing
and reasoning about medical work, and about the role of
device design within that work. We focus in particular on
the design and use of infusion devices. This work highlights
the value of observational studies for engineering
interactive medical devices, and illustrates the value of a
systematic approach to gathering and analyzing qualitative
data.