Publications by authors named "Harold Thimbleby"

16 Publications

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The problem isn't Excel, it's unprofessional software engineering.

Authors:
Harold Thimbleby

BMJ 2020 11 2;371:m4181. Epub 2020 Nov 2.

Swansea University, Swansea SA2 8PP, UK.

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http://dx.doi.org/10.1136/bmj.m4181DOI Listing
November 2020

Why is it so difficult to govern mobile apps in healthcare?

BMJ Health Care Inform 2019 Nov;26(1)

Australian Institute of Health Innovation, Centre for Health Informatics, Macquarie University, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1136/bmjhci-2019-100006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252987PMC
November 2019

: User Interface Software Errors in Medical Devices: Study of U.S. Recall Data.

Biomed Instrum Technol 2019 May/Jun;53(3):182-194

The current work assessed U.S. medical device recalls during 2012-15, with the goal of under-standing the impact and nature of user interface (UI) software errors in medical devices. Based on information from the Food and Drug Administration's public and internal recall databases, 423 (~140/year) medical device recalls were identified as resulting from UI software errors, which accounted for nearly one-half of recalls caused by software errors during the same period. A total of 499 UI software errors were identified as the root causes of medical device recalls, and a detailed classification of those errors (into 20 categories) was established. This error classification can be used by device manufacturers, end users (e.g., healthcare providers), and regulatory authorities to raise awareness of the type and impact of UI software errors. The classification also provides stakeholders with an evidence-based challenge to assess and improve the quality of UI software in medical devices.
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http://dx.doi.org/10.2345/0899-8205-53.3.182DOI Listing
June 2019

Three laws for paperlessness.

Authors:
Harold Thimbleby

Digit Health 2019 Jan-Dec;5:2055207619827722. Epub 2019 Jan 22.

University of Swansea, UK.

We are familiar with paper and rarely think much about it, except that in healthcare there seems to be too much of it, and it is slow, inefficient, and old. In contrast, paperlessness promises the future and freedom from paper's obvious limitations. We need to think clearly how to ensure paperlessness really improves healthcare, hence three simple laws: 1.  Paperlessness must be first about improving clinical processes, supporting staff and patients, not about replacing paper with new 'solutions'. 2.  Pursue paperlessness only where there is scientific evidence it is better for the real task. Successful paperlessness depends on user centred design and on quality implementation. 3.  Culture has to change to take advantage of technology, and technology is changing at pace regardless. Paperless requires planning for monitoring, improvement, revision and, eventually, obsolescence and further innovation. Pay attention to culture, including regulation, and to developing human skills to exploit new technologies.
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http://dx.doi.org/10.1177/2055207619827722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348492PMC
January 2019

Trust me, I'm a computer?

Authors:
Harold Thimbleby

Future Healthc J 2017 Jun;4(2):105-108

Swansea University, Swansea, UK.

Computers, IT, digitisation, apps - whatever we call it - is everywhere in healthcare, and it is also racing ahead of healthcare and creating dreams and exciting opportunities for quality improvement and transformation. We want a paperless NHS. Yet we have to be careful what we wish for. We are most familiar with consumer IT, our own personal phones and tablets, but our enthusiasm for this must not be confused with what might be best for healthcare.
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http://dx.doi.org/10.7861/futurehosp.4-2-105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502629PMC
June 2017

Interactive numerals.

R Soc Open Sci 2017 Apr 26;4(4):160903. Epub 2017 Apr 26.

Department of Computer Science, University of York, York YO1 5DD, UK.

Although Arabic numerals (like '2016' and '3.14') are ubiquitous, we show that in interactive computer applications they are often misleading and surprisingly unreliable. We introduce as a new concept and show, like Roman numerals and Arabic numerals, interactive numerals introduce another way of using and thinking about numbers. Properly understanding interactive numerals is essential for all computer applications that involve numerical data entered by users, including finance, medicine, aviation and science.
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http://dx.doi.org/10.1098/rsos.160903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414246PMC
April 2017

Using and choosing digital health technologies: a communications science perspective.

J Health Organ Manag 2017 Mar;31(1):28-37

Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera italiana (USI) , Lugano, Switzerland.

Purpose The purpose of this paper is to explore a non-technical overview for leaders and researchers about how to use a communications perspective to better assess, design and use digital health technologies (DHTs) to improve healthcare performance and to encourage more research into implementation and use of these technologies. Design/methodology/approach Narrative overview, showing through examples the issues and benefits of introducing DHTs for healthcare performance and the insights that communications science brings to their design and use. Findings Communications research has revealed the many ways in which people communicate in non-verbal ways, and how this can be lost or degraded in digitally mediated forms. These losses are often not recognized, can increase risks to patients and reduce staff satisfaction. Yet digital technologies also contribute to improving healthcare performance and staff morale if skillfully designed and implemented. Research limitations/implications Researchers are provided with an introduction to the limitations of the research and to how communications science can contribute to a multidisciplinary research approach to evaluating and assisting the implementation of these technologies to improve healthcare performance. Practical implications Using this overview, managers are more able to ask questions about how the new DHTs will affect healthcare and take a stronger role in implementing these technologies to improve performance. Originality/value New insights into the use and understanding of DHTs from applying the new multidiscipline of communications science. A situated communications perspective helps to assess how a new technology can complement rather than degrade professional relationships and how safer implementation and use of these technologies can be devised.
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http://dx.doi.org/10.1108/JHOM-07-2016-0128DOI Listing
March 2017

Open-source hardware for medical devices.

BMJ Innov 2016 Apr 14;2(2):78-83. Epub 2016 Mar 14.

Department of Computer Science , Swansea University , Swansea , UK.

Open-source hardware is hardware whose design is made publicly available so anyone can study, modify, distribute, make and sell the design or the hardware based on that design. Some open-source hardware projects can potentially be used as active medical devices. The open-source approach offers a unique combination of advantages, including reducing costs and faster innovation. This article compares 10 of open-source healthcare projects in terms of how easy it is to obtain the required components and build the device.
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http://dx.doi.org/10.1136/bmjinnov-2015-000080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853539PMC
April 2016

What makes a good clinical app? Introducing the RCP Health Informatics Unit checklist.

Clin Med (Lond) 2015 Dec;15(6):519-21

Swansea University, Swansea, UK, and director, HIU, RCP, London, UK.

Doctors increasingly rely on medical apps running on smart phones or tablet computers to support their work. However, these apps vary hugely in the quality of their data input screens, internal data processing, the methods used to handle sensitive patient data and how they communicate their output to the user. Inspired by Donabedian's approach to assessing quality and the principles of good user interface design, the Royal College of Physicians' Health Informatics Unit has developed and piloted an 18-item checklist to help clinicians assess the structure, functions and impact of medical apps. Use of this checklist should help clinicians to feel more confident about using medical apps themselves, about recommending them to their staff or prescribing them for patients.
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http://dx.doi.org/10.7861/clinmedicine.15-6-519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953250PMC
December 2015

Unreliable numbers: error and harm induced by bad design can be reduced by better design.

J R Soc Interface 2015 Sep;12(110):0685

Department of Computer Science, University of York, York YO10 5DD, UK.

Number entry is a ubiquitous activity and is often performed in safety- and mission-critical procedures, such as healthcare, science, finance, aviation and in many other areas. We show that Monte Carlo methods can quickly and easily compare the reliability of different number entry systems. A surprising finding is that many common, widely used systems are defective, and induce unnecessary human error. We show that Monte Carlo methods enable designers to explore the implications of normal and unexpected operator behaviour, and to design systems to be more resilient to use error. We demonstrate novel designs with improved resilience, implying that the common problems identified and the errors they induce are avoidable.
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http://dx.doi.org/10.1098/rsif.2015.0685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614478PMC
September 2015

Making healthcare safer by understanding, designing and buying better IT.

Clin Med (Lond) 2015 Jun;15(3):258-62

College of Medicine, Swansea University, Swansea, UK.

When nobody or nothing notices an error, it may turn into patient harm. We show that medical devices ignore many errors, and therefore do not adequately support patient safety. In addition to causing preventable patient harm, errors are often reported ignoring potential flaws in medical device design, and front line staff may therefore be inappropriately blamed. We present some suggestions to improve reporting and the procurement of hospital equipment.
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http://dx.doi.org/10.7861/clinmedicine.15-3-258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953110PMC
June 2015

Technology and the future of healthcare.

Authors:
Harold Thimbleby

J Public Health Res 2013 Dec 1;2(3):e28. Epub 2013 Dec 1.

College of Science, Swansea University , UK.

Healthcare changes dramatically because of technological developments, from anesthetics and antibiotics to magnetic resonance imaging scanners and radiotherapy. Future technological innovation is going to keep transforming healthcare, yet while technologies (new drugs and treatments, new devices, new social media support for healthcare, etc) will drive innovation, human factors will remain one of the stable limitations of breakthroughs. No predictions can satisfy everybody; instead, this article explores fragments of the future to see how to think more clearly about how to get where we want to go. Significance for public healthTechnology drives healthcare more than any other force, and in the future it will continue to develop in dramatic ways. While we can glimpse and debate the details of future trends in healthcare, we need to be clear about the drivers so we can align with them and actively work to ensure the best outcomes for society as a whole.
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http://dx.doi.org/10.4081/jphr.2013.e28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147743PMC
December 2013

A design to empower patients in long term wellbeing monitoring and chronic disease management in mHealth.

Stud Health Technol Inform 2013 ;194:82-7

Future Interaction Technology Laboratory, Computer Science, Swansea University, United Kingdom.

With the growing population with chronic disease in most developed countries, the amount and variety of interactive medical devices adopted in healthcare and wellbeing management is on the rise. Studies show that people with chronic conditions are facing many barriers to effective self-management, which leads to significant economic losses in many countries. The question as to how we can design personal medical devices that are able to facilitate an effective self-management by tackling these barriers presents a challenging research topic. We offer an overview of a controlled-experiment designed to evaluate an innovative tagging feature and a confidence of measurement feature in chronic disease management. This is a work-in-progress, which will finish by the end of June 2013.
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May 2014

SYFSA: a framework for systematic yet flexible systems analysis.

J Biomed Inform 2013 Aug 31;46(4):665-75. Epub 2013 May 31.

The University of Texas School of Biomedical Informatics at Houston, 7000 Fannin Suite 600, Houston, TX 77030, USA.

Although technological or organizational systems that enforce systematic procedures and best practices can lead to improvements in quality, these systems must also be designed to allow users to adapt to the inherent uncertainty, complexity, and variations in healthcare. We present a framework, called Systematic Yet Flexible Systems Analysis (SYFSA) that supports the design and analysis of Systematic Yet Flexible (SYF) systems (whether organizational or technical) by formally considering the tradeoffs between systematicity and flexibility. SYFSA is based on analyzing a task using three related problem spaces: the idealized space, the natural space, and the system space. The idealized space represents the best practice-how the task is to be accomplished under ideal conditions. The natural space captures the task actions and constraints on how the task is currently done. The system space specifies how the task is done in a redesigned system, including how it may deviate from the idealized space, and how the system supports or enforces task constraints. The goal of the framework is to support the design of systems that allow graceful degradation from the idealized space to the natural space. We demonstrate the application of SYFSA for the analysis of a simplified central line insertion task. We also describe several information-theoretic measures of flexibility that can be used to compare alternative designs, and to measure how efficiently a system supports a given task, the relative cognitive workload, and learnability.
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http://dx.doi.org/10.1016/j.jbi.2013.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775005PMC
August 2013

Analysis of infusion pump error logs and their significance for health care.

Br J Nurs 2012 Apr 26-May 9;21(8):S12, S14, S16-20

Medical Devices Training Manager,ABMU Local Heath Board, Medical Physics and Clinical Engineering Department, Singleton Hospital, Swansea,Wales, UK.

Infusion therapy is one of the largest practised therapies in any healthcare organisation, and infusion pumps are used to deliver millions of infusions every year in the NHS. The aircraft industry downloads information from 'black boxes' to help design better systems and reduce risk; however, the same cannot be said about error logs and data logs from infusion pumps. This study downloaded and analysed approximately 360 000 hours of infusion pump error logs from 131 infusion pumps used for up to 2 years in one large acute hospital. Staff had to manage 260 129 alarms; this accounted for approximately 5% of total infusion time, costing about £1000 per pump per year. This paper describes many such insights, including numerous technical errors, propensity for certain alarms in clinical conditions, logistical issues and how infrastructure problems can lead to an increase in alarm conditions. Routine use of error log analysis, combined with appropriate management of pumps to help identify improved device design, use and application is recommended.
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http://dx.doi.org/10.12968/bjon.2012.21.Sup8.S12DOI Listing
June 2012

Reducing number entry errors: solving a widespread, serious problem.

J R Soc Interface 2010 Oct 7;7(51):1429-39. Epub 2010 Apr 7.

Future Interaction Technology Laboratory, Swansea University, Swansea SA2 8PP, UK.

Number entry is ubiquitous: it is required in many fields including science, healthcare, education, government, mathematics and finance. People entering numbers are to be expected to make errors, but shockingly few systems make any effort to detect, block or otherwise manage errors. Worse, errors may be ignored but processed in arbitrary ways, with unintended results. A standard class of error (defined in the paper) is an 'out by 10 error', which is easily made by miskeying a decimal point or a zero. In safety-critical domains, such as drug delivery, out by 10 errors generally have adverse consequences. Here, we expose the extent of the problem of numeric errors in a very wide range of systems. An analysis of better error management is presented: under reasonable assumptions, we show that the probability of out by 10 errors can be halved by better user interface design. We provide a demonstration user interface to show that the approach is practical.To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact. (Charles Darwin 1879 [2008], p. 229).
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http://dx.doi.org/10.1098/rsif.2010.0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935596PMC
October 2010
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