The think aloud method: a guide to user interface design

OBJECTIVES Clinical use of computer systems has been hampered by their poorly designed user interfaces. The objective of this study was to design a user interface for a pediatric oncologists' computerized patient record with great consideration of their working behavior and of human computer interfacing principles so as to contribute to oncologists' efficiency and satisfaction in interaction with the system. METHODS The think aloud method was used in combination with video recording to get a deep understanding of the way in which four pediatric oncologists searched through the paper-based patient record in preparing a patient visit. Protocol and video analyses was used to develop a cognitive task model reflecting pediatric oncologists' task behavior. This model was input for a prototype user interface, which was subsequently evaluated by eight other pediatric oncologists. RESULTS The resulting computerized medical record system proved to meet pediatric oncologists' information needs and task behavior patterns. The design of the user interface minimized pediatric oncologists' work load and was highly efficient in supporting the pediatric oncologists in preparing their patient visits. The pediatric oncologists were very much satisfied with the computer system. CONCLUSIONS It is argued that early involvement of cognitive engineering methods in the system design process may be of great help in designing systems that fully support health care professionals' work practices. The think aloud method, if applied under prescribed conditions, is a valuable information source of human task-behavior and as such a useful technique for requirements analysis in designing clinical computer systems.

[1]  Susan Wiedenbeck,et al.  The use of icons and labels in an end user application program: An empirical study of learning and retention , 1999, Behav. Inf. Technol..

[2]  Elske Ammenwerth,et al.  Evaluation of health information systems - problems and challenges , 2003, Int. J. Medical Informatics.

[3]  Vimla L. Patel,et al.  'Televaluation' of clinical information systems: an integrative approach to assessing Web-based systems , 2001, Int. J. Medical Informatics.

[4]  Marc Berg,et al.  Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context , 1998, Int. J. Medical Informatics.

[5]  Vimla L. Patel,et al.  Cognitive evaluation of decision making processes and assessment of information technology in medicine , 1998, Int. J. Medical Informatics.

[6]  Markus F. Peschl,et al.  Representation still matters: Cognitive engineering and user interface design , 1998, Behav. Inf. Technol..

[7]  E. Tufte,et al.  Graphical summary of patient status , 1994, The Lancet.

[8]  Lawrence M. Fagan,et al.  Research Paper: The PEN-Ivory Project: Exploring User-interface Design for the Selection of Items from Large Controlled Vocabularies of Medicine , 1996, J. Am. Medical Informatics Assoc..

[9]  Jeremy C Wyatt,et al.  Helping clinicians to find data and avoid delays , 1998, The Lancet.

[10]  Kent L. Norman,et al.  Development of an instrument measuring user satisfaction of the human-computer interface , 1988, CHI '88.

[11]  E Nygren,et al.  Reading the medical record. I. Analysis of physicians' ways of reading the medical record. , 1992, Computer methods and programs in biomedicine.

[12]  Timothy D. Wilson,et al.  Telling more than we can know: Verbal reports on mental processes. , 1977 .

[13]  John M. Carroll,et al.  Human-computer interaction: psychology as a science of design , 1997, Int. J. Hum. Comput. Stud..

[14]  W. Buxton.  Human-Computer Interaction , 1988, Springer Berlin Heidelberg.

[15]  J Brender,et al.  Cognitive evaluation: how to assess the usability of information technology in healthcare. , 1997, Computer methods and programs in biomedicine.

[16]  P C Tang,et al.  Major issues in user interface design for health professional workstations: summary and recommendations. , 1994, International journal of bio-medical computing.

[17]  Jeremy C Wyatt,et al.  Design should help use of patients' data , 1998, The Lancet.

[18]  J. Long,et al.  A conception of the cognitive engineering design problem , 1998 .

[19]  David F. Lobach,et al.  Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care , 1998, AMIA.

[20]  K. A. Ericsson,et al.  Protocol Analysis: Verbal Reports as Data , 1984 .

[21]  C Y Young,et al.  Modelling work practices: input to the design of a physician's workstation. , 1991, Proceedings. Symposium on Computer Applications in Medical Care.

[22]  Keith Duncan,et al.  Cognitive Engineering , 2017, Encyclopedia of GIS.

[23]  J J Cimino,et al.  Cognitive evaluation of the user interface and vocabulary of an outpatient information system. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[24]  Aziz A. Boxwala,et al.  Acceptability and usage patterns of an image analysis workstation , 1997, AMIA.

[25]  C Y Young,et al.  Physicians' workstations: integrated information management for clinicians. , 1991, Proceedings. Symposium on Computer Applications in Medical Care.

[26]  Jc Wyatt,et al.  Clinical data systems, part 2: components and techniques , 1994, The Lancet.

[27]  Bonnie Kaplan,et al.  Evaluating informatics applications - some alternative approaches: theory, social interactionism, and call for methodological pluralism , 2001, Int. J. Medical Informatics.

[28]  Harold W. Thimbleby,et al.  User interface design , 1990, ACM Press Frontier Series.

[29]  V. Patel,et al.  Studying the human-computer-terminology interface. , 2001, Journal of the American Medical Informatics Association : JAMIA.

[30]  Gerhard Deffner,et al.  Verbal Protocols as a Research Tool in Human Factors: Symposium Abstract , 1990 .

[31]  Wilbert O. Galitz,et al.  The Essential Guide to User Interface Design: An Introduction to GUI Design Principles and Techniques , 1996 .

[32]  Julie M. Fiskio,et al.  Evaluating physician satisfaction regarding user interactions with an electronic medical record system , 1999, AMIA.

[33]  Jakob Nielsen,et al.  Usability engineering , 1997, The Computer Science and Engineering Handbook.

[34]  Vimla L. Patel,et al.  The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records , 2002, Int. J. Medical Informatics.

[35]  V L Patel,et al.  Cognitive computer-based video analysis: its application in assessing the usability of medical systems. , 1995, Medinfo. MEDINFO.

[36]  Françoise Anceaux,et al.  Integrating users' activity modeling in the design and assessment of hospital electronic patient records: the example of anesthesia , 2001, Int. J. Medical Informatics.

[37]  James J. Cimino,et al.  Evaluation of a system to identify relevant patient information and its impact on clinical information retrieval , 1999, AMIA.

[38]  Ted Boren,et al.  Thinking aloud: reconciling theory and practice , 2000 .

[39]  E Nygren,et al.  Reading the medical record. II. Design of a human-computer interface for basic reading of computerized medical records. , 1992, Computer methods and programs in biomedicine.

[40]  Vimla L. Patel,et al.  Interface design for health care environments: the role of cognitive science , 1998, AMIA.

[41]  Ted Boren,et al.  Thinking aloud: reconciling theory and practice , 2000 .

[42]  J. Sandberg,et al.  The think aloud method , 1994 .

[43]  Norbert A. Streitz.  Mental models and metaphors: implications for the design of adaptive user-system interfaces , 1988 .

[44]  John Long,et al.  Target Paper Conception of the cognitive engineering design problem , 1998 .

[45]  Vimla L. Patel,et al.  Research Paper: Studying the Human- Computer-Terminology Interface , 2001, J. Am. Medical Informatics Assoc..

[46]  Heinz Mandl,et al.  Learning Issues for Intelligent Tutoring Systems , 1988, Cognitive Science.

[47]  Jill Gerhardt‐Powals,et al.  Cognitive engineering principles for enhancing human-computer performance , 1996, Int. J. Hum. Comput. Interact..

[48]  Joseph A. Goguen,et al.  Techniques for requirements elicitation , 1993, [1993] Proceedings of the IEEE International Symposium on Requirements Engineering.

[49]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[50]  M. Gardiner,et al.  Applying cognitive psychology to user-interface design , 1987 .

[51]  V. Patel,et al.  Assessment of a computerized patient record system: a cognitive approach to evaluating medical technology. , 1996, M.D. computing : computers in medical practice.

[52]  Penelope M. Sanderson,et al.  Verbal Protocols as a Research Tool in Human Factors: Panel Discussion , 1990 .

[53]  Vimla L. Patel,et al.  Cognitive and usability engineering methods for the evaluation of clinical information systems , 2004, J. Biomed. Informatics.