Ergonomic automated anesthesia recordkeeper using a mobile touch screen with voice navigation

Objective. To develop an ergonomically designed computerized recordkeeping tool for anesthesiologists that allows the clinician to maintain visual con tact with the patient while performing recordkeeping. Methods.To simplify t he human interface software, we developed two general use software componen ts. All purpose menu type 1 (APM1) was used for entering events using a tre e structured menu. APM1 was designed to adapt to the limits of human memory , by using Miller's rule of 7 to guide the input process. APM1 can be consi dered to be a three-dimensional table list consisting of 7 vertical and 7 h orizontal choices, which has further 5 tree-structured divergences. APM1 is also completely configurable by the user. All purpose menu 2 (APM2) was us ed to implement the system-initiated human interface where the system will prompt the user by voice for each entry. When users touch a key on APM1 and APM2, the system was designed to respond with a voice prompt. A touch-scre en was also utilized and designed to fit the anesthesia machine. The screen is equipped with a small speaker for voice response and a microphone for v oice recognition. The positions of the screen are adjustable supported by a long flexible limb (85 cm). Results. After improving the design, systems w ere assembled for 10 operating rooms. Of the multiple features of the VOCAA R user interface, the following were well accepted by users and employed da ily: touch-screen input, and voice response. The noncompulsory use rate was 87% during the initial 2 weeks, increased to 94% after 2 weeks and 100% af ter two months. The mean sound emission by voice response (n = 10, mean +/- SD) was 8.2 +/- 2.3 dB at the main anesthetist site (35 cm from the speake r mounted on the touch-screen), 2.2 +/- 1.3 dB at the staff site (1.5 m fro m the touch-screen), which was only audible for anesthesiologist but for su rgeon. Discussion. An EARK system was designed to allow the user to maintai n visual contact with the patient while performing recordkeeping tasks. The combination of a mobile touch screen and voice response/recognition facili tated the design goals of the system. Although the system has enjoyed unive rsal clinical acceptance, the voice functions remain too limited to satisfy the needs of a completely handsfree user interface. Enhancements to voice recognition technology will offer the potential for improved functionality. Additional research is also needed to better define the relationship betwe en vigilance and visual contact with the patient.