Integrating User-centred Design in an Early Stage of Mobile Medical

Application Prototyping

A Case Study on Data Acquistion in Health Organisations

Bernhard Peischl

, Michaela Ferk

and Andreas Holzinger

Softnet Austria, Inffeldgasse 16b/II, 8010 Graz, Austria

FERK Systems GmbH, Raiffeisenstrasse 46, 8010 Graz, Austria

Medical University Graz, Auenbruggerplatz 2/V, 8036 Graz, Austria

Keywords: ICF, ICD, User-centred Design, Data Acquisition in Healthcare, Usability Engineering in SMEs.

Abstract: This paper reports on collaborative work with an SME, developing a system for data acquisition in health

care organisations, providing mobile data support. We briefly introduce the ICF and the ICD classification

scheme from the WHO as a foundation for our mobile application. A two-staged usability evaluation in a

very early stage of development allows us to integrate user-centred design in the mobile application

development process. Our procedure comprises interviews and usability tests with a limited number of users

and thus can even be performed within a resource-constrained setting as it is typically found in smaller

software development teams. We discuss the consolidated results of the usability tests quantitatively and

qualitatively. From these results we deduce recommendations (and open issues) concerning the user

interface design of the mobile application.

1 INTRODUCTION

For almost 40 years, experiences have shown that

software engineering methods (e.g. the waterfall

model, V model and recently agile methods such as

Scrum) often result in poor user experience

(Holzinger and Slany, 2006). One of the reasons for

this is that requirement specifications (in particular

regarding the user interface and interaction design)

often do not reflect the real needs of the users.

Over the past decades, work in usability

engineering has shown that one of the best ways to

evaluate the quality of a user interface is to carefully

watch users interacting with the user interface

(Norman and Draper, 1986); however, this alone is

not enough, also the context and the environment is

of importance and we can speak of a total workplace

usability (Holzinger and Leitner, 2005). Depending

on the concrete development process and stage of

development this can be done with the application

(if already in place) or a mock-up in the form of a

paper prototype (Snyder, 2003).

Numerous projects have also shown that

substantial resources are needed for an adequate

interaction design and usability engineering

However, in practice software projects always

struggle with limited resources. Thus, today’s

challenge is to use fast, cheap and still efficient

usability engineering that can be used iteratively

throughout the development process (Hussain et al.,

2009).

This particularly holds for the development of

mobile business applications that typically do not

only have to fulfil high usability requirements but

also business-critical requirements. Moreover, the

sector specific contextual knowledge will influence

how user interface designs are perceived and

interpreted. Consequently, it is of uttermost

importance to integrate human-centred design into

the software development process as early as

possible (Holzinger et al., 2005).

In this paper we report on the design and

development of a mobile application for data

acquisition within healthcare organisations.

Typically, such an application is used by the nursing

staff, physiotherapists and other medical

professionals.

The application requires some basic knowledge

of standards such as the ICF (International

Classification of Functioning, Disability and Health,

WHO2) and the ICD classification (International

185

Peischl B., Ferk M. and Holzinger A..

Integrating User-centred Design in an Early Stage of Mobile Medical Application Prototyping - A Case Study on Data Acquistion in Health Organisations.

DOI: 10.5220/0004493901850195

In Proceedings of the 4th International Conference on Data Communication Networking, 10th International Conference on e-Business and 4th

International Conference on Optical Communication Systems (ICE-B-2013), pages 185-195

ISBN: 978-989-8565-72-3

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

Classification of Diseases, WHO1). This

prerequisite has to be taken into account when

addressing usability engineering methods from the

very beginning.

In this article we briefly provide an introduction

to the ICF and the ICD classification and outline

some surrounding success factors for mobile

business applications in general. In Section 4 we

focus on the user-centred design of our application.

We briefly explain the research questions, outline

the design of our usability tests and their execution

and describe the specific tasks our test users had to

fulfil. Afterwards we summarize the (1) results

quantitatively and briefly show the (2) outcome of

our qualitative evaluation. As a concrete outcome

for the next iteration within the software

development cycle we come up with

recommendations even before a single line of code

has been written. Our procedure is fast, cheap in

terms of resources and can be repeated at any point

in the development lifecycle. Notably this procedure

helped to discover usability flaws in a very early

stage of mobile application development.

2 ICF / ICD CLASSIFICATION

Our goal is to develop a software system, including

an application running on mobile devices that

supports acquisition and documentation of the health

state of a patient. Therefore we make use of the ICF

and the ICD standards (WHO1, 2012); (WHO2,

2012). Internationally endorsed classifications like

ICF and ICD facilitate the storage, retrieval,

analysis, and interpretation of data. For example,

this allows one for comparison of data within

populations over time as well as the compilation of

nationally or regionally consistent data.

ICF is a comprehensive classification of the

health state of a person. “Comprehensive” in this

sense means that the health state of a person is not

exclusively assessed by relying on physical

functions or disorders but also by taking into

account the possibility of an active lifestyle and

factors regarding the environment of the patient. The

ICF consists of several components (a hierarchical

structure grouped into physical functions, activities,

means of participation, environmental factors,

factors regarding the person itself), where each

component is assigned a set of ICF codes. The

assessment for each ICF code is done with the help

of a five-valued scale. The value increases with

increasing limitation of the patient. Details regarding

the assessment are explained in the ICF application

and training tools (WHO3).

The ICD is a classification system of medical

diagnoses. Within the ICD each medical diagnosis is

assigned to a three or four digit code. ICD also

supports hierarchies in terms of chapters, groups and

categories. In general the relevance of ICF codes

depends on ICD diagnoses. Therefore ICF-CoreSets

have been developed. ICF-CoreSets contain ICF

codes that are of particular relevance for groups of

ICD diagnoses.

3 SUCCESS FACTORS

The development of mobile applications for

professional usage in the healthcare field challenges

mobile software development in various ways.

First, there is the question of the platform being

supported. As the current landscape for mobile

operating systems is rather heterogeneous we need

to trade off advantages and drawbacks particularly

for the healthcare sector.

Second, and in contrast to the mainstream

consumer market, mobile business applications must

fulfil business critical requirements like a certain

degree of quality of service and requirements with

respect to security and privacy. The communication

of the mobile device and the data synchronisation

mechanism has to be robust and reliable independent

from place, time or usage context.

Third, as the application being developed is

highly interactive, the acceptance among the staff

members is crucial (Holzinger et al., 2011). This

success factor becomes even more crucial, as the

exposure to occupational stress in health care

organisations typically is extremely high. Unclear

user requirements pose a further challenge in

developing a user-centred and useful application. In

the following we particularly address this aspect.

4 USER-CENTRED DESIGN

Today it is well-known that usability engineering

methods have a huge impact on the perceived

quality of a software product or a software service.

However, in practice high costs and stringent time

planning prevent the use of these expensive methods

(Boivie et al., 2003), (Cooke and Mings, 2005),

(Larusdottir, 2011). In order to address user-centred

design in spite of limited resources, we propose to

integrate usability evaluation in a very early stage of

software design in terms of paper prototypes.

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Particularly within a fast-paced and innovation

driven setting, under presence of rather fuzzy

requirements, the early feedback of potential users

may considerably improve the quality of the

obtained design and product. Due to this, we

prohibit development efforts that do not match

market and user requirements. Our core element in

integrating usability engineering techniques into the

software development lifecycle is the interview-

guided usage of usability tests in combination with

paper prototypes.

Rubin and Chisnell (Rubin and Chisnell, 2008)

emphasize that the usage of usability engineering

techniques is appropriate as soon as obvious

usability flaws have been removed. Due to this, prior

to conducting usability tests we carried out several

walk-throughs within the small development team.

Further the initial design considered the usability

guidelines for mobile applications according to

Inostroza (Inostroza et al., 2012) as well as the

design guidelines for Android and iOS.

According to Rubin and Chisnell (Rubin and

Chisnell, 2008) we conducted an exploratory and

formative part of the usability evaluation. The

exploratory part of our usability tests aims to clarify

whether or not the assumed user profiles match with

the reality and whether our app provides assistance

in the daily work. In addition to the tests, we

emphasized this aspect by conducting interviews

questioning the state of practice in acquiring health-

related data. The formative part of our usability tests

aims to verify whether our design supports the user

in an optimal way.

4.1 Research Questions

As we relate usability tests with interviews about the

common work practices we decided to classify the

research questions accordingly. The interviews

being performed intend to strengthen the exploratory

component in our evaluation. In the course of the

interview, we reveal typical working procedures in

order to confirm our assumptions on user profiles

and the usage context.

As we interrelate usability test to the everyday

work in data acquisition in health care organisations

we break down our research questions according to

this. The interviews are supposed to strengthen the

explorative part of our evaluation and involve the

following questions:

 What are typical working procedures for the

documentation of the health status of a patient in

the course of care and therapy?

 To what extent are these procedures standardised?

For example, do you use standardised

questionnaires?

 Is ICF used in practice or is the term ICF known at

all?

 To what extent are medical doctors involved in the

documentation of a patient’s health status?

After having conducted these interviews in a

very early state of app development, we conducted

the formative component of the evaluation to

evaluate the quality of the user interface design. This

part of the evaluation strived to answer the following

questions:

 Does the user benefit from using ICF, that is, does

ICF provide assistance in the working procedures?

 Is all the relevant information processed?

 Are overall usability and navigation within the app

intuitive?

 Which kind of previous knowledge or which kind

of training is required in order to use the app in

everyday work?

This first and very early evaluation of the

usability in the software lifecycle mainly serves the

purpose of providing feedback regarding the

suitability of the user interface design. Taking into

account the lack of resources and the current

practice in software engineering this can be done

even with a small amount of test persons. It is well-

known that the number of test persons has an

economic as well as a qualitative impact. The more

test persons are being considered, the higher the

costs are and the more relevant the results of the

tests are. Thus, the main challenge in the given

context is to reveal as many usability problems as

possible with a small number of test persons.

According to Bastien (Bastien, 2010) the optimal

number of test persons is discussed since the

Nineties. At that time, about four to five test persons

were considered adequate to reveal 80 to 85 per cent

of all usability problems. In the meanwhile more

recent studies recommend a considerably higher

number of test persons (Bastien, 2010).

The number of persons is further determined by

the complexity of the tasks scheduled for the

usability test and is still an open research issue at the

moment. Up to now many successful research works

with practical relevance (Holzinger and Errath,

2007), (Horsky et al., 2010) follow the

recommendation from the Nineties (Short et al.,

1991), (Nielsen, 1994) to conduct usability tests with

four to five persons. According to Rubin (Rubin and

Chisnell, 2008) this number is sufficient to reveal

the majority of the usability problems.

Furthermore, Rubin (Rubin and Chisnell, 2008)

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notes that the number of test persons can be smaller,

if the tests are carried out in an iterative manner.

Usability tests that consider the Thinking-Aloud

method can be conducted in an adequate manner

even with three persons per user group (Holzinger,

2005), (Holzinger, 2006), (Holzinger and Brown,

2008). As we used the Thinking-Aloud method,

supported the test in terms of interviews and

performed these tests in an iterative way, we

considered three persons as lower bound for

obtaining meaningful results. This holds for the

relevant user groups of nursing staff and therapists.

Medical doctors are considered as a fringe group, as

they turned out not to be the main users of our

application.

4.2 Test Design and Execution

After conducting the interview regarding the

common practice of collecting health-relevant data

we explained the basic idea of our application and

the concept of ICF. This was followed by a

demonstration of paper prototype tests and an

introduction to the Thinking-Aloud method.

For the usability tests we selected problems that

reflect the most common working procedures in the

daily business. The sequence of the individual tasks

was chosen to represent the typical sequence of tasks

in daily business with an increasing difficulty. After

conducting the usability tests the critical issues

observed during the test have been discussed with

the participants. In the following we briefly

summarize the individual tasks that had to be carried

out:

Task 1: Remembering the concepts of ICF and

ICD in order to establish optimal prerequisites for

the test. Participants were given the design of a

patient sheet(see Figure 2). Based on this design, we

asked the participants to describe the functionalities

behind the individual ICF- and ICD-related buttons.

Task 2: Assigning an ICD diagnoses and the

appropriate ICF-CoreSet to a patient. This test is

intended to establish the relationship between an

ICD diagnoses and an ICF-CoreSet. This

relationship aids in documenting the health state of

the patient at a later stage.

Task 3: Documenting the health status with ICF.

This task deals with the core of our application, the

recording of health-relevant data based on ICF

codes. The participants were asked to evaluate the

code “d450 Gehen”. For this purpose we provided

further information (diagnostic findings of nursing

staff etc.).

Figure 2: Patient sheet.

Task 4: Analysing the health status based on ICF

data. The final task considered the visualisation and

analysis of the ICF recording. First, the participants

were asked to retrieve those ICF codes that have

improved in the recent past (Task 4.1). Second, we

asked the participants to retrieve details about the

evolution of the ICFcode “d450 Gehen” (Task 4.2)

5 RESULTS

AND RECOMMENDATIONS

According to the questions raised in the previous

section, we summarize the results of the interviews

and usability tests. Large parts of the interviews

confirmed our assumptions about the common

working practices of our potential users.

5.1 Consolidated Findings

from the Interviews

Documentation of Health Status in Practice:

Typically the workflow related to the documentation

of the health status is perceived as tedious and

intensive in writing. Both, in health care and therapy

standardised metrics and questionnaires are used

(e.g. Barden index, Barthel index, or Morse-Fall

index). Besides the questionnaires particularly

physiotherapists mentioned the usage of the

“Visuelle Analogskala” (VAS) which is used for

subjective evaluation of pain intensity. The

standardised tools being employed capture a specific

aspect of the health state of a patient. Relevant

additional information is usually captured in the

form of free text. Questionnaires regarding the

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health state are employed on a regular basis,

however, the period of usage largely varies

depending on the patient. Besides the questionnaires

and the indexes most of the documentation work is

carried out in the form of free text. In care, almost

every action is documented in the form of free text.

Furthermore, the actions carried out by

physiotherapists and the goals of the therapy are

documented using free text.

Separation of Areas of Activity and user

groups: Nursing staff and physiotherapists consider

ICD diagnoses from medical doctors as a starting

point for their work, whereas the medical doctor

emphasised not to use the documentation and

questionnaires of nursing staff and physiotherapists.

This confirms our decision to put the focus of the

usability tests on nursing staff and physiotherapists

rather than on medical doctors.

ICF in Practice: The ICF schema is not used in

practice but is known from time of studying.

Particularly this holds for physiotherapists as the

ICF has been considered an important part of

vocational training. However, none of the

interviewed physiotherapists has used the ICF in

practice.

IT Support: Yet mobile technologies are not

used in daily work by the interviewed persons. In

some cases ward rounds are carried out with a

mobile laptop computer on a creeper. However,

aside of using mobile devices in healthcare, even the

usage of IT in the field of health documentation is

not very common. For example, some of the

interviewed persons mentioned that standardised

questionnaires are not processed automatically but

printed out and handwriting is used to fill out these

forms. Thus, for every patient there is a bulk of

paper to document the state of health and care.

5.2 Consolidated Findings

of the Usability Tests

In the following we provide a summary of the

quantitative results of our tests. However, our main

focus regarding the usability tests is on the

qualitative feedback from our test persons regarding

our design concept. Figure 1 outlines the degree of

fulfilment of the tasks discussed in the previous

section (percentage of fulfilled tasks) with (light

shaded) and without (dark shaded) assistance. On

average six out of eight participants were able to

fulfil the given tasks.

Table 1 outlines the comparison according to our

target user groups whereas Table 2 breaks the results

down according to whether a participant is

Figure 1: Percentage of fulfilment of the individual tasks.

experienced in handling a smartphone. Notably, the

results among physiotherapists are considerably

better than among the nursing staff and smartphone

users provided better results than test persons that

have no experience with smartphones at all.

However, it is important to note that all

physiotherapists in our test setting had experience

with smartphones whereas this only holds for about

50 per cent of the nursing staff. This fact has to be

taken into account when interpreting Table 1 and

Table 2.

Table 1: Results grouped by profession.

nursing staff physiotherapist

Task

no.

with.

assist.

without

assist.

with

assist.

without

assist.

Task 1

50 pc. 0 pc. 75 pc. 0 pc.

Task 2

75 pc. 25 pc. 100 pc. 0 pc.

Task 3

25 pc. 25 pc. 75 pc. 0 pc.

Task

4.2

0 pc. 75 pc. 0 pc. 100 pc.

Task

4.1

100 pc. 0 pc. 100 pc. 0 pc.

Table 2: Results grouped by experience of user.

exp. user non-exp. user

Task

no.

with.

assist.

without

assist.

with

assist.

without

assist.

Task 1

75 pc. 0 pc. 0 pc. 0 pc.

Task 2

100 pc. 0 pc. 67 pc. 33 pc.

Task 3

20 pc. 60 pc. 0 pc. 0 pc.

Task

4.2

0 pc. 100 pc. 0 pc. 67 pc.

Task

4.1

100 pc. 0 pc. 67 pc. 33 pc.

For the individual tasks, we obtained the following

qualitative feedback:

Task 1: Figure 2 shows the design of a patient

sheet. The bad results we obtained in this task of our

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usability test are mainly due to a term

(“Krankheitsbild” in the German speaking test

environment corresponds to clinical picture or

disease pattern) we used to describe ICF-CoreSets.

Most of the test persons associated this term with the

term “diagnosis” and were not able to associate the

functionality of our application with this specific

term.

Recommendation: Choose a unique and well-

known term that captures the functionality of the app

also for users with a low knowledge of ICF so that

these users are able to associate the right

functionality with the term.

Figure 3: Acquisition of ICD diagnosis (left) ICF

classification (right).

Task 2: Figure 3 outlines the designs for the

acquisition of diagnoses and ICF classifications. All

participants have been able to fulfil this task. At the

very beginning of the design process, the

relationship between acquisition of ICD diagnoses

and ICF-CoreSets in everyday practice was an open

issue. Our interviews revealed that nursing staff and

physiotherapists partially carry out documentation of

a patient’s health status by relying on medical

diagnoses but do not fully rely on these. Therefore

the acquisition of ICF-CoreSets independently of the

medical diagnoses (given an appropriate hint)

appears to be suitable. The good results obtained

from this task emphasize that the user interface

design manages to convey the relationship between

both categories (ICF, ICD) and that navigation

within our application is intuitive.

Task 3: Figure 4 outlines the design of the ICF

acquisition supporting the documentation process.

The rather bad results obtained at this task primarily

result from the fact that around half of the test

persons did not use the supplemental information

regarding the assessment of the ICF codes.

Retrieving this supplemental information has been a

part of the finishing criteria for this task. Without

this finishing criterion the success rate would be 100

per cent. In Figure 4, each value is associated with

concrete criteria that a patient has to fulfil. This

supplemental information can be retrieved by

pressing the central buttons with the numbers.

Figure 4: Dialog for acquisition of the ICF values.

We identified several issues for this problem:

The meaning of the numbers for assessment is

not clear: A part of our test users did not understand

the meaning of the value. Figure 4outlines the value

for the code “d450 Gehen” which is displayed two

times (the green number 1). Although we had

briefed the participant that the assessment is based

on a 5 step scale, they could not associate this value

with the ICF number.

Recommendation: The problem revealed can be

addressed in two different ways. Training on the ICF

codes is a prerequisite for using our application.

Once it is clear to the users, how exactly an ICF

assessment is carried out, the interpretation of the

numbers should be quite obvious. On the other hand,

it might be possible to hide the numbers and use a

colour palette instead. Due to the problems with

colours used in our application (see the following

recommendation) we recommend to use numbers.

However, this issue should be an integral part of the

next iteration.

The relationship between assessment buttons

and the value for the assessment is not obvious:

Several test persons did not recognize the

relationship between the assessment buttons and the

number in the centre. Although our test persons

understood that red, yellow and green buttons denote

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a degradation of the health state, stable state or an

improvement regarding the health state, the fact that

hitting one of these buttons affected the ICF value in

the centre was not obvious to them. This problem

has already been revealed in the very early walk-

throughs and yielded to the decision to place the ICF

value in the centre of the assessment buttons.

However, the majority of our test persons preferred

positioning the value for the ICF assessment left to

the assessment buttons.

Recommendation: Relying on the obtained

results, the value for the ICF assessment should be

placed left to the assessment buttons. Moreover, a

visual aid, e.g. flashing the number when hitting an

assessment button, should emphasize the

relationship between the assessment buttons and the

value displayed for the ICF code.

Double meaning of colours: This task further

revealed a weakness of our colouring concept.

Several test persons were unsure about the (double)

meaning of our colour concept. On the one hand we

use the colours red, yellow and green for the

assessment buttons to depict degradation of the

health state, stable health state, and improvement of

the state. On the other hand we associated colours to

the ICF values. However, these colours do not

denote the evolvement of the health state but rather a

static assessment. For example, values 0 and 1 are

displayed in green as these values indicate a small

limitation of the patient whereas the values 3 and 4

are displayed in red correspondingly indicating a

severe limitation of the patient.

Recommendation: To solve this issue, set aside

the colouring for the ICF values. The colours green,

yellow and red should solely be used to indicate the

variation (degradation, stable state or improvement)

of ICF values.

Discovering information regarding the ICF

values: Our test persons had problems retrieving the

supplemental information regarding the ICF values.

Often the information for the ICF codes itself or

actions and goal planning (Figure 5) have been

retrieved.

Recommendation: To remove this problem, use

visual means to emphasize that there is some

relevant supplemental information regarding the

ICF values.

Task 4: This task deals with the assessments of

ICF codes. Notably the learning curve is strongly

increasing (see Figure 1) when moving from Task

4.1 to Task 4.2. Whereas none of our test persons

managed to solve Task 4.1 without assistance, 87.5

per cent of our test users were able to perform Task

4.2. This indicates that our user interface enables

simple guidance of the user through the menu and

our test users experienced some learning effect.

Task 4.1: Figure 5 (left) shows the alternation of

certain ICF codes over a certain period of time. In

this figure the current ICF assessment is compared

to 100 acquisitions. Our test persons have not been

able to correctly interpret this alternation. The

following issues have been discovered due to this

test.

Figure 5: ICF trend view (left) and details view on the

ICF-code “d450 Gehen” (right).

Information visualisation: Our test users did not

perceive that the values being displayed refer to a

time period of 100 acquisitions in between.

Intuitively our test users assumed that the current

assessment is compared with the previous

assessment. Our users did not pay attention to the

information that is indicating the longer time period

for acquisition (“100 Erfassungen”). Further, as in

Task 3, the double meaning of colours was

mentioned as a problem.

Recommendation: The time period over which

the trend of the assessment (degradation, constant

state, and improvement) is taking place has to be

emphasized. If possible, also try to reduce the

amount of information displayed to the user to ease

interpreting the data. Use the colours red, yellow

and green consistently but exclusively to depict the

change of health state.

Task 4.2: As mentioned previously the learning

effect from Task 4.1 was vast. Almost no one of our

test users had problems in navigating through the

menu. Figure 5 (right) outlines the detailed view for

the ICF code “d450 Gehen” which lots of our test

persons managed to retrieve without problems.

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6 RELATED WORK

The number of health applications and research in

the area of mHealth is growing steadily with lots of

special applications for both the private and

professional sector (Waegemann, 2010), (Zuehlke et

al., 2009), (Phillips et al., 2010).

Applications for the consumer market cover a

variety of fitness and wellness applications, the

management of medication and assistance with self-

diagnosis (Holzinger et al., 2010). Furthermore there

is a variety of mobile health applications for

professional use which ranges from medical

applications to display medical images over

applications of ICD to electronic recording of patient

data.

Software solutions for using ICF are rather rare.

Most of the work regarding ICF deals with the

construction of ICF-CoreSets (DIMDI). In order to

select the relevant ICF codes for patients out of the

thousands ICF codes in general, there is a need for a

standardised set of ICF codes. In general, the set of

relevant ICF codes is related to the ICD diagnoses of

a patient. Therefore there are ICF CoreSets that

cover certain diagnoses or groups of diagnoses. Our

research revealed that there are well-documented

ICF-CoreSets for patients with backache,

osteoporosis, Diabetes mellitus, pain disorder and

depressive disorder (Rensch and Bucher, 2006).

Bender (Bender, 2010) points out that numerous

health organisations experience problems when

applying the ICF classification in practice.

According to (Bender, 2010) the reason for this is

the lack of guidelines for practical application of the

complex ICF classification scheme.

The Rehab-CYCLE software from the RehabNet

AG (DIMDI) to our best knowledge has been the

first ICF-based desktop application for

rehabilitation. This software allows describing the

health status of a patient by using the ICF as well as

the formulation of rehabilitation goals and the

planning of the corresponding activities. This

functionality is supported in terms of an ICF-

browser and ICF-CoreSets for numerous diseases.

As in our case Rehab-CYCLE has been developed in

close collaboration with universities and has been

successfully used from 2004 to 2011 within hospital

facilities in Switzerland and Germany.

In the meanwhile Rehab-CYCLE has been

substituted by the web-enabled application

RehabNET-IPS. As this application can be accessed

via a browser, the access via mobile devices is

possible. However, to our best knowledge there has

been no effort in adapting the application towards

the usage with mobile devices.

Our market research revealed only a single ICF-

based documentation system explicitly supporting

mobile devices, the ICOSys application developed

by Management Partners (ICOSYS, 2012);

(ICOSYS.MOBIL, 2012). The possibility to use the

ICF-classification is embedded within a module

system which is providing functionalities ranging

from the management of resources and patients to

time recordings for employees. ICOsys.mobil runs

on the Windows Mobile operating system. It is an

open issue whether there have been attempts to port

ICOsys.mobil to state of the art platforms like iOS

or Android.

The German company MediFox (MEDIFOX)

offers a mobile software solution on the Windows

Phone platform. However, to our best knowledge

this application does not support the usage of the

ICF classification but offers a spectrum of metrics to

measure the health status of a patient, e.g. the

Braden-Skala. Notably, there is a major difference to

our ICF-based approach: Each of the metrics and

assessments captures a part of the health status in a

highly specialized but isolated manner. Opposed to

this, ICF considers the health status as a whole and

uses a uniform and quantifiable assessment scheme.

However, today it is an open issue whether a

documentation based on the ICF can fully substitute

this spectrum of metrics.

7 CONCLUSIONS

In this article we presented collaborative research

conducted in association with an SME dealing with

the integration of user-centred engineering methods

into mobile application development in a very early

phase of development. The application that has been

designed and developed is part of a larger system

that allows one for acquisition and documentation of

the health state of a person. Our mobile application

is primarily used by nursing staff and

physiotherapists. In this context usability questions

are tied to domain knowledge and practices and thus

this has to be taken into account in particular.

The article gives a brief overview on the

documentation of the health state of a person using

the ICF and the ICD classification scheme according

to the WHO. In our research it turned out that the

scheme is known by physiotherapists but not used in

practice yet. However, our research further revealed

that additional training on the basic ideas of the ICF

and ICD might be necessary in order to establish

acceptance among nursing staff. The authors of

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192

(Ziefle et al., 2011) also point out the need for

additional training and thus further support our

findings. Nevertheless, the ICF and the introduction

of mobile devices appears to be beneficial as it

simplifies the prevailing working procedures.

Regarding the mobile application development

for the healthcare domain we identified three success

factors: choosing the appropriate platform, the

fulfilment of business-critical requirements and the

integration of user-centred design into mobile

application development.

In integrating user-centred design into the

software development lifecycle we conducted a two-

staged procedure based on walk-throughs,

interviews and usability tests. Notably this can be

performed in an (1) early stage of development and

with (2) a limited amount of resources and thus is

suitable for smaller development teams and SMEs.

Our procedure is repeatable and revealed design

flaws in the user interface in a very early stage of

development. We briefly summarized quantitative

and qualitative results (with emphasis on the latter

one). From the results we deduced some

recommendations and issues to be investigated in the

next iteration. Finally we summarized related work

on acquisition and documentation of the health state

of a person focusing primarily on products and

studies that use the ICF and ICD classification for

documentation.

ACKNOWLEDGEMENTS

The work presented herein has been partially carried

out at Ferk Systems and has been partially funded by

Ferk Systems and the SME program

“Innovationsscheck” of the Austrian Research

Promotion Agency (FFG, contract no. 840346).

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