CWOW Chairside Device Research

Device Research
Findings
DaVita \ July 29, 2016

Device Research Findings
Overview 3
Objective 3
Process 3
Who we talked to 3
When 3
Device Use by Location 4
Office 4
Nurses’ Station 5
Chair-side 5
Provider Rounding 6
Accessories & Peripherals 7
Keyboard 7
Stand 7
Mount 7
Straps/Slings/Pockets 7
Case 7
Storage and Charging 8
Checking out iPads 8
Storage 8
Charging 8
Concerns 9
High priority 9
Infection control 9
Theft 9
Hands free 9
Medium priority 9
Charging 9
Another thing to worry about 9
Clutter 10
Low priority 10
Drop/Break 10
Info privacy 10
Sync keyboard to iPad 10
Summary 11
Research Insights 11
VAM MLP Recommendations 11
Contact 13
PG 2

Device Research Findings
Overview
Objective
To learn what devices, peripherals and accessories clinical teammates will need for the MLP
release of the CWOW Vascular Access Management (VAM) Pathway tool in October 2016.
Process
We conducted eight 45-minute interviews with clinical teammates. The device research was
conducted immediately after we conducted a usability test with the same participant. Since the
participants had just gone through a usability session they were familiar with the CWOW
concept and interface. The device research interview consisted of two activities.
• The first activity was a walk through of their top Vascular Access Management tasks. The
participants were asked to describe their tasks, the systems and people they interacted
with to accomplish the task, and where in the clinic they performed these tasks. If there
were corresponding screens on the VAM Pathway tool prototype we asked them to walk
us through how they would do that task with the CWOW VAM Pathway tool using one of
the tablets.
• The second activity was a “Magic Wand” discussion. The participants were asked to
describe their ideal experience with an iPad to complete their top VAM tasks. We asked
them a series of questions to better understand their needs, concerns and reaction to
using an iPad in the clinic for these tasks.
The participants were given the choice of the iPad Pro 12.9” or 9.7” in an Otterbox case as well
as the option to use a keyboard or stand. They were shown photographs of a storage cabinet
and stands being considered for the MLP rollout in October.
Who we talked to
We talked with eight participants:
• 5 VAM
• 3 RN
Their clinical roles were:
• 3 RN/FA
• 1 PCT/FA
• 2 RN
• 1 PCT/AA
• 1 RN/CC
When
The research was conducted between July 13-18, 2016 in Las Vegas and Denver.
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Device Research Findings
Device Use by Location
During the research sessions the participants walked through the VAM activities they engage
in, in the context of where they typically conduct those tasks. Participants were asked about
their ideal iPad set up as well as about any specific needs or concerns. They were shown
photographs of stands being considered for use as conversation prompts.
Office
Office VAM activities the participants walked through included:
• Update One Stop Tool
• Admissions
• Print reports
• Update VAM statuses
• Schedule patient’s appointments
• Document
• Review census
• Notify transportation
• View patient’s access summary
Six of the eight total participants had an office or desk. The participants who had a desk walked
us through activities they expected to complete there.
Six out of the six teammates who expected to use the CWOW VAM interface in their office to
gather and document information about VAM patients wanted to have the 12.9” iPad pro as well
as the ability to charge the iPad at their desk. They expected a stand and keyboard. They also
expected to have one assigned to them to use to accomplish the administrative tasks they have
for VAM and other CWOW projects down the line.
The reason three participants stated for wanting the larger 12.9” iPad is that they have “Old
Eyes” and feel they could see it better.
Many of these teammates never saw themselves taking the iPad out of their office to gather the
data they need to collect for VAM, rather continuing the same process of collecting data and
coming back to the office to document it. Reasons for this included: relying on their current
workflow, infection control worries, and carrying the 12.9” iPad was heavy and a bit
cumbersome.
The office teammates speculated that the MSW and RD might have dedicated 12.9” iPads as
well.
Participants’ expectation for offices:
• 6 of 6 participants wanted to have the 12.9” iPad for documenting and administrative
tasks.
• 5 of 6 participants expected to have a keyboard, stand, and charging cable at their desk.
• 3 of 6 declared they had “Old Eyes” as justification for a larger sized iPad.
• 4 of 6 expected the iPad would be assigned to them, not a shared resource.
• Participants did not expect to take the 12.9” iPad to the floor to gather information. Some
thought they could share the iPads at the nurses’ station while on the floor as they
currently do with desktop. They preferred to use the 9.7” if they were gathering
information and walking around on the floor.
• Participants’ desks were already crowded. Adding the iPad adds to the clutter.
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Device Research Findings
Nurses’ Station
Nurses’ Station VAM activities the participants listed included:
• Enter orders
• Chart on patients
• Look up access information to share with VAM
Eight of the eight total participants had tasks to complete while on the center floor. All eight
contributed to the data gathered regarding the nurses’ station.
RNs expected to use the CWOW VAM interface at the nurses’ station to document information
about patients. They wanted to have the 12.9” iPad available for nurses to share much like they
currently share the desktop computers.
The RNs saw themselves with a 12.9” iPad plus desk stand, keyboard and charging cable. The
RNs saw themselves sharing the iPads in the nurses station like they currently do with the
computers located there, but they did not see themselves sharing the iPads with the PCTs.
They expected to have a 9.7” iPad available as a shared portable device.
When asked about the iPads co-existing with the desktop devices, the RNs did not feel it would
take up too much space.
Participants’ expectation for nurses’ station:
• 6 of 8 participants stated the nurses’ station should have 12.9” iPads.
• 2 of 8 stated the nurses’ station should have 9.7” iPads.
• 5 of 8 participants stated they wanted a keyboard and stand.
• Participants stated they wanted the iPad locked at the desk and charging.
Chair-side
Chair-side VAM activities the participants walked through included:
• Patient education
• Notify and schedule patient
• Follow up on appointment
• Assessing the patient’s access during treatment
Eight of the eight total participants had tasks to complete while on the center floor. All eight
contributed to the data gathered regarding the chair-side tasks.
The RNs do not want to carry either sized iPads with them to document VAM activities. Two of
the three staff RNs stated, “I need to be able to use my hands!” Most of their current VAM
activities are things they do at the same time as routine care. For example, if an RN has a
patient who has a maturing access; they would include the vascular assessment with their pretreatment
assessment. The RN would not make a special trip to assess and document the
patient’s access on the iPad. If the RN had to bring the iPad along with them during routine
care just to document VAM activities, they felt that it would become a burden, as they would not
be able to easily carry medications or feel like they could put it down chair-side easily. The
participants expected iPads to be available chair-side if they were needed for documentation.
If the RNs were to carry an iPad with them for a specific task such as to help schedule an
appointment for a patient or perform education, they envisioned themselves using the 9.7” as
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Device Research Findings
the smaller lighter iPad is more “handy.” They felt the iPad was more appropriate for those
types of tasks because they were not in the middle of performing patient care and did not have
to worry about infection control, as they would not be touching the patient or any dirty surfaces.
Overwhelmingly, they wanted to have an easy way to disinfect the iPads and to have the
disinfecting wipes available on every stand.
Participants’ expectation for chair-side:
• Participants were split evenly on the size they wanted to use chair-side for documenting
VAM activities.
• 4 of 8 participants wanted the iPads on a stand that can be locked down, charge and
include wipes and gloves with the stand.
• 4 of 8 participants wanted the iPad mounted chair-side.
• 1 of 8 participants wanted a keyboard chair-side to document VAM activities, this answer
would probably change if they expected to document treatment and chart on the iPad as
well.
• Participants expected the iPads to be shared across chairs in a similar ratio as how they
currently share Chairside Snappy.
• Participants were concerned about adding clutter on the clinic floor. Adding another
stand to the chair-side area will make it difficult to maneuver on the clinic floor.
• One participant who has been testing the iPad stands that connect via a magnet felt that
the connection was not stable and it was too easy to knock them off the magnetic arm.
• The participants had concerns about holding the iPad while working and having a
clean/safe place to put the device.
• Participants stated they thought that iPads would be helpful for social workers, dieticians
and rounding with the doctor when centralized patient data was available through
CWOW.
• Participants brought up they would like to have VAM educational information on the iPad
to share with patients.
Provider Rounding
Provider rounding activities the participants walked through included:
• Sharing patient data with the provider during rounding
• Documenting provider orders
• Taking notes on provider visit
Participants’ expectation for rounding:
• 3 participants brought up the idea of rounding and stated they would like to have the 9.7”
iPad for rounding with the provider.
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Device Research Findings
Accessories & Peripherals
During the research sessions the participants were offered options for a few different types of
accessories.
Keyboard
Clinical teammates would like keyboards at fixed positions like offices and desks, but general
consensus is not at chair-side and definitely not while walking around the floor. Concerns
around the keyboard include infection control and maintaining a sync with the tablet and
charging if the keyboard is wireless.
Stand
In an office or at the nurse’s desk, staff preferred a stand for the tablet at approximately 70 o
angle to be visible without having to lean over the screen and to reduce glare. All participants
placed the tablet on the stand in landscape orientation, but they had just completed usability
testing with a landscape oriented design, so no conclusion can be drawn from this.
Participants were shown examples of rolling or fixed stands for moving the tablet around the
floor or placement at chair-side. A few participants liked this idea, but there were several
concerns.
1. Stands can be a tripping hazard.
2. Stands can fall over and break the device.
3. Unclear how tablets on stands would be charged/maintained.
4. At chair-side, stands may get dripped/leaked on and need to be disinfected.
5. Stands must have a stable but easy to use mount for the tablet. Staff do not want to
have to cautiously attach and adjust the tablet to the mount every time it is replaced.
6. Stands need to have wheels so that they can be moved for routine cleaning and in case
of spills.
If a stand is utilized, it should include a spot to hold gloves and wipes.
Mount
A majority of participants preferred a strong mount for permanent placement of the tablet at
chair-side next to the current monitor. This mount should be strong enough to type without
movement, but can be flexible in order to use for patient education.
Straps/Slings/Pockets
Though participants voiced a clear need to have two free hands for administering to patients,
few were interested in a strap or pocket to hold the tablet when not in use. Concerns were that
the device would swing or get in the way and the device would be heavy and cumbersome to
carry throughout the day. They were also concerned with how to clean a strap or sling.
Managing infection control issues with any equipment in the clinic is a high priority for
teammates.
Case
The tablets used during testing were encased in an Otterbox, a sturdy and large iPad case.
Participants did not seem to have an issue using the tablet with the case, and based on the
concern for dropping or breaking the tablet, having robust protection was appreciated. The
only issue with this particular case is that the cover can be frustratingly difficult to remove. This
will not be an issue for fixed position tablets, but may be an issue for floating or office tablets.
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Device Research Findings
Storage and Charging
During the research sessions the participants were asked about storing and charging iPads,
they were shown photographs of a potential storage and charging cabinet as conversation
prompts.
Checking out iPads
Floor teammates were comfortable with checking out an iPad for use during their shift. They did
not expect to have one assigned to them indefinitely.
Office teammates were split by role about checking out iPads. The FA and CC teammates
expected to have an iPad assigned to them, while the AA was more comfortable checkout out
an iPad for the day.
Storage
The clinical teammates were concerned with potential theft overnight and during the day if the
iPad were left unattended on the floor outside of the nurses’ station. They were comfortable with
the idea of having a locking cabinet to secure and charge the iPads. The size and placement of
the cabinet is important as the teammates dislike clutter on the treatment floor.
Charging
Participants assumed tablets fixed in place at chair-side and at the nurses’ station would be
perpetually connected to a charging cable. iPads used in offices would be plugged in to
charge on the desk at the convenience of the user. The open question is for maintenance of the
floater iPads for doctors or specialists. The combined vault and charging station was well
received for overnight storage and charging. It may also make sense to provide one or two
additional charging cables near the nurse’s desk to support heavy usage days.
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Device Research Findings
Concerns
High priority
Infection control
Infection control was by far the largest concern with having iPads on the floor or chair-side. This
concern included both maintaining the ‘clean’ state of the tablet, but also the time required to
do that when moving between patients. Overwhelmingly, participants would like tablets
mounted in clean spaces and a set-up which can be thoroughly and quickly sanitized without
having to worry about harming the technology.
Theft
Virtually all participants sited theft/security as a concern. The issue was less of a priority during
the day, as long as the iPads were kept at the nurses’ station when or stored when not in use.
Proper storage or anti-theft measures are required to secure the tablets during shifts changes
and after hours. Participants reacted well to a combined vault and charging station for
overnight storage.
Hands free
When interacting with patients, participants said clearly that they need two hands available. The
question is, where to place the tablet during those periods. The general sense is that tablets
should be fixed near chairs like Chairside Snappy, but some teammates may still carry an iPad
around. Few participants were interested in a sling or strap for the iPad, leading to a need for a
quick place to put the device down while working with patients, something like a small basket
or similar in clean spaces near chairs.
Medium priority
Charging
Participants assumed tablets fixed in place at chair-side and at the nurses’ station would be
perpetually connected to a charging cable. iPads used in offices would be plugged in to
charge on the desk at the convenience of the user. The open question is for maintenance of the
floater iPads for doctors or specialists. As mentioned above, the combined vault and charging
station was well received for overnight storage and charging. It may also make sense to
provide one or two additional charging cables near the nurse’s desk to support heavy usage
days.
Another thing to worry about
RNs and VAMs stressed repeatedly how busy they are and how quickly they have to move
between tasks. If they move from a task which requires a tablet to one that does not, the tablet
needs to be placed somewhere clean and then retrieved at some point later. In a hectic
atmosphere where many pieces of patient data must be committed to memory for short periods
of time, keeping track of a small tablet can be a burden.
PG 9

Device Research Findings
Clutter
Clutter is of particular concern around the chairs. Having a tablet on a stand, whether fixed or
rolling, will be another item in a tightly packed area which already includes chair-side snappy
as well as potentially IV and O 2 . This additional clutter can also be problematic if something
leaks or spills and the area needs to be cleaned. The strong preference around chair-side is to
mount the tablet next to, and eventually replace Chairside Snappy.
Low priority
Drop/Break
Participants noted that dropping or damaging the tablet is a risk, but they work with other
expensive or fragile machinery and it is a part of the job. They assume that a broken device will
be replaced by DaVita.
Info privacy
One participant noted a concern around having patient data displayed at chair-side visible to
other patients or guests on the floor.
Sync keyboard to iPad
One participant noted a potential issue and frustration point with syncing Bluetooth keyboards
with the tablet. This is an issue both in terms of having multiple tablets and keyboards synced in
one place and ensuring the right ones are connected, as well as staff learning how to correctly
implement the sync.
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Device Research Findings
Summary
The objective of this research study is to learn what devices, peripherals and accessories
clinical teammates will need for the MLP release of the CWOW Vascular Access Management
(VAM) Pathway tool in October 2016.
These recommendations are specifically for VAM Pathway MLP release. The VAM Pathway tool
is being released to a limited audience. These configurations will need to be reassessed with
the release of additional CWOW modules and updates to VAM functionality. It is also
recommended that once the devices are piloted in centers that additional research is
conducted to assess how teammates are actually using the devices, accessories and
peripherals for these activities.
Research Insights
Teammates treat a 12.9” iPad like a desktop computer
The teammates gravitated to the 12.9” iPad for use when doing complex or documentation
heavy tasks. They felt they could see more information on the larger screen. They expected to
have a keyboard and a desk stand, which basically emulates a desktop. Furthermore, they did
not envision the 12.9” iPad as portable due to its size and weight.
Managing infection control
Teammates are incredibly aware of the risks of poor infection control procedures. Teammates
inspected the devices, case, keyboard and questioned the ability to clean them. Teammates
were reluctant to carry an iPad past the nurses’ station for fear of introducing it to a dirty
surface. To encourage adoption of carrying iPads chair-side teammates will need to have easily
accessible mounts or clean spaces to put the iPads down while working with patients.
Hands free on the floor
Teammates need to have their hands free to work with patients. Teammates seemed lukewarm
to the idea of routinely carrying an iPad even with a strap or sling. Additionally, they have
concern about both keeping track of an iPad once they set it down and potential theft once it is
out of their sight. As with managing infection control, to encourage adoption of carrying iPads
chair-side teammates will need to have easily accessible mounts or clean spaces to put the
iPads down while working with patients.
VAM MLP Recommendations
Office work
Provide the VAM a dedicated 12.9” iPad with keyboard, desk stand and charging to keep at
their desk.
• The VAM role has the majority of the tasks for the VAM Pathway Tool’s October MLP
release easy access to a dedicated iPad will foster use of the VAM Pathway Tool.
• VAMs overwhelmingly stated a preference for a 12.9” iPad for heavy documentation.
• The desk stand reduces glare from the overhead lights and wrist fatigue from holding the
iPad up.
• VAMs expected a keyboard for heavy documentation tasks.
• VAMs expected charging cables at their desk as they saw themselves responsible for
their charging their own device.
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Device Research Findings
Nurses’ station
Provide the RN shared 9.7” iPads with keyboard, desk stand and charging cable for use at the
nurses’ station.
• RNs overwhelmingly stated a preference for a 12.9” iPad for use at the nurses’ station,
but for the VAM Pathway Tool’s October MLP release they are not the primary actor and
their use will be lower than the VAM. The 9.7” iPad is more portable and more likely to be
taken chair-side with the RN.
• The desk stand reduces glare from the overhead lights and wrist fatigue from holding the
iPad up.
• RNs expected a keyboard for documentation tasks.
• RNs expected charging cables at their desk as they viewed it much like the desktop
computer they currently use in the nurses’ station.
• As VAM Pathway and CWOW add more functionality and modules such as Orders, the
nurses’ station will most likely need to be upgraded to 12.9” iPads or desktop like
solutions.
Chair-side
Provide the VAM and RN roles shared 9.7” iPads for use on the treatment floor away from the
nurses’ station. All Chairside Snappy stations equipped with a magnetic arm and wipes. Rolling
stands available for use in the clinic, but not at every Chairside Snappy station.
• Seven of the eight participants stated a preference for a 9.7” iPad for use chair-side due
to its size and weight.
• The magnetic arm attached to the Chairside Snappy station would give teammates a
clean surface to put an iPad as they work with the patient.
• Teammates are very concerned with infection control on the clinic floor. Any dedicated
location to put an iPad down should have disinfecting wipes.
• Rolling carts with disinfecting wipes are convenient to the teammates who need to collect
information from multiple patients while not getting in the way of clinical teammates who
need access to Chairside Snappy at the same time.
o The number of carts needed for a clinic depends on the size.
o The VAM Pathway tool will have limited users initially so the need for iPad carts is
low now, but expected to grow with the introduction of future CWOW modules.
• The VAM Pathway Tool’s October MLP release has limited chair-side documentation
necessary so having dedicated mounted devices for this pilot would be excessive.
o In the future as VAM Pathway and CWOW add more functionality and modules
requiring heavy use and reliance on the CWOW apps at the chair-side location
the device distribution will need to be reassessed for those activities.
o For that future states teammates stated they would like to have 12.9” iPads on
carts or mounted in the same ratio as they have Chairside Snappy currently.
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Device Research Findings
Contact
If you have any questions regarding this document, please contact:
Jay Janowicz –Sr. Engagement Manager
Jay.Janowicz@effectiveui.com
Lys Maitland – Sr. Experience Planner
Lys.Maitland@effectiveui.com
PG 13