Specific methods used in this research
Why this research is unique, with a description of the three PAR research cycles
Dave Pao
3 min read
‘There are circumstances where the best or only way to shed light on a proposition, a principle, a material, a process or a function is to attempt to construct something.'
- Bruce Archer (1995)
This approach to EHR interface design is unusual in that clinical usability knowledge emerges from a 'blank canvas' provotype, built without any pre-determined concepts of what is possible technically, semantically or syntactically. Where most usability research relies on the observation of clinicians on existing EHR interfaces, consensus opinion or the modification of existing heuristics (rules of thumb) through analysis, this research takes the view that clinical usability knowledge will be embedded within an artefact that a clinician builds themself—whether explicit, tacit or experiential.
This research approach is also rare in that I am both the design researcher and an experienced doctor within the field of ISH. This dual role has a significant influence throughout—in planning the research, building and reflecting on both the provocative prototype (provotype) and development prototype, and through engagement with my own clinician community. It is this engagement (in Cycle 2) that refines and transforms a single clinician's viewpoint into a consensus.
The cyclical approach of PAR, acting iteratively until reaching stability or misfit, exploits this role of observer-as-participant in constructing knowledge and abstracting it to theory. It is an approach that—despite and because of bias and subjectivity—stands a good chance of discovering reliable new knowledge and more importantly, understanding.
Three PAR cycles were undertaken: a community diffractive cycle bookended by two reflective cycles. Running as the core methods through these cycles were iterative prototyping, a concurrent triangulation mixed methods survey approach, heuristic evaluation, and systematic design and evaluation.
Cycle 1 began with the creation of the single-clinician-designed STIQI provotype to capture CU knowledge. Subsequent reflection elicited and codified this knowledge through the lens of a single clinician researcher (me), producing preliminary CU knowledge and deriving two research tools that are used in subsequent cycles:
(1) A mixed methods CU survey within which is a preliminary set of CU heuristics that will act as a diffraction instrument in Cycle 2
(2) The STIQI provotype itself, which will act as a source of ‘light’ specific to the ‘wavelength’ of CU, that will be diffracted through the CU survey in Cycle 2
Cycle 2 employed diffraction, to split (diffract) clinician community feedback (of both commercial EHRs and the STIQI provotype) into constituent ‘wavelengths’, allowing focused and systematic analysis of CU themes. This cycle aimed to corroborate and refine my own CU knowledge with that of the community, through the research tools designed in Cycle 1.
Cycle 3 returned to reflection, building on research findings to create and communicate new CU knowledge through:
(1) A revised CU survey, generalisable to all outpatient clinical specialities
(2) The STIQI development prototype, systematically designed using Cheng and Barone’s (2007) Representational Epistemic (REEP) approach, and validated by Moody’s (2009) principles for designing effective visual notations
Whilst this research is pragmatic in its worldview, there is an undeniable sense of advocacy and empowerment that aligns strongly with PAR’s goals and attributes. It is research that advocates for clinicians as the primary users of the EHR interface and, indivisibly, patients as their primary concern. Beyond the clinical domain, it is research that places value in effective collaboration and, by corollary, a shared trans-disciplinary language.
Archer, B. (1995). The nature of research. Co-design, interdisciplinary journal of design. [Online].
Available at: https://ia800201.us.archive.org/21/items/TheNatureOfResearch/Archer1995Codesign.pdf
Cheng, P. C.-H. and Barone, R. (2007). Representing complex problems: A representational epistemic approach. In: Jonassen, D. H. (Ed). Learning to Solve Complex Scientific Problems. Milton Park, UK: Routledge.
Moody, D. (2009). The ‘physics’ of notations: Toward a scientific basis for constructing visual notations in software engineering. IEEE Transactions on Software Engineering, 35 (6), pp.756–779.
November 2023
