Purpose: The aims of this study were to investigate how a variety of research methods is commonly
employed to study technology and practitioner cognition. User-interface issues with infusion pumps
were selected as a case because of its relevance to patient safety.
Methods: Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram
showing the relationship of computer technology, cognition, practitioner behavior, and system failure
in the area of medical infusion devices. We subsequently conducted a systematic literature review on
user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and
noted the usability problems found with particular methods. Next, we assigned usability problems and
related methods to the levels in the Impact Flow Diagram.
Results: Most study methods used to find user interface issues with infusion pumps focused on observable
behavior rather than on how artifacts shape cognition and collaboration. A concerted and theorydriven
application of these methods when testing infusion pumps is lacking in the literature. Detailed
analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well
as how the scope of analysis may be broadened to include organizational and regulatory factors.
Conclusion: Research methods to uncover use problems with technology may be used in many ways, with
many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely
focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption
of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology.