Michael F Rayo

• PhD
• Professor (Assistant) at The Ohio State University

Background Despite the growth of digital healthcare data, surveillance for healthcare associated infections (HAIs) often consists of reviewing cases using lists, charts, or tables. For infections, such as C.diff which can be transmitted patient-to-environment and patient-to-patient, it can be useful to visualize the location of these infections to...

A common pattern among intervention implementations is that, in many cases, initial adoption and early signals of success are followed by dwindling participation, signals that the intervention is not achieving its goals, and abandonment of the intervention as it was originally conceived. The IMPActS Framework facilitates anticipation of misalignmen...

Deployments of artificial intelligence (AI) and machine learning (ML) in healthcare can both help and harm patient outcomes, amplifying calls for a human-centered approach to AI/ML development. This paper details one approach guided by three principles: (1) pursue human-machine team (HMT) performance, not algorithm performance, (2) build interpreta...

Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network, with regular coordination occurring across departmental boundaries. To represent these relationships, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS...

The Sterile Processing Department (SPD) in a hospital is responsible for decontamination and sterilization of used surgical instruments, and supplying trays of clean instruments to operating rooms (ORs) for upcoming surgeries. The SPD’s functioning is critical for patient safety, care quality, and efficiency in a health system. For instance, missed...

As machines increasingly behave more like active cognitive agents than passive tools, additional heuristics for supporting joint human-machine activity are urgently needed to complement existing usability heuristics. Despite the rich and extensive design guidance produced by forty years of cognitive systems engineering (CSE) and related fields, the...

This expert panel is the second of a two-panel series marking the 40 th anniversary of “Cognitive Systems Engineering: New Wine in New Bottles” by Hollnagel and Woods (1983) and, arguably, the beginning of Cognitive Systems Engineering (CSE). These experts were there at (or near) the beginning. They wrestled with the daunting issues of how to apply...

This expert panel is the first of a two-panel series marking the 40 th anniversary of “Cognitive Systems Engineering: New Wine in New Bottles” by Hollnagel and Woods (1983) and, arguably, the beginning of Cognitive Systems Engineering (CSE). These experts were there at (or near) the beginning, devising new methods, expanding and creating new theori...

From their common roots in Human Factors Engineering, Human-Centered Design and Cognitive Systems Engineering have drifted into distinct fields over the past three decades, each developing beneficial heuristics, design patterns, and evaluation methods for designing for individuals and teams, respectively. GeoHAI, a clinical decision support applica...

Abstraction hierarchies (AHs) are essential to a work domain analysis (WDA), the “most important and unique” phase of cognitive work analysis (CWA) (Vicente, 1999). Although AHs have been the industry standard for assessing and describing work systems for several decades, they are not without limitations (Vicente, 2002). We have developed an evolut...

In this panel, we present perspectives on how to incorporate fundamental concepts in resilience engineering into health care human-in-the-loop simulations. Our panelists have successfully implemented concepts, but also continue to experience challenges with convincing colleagues of the importance and value of doing so for simulations that have othe...

Description: Efficient, effective, and safe surgical services are a key financial and operational concern for many hospitals that are vital for patient care and wellbeing. Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network. En...

Explainable AI must simultaneously help people understand the world, the AI, and when the AI is misaligned to the world. We propose situated interpretation and data (SID) as a design technique to satisfy these requirements. We trained two machine learning algorithms, one transparent and one opaque, to predict future patient events that would requ...

After use, surgical instruments are sent to a Sterile Processing Department (SPD) or facility to be cleaned, reorganized, maintained, sterilized and stored for eventual re-use. Though essential for safe, efficient and cost-effective surgical delivery, the functions, trade-offs and outcomes within SPDs have rarely been studied. Patient safety incide...

The fields of Cognitive Engineering (CE) and Decision Making (DM) have made exceptional contributions to our understanding of complex sociotechnical systems; however, it can be difficult to apply research and findings from CE work to drive Systems Development (SD). This panel discussion examines the connective tissue between the worlds of CE resear...

Quantitative evaluations of human-machine teams (HMTs) are desperately needed to ensure technological implementations are helpful rather than harmful to overall system performance; however, as machines increasingly behave like active cognitive teammates, traditional evaluation strategies risk overestimating HMT capabilities. Areliable HMT evaluatio...

Traditional event exploration techniques in safety operations such as RCA and FMEA focus on developing explanations of specific events and in so doing, risk producing over-simplified highly linearized models of organizational behavior which are largely divorced from the realities of the work. Techniques such as FRAM, STAMP, and AcciMap, produce hig...

The COVID-19 pandemic has highlighted the need for increased and more dynamic access to healthcare resources. It has also revealed a novel complication to the effective delivery of health resources to communities, which we call the final inch problem. In our recent COVID-19 pop-up testing work with Columbus Public Health and the Ohio National Guard...

Despite the promise of a proactive approach to safety, a lack of resources and tangible measures have limited its implementation in organizations. We are exploring Joint Activity Monitoring (JAM) as one key component of a proactive safety program within the domain of infection prevention. However, despite a conceptual alignment to the requirements...

Determine if situated visual alarm displays can support machine fitness assessment (MFA), facilitating improved hazard recognition and alarm accuracy assessment in the presence of inaccurate alarms. Poor performance of opaque automation is more difficult to detect, which increases the likelihood of cascades resulting in overall system failure. MFA...

BACKGROUND The Flexible Adaptive Algorithmic Surveillance Testing (FAAST) program represents an innovative approach for detecting cases of infectious disease, deployed here to diagnose SARS-CoV-2. OBJECTIVE This study’s objective was to evaluate a Bayesian search algorithm to target hotspots of viral transmission in the community with the objectiv...

Background The Flexible Adaptive Algorithmic Surveillance Testing (FAAST) program represents an innovative approach for improving the detection of new cases of infectious disease; it is deployed here to screen and diagnose SARS-CoV-2. With the advent of treatment for COVID-19, finding individuals infected with SARS-CoV-2 is an urgent clinical and p...

As COVID-19 spread through the United States in 2020, states began to set up alert systems to inform policy decisions and serve as risk communication tools for the general public. Many of these systems included indicators based on an assessment of trends in reported cases. However, when cases are indexed by date of disease onset, reporting delays c...

Previous biomechanics studies suggest that higher cognitive mental workload when performing office computer tasks may increase the risk of MSDs among office workers. Cognitive workload can be interpreted in terms of task factors (e.g. task complexity and time pressure) and mental workload factors which include mental demand and mental effort. A lab...

Prior research has found that office workers may not be fully utilizing their chair's back support. This may be due in part to cognitive demands or other psychological stressors. Not using the back support may increase the muscle tension and contribute to muscle fatigue and discomfort. Historically, footrests have been advocated to address anthropo...

This panel discussion will examine the societal awareness of cognitive engineering today. Cognitive engineering celebrated its 30 th anniversary in 2018 at the HFES annual meeting. Still, some would say that cognitive engineering is not as well-known as it should be, and that it is applied in an ad hoc manner in the many high-stakes, high-risk tech...

Human factors/ergonomics is an applied discipline. As such, we question whether students are adequately prepared if they are not learning, at least in part, from instructors who have real-world experience applying human factors/ergonomics knowledge to practical design problems. A wide variety of other disciplines such as medicine, the building trad...

Objective Reduce nurse response time for emergency and high-priority alarms by increasing discriminability between emergency and all other alarms and suppressing redundant and likely false high-priority alarms in a secondary alarm notification system (SANS). Background Emergency alarms are the most urgent, requiring immediate action to address a d...

UNSTRUCTURED Advances in mobile application technologies offer opportunities for researchers to feasibly collect a large amount of patient data that were previously inaccessible through traditional clinical research methods. Data collected via mobile device allow for several advantages, such as the ability to continuously gather data outside of res...

Advances in mobile app technologies offer opportunities for researchers to feasibly collect a large amount of patient data that were previously inaccessible through traditional clinical research methods. Collection of data via mobile devices allows for several advantages, such as the ability to continuously gather data outside of research facilitie...

Background Specialized education is critical for optimal insulin pump use but is not widely utilized or accessible. We aimed to (1) test the usability and acceptability of A1Control, a simulation platform supporting insulin pump education, and (2) determine predictors of performance. Method Rural adult insulin pump users with type 1 diabetes (T1D)...

Even as vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) expands in the United States, cases will linger among unvaccinated individuals for at least the next year, allowing the spread of the coronavirus to continue in communities across the country. Detecting these infections, particularly asymptomatic ones, is critical...

Any clinical decision support (CDS) design project integrating computational technologies with clinician workflows will require the merging of multiple perspectives and fields of expertise in multidisciplinary teams. Much like the tools these teams aim to create, the team itself will need to continuously build, monitor, and repair a mutually benefi...

Objective Address the alarm problem by redesigning, reorganizing, and reprioritizing to better discriminate alarm sounds and displays in a hospital. Background Alarms in hospitals are frequently misunderstood, disregarded, and overridden. Method Discovery-oriented, intervention, and translational studies were conducted. Study objectives and measu...

As COVID-19 spread through the United States in 2020, states began to set up alert systems to inform policy decisions and serve as risk communication tools for the general public. Many of these systems, like in Ohio, included indicators based on an assessment of trends in reported cases. However, when cases are indexed by date of disease onset, rep...

Although the majority of effort in Artificial Intelligence (AI) ideation, design, and development seeks to optimize the AI as the primary method of optimizing overall system performance, the evidence is clear that for risk-critical work in high-complexity, high-uncertainty settings, it is the interactions between human and machines that must be pri...

With all of the research and investment dedicated to artificial intelligence and other automation technologies, there is a paucity of evaluation methods for how these technologies integrate into effective joint human-machine teams. Current evaluation methods, which largely were designed to measure performance of discrete representative tasks, provi...

We assess the relationship of active or passive presentation of Best Practice Advisories (BPAs) for hospital clinicians with compliance rates of recommended actions. We identify the design characteristics of alerts that can be used to assess the effectiveness of design choices with superior usability. Alerts in Electronic Health Records (EHRs) are...

We introduce the concept of machine fitness assessment, which is the process of correctly determining the degree of fit between a machine’s inferences on a specific world and the world itself. We describe its importance in complex, high-stakes worlds, including healthcare, and how it will be critically important to realize the potential of consumer...

Clinical decision support (CDS) has become an important component of all health settings. Despite a long history of research on their design and implementation, their use is still suboptimal. Unique characteristics of specific settings can require highlighting different features and design recommendations for CDS. This panel will focus on various p...

Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal...

Identifiability and perceived urgency were compared between two sets of alarms in a healthcare inpatient setting. One contained currently used alarms where possible, with new sounds added as needed. The other was designed together, and was more heterogenous, used timbre to encode intended similarities, and explicitly encoded intended urgency across...

Changes in alarm perception and response after prolonged daily exposure is not well studied due to the difficulties in setting up rigorous longitudinal studies in real work domains. A prime example of this is the absence of research studying how conveyed urgency and identifiability of auditory alarms change over time. We conducted a three-year stud...

Despite noticeable efforts over the last 30 years to try and resolve the clinical alarm problem, the utilization of opinion-based and nonscientific alarm interventions has resulted in ineffective solutions. The field of human factors offers many insights to permanently solving the burdens of this problem, however often times the field’s direct appl...

The overwhelming number of alarms on medical center floors are false and nonactionable. This leads to delay in alarm response and adverse events. Furthermore, current alarm technology does not have the ability to display patient trends, it only displays one isolated patient event. This paper focuses on describing the methods for creating novel visu...

Proposing a new solution implies an underlying prediction that the design will succeed in its direct purpose and will minimize unintended negative consequences. These consequences could happen immediately or slowly through a cascade of changes as the system adapts to the new work patterns that the solution requires. Human Factors Engineering (HFE)...

The reserved set of audible alarm signals embodied within the global medical device safety standard, IEC 60601-1-8, is known to be problematic and in need of updating. The current alarm signals are not only suboptimal, but there is also little evidence beyond learnability (which is known to be poor) that demonstrates their performance in realistic...

Background: There is little knowledge on how health care providers individually interpret and communicate early warning signs to other providers. The aim of the study described here was to qualitatively assess the similarities and differences in how nurses and physicians perceive early warning signs that potentially predict clinical decompensation...

Decompensation is a change in the overall ability to maintain physiological function in the presence of a stressor or disease. In the medical setting, clinicians utilize a wide range of technological tools to aid in their clinical decision making and to identify early warning signals for decompensation. However, many of these technologies have unde...

Critical Decision Method (CDM), a popular cognitive task analysis (CTA) method, is an in-depth retrospective interview that uses a historical non-routine incident to identify experts’ decision-making factors in complex socio-technical settings with high consequences for failure. However, it is challenging to use CDM to make comparisons, including t...

The continued development of Cognitive Systems Engineering (CSE) as both an academic discipline and as a field of practice requires constant and continuous reconsideration of the types of techniques used in research. Currently, all CSE research is conducted in one of three research settings: experimental/spartan laboratory studies, simulation/stage...

Across a wide variety of systems, from aviation and ground transportation to energy and financial systems, there continues to be a move toward introducing more powerful technological support. Research and practice have clearly demonstrated that, for these complex systems, human centered designs are critical, especially when anomalous scenarios aris...

As we design automated and autonomous products that make increasingly sophisticated inferences and stronger interjections in a wider range of settings, it is increasingly critical to conceptualize these products as cognitive agents, and not simply as passive tools. Our repertoire of heuristics and techniques must expand to explicitly support not on...

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical inte...

In 2013 NASA nearly drowned an astronaut during an Extravehicular Activity (EVA 23) on the International Space Station due to spacesuit water leakage. Indicators of trouble on the preceding EVA (22) were discounted. NASA carried out an investigation of the near miss event that is a sample of how root cause analysis is carried out in actual organiza...

Background: Hospitals have been slow to adopt guidelines from the American Heart Association (AHA) limiting the use of continuous cardiac monitoring for fear of missing important patient cardiac events. A new continuous cardiac monitoring policy was implemented at a tertiary-care hospital seeking to monitor only those patients who were clinically...

The aim of this study was to compare the effectiveness of two types of real-time decision support, an interrupting pop-up alert and a noninterrupting dynamically annotated visualization (DAV), in reducing clinically inappropriate diagnostic imaging orders. Alerts in electronic health record software are frequently disregarded due to high false-alar...

Although there are powerful incentives for creating alarm management programmes to reduce 'alarm fatigue', they do not provide guidance on how to reduce the likelihood that clinicians will disregard critical alarms. The literature cites numerous phenomena that contribute to alarm fatigue, although many of these, including total rate of alarms, are...

Purpose Cancer risks associated with radiation from CT procedures have recently received increased attention. An important question is whether the combined impact of CT volume and dose reduction strategies has reduced radiation exposure to adult patients undergoing CT examinations. The aim of this study was to determine differences in radiation exp...

Although there is a growing recognition of the importance of active communication behaviours from the incoming clinician receiving a patient handover, there are currently no agreed-upon measures to objectively describe those behaviours. This study sought to identify differences in incoming clinician communication behaviours across levels of clinica...

Numerous training interventions on patient handoffs have been initiated in the last few years, in part to meet new residency program accreditation requirements. Most of these programs focus on increasing the structure, comprehensiveness, and accuracy of the information conveyed by the outgoing clinician in either verbal or written format. Our team...

Handoff communication is one of the most typical clinical communication mechanisms in a healthcare setting to transfer information and responsibilities of the care provider. Handoff communication is varied across settings, provider type, and even within a clinical unit. Information technology has the capability to support handoff communication, wit...

Adoption of digital images for pathological specimens has been slower than adoption of digital images in radiology, despite a number of anticipated advantages for digital images in pathology. In this paper, we explore the factors that might explain this slower rate of adoption. Semi-structured interviews on barriers and facilitators to the adoption...

Understanding the strengths and weaknesses of a technology in the context of the distributed system in which it is working is critical to assessing and improving the performance of that system. Taking a systems approach requires knowledge about how all agents in a system work together to achieve the goals of that system. With these aims, the alerti...

Abstract: In order to reduce the impact of incidents causing harm to patients, we must detect and rectify them sooner. The system of patient care, which is comprised of a number of human and machine agents, must improve in order to better detect the causes of the incidents that in turn cause harm to patients. To effectively do this, all agents in t...