Collaborative Research: FW-HTF-RL: Collaborative Remote Physical Examination: Transforming Medical and Nursing Practice

自从FDA在COVID-19大流行期间和之后取消了对远程医疗的限制以来，远程远程医疗就诊已经增长到每五次患者-医生咨询中就有一次。这种远程医疗咨询带来了便利和可及性，特别是对老年人和最需要的农村社区。然而，远程医疗咨询通常仅限于视频和语音交流，通常通过智能手机的受限界面进行。对早期发现和诊断严重健康问题至关重要的身体检查，被简化为医生要求病人做自我检查。该项目将调查使远程医生能够与当地护士合作进行医疗体检的技术和做法。护士戴着触觉感应手套进行检查。医生通过触控式医疗座舱体验护士的感受，医生也从护士的角度看待检查。临床医师和护理研究人员；机械、工业和计算机工程师；心理学家将在这项研究中合作开发触摸传感和显示技术、交互方法和设计，以及此类远程体检所需的医疗/护理实践和培训。该小组将研究这种技术和实践的有效性，以及医生、护士和患者接受这种检查的程度。该小组还将研究如何在偏远和农村地区部署这项技术，在这些地区，患者可能无法获得医疗检查，特别是在需要专家的情况下。因此，本研究旨在实现对社会的更广泛影响，特别是对服务不足的社区，以及在传染病暴发期间，当前往集中医疗机构进行物理访问时存在风险。该项目旨在改变医生和护士的联合工作环境，同时解决通过远程医疗提供包容性医疗保健服务的社会需求。研究工作将远程体检作为一种合作实践，在多模式互动座舱中，近端护士/护理人员与远端医生之间佩戴触觉感应手套进行远程体检。这一框架面临的关键挑战是触觉感知是活跃的（这意味着如果一个人不能直接控制手指的运动，就很难解释触觉模式），触觉传感和显示技术的缺乏，以及对这种交互设计及其对医生、护士和患者这三种检查成员的影响缺乏理解。这些挑战激发了耳鼻喉检查领域的三个研究重点：1。考试座舱交互动力学与设计与方法2. 触觉传感和显示/驱动的触摸技术创新；和3。从感知和社会理解、认知负荷、技术接受、医疗/护理实践和培训的角度理解该方法的影响。所有的重点都涉及工程师、社会/人文科学家和临床/护理研究人员之间的跨学科合作。研究将采用迭代的设计-构建-测试-观察/反思方法。推力1将研究交互和试验台配置问题，并开发/维护一个研究试验台。推力2将开发技术，这些技术将被单独评估并集成到测试平台中。推力3将评估迭代设计和技术，并为医疗专业人员制定新的工作流程和培训。临床医师和护理研究人员将参与所有设计和评估阶段，以奠定研究基础，激励设计轨迹，并为医生和护士制定新的实践和培训方法。这些方法将依次与技术和试验台一起进行测试。一个咨询小组将指导研究工作，并为农村和偏远社区技术可行性的调查提供信息。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Since the FDA lifted restrictions on telemedicine during and after the COVID-19 pandemic, remote tele-health visits have grown to account for one of every five patient-physician consultations. Such telemedicine consultation has brought convenience and access, especially for the elderly and rural communities that are in the greatest need. Telemedicine consultations, however, are typically limited to video and voice exchanges, often through the constrained interface of a smartphone. Physical examinations, critical to early detection and diagnosis of serious health concerns, are reduced to the physician asking the patient to do a self-examination. The project will investigate technologies and practices that enable remote physicians to collaborate with nurses at local sites to perform medical physical examinations. The nurse wears touch sensing gloves to do the examination. The physician experiences what the nurse feels through a touch-enabled medical cockpit at which physician also sees the examination from the nurse’s perspective. Clinical physician and nursing researchers; mechanical, industrial, and computer engineers; and psychologists will collaborate on this research to develop the touch sensing and display technologies, the interaction methodologies and designs, and the medical/nursing practices and training needed for such remote physical examinations. The team will study the effectiveness of the technology and practices, and the degree to which physicians, nurses, and patients will accept such examinations. The team will also investigate how this technology may be deployed in remote and rural settings where patients may not otherwise have access to medical examinations, especially if a specialist is required. Hence, this research aims at realizing broader impacts on society, especially for underserved communities, and during infectious disease outbreaks when physical visits to centralized medical facilities carry risks.The project seeks to transform the allied work contexts of physicians and nurses while addressing the societal need of providing inclusive access to healthcare through telemedicine. The research efforts frame remote physical examination as a cooperative practice between a nurse/caregiver wearing tactile sensing gloves proximal to the patient with a distal physician at a multimodal interactive cockpit. Critical challenges to this framing are that tactile perception is active (meaning that it is difficult to interpret tactile patterns if one is not in direct control of the movement of one’s fingers), the paucity in haptic sensing and display technologies, and the lack of understanding of such interaction designs and their impacts on the members of the examination triad: the physician, nurse, and patient. These challenges motivate three research thrusts in the context of ear, nose, and throat examinations: 1. The interaction dynamics and design of examination cockpits and methodologies; 2. Touch technology innovations for haptic sensing and display/actuation; and 3. Understanding the impacts of the approach from the stand-points of perceptual and social understanding, cognitive load, technology acceptance, and medical/nursing practice and training. All thrusts involve interdisciplinary collaboration among engineers, social/humanities scientists, and clinical/nursing researchers. The research will take an iterative Design-Build-Test-Observe/Reflect approach. Thrust 1 will investigate interactive and testbed configuration issues and develop/maintain a research testbed. Thrust 2 will develop technologies that will be evaluated separately and integrated in the testbed. Thrust 3 will evaluate the iterative designs and technologies and develop new workflows and training for medical professionals. Clinical physician and nursing researchers will participate in all design and evaluation phases to ground the research, motivate design trajectories, and formulate new practice and training approaches for doctors and nurses. These methods will, in turn, be tested in conjunction with the technology and testbeds. An advisory team will guide the research and inform investigation of feasibility of the technology in rural and remote communities.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.