Date of Award

December 2020

Document Type


Degree Name

Doctor of Philosophy (PhD)


Industrial Engineering

Committee Member

Anand Gramopadhye

Committee Member

David Neyens

Committee Member

Anjali Joseph


Telemedicine, the use of communications technology to connect patients to medical professionals remotely, can be applied to a variety of settings, for example connecting older adults with their physicians from home, specialists to rural county hospitals or patients to physicians for emergency care. This dissertation focuses on the use of telemedicine for ambulance-based care for stroke patients, including how the design of this system impacts caregivers. The initial study investigated both the usability of a telemedicine system implemented in ambulances for stroke care as well as the possibility of human error when using it. The heuristic evaluation of usability violations found several issues that needed to be addressed, including the lack of clarity in the tab structure and the lack of suggestions for correct data inputs. Similarly, the analysis of possible errors also determined several issues with this system, with the two most common being miscommunication and difficulty in locating data input or selecting an incorrect option. Several remediations strategies were recommended based on this study: improvement of the labelling of the tab structure, consistent formatting, rigid or suggested formatting for data input, automation of task structure and camera movement, and audio/visual improvements to support communication. The second study investigated the experience of caregivers with the ambulance-based stroke telemedicine system, focusing on the support of the distributed cognition of the caregiving teams. Teams comprised of a neurologist, nurse, and paramedic were observed conducting 13 simulated stroke consults, after which each caregiver completed a survey on the perceived workload, usability, and teamwork during the session and an interview about their experience with the telemedicine system. In total, thirty-nine caregivers were interviewed, and the data collected were analyzed for themes. The themes that emerged identified such barriers to and facilitators for using telemedicine for ambulance-based stroke caregiving as training and experience, technical difficulty barriers, and patient care and efficiency improvement facilitators. The findings from this study resulted in design recommendations for supporting healthcare professionals during caregiving, especially ones that support their distributed cognition when using ambulance-based telemedicine for stroke care. The final study evaluated the effect of design recommendations implemented in a new telemedicine system on the neurologist’s workload, situation awareness, and task performance in addition to evaluating the perceived usability of this new design and its support of distributed cognition. For this study based on a within-subjects experimental design, 20 neurologists completed simulated stroke assessments using both the new design and the design investigated in the two previous studies and evaluated each system. Overall, the results found that the neurologists experienced a lower workload, performed better in their task, exhibited higher situation awareness, and rated usability highly in the new design. In addition, most participants thought that the new design better supported distributed cognition principles and preferred the new system for ambulance-based stroke consults.



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