This document describes a research project to address information loss in rehabilitation therapy. Therapists have difficulty recording important details from therapy sessions because they cannot take notes during sessions. The project uses human-centered design principles to understand therapists' work processes and information needs. This includes observing therapists to identify challenges and testing prototype devices. The proposed solution is a wearable voice transcription device called "Say What?" that allows therapists to record, tag, and share session notes and photos in real-time.

1. Research and Demonstration Project
Institute of Design
Say What?
H e l p i n g r e h a b i l i t a t i o n p r o f e s s i o n a l s r e m e m b e r p a t i e n t c o n v e r s a t i o n s
Therapists are reluctant to take notes during the
therapy session, relying on memory to make
progress notes days later.
Such instances of "Information Loss" – the inability
to gather, communicate, and access information
– contribute to the high cost of therapy.
O B S E R V A T I O N S – I N F O R M AT I O N L O S S
Rehabilitation is a hands-on profession that requires a high
level of mobility and patient interaction. This means that
therapists are generally unable to take notes during the
therapy session, relying on memory to record patient progress
notes long afterward. This is one example of "Information
Loss" that occurs during the daily activities of therapists.
Therapists’ daily activities fall into three categories: access,
gather, and communicate (see Figure 2). Each category has its
own examples of Information Loss:
Access
Therapists spend a lot of time searching for patient
information. It is often trapped in private files or
checked out by another caregiver.
Gather
Information gathered during the patient session is
often lost before it can be recorded because
therapists cannot or will not take notes during the
session.
Communicate
Health providers tend to communicate through the
patient rather than with each other directly. This
practice results in poor communication and
expensive, lower quality care.
P R O B L E M – E X P E N S I V E , Q U A L I T A T I V E T H E R A P Y
Why is Information Loss a problem? Rehabilitation is under
great pressure from managed care to reduce costs, document
procedures, and quantify patient improvement. The
information needed to do this already exists, but it cannot be
used because it is forgotten before it is written down, difficult
to decipher, or impossible to access.
Therapists need a device that will prevent Information Loss by
helping them gather, access, and communicate information to
the rest of the patient care team. With such a device,
therapists can then quantify their procedures and increase the
quality of patient care.
S O L U T I O N – S A Y W H A T ?
Say What? is a watch-sized computer that provides real-time
digital transcription of patient-therapist conversations. Say
What? allows the therapist to “tag” important parts of the
record with the touch of a button, supplement it with digital
photos, and transmit the data into the hospital data network.
Qualitative information gathered during these sessions –
patient condition, medical history, treatment efficacy – can
then become instantly available to the rest of the medical
team.
Figure 1. Therapist-patient conversation.
Figure 2. Activity revolves around the therapy session.
John Milanski
G a t h e rA c c e s s
C o m m u n i c a t e

2. Research and Demonstration Project
Institute of Design
John Milanski
System Solution
A w e a r a b l e t r a n s c r i p t i o n d e v i c e f o r r e h a b i l i t a t i o n p r o f e s s i o n a l s
Display watch
Records and displays indexed transcript.
Also functions as a normal watch and a
viewfinder for camera.
• curved 2" by 2" touch-sensitive, graphic display
• directional microphone
• wide, rubberized wrist strap
• mode button
• message buzzer
• battery compartment
• random access memory
• voice recognition software
• 2 attachment ports for camera, transmitter, and/or
flash memory units
Flash memory unit
Stores indexed transcript and up to 24
snapshots (6 per session). Useful when
not in range of a wireless network.
• 12 megabyte flash memory chip
• attachment port (I/O and power)
RF transmitter unit
Instantly sends transcript and pictures to
hospital wireless network, keeping
everyone informed of patient progress.
• spread spectrum wireless network card
(transmitter/receiver)
• short range antenna (<500 feet)
• attachment port (I/O and power)
Digital camera unit
Allows therapist to document progress
and create visual exercise plans for
patients.
• 1/3" CCD detector
• 1" lens
• shutter button
• on/off light
• attachment port (I/O and power)
Watch interface
Color coding is used to separate the
therapist and patient’s portions of the
transcript.
• green text (therapist)
• black text (patient or other)
• red text (system-generated such as index tags,
picture tags, and time stamps)
Say What? allows therapists to automatically
capture and distribute information during therapy
sessions.

3. Research and Demonstration Project
Institute of Design
John Milanski
Scenario of Use
T h e r a p i s t s b e n e f i t f r o m u s i n g S a y W h a t ?
G A T H E R
“Who am I seeing this morning?” Don, a physical therapist at
a large hospital, is running late. He doesn’t have time to read
through the patient’s file before his first session. But since the
hospital replaced his beeper with a Say What? watch, Don
always his the big facts with him: name, age, and diagnosis.
Walking into the gym, Don sees that his first patient has
already started her program. “Hi, Mrs. Morrison!” Before he
had Say What?, Don had a hard time remembering every
patient’s name. He taps the Say What? screen twice to start
recording a new session. As they talk, the Say What?
transcript scrolls down the screen. That will be useful later
when he writes up the progress notes.
“When did these sores on your feet show up?” Don taps the
screen of the watch to "tag" that portion of the transcript;
he’ll want to remember that later. Don takes a snapshot for
Mrs. Morrison’s home exercise program using the built-in
camera. He also takes one of her foot. The pictures are
transmitted into her patient record.
C O M M U N I C AT E
A vibration from his watch alerts Don of an incoming
message. Gone are the days of those annoying intercom
messages pagers. Mrs. Morrison’s doctor has already seen the
picture of the sore foot and would like to discuss it with Don
between sessions. As she finishes her program, Mrs. Morrison
asks if she’ll be getting a wheelchair when she goes home next
week. Don taps his watch to remind himself and heads
upstairs to treat a patient at bedside.
“Hey, Don! Hold up a second!” It’s Mrs. Morrison’s doctor.
He’s a little concerned about that foot. They review the audio
transcript taken during the morning session using Say What?,
jumping to the tag about her sore foot. Maybe an anti-
inflammatory would help. “Good idea,” says Don as he taps
the watch three times to record the last 10 seconds of this ad-
hoc conversation. Don continues on his morning rounds.
A C C E S S
By 5pm Don has had a long day. After 6 patient sessions and
3 meetings, he sits down at his desk to write patient progress
notes; he still doesn’t have a personal computer. Mrs.
Morrison – 9 am. What did he promise her? Say What? comes
to the rescue. Switching the display from “watch mode” to
“review mode,” Don jumps to Mrs. Morrison’s session. He
jumps through the record tags, making notes on the things he
marked during the session. A red tag near the bottom of the
record reminds him. “Right... I promised her a wheelchair! I
can’t believe I used to rely on my memory to make progress
notes. Now what did her doctor ask me to do...”
Therapists do not
need to worry about
forgetting facts from
the session.
No more difficulty
finding patient files.
Making progress
notes long after the
session is much
easier.

4. Research and Demonstration Project
Institute of Design
John Milanski
C O N T E X T : S E C O N D A R Y R E S E A R C H
To create products or systems that people want, you must
fully understand the people who will use them. I started by
reading, studying the history of therapy, trends in the field,
and technologies that could be used to help therapists. Then I
talked with therapists, administrators, patients, and doctors.
Human-centered Development Process
Traditional product development focuses only on how to
make a product – the artifact. This approach often results in
things no one wants. Marketing research goes further, asking
users what they want in order to generate better ideas. But
what people say and what they do can be very different.
Human-centered Design (HCD) looks at what people do.
Watching people in the context of their environment results in
better insights and user-centered rather than designer-centered
ideas. By focusing on behavior, HCD produces consistently
better artifacts – things that customers will buy.
I N S I G H T : F I E L D O B S E R V A T I O N S
Human-centered designers immerse themselves in the users’
environment. Simple observations can reveal major problems.
I observed therapists at two sites: the Bowman Center for the
Elderly and the University of Illinois Chicago Medical Center.
Using video ethnography and analysis techniques, I began to
see a major problem – "Information Loss."
I D E A : S K E T C H I N G
Designers will always create based on their personal experience
– what they know. Behavioral observation ensures that
solutions are based on user needs, not just designer whims.
Dozens of ideas – environmental, product, and system – were
sketched during the course of the project. Scenarios were also
created to convey the concepts during presentations.
A R T I FA C T : B E H AV I O R A L P R O T O T Y P E S
You’ll never know if an idea works until you try it. Human-
centered designers create behavioral (“works-like”) and
conceptual (“looks-like”) prototypes and ask users to work
with them. One set of behavioral prototypes tested various
display sizes. Therapists wore them as they did their jobs.
C O N C E P T U A L P R O T O T Y P E S
Looks-like models are especially useful to determine form and
size. But they must be made quickly and iterated upon. In one
iteration, I tested how a display, transmitter, and camera might
come together in the final design.
What to make?Why make it?
How to make it?Who is it for?