Table 3.

Cardiac rehabilitation patient and clinician experiences during usability-testing and design solutions (Step 3).

Intervention Component (stakeholder)	Usability Themes	Codes & Examples	Design Solutions & Examples
RPM devices (Patient)	Ease of using the RPM devices	Capability, comfort “Using the pulse oximeter while on the bike was hard” Visibility Patient struggled to see screen (of the tablet) while on the bike Navigation [the patient] didn’t know that pressing the Philips icon opened the tablet and didn’t know the PIN. [the patient] accidently pressed the mute button on tablet	Onboarding Support Provide binder with written instructions on how to use RPM devices In-person onboarding session to (1) introduce RPM devices, (2) demonstrate how to use RPM devices, and (3) have patient practice using the RPM devices
	Technology disruptions	Wi-Fi/Cellular/Blue-tooth connectivity The [pulse oximeter measurements] weren’t syncing. At this point [the patient] verbally reported [his heart rate] The [pulse oximeter measurements] weren’t populating in real-time. [the patient] removed it and then replaced it on his finger. [the patient] said “[the clinician] froze…”	Alternative remote monitoring methods Verbally report vitals via video call Manually enter vitals into tablet Onboarding Support Remote onboarding session to confirm RPM devices and features (e.g., video call audio, measurements, surveys) are working from home-based environment
Exercise (Patient)	Comfort with ability to perform/use exercise modality and equipment	Capability, Comfort “[the bike] feels different than the treadmill” “…exercise on the bike was harder, but in a good way.” [the clinician] spent 3-4 minutes of [the CR session] helping the patient adjust [the bike] Safety “[the patient] wants to make sure [the clinicians] could see him [while exercising on the bike]” “[the patient] needs to make sure he has something sturdy to hold onto [during strength training]”	Onboarding Support Provide binder with written instructions on how to setup and adjust the exercise equipment In-person onboarding session to (1) introduce exercise equipment and modality, (2) demonstrate how to use exercise equipment, and (3) have patient practice using the exercise equipment Safety protocol Provider patient with fully supervised remote sessions at the beginning of the program to ensure safety Provide patient with outline of safety protocol Pre- and Post-exercise Surveys Confirm patient location in the case of an emergency Confirm patient well-being Confirm exercise is completed
	Flexibility with exercise experience	Adaptations/Flexibility The clinician allowed a patient to try interval training on the bike. When asked “what did you like the most” the patient responded, “interval training” The clinician stated “…give flexibility based on patient needs” The clinician discussed “… importance of tailoring exercise to current energy levels.”	Flexibility in programming based on exercise progression The rating of perceived exertion target will vary week to week depending on the patient’s progression throughout the program The assigned weight (lbs) and number of repetitions per exercise will vary week to week depending on the patient’s progression throughout the program
eCC platform (Clinician)	Ease of using the telehealth platform to remotely monitor patient	Visibility During Video Visit: “it’s easy to view the patient with the eCC video call platform” When starting the Video Visit: “There’s no way to tell [in the eCC platform] that someone is waiting for you on the video call” Navigation When monitoring the patient: The clinician couldn’t toggle between the “video visit” tab and “trends” tab in the eCC platform.	Revise eCC feature layout and interface Split “trends” and “Video Call” feature on computer screen to allow simultaneous visibility of vitals and patient Training Provide CR clinicians with formal Philips Healthcare training on how to use eCC platform to enroll and monitor patients
	Technology disruptions	Wi-Fi/Cellular/Blue-tooth connectivity “..,syncing was an issue between pulse oximeter, cuff, and eCC platform…[clinician] had to enter information manually” “…there seemed to be a longer delay between audio and video… there may be an issue with Wi-Fi strength” “[the pulse oximeter reading] seems slower today… want to [verbally] read me the numbers” The clinician had to enter blood pressure measurement into eCC manually	Technical support Philips Healthcare representative to troubleshoot issues Alternative remote monitoring methods Ask patient to verbally report vitals via video call Manually enter vitals into eCC
	Confidence in using telehealth platform to safely monitor patient	Confidence in technology “The [blood pressure and pulse oximeter] readings [the clinicians] got were pretty accurate” “The BP seemed to work more accurately” “The pulse oximeter reading was fine…” Safety concerns Clinician instructed the patient that “more weight isn’t always better… we want to prevent injury” After the survey was completed- [the clinician] was waiting for the blood pressure measurement to come in [to the eCC platform], but it never did. The clinician said: “I have no idea what he’s doing” [Clinician] cannot see [the patients] feet to determine if wearing appropriate footwear.	Add safety check features to eCC protocol Surveys to confirm patient location Intervention rules to flag abnormal resting vitals Verbally confirm patient is wearing appropriate attire
General Programming (Patient and Clinician)	Satisfaction	Positive comments/feedback The clinicians said that the patient “loved [the home-based model] and was ecstatic [with his experience].” The clinicians said that the patient “seem to like it… they like the equipment” The clinician said “all things considered, it was good” At the end of the user-testing sessions, the patient said “thank you again for everything and for the devices”	Satisfaction assessment Administer satisfaction surveys on tablet as part of CR session assessment
	Programming	Process/workflow (patient) “[the patient] thinks the model works” The patient felt the “roll out was pretty smooth” “The process itself [the patient] really loved” Process/workflow (clinician) “…the pulse oximeter reading was fine and the dry run session was seamless” “(the session) was a bit of a learning curve with the patient- but they were happy to go through it”	Kept foundational outline of measurements and surveys outlined in the home-based CR prototype Sequence: resting vitals/surveys, aerobic exercise, strength training, post-exercise vitals/surveys

Notes: CR= cardiac rehabilitation, eCC= eCareCoordinator, RPM= remote patient monitoring.