3D Visualization as a Communicative Aid in Pharmaceutical Advice-Giving over Distance

Background Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information. Objective To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker. Methods We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies’ call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features. Results In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In the second study, directly comparing AssistancePlus and the telephone, AssistancePlus was judged positively for ease of communication (P = .001), personal contact (P = .001), explanatory power (P < .001), and efficiency (P < .001). Participants in both studies said that they would welcome this type of service as an alternative to the telephone and to face-to-face interaction when a physical meeting is not possible or not convenient. However, although AssistancePlus was considered as easy to use as the telephone, they would choose AssistancePlus over the telephone only when the complexity of the question demanded the higher level of expressiveness it offers. For simpler questions, a simpler service was preferred. Conclusions 3D visualization paired with video conferencing can be useful for advice-giving over distance, specifically for issues that require a higher level of communicative expressiveness than the telephone can offer. 3D-supported advice-giving can increase the range of issues that can be handled over distance and thus improve access to product information.

The 3D content is embedded on an ordinary web page using a custom 3D player. The 3D player comes in two versions with different features, but with the same function and purpose: to present a virtual version of a pharmaceutical product that can be used to present and demonstrate function and handling of said product. Both versions require very little bandwidth with small initial download sizes and marginal bandwidth demands for the data exchanged to keep advisor-and advice-seeker versions synchronised. Shockwave technology was used for the 3D content. This does limit the accessibility of the service somewhat. Only about 50% of web users have this plug-in pre-installed (47%, June 2010). However, recent advances in Flash technology make it possible to achieve the same functionality using Flash only, making the service available to practically all web users (99%, June 2010).

3D player, version I
The first version of the 3D player is shown in figure 1 displaying an asthma inhaler. The buttons below the 3D model are used to rotate, pan and zoom. When either party uses the controls, the same action is performed on the other side, thereby synchronising their views of the 3D model. Typically it will be the advisor who controls the model, but the advice-seeker has access to the same controls (and can see how they are used by tracking the advisor's cursor movements when he/she uses them).

Figure 1.
Close-ups of the 3D controls for the first version of the 3D player (displaying an asthma inhaler) and incoming and outgoing video streams.

3D player, version II
The second version of the 3D player (see figure 2) uses a click-and-drag system to control rotation, zoom and pan with left-click and horizontal drag for rotation around the yaxis, left-click and vertical drag for zoom, and right-click-and-drag for pan. X-and z-axis rotation was not supported in this version. To make it possible for the advisor to demonstrate the click-and-drag functionality an icon is shown every time the advisor performs a click-anddrag action showing what button was pressed and in which direction the mouse was moved.
3D animation is used to playback series of actions in a video-like sequence. The animation sequences are subdivided into named episodes and are navigated using the timeline below the 3D model, pressing play to start playback of the current episode. Rotation, zoom and pan can be performed independently of the animation playback, i.e. not only when the sequence is paused, but also during playback. Pre-recorded animation was chosen over having a fully interactive model with moveable parts because it allows content to be standardised to a greater degree and it is much easier to control for the user.
The timeline controls are different for the advisor and advice-seeker (see close-ups in figure 3). The interface for the advice-seeker has been kept simple with only play/pause and rewind controls. The playhead can also be dragged to skim through the animation content. The advisor has a more advanced interface with additional controls that add flexibility to the way the animations can be controlled including a drop-down section menu, thumbnail preview images, timeline scrolling and helper notes. The features that are shared by the advice-seeker and the advisor (play/pause and rewind) are in the same position in both interfaces so that the advisor can demonstrate their function by using them.