So what’s a good solution?

As a doctor working in an Emergency Department and seeing patients (sic: people) with largely preventable conditions/diseases alot of the time, I really like the idea of personalised medicine and involving patients and empowering them to take control of their healthcare. Brushing teeth is an excellent example that I wouldn’t have thought of before. However, I would echo some of the previous comments on the dangers/naivety of providing some of this info. Lab results are only relevant when married to the clinical information (i.e. the pateint’s history, symptoms, past history and examination findings). This information is far more important and lab tests should only then be done to confirm or rule out your findings from the clinical info. Therefore providing patient information printouts based on the lab results alone is foolish and dangerous.

Also the speaker makes a good point that fear does not work in health education/promotion. I think that giving a patient a printout saying that you have 15% (or whatever) chance of getting prostate cancer/breast cancer/arthritis/whatever is probably one of the most fear-inducing things you can do to a patient. Especially considering it is almost impossible to generate that kind of accurate prediction of any condition based on a blood test or even group of blood tests.

The speaker also says that they have used colour (as if to say “Duh why hasn’t this been done before”). The dept I work in has been told by hospital management to stop ordering more paper as the hospital acn’t afford it. We have had to totally rationalise the amt we are printing and handing out. I know this happens alot of places in the public health system. So we have barely enough paper to put in printers let alone colour printers and the cartridges to keep them running. he may be aiming his comments at the lab companies that make all that money but I feel his talk doesn’t take into account the practicalities that exist in an ED / other healthcare settings

John Cronin (Posted 3 years ago) on Thomas Goetz’s TEDMED talk titled: It’s time to redesign medical data.

I found this comment as a perfect example of the real challenge on Information Design in Healthcare still Today.

We have to think and design for real practice with its context, its users, its information quality. Colour sometimes is a luxury and ranges, percentages and reference values could mislead instead of giving support.

 

Healthcare start-ups

The path to the well planned and designed health services of the future goes through many professions from the medical to architecture to interior design to UI and UX expertise to app development, industrial design and landscaping.

We may live in an increasibly ‘virtual world’ of connected devices and experiences, yet there are still innovators, entrepreneurs and startups focused on building the bricks and mortar of tomorrow’s healthcare experiences.

Inside Britain’s busiest A&E – video

Inside Britain’s busiest A&E – video

Selectores de género

littlebigdetails:

Instructables – Offers a variety of gender options when signing up for an account

/via Vonn

Interesante detalle. En el ámbito clínico este tipo de datos es punto de controversia. Por un lado hay usuarios para los que este dato al no ser clínicamente relevante desprecian su utilidad, por otra parte ciertos estándares obligan a especificarlo de acuerdo a un respeto a la identidad de género del paciente, para otros, el dato es clínicamente relevante cuando se ajusta a la realidad fisiológica del paciente.

La solución: diferenciar entre Sexo (Biológico) y Género (Identidad), puesto que tenemos que seguir educando a la ciencia y a la conciencia de que las diferencias existen porque son relevantes y que deben ser las personas (los usuarios en este caso) los que interpreten los datos y decidan qué significan para ellos.

Relacionado con la interpretación o cómputo de datos clínicos y la forma en que se muestran encontramos también la ocurrencia de riesgos clínicos.

Performance vs Clinical Risk

The complexity of creating usable solutions in healthcare 

The productivity that a user can get with a tool depends, among other things, on the usability of the interface used to work. In the context of healthcare applications, the interface design solutions can supose in certain situations a number of hazards that result in clinical risk. A productive solution is incompatible with clinical risk free solution? In an effort to provide a broad view of the problems, in this article we offer solutions addressing the most common design patterns used to increase productivity in user interfaces.

For the analysis, we propose two specific usage modes: data entry (interaction with the system) and data output (representation of information and data management interactions) in a health system.

Data Entry (garbage-in)

Help to complete the information

  • Problem: Help may be decontextualized
  • Solution: The help that is offered to the user should not contextualize only normal activity but the content and the information required.

Autocomplete

  • Problem:The autocomplete action may end up in the selection of an unwanted value
  • Solution: Actions should allow the end user to overwrite the value and warn you that you are entering a value outside the catalog.

Validation and error feedback

  • Problem: The errors reported are partial
  • Solution: Inform the user about the possible existence of more errors and the need for revision

Defaults

  • Problem: Default values ​​may be based on faulty assumptions
  • Solution: Report existing defaults and even offer the possibility of removing.

Shortcuts

  • Problem: Loss of visual feedback on what you are doing.
  • Solution: Inform the user with a message of the action to be executed.

Commands (actions, undo, massive actions)

  • Problem: The command may cause a failure in the integrity of the data.
  • Solution: Run command to complete mock confirmation by the user and inform the local view of the result.

Data Output (garbage-out)

Indexes and data summaries

  • Problem: The data are not updated
  • Solution: Inform the user of the last update of the data and provide the ability to update it in context.

Search

  • Problem: The search is hidding results.
  • Solution: Reporting results of existence visible and hidden results either paging issues as matching with the search.

Notifications

  • Problem: Notifications are not prioritized.
  • Solution: Offer a prioritization system and allow customization of alert priority one by one or by type.

Alerts

  • Problem: It was considered an alert something that is not.
  • Solution: Associate clinical alerts to static domains consistently identifiable
  • Problem: An unintuituve icon has been associated to an alert
  • Solution: Tagged alerts with short terms  and / or group them under predefined domains

The healthcare scenario

We should note that in the health context, the tasks that a user must perform that require a computer system can account for up to 30% of their time and therefore there is a clear need to improve the efficiency and productivity in their daily use.

At the same time it is important to consider that during the working day there are many and frequent changes of tasks, activities and contexts, for instance, a doctor in the emergency room in a 10’ frame has been triaging two patients, be consulted by the nursing team 3 times on matters of different nature, it has been lifted from his seat 6 times for different tests of material, information, etc.

Therefore, although the task itself requires a high concentration effort, attention span is reduced by the high number of interruptions. In this context, the user controls what he does but is subjected to a high load of stress and distractions in almost any of its activities. A medical error could pose a risk to the health of their patients.

From the most simplified view of a computer system as a mere representation of the information model, the most basic interface is build up with forms to fill available data and views for display them. Even with this formula, the application would not be free of clinical risks. Any solution applicable for the simplest interface is not incompatible with richer and more usable interfaces. For this we consider that not only is not incompatible to have solutions which can enhance productivity and usability, but it is also necessary.

References

[es] Productividad vs Riesgo Clínico

La dificultad de crear soluciones usables en sanidad

La productividad que un usuario puede conseguir con una herramienta depende, entre muchas otras cosas, de la usabilidad de la interfaz con la que trabaje. En el contexto de las aplicaciones sanitarias, las soluciones de diseño de interfaz que se aportan pueden llegar a suponer en determinadas ocasiones una serie de peligros que deriven en riesgos clínicos. ¿Es incompatible una solución productiva con una solución libre de riesgos clínicos? Con el ánimo de ofrecer una visión amplia de las problemáticas, en este artículo ofrecemos posibles soluciones atendiendo a los patrones de diseño más habituales usados para aumentar la productividad en las interfaces de usuario.

Para el análisis se proponen dos modos de uso concretos: la entrada de datos (interacción contra el sistema) y la salida de datos(representación de información e interacciones de manejo de datos) en un sistema sanitario.

Entrada de datos (garbage-in)

Ayuda para completar la información

  • Problema: La ayuda puede estar descontextualizada
  • Solución: La ayuda que se ofrezca al usuario no debe estar sólo contextualizada a su actividad habitual sino al contenido y la información que se requiere.

Autocompletar

  • Problema: La acción para autocompletar puede terminar en la selección de un valor no deseado
  • Solución: Las acciones de autocompletar deben permitir al usuario final sobrescribir el valor y advertirlo de que está introduciendo un valor fuera del catálogo

Informar de errores de validación

  • Problema: Los errores de los que se informan son parciales
  • Solución: Informar al usuario de la posible existencia de más errores y de la necesidad de su revisión

Opciones por defecto

  • Problema: Los valores por defecto pueden estar basados en suposiciones erróneas
  • Solución: Informar de que existen valores por defecto e incluso ofrecer la posibilidad de eliminarlos

Atajos de teclado

  • Problema: Pérdida de feedback visual sobre lo que se está haciendo
  • Solución: Informar al usuario mediante un mensaje de la acción que se va ejecutar

Comandos (lanzar acciones, deshacer, acciones masivas)

  • Problema: El comando puede provocar un fallo en la integridad de los datos
  • Solución: Ejecutar comando en modo simulado hasta la completa confirmación por parte del usuario e informar de la vista local del resultado

Salida de datos (garbage-out)

Resumen de datos e índices

  • Problema: Los datos no están actualizados
  • Solución: informar al usuario de la última actualización de los datos y ofrecer la posibilidad de actualizarlos in-situ

Búsqueda

  • Problema: La búsqueda oculta resultados
  • Solución: Informar de los resultados visibles y de la existencia de resultados ocultos ya sea por cuestiones de paginación como de coincidencia con la búsqueda

Notificaciones

  • Problema: Las notificaciones no están priorizadas
  • Solución: Ofrecer un sistema de priorización y permitir la personalización de la prioridad de las alertas una a una o por tipologías

Alertas

  • Problema: Se ha considerado una alerta algo que no lo es
  • Solución: Asociar las alertas a dominios clínicos estáticos e identificables de forma consistente
  • Problema: Se ha asociado un icono poco intuitivo a una alerta
  • Solución: Etiquetar las alertas con términos cortos y/o agruparlas bajo dominios predefinidos

El escenario sanitario

Debemos tener en cuenta que en el contexto sanitario, las tareas que un usuario debe realizar que requieran de un sistema informático pueden llegar a suponer hasta el 30% de su tiempo y por tanto existe una necesidad evidente de mejorar la eficiencia y productividad en su uso diario. Al mismo tiempo es importante considerar que durante la jornada laboral son múltiples y muy frecuentes los cambios de tareas, actividades y contextos, por ejemplo, un médico en la sala de urgencias en un intervalo de 10’ ha podido realizar el Triaje a dos pacientes, ser consultado por el equipo de enfermería 3 veces sobre asuntos de diferentes naturaleza, se ha podido levantar de su asiento 6 veces para diferentes comprobaciones de material, información, etc. Por lo tanto, si bien la propia tarea favorece y exige una alta capacidad de concentración, la capacidad de atención se reduce por el alto número de interrupciones. En este contexto, el usuario controla lo que hace pero está sometido a una carga alta de estrés y distracciones en casi cualquiera de sus actividades. Un error médico podría suponer un riesgo para la salud de sus pacientes.

Desde la visión más simplificada de un sistema informático como mera representación del modelo de información, la interfaz básica más directa consiste en la disposición de formularios para rellenar datos y vistas para mostrarlos. Incluso con ésta fórmula, la aplicación no estaría exentas de riesgos clínicos. Cualquier solución aplicable para la interfaz más sencilla no es incompatible con interfaces más ricas y usables. Por esto consideramos que no sólo no es incompatible ofrecer soluciones que aumenten la productividad y la usabilidad, sino que además es necesario.

Referencias

Facebook-like EMR (Part II)

Facebook-like EMR Hi-Fi

In my previous post, I published a simple mock-up to introduce the idea of an Electronic Medical Record looking like Facebook social network.

We initially saw how taking advantage of this website could help to contribute for a better tool for doctors, nurses, and patients.

In this second part of the exercise, we can see as well the hi-fi prototype where the visual design will allow us to make new musings.

Top Bar

Notifications will lead the activity of users under specific contexts.This space would be used in a similar way, so we would expect to see there:

  • New patient admissions
  • New results
  • Prescription modifications
  • Activity of another physicians on my patient’s profile
  • Events notifications
  • Automatic clinical alerts

The search box will index patients, activities and tasks. This way, finiding a patient grouped under a particular list or jumping to the a functional module will be quick and simple.

Patient Banner

The patient banner is now taking a considerable amount of space: Is is really needed? Well, If we follow the idea of having patients accessing to their own profiles, it would be nice to have this personlizable. This way, patients would create a human connection between them and their clinical staff. I think the balance between the clarity of a customizable banner and the used space make of this a valuable area.

Thumbnail area will show the teaser of each content type (clinical domains). This way the patient banner won’t be only an area to ensure the patient identification but to highñight a meaninful set of content related with the latest activity of the patient.

What about the ‘Like’ buttton?

What would ‘Like’ mean in a clinical context? It might be pretty controversial saying ‘Like’ under a patient diagnosis. However, there are other social actions which could provide a helpful support to the care activity.

  • Notify
  • Comments
  • Share

Notifications could be triggered automatically by events or due to a professional opinion. A notification doesn’t express an emotion, but a objective idea. It’s not a bad idea having a mechanism to communicate subjective feelings but here we shouldn’t make an error by this Facebook ‘positive-thinking’.

About the prototype

The opinions, ideas and suggestions shared in this article and in the ‘Facebook-like EMR (Part I)’ one only represent me (Carmel Hassan).

This prototype has been made adapting the icons of Jigsoar. The shown data is fake and the girl in the picture is me! I know I know…

Facebook-like EMR (Part I)

Facebook-like EMR (Part II)

In 2008, Bob Watcher wrote an article called “Why the medical record needs to become more like Facebook” where lay down the idea of having the social network as the mirror for a new Electronic Medical Record (EMR) User Experience (UX). A collaboration and social framework to provide better care to patients while keeping useful information between physicians and nurses.

He was not the only one; already in 2007, Robert Nadler established a high-level model remarking out the core functionalities that it could have EMR software. However, it was not intended to get only a Facebook-like UI but a real social site to connect Patients and Doctors.

The idea is not new; many authors – doctors and software engineers – have continued talking about this idea with no final proposal.

After the latest Facebook re-design I don’t know if those authors would still maintain the same opinion about this topic, anyway I do think it’s a very very interesting approach even assuming any usability issue that Facebook could have. So here are my two cents.

A Design Proposal

Users & Profiles

If a clinical solution would need to completely work like Facebook, every user (physician, nurse, etc.) would have their own user porfile. However, the analysis of having a EMR looking like Facebook timeline suggests that the profile page is planned to show only patient data. Why would we need to see a nurse profile, then?

Following this idea, the Home page would be reserved for (primary) users and the Profile pages for showing the electronic medical records of patients (secondary users).

A possible extension would be allowing the access to the EMRz by Patients, so they could also check their own EMR online by themselves. In this case, we could consider them as secondary users not as part of the network community, but just to contribute to their own medical history and keep a direct communication between them and they’re care providers.

Social network

Social activity will be generated by clinicians considering patient-centred documentation based on Profiles. As suggested before, there are two main social groups: the one created by clinical staff only, and the one where patients and clinicians would interact.

Social interaction is the key point of this proposal and it underpins the main usaibility goals:

Profiles: Patient Timeline

Facebook profile pages have been re-design to look more like a real timeline where any important event is chronologically displayed. In this example, right side will be used to show a summary of the most important event types associated to the patient medical history like Health issues, Allergies, Diagnosis, Requests and Results, Progress Notes, Prescriptions and any other clinical subject. On the left side, any user (doctor, nurse and the patient) could add comments anytime.

Privacy

Privacy should have a strong presence here, since having restricted-access data is a valuable feature that doctors, nurses and patients. They all will need to control the visibility of the data they entered in a fashionable way. Although setting permission in Facebook is pretty hard and unclear to get control about which type of users see which type of patient data or personal comments is still a requirement. This could be done seeing users by their role, applications as domains, and groups as teams. Still, patients are a special kind of user which will have direct access to his own record.

Utility

There’s a weak line which separates the Facebook familiarity advantage into the most confusing UI for a productivity tool and it’s called “enjoyment”. The idea of this Facebook-like EMR was to promote some typical behavioural patter of users when interacting with a social network like:

  • Safe Exploration
  • Microbreaks
  • Habituation
  • News Stream
  • Other people’s advice
  • Personal Recommendations

However, there are some other existing activities that the clinical staff usually does and this UI is not oriented to

  • Changes in Midstream
  • Keyboard only
  • Streamlined repetition activities

Nevertheless, the app integration approach of Facebook suggest me to become a good exercise to imitate outside the UX field.

Content

The content is not about what people think or feels, but what physicians and nurses make, diagnose, treat or provide to patients. The language of the user interface should be adapted to the purpose in order to ease the kind of content expected to be entered.

Data entry is one of the most challenging features in healthcare apps. The smarter the application, the quicker the data is entered. The whole phylosiphy of Facebook puttin atention into every single details should be adopted also to create content such as vital signs, prescriptions, a soap note, or a discharge letter. As an example, below there’s a list of content with different natures which depends on the context of use, the user role and the business model.

  • Task Oriented
    • Notifications
    • Lists of patients
    • Lists of tasks
    • Scheduled activities
    • Events
  • Content Oriented
    • Patient history summary
    • Patient evolution
    • Patient current health status and diagnosis
    • Clinical decisions
    • Procedures
  • Process Oriented
    • Treatments
    • Protocol based care planning
    • Admissions and discharge
    • Scheduling
    • Follow-up

What’s next

This is only the first part of the exercise. For the second part I’ll try more mock-ups and the high-fidelity prototype adding more details also in the content used in this sketch to get a better idea about how crazy (or not) is the proposal of being inspired by Facebook to create an electronic medical record.

There’s also an important gap where Facebook has no direct answer: clinical safety and episode-related information. We’ll talk about it also for the next post.

By now, how realistic do you think it is?