Interfaces de usuario en el ámbito sanitario

Diseñada para la salud

Este viernes 23 de Mayo participé en el evento de UXSpain para hablar de Interfaces Usuario en el ámbito sanitario. Me ha hecho una enorme ilusión asistir a este evento un año más y en esta ocasión como ponente para introducir un tema como el de la Experiencia de Usuario en la Industria Tecnológica Sanitaria a la que llevo dedicándome casi 5 años.

Nervios a parte, intenté comunicar con algunos ejemplos cómo las interfaces de usuario en este sector pueden llegar a representan y determinar el modelo de antención sanitaria (servicios y productos incluidos).

La Sanidad es un ámbito de caracter humanitario que, sin duda, puede y debe verse beneficiado de las disciplinas del diseño, no sólo como especilidades sino como parte de sus estrategias transformadoras. Esta es la idea que me animó a compartir mi experiencia y que espero que resultara interesante a todo/as los asistentes.

Gracias a todos por vuestros amables comentarios en en Twitter y sobre todo a los que pude verles las caras e intercambiamos impresiones. No me gustaría que se perdiera el caracter de encuentro de este evento ya que es sin duda lo que más aporta a nivel personal para construir esta comunidad tan importante a nivel profesional.

Quiero agradecer también a mi compañero de vida Antonio Benítez su apoyo y ayuda, que se ha currado la mitad de las slides y sabe tanto o más que yo lo difícil que es la toma de decisiones de diseño y procesos en este sector.

¡Muchísimas gracias a todos, nos vemos en el próximo uxspain! Por supuesto, enhorabuena a la organización.

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.

[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?

Clinical Risks and Design Decisions – How usability can save lifes

Information technology has made possible to improve healthcare services by increasing productivity, getting more accessible services, and automating daily care activities – among others. However, the software itself allows getting a better patient care at the same time that it opens a door to clinical risks. It is a responsability for designers to avoid hazards as well as design rich-interactive solutions.

As you know, it is part of the process of making design decisions: user centred design to ensure usable products. UCD, UX and Usability have a lot of meanings and aspects that influence in reducing the errros that clinical staff could make by only interacting with the software.

I’ll give some examples of how the main topics of usability could avoid clinical risks:

Visibility of system status

Working with the right patient in the right time. Keep always visible the patient information that will help users to identify it without any doubt.

Match between system and the real world

Use clinical language as much as you can to help to understand the purpose, the scope, and to support the clinical process. Clinical procedures has specific names which require clarity unambigously.

User control and freedom

Provide multiple visualization modes to ease the data understanding. Allow performing activities in different orders to get adapted both users and business process. The more natural the process is for the user the more confident s/he will feel.

Consistency and standards

Respect familiarities with the real world activities and with previous software solutions. Clinical staff is very hard-working with protocols and routines, consistency could be boring but effective.

Error prevention

Provide clear points of interaction and valuable data for decision-making. A correct labeling and control aesthetic will help to easily understand how the data can be managed, as well as a correct data presentation will avoid performing wrong actions.

Recognition rather than recall

Reduce the workload by creating recognisable solutions. Do not stress the user with a lot of information to be remembered.

Flexibility and efficiency of use

Provide shortcuts and give a chance to experts, the more efficient they’ll use the solution the more time they’ll spend providing care. Allow users workarounds.

Aesthetic and minimalist design

Minimal design will simplify the data presentation and a good aesthetic will increase the content meaning to facilitate the interpretation and the decision-making. Use aesthetic to provide meaning and avoid decorators that mix up the patient information.

Help users recognize, diagnose, and recover from errors

Allow undo actions for the most critical actions: prescribing medications, deleting patient data, managing patient history, etc. A mistake should be able to be recovered by a an undo action or a rollback process.

Help and documentation

Describe how every care activity can be achieved by your solution. Show main conflicts and risks if there are any dependency between them.

These are only some clues about how putting attention in usability can help to reduce the amount of clinical risks. Lately, every data that is presented in a screen and every allowed interaction between users and clinical software it’s a potential risk to provide a wrong care to patients. Undoubtlely, there are many other hazards non-UI-related that can end up in a catastrophic situation.

Nothing is free of hazards, but good design decisions can save time, costs, and even lifes.