Urgent InteractionsEvaluating Usability and Incorporating Information

Visualization in Emergency Medicine Interfaces

Julia HainesMarch 8, 2010

Importance of EHR• EHR first introduced more than 30 years ago as the Computer-

Based Patient Record (CPR); also called EMR, EPR Wise, 2006). Different from PHR.

• Recent statistics showed less than 10% of the nation’s health systems (Smaltz & Berner, 2007) and 4% of physicians in primary care (Desroches et al., 2008) have implemented full-scale EHR. (This has increased substantially since.)

• Have been multiple pushes toward EHR in last 20 years, including:

• Institute of Medicine put forth plan in 1991 to achieve ubiquitous use of patient records by all U.S. health care delivery organizations by 2001.

• In 2004, Executive Order 13335 called for the development and implementation of a nationwide interoperable health information technology infrastructure by 2014.

• In February 2009, economic-stimulus package allocated $19 billion to “health information technology” (HIT); $17 billion to helping medical providers switch to digital record keeping; $2 billion toward creating a network to allow medical providers to share those records.

• $36 billion allocated total

EHR System Development• Eight core functions (IOM, 2003):

• Health information and data

• Result management

• Order management

• Decision support

• Electronic communication and connectivity

• Patient support

• Administrative processes and reporting

• Reporting and population health

• Huge focus on interoperability (HITSP)• Where does usability fit in . . . ?

“A major change is occurring in medical record keeping, driven by the embarrassing realization that until now the information systems that keep track of Americans' cancer treatments have mostly lagged behind the ones they use to buy movie tickets online.”

-Jerry Adler, 2009

TRACKING BOARD

EMR

Project

Issues & Recommendations

• From data gleaned from the contextual inquiry sessions and problem report diaries and interviews, problem areas were identified, categorized, and delineated. • Tracking Board:

• General Usability Issues/Design Problems

• Learning and Memory Issues

• Information Availability Issues

• Interaction Issues

• Using a combination of guidelines, research sources (especially Shneiderman’s task by data type taxonomy for information visualization), and general HCI principles, design recommendations were developed to address issues.

• EHR:• Referential and Temporal Relation Issues

• Visual Cue Problems

• Record Macrostructure Issues

• Scanability Issues

TRACKING BOARD ISSUES

TRACKING BOARD RECOMMENDATIONS

EMR ISSUES

PatientPatient

DischargeDischarge Admitted Visits

Admitted Visits SurgeriesSurgeries ED VisitsED VisitsConsultationsConsultations

PulmonologyPulmonology CardiologyCardiology

EMR ISSUES

Supporting Visual Data for Impressions &

Recommendations (Assessment

& Plan)

•Seven TasksOverview: Gain an overview of the entire collection.Zoom: Zoom in on items of interestFilter: filter out uninteresting items.Details-on-demand: Select an item or group and get details when needed.Relate: View relationships among items.History: Keep a history of actions to support undo, replay, and progressive refinement.Extract: Allow extraction of sub-collections and of the query parameters.

VISUALIZATIONCommon types of data•1-Dimensional: Linear data, such as lists, textual documents, code•2-Dimensional: Planar and map data, such as geographic maps, floor plans•3-Dimensional: Volume data, such as a human molecule or CAD model •Temporal: Timeline data, such as an EKG or editing video •Multi-dimensional: Relational and statistical data, such as a scattergram•Tree: Data hierarchies or collections having a link to a root, such as file managers•Network: Complex data relationships depicted through links, nodes, etc.