Electronic Medical Records: Provotype visualisation maximises clinical usability

The Electronic Medical Record (EMR) is the essential tool of the clinical consultation, effectively replacing the paper medical record. Since its gradual adoption in the early 2000s there has been a failure to achieve even moderate levels of EMR usability in clinical settings, resulting in a negative impact on clinical care, time efficiency and patient safety. This research explores how deeper collaboration with clinical users through participatory design, drawing on the disciplines of visual design, user experience (UX) design and visual analytics, might offer a more effective approach to this important problem. The lead researcher for this project is both a practising doctor and design researcher. Usability of two commercial EMR interfaces in the field of sexual health is explored through a mixed method survey, with responses used to inform the design of an interface provotype. This in turn is evaluated through repeat survey and ‘test-drive’ talk-aloud workshops. Results from the survey on two commercial EMR interfaces (n=49) revealed deep dissatisfaction particularly around issues of navigation, flow of consultation, frustration, safety, time-dependent and time-independent data, data complexity and data salience. Comparative provotype evaluation (n=63) showed that clinically-relevant visualisation offers marked gains in clinical usability and performance. This research argues for a re-imagining of the way we look at medical data during the clinical consultation so that the affordances and benefits of the digital format can be exploited more fully. It highlights the value of combining participatory design with visualisation to embed explicit, experiential and even tacit clinical knowledge into the EMR interface.

Content

Author and article information

Contributors

David Pao

John Stevens

Dan Lockton

Netta Weinstein

Conference

Publication date: July 2018

Publication date (Print): July 2018

Pages: 228-235

Affiliations

[0001]School of Design

Royal College of Art

London, SW7 2EU, UK

[0002]School of Design

Carnegie Mellon University

Pittsburgh, PA 15213, USA

[0003]School of Psychology

Cardiff University

Cardiff, CF10 3AT, UK

Article

DOI: 10.14236/ewic/EVA2018.44

SO-VID: 8514c6dc-53c6-42dc-abdb-a36649dcecb6

License:

This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Conference name: Electronic Visualisation and the Arts

Conference acronym: EVA

Conference number:

Conference location: London, UK

Conference date: 9 - 13 July 2018

Conference sponsor: Electronic Workshops in Computing (eWiC)

Conference theme: Electronic Visualisation and the Arts

History

Product

1477-9358 BCS Learning & Development

Self URI (article page): https://www.scienceopen.com/hosted-document?doi=10.14236/ewic/EVA2018.44

Self URI (journal page): https://ewic.bcs.org/

REFERENCES

W. Aigner 2012 Challenges of Time-oriented Data in Visual Analytics for Healthcare IEEE VisWeek Workshop on Visual Analytics in Healthcare. Utah, USA 24-29 October
T. Bodenheimer et al. 2014 From Triple to Quadruple Aim: Care of the patient requires care of the provider Annals of Family Medicine 12(6): 573 6
L. BoerJ. Donovan 2012 Provotypes for Participatory Innovation Proceedings of the Designing Interactive Systems Conference. Newcastle, UK 11-15 June
A. Broeckmann 1997 Remove the Controls – Machine Aesthetics V2_Lab for the unstable media conference Rotterdam, the Netherlands 27 June-13 July
R. Collier,2017 Electronic health records contributing to physician burnout Canadian Medical Association Journal, 189(45): E1405 E1406
M. Csikszentmihalyi et al. 1993 The measurement of flow in everyday life: toward a theory of emergent motivation USA University of Nebraska Press
G Elwyn 2014 ‘Patientgate’ – Digital Recordings Change Everything British Medical Journal, 348: 2078
J. Gibson 1981 The Ecological Approach to Visual Perception Boston, USA Houghton Mifflin
W. Horn et al. 1998 Metaphor Graphics to Visualize ICU Data Over Time Intelligent Data Analysis in Medicine and Pharmacology. UK Springer
C. Imison et al. 2016 Delivering the Benefits of Digital Health Care UK The Nuffield Trust
B. Middleton, et al.2013 Enhancing Patient Safety and Quality of Care by Improving the Usability of Electronic Health Record Systems: Recommendations from AMIA Journal of the American Medical Informatics Association 20(e1): 2 8
M. Miliard 2016 Frustrations Linger Around Electronic Health Records and User-centred Design Healthcare IT News http://www.healthcareitnews.com/news/frustrations-linger-around-electronic-health-records-and-user-centered-design (retrieved March 19 2018 )
P. Pangaro 2008 Instruction for Design and Designs for Conversation. In: Handbook of Conversation Design for Instructional Applications New York, USA ICI Global Publishers
C. Plaisant et al. 2015 Novel User Interface Design for Medication Reconciliation: An evaluation of Twinlist Journal of the American Medical Informatics Association 22(2): 340 9
C. Plaisant et al. 1996 LifeLines: Visualizing personal histories Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 221 7 Montreal, Canada 22–27 April
S. M. Powsner et al. 1994 Graphical summary of patient status The Lancet 344(8919): 386 9
A. Rind 2013 Interactive Information Visualization to Explore and Query Electronic Health Records Foundations and Trends® in Human–Computer Interaction, 5(3): 207 98
B. Shneiderman 2011 Tragic Errors: Usability and Electronic Health Records Interactions, 18(6): 60 3
L. Strausfeld,2014 Visualising Data Lecture at Stamps School of Art & Design, Michigan University MI, USA
I. Tait 1977 The History and Function of Clinical Records (MD Thesis) UK University College London
J. Viitanen, et al.2011 National Questionnaire study on Clinical ICT Systems Proofs: Physicians suffer from poor usability International journal of medical informatics, 80(10): 708 25
R. Wachter 2016 Making IT Work: Harnessing the power of health information technology to improve care in England London, UK Department of Health
N. Weibel 2015 LAB-IN-A-BOX: semi-automatic tracking of activity in the medical office Personal and Ubiquitous Computing 19: 317 334
V. West 2015 Innovative Information Visualization of Electronic Health Record Data: A systematic review Journal of the American Medical Informatics Association, 22(2): 330 9
M. Zahabi et al. 2015 Usability and Safety in Electronic Medical Records Interface Design: A Review of Recent Literature and Guideline Formulation Human factors 57(5): 805 34
Z. Zhang et al. 2013 The Five Ws for Information Visualization with Application to Healthcare Informatics IEEE transactions on visualization and computer graphics, 19(11): 1895 910
K. Zheng et al. 2009 An Interface-driven Analysis of User Interactions with an Electronic Health Records System Journal of the American Medical Informatics Association 16(2): 228 37

Comments

Comment on this article

[1] W. Aigner 2012 Challenges of Time-oriented Data in Visual Analytics for Healthcare IEEE VisWeek Workshop on Visual Analytics in Healthcare. Utah, USA 24-29 October

[2] T. Bodenheimer et al. 2014 From Triple to Quadruple Aim: Care of the patient requires care of the provider Annals of Family Medicine 12(6): 573 6

[3] L. BoerJ. Donovan 2012 Provotypes for Participatory Innovation Proceedings of the Designing Interactive Systems Conference. Newcastle, UK 11-15 June

[4] A. Broeckmann 1997 Remove the Controls – Machine Aesthetics V2_Lab for the unstable media conference Rotterdam, the Netherlands 27 June-13 July

[5] R. Collier,2017 Electronic health records contributing to physician burnout Canadian Medical Association Journal, 189(45): E1405 E1406

[6] M. Csikszentmihalyi et al. 1993 The measurement of flow in everyday life: toward a theory of emergent motivation USA University of Nebraska Press

[7] G Elwyn 2014 ‘Patientgate’ – Digital Recordings Change Everything British Medical Journal, 348: 2078

[8] J. Gibson 1981 The Ecological Approach to Visual Perception Boston, USA Houghton Mifflin

[9] W. Horn et al. 1998 Metaphor Graphics to Visualize ICU Data Over Time Intelligent Data Analysis in Medicine and Pharmacology. UK Springer

[10] C. Imison et al. 2016 Delivering the Benefits of Digital Health Care UK The Nuffield Trust

[11] B. Middleton, et al.2013 Enhancing Patient Safety and Quality of Care by Improving the Usability of Electronic Health Record Systems: Recommendations from AMIA Journal of the American Medical Informatics Association 20(e1): 2 8

[12] M. Miliard 2016 Frustrations Linger Around Electronic Health Records and User-centred Design Healthcare IT News http://www.healthcareitnews.com/news/frustrations-linger-around-electronic-health-records-and-user-centered-design (retrieved March 19 2018 )

[13] P. Pangaro 2008 Instruction for Design and Designs for Conversation. In: Handbook of Conversation Design for Instructional Applications New York, USA ICI Global Publishers

[14] C. Plaisant et al. 2015 Novel User Interface Design for Medication Reconciliation: An evaluation of Twinlist Journal of the American Medical Informatics Association 22(2): 340 9

[15] C. Plaisant et al. 1996 LifeLines: Visualizing personal histories Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 221 7 Montreal, Canada 22–27 April

[16] S. M. Powsner et al. 1994 Graphical summary of patient status The Lancet 344(8919): 386 9

[17] A. Rind 2013 Interactive Information Visualization to Explore and Query Electronic Health Records Foundations and Trends® in Human–Computer Interaction, 5(3): 207 98

[18] B. Shneiderman 2011 Tragic Errors: Usability and Electronic Health Records Interactions, 18(6): 60 3

[19] L. Strausfeld,2014 Visualising Data Lecture at Stamps School of Art & Design, Michigan University MI, USA

[20] I. Tait 1977 The History and Function of Clinical Records (MD Thesis) UK University College London

[21] J. Viitanen, et al.2011 National Questionnaire study on Clinical ICT Systems Proofs: Physicians suffer from poor usability International journal of medical informatics, 80(10): 708 25

[22] R. Wachter 2016 Making IT Work: Harnessing the power of health information technology to improve care in England London, UK Department of Health

[23] N. Weibel 2015 LAB-IN-A-BOX: semi-automatic tracking of activity in the medical office Personal and Ubiquitous Computing 19: 317 334

[24] V. West 2015 Innovative Information Visualization of Electronic Health Record Data: A systematic review Journal of the American Medical Informatics Association, 22(2): 330 9

[25] M. Zahabi et al. 2015 Usability and Safety in Electronic Medical Records Interface Design: A Review of Recent Literature and Guideline Formulation Human factors 57(5): 805 34

[26] Z. Zhang et al. 2013 The Five Ws for Information Visualization with Application to Healthcare Informatics IEEE transactions on visualization and computer graphics, 19(11): 1895 910

[27] K. Zheng et al. 2009 An Interface-driven Analysis of User Interactions with an Electronic Health Records System Journal of the American Medical Informatics Association 16(2): 228 37

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