EHR Usability: An Illustrated Guide

I did a brief presentation at NIST on July13, along with about 2 dozen other usability geeks like me. The government recognizes the importance of having usable software if physicians and hospitals are to be expected to adopt electronic medical records. The ARRA incentives alone won't be sufficient if the software usability is lacking, causing physicians and other healthcare workers to lose productivity. They might break even, but many physicians worry that they won't, even with the financial incentives. Here are the pictures. You have to imagine my voice.

Belden nist 13_july2010 from Jeff Belden MD

View more presentations from Jeff Belden MD.

NIST will be posting the slides and audio later. You might try here.

Dashboards from Sparklines: All Systems Go!

Dashboards will have several uses in the EMR environment.

• ICUs for displaying those 3-page wide flowsheets of clinical data: intake, output, vital signs, lab, drips, PCA.
• Chronic disease overviews: lab, home monitoring results, vital signs, prompts for next lab or immunization
• Quality Improvement: compliance with standards, progress toward targets, peer comparisons
• Pay for Performance: Budget, progress toward targets, return on investment
• Management dashboards: trends, year-to-year comparisons, key performance indicators

Here are some nice examples

Traffic light (colored dots of red) in the second column. Sparklines in the third column. Bullet graphs in the rightmost columns.

Microbar graphs on the lowest row, with sparklines just above them.

After you sketch out a new dashboard with pencil and paper, you may want to dress it up to show off before you start spending engineer time on it.

Here is a nice PowerPoint template for making high-fidelity wireframe mock-ups.
Download Dashboard Template

Sparklines: Coming to an EMR near you

Sparklines are data-intense, word-sized graphics designed to be incorporated into text. Used in an EMR, we can see the recent lab value and its associated trend over time.

Edward Tufte pioneered the concept of sparklines, and his website has a large collection of resources to those who want to explore sparklines further.

We should be using sparklines throughout our EMRs.

• As elements of clinical dashboards
• Monitoring chronic disease processes (lipids, A1C, renal function for diabetes)
• Monitoring vital sign and physiologic parameters in ICU patients
• Managing improvement trends in CQI processes
• Tracking financial performance in management dashboards

Where can I find code to implement sparklines?
Visit this site for links to non-commercial in several programming environments, including PHP, Javascript, C#, Lisp, Perl, Python, Ruby, Java, Excel VBA.

Commercial Implementations of sparklines include software add-ons for Excel:
BissantzSparkMaker
MicroCharts
Business Refinery SimpleCharts

This graphic from MicroCharts gives detail on how we can show "normal range" or "target range" with a gray band, or a threshold value with a red line.

Developers! Start your engines!

Clinicians! All you need is pencil and paper to start sketching the dashboards, lab displays, and other graphs you need. Then share those with your EMR vendor.
Let's start seeing these word-sized, data intense graphics in all our EMR visual displays.