Making Lists of Diagnoses to Pick From

If I can't get a list with predictive search (where the search field starts guessing what I want from the few characters I've typed so far), then at least give me a heads-up list on one page. Make the list short and comprehensive enough.

I want to find about 80% of my commonly used diagnoses on one page, then multi-select all the diagnoses that I need, and then click "OK". If I can do that, I will be very happy. I've seen it done in at least one EMR.

See, I'm not hard to please.

How would you build the list?

  1. Make a fairly comprehensive list first, sorted by how often I (or family physicians in general) select that diagnosis.
  2. Then create the list on a page or two.
  3. Then add columns (to allow more items) and shrink the font until it is still readable. Test readability with a few 50-60 year old users wearing bifocals.
  4. Trim the list to one (or two, A-L and M-Z) pages.

What are the user-centered-design principles?

  1. Get it on a single visual plane in plain sight. (expand to a second page, if needed, or if users wanted it).
  2. List alphabetically. Avoid organ system grouping, which takes more cognitive effort and more visual scanning time.
  3. Use simple, frequently-used-by-clinician word choice (e.g. “headache” instead of “cephalgia”).
  4. Put most relevant words first (e.g. “diabetes mellitus, type 2”, not “type 2 diabetes”)
  5. Make font big enough to read.
  6. Eliminate words that don’t add benefit for user (e.g. for “250.41 Diabetes 1 w/ renal changes”, do include “w/ renal changes”. For “250.00 Diabetes 2 uncomplicated”, I’d argue that the “uncomplicated” is optional, and takes up space).

The single page has some advantages over the predictive search, which can only do one diagnosis at a time.

  • I don't have to use the keyboard.
  • I can select 6 diagnoses with only 6 clicks.
  • I press OK once, and not 6 times.
  • I can go a lot faster.
  • I'll develop muscle memory finding the commonly picked items on the page (could pick them blindfolded!).

Go ahead. Make my day.

New AHRQ-Funded Reports on Usability of EMRs

I'm excited!

I just browsed two new reports on EMR (EHR) Usability funded through AHRQ. They outline some high-priority research agenda and public policy items, and acknowledge the dearth of systematic evidence on EMR usability.

New AHRQ-Funded Reports on the Usability of Electronic Health Record (EHR) SystemsTo explore the opportunity to improve EHR system usability, AHRQ commissioned the creation of two reports that synthesize the existing research and evidence in this area and suggest common methods to evaluate EHR usability going forward.

What EMR functions would be great on a smartphone?

Answer:

Not everything.

The form factor of an iPhone is great for portability, handling messages, and doing lists.

It is not great for viewing a half-dozen tables on a single dashboard screen, or viewing a grid of 6x12 (like a medication list for many of my patients with chronic disease).

Here is a little wireframe (made very quickly with BalsamiqMockup) that offers my preliminary thoughts.

I doubt that I'd want to document a visit that had a complicated story using the iPhone. Too much keyboard work.

I could document a simple sinus infection or UTI, assuming I could do it in 6-clicks, my de facto standard for documenting an acute illness.

What would a surgeon want? On rounds, a smart phone would be convenient for:

  • automatically receiving key lab results
  • looking up today's vitals, labs, and I&O
  • viewing the OR schedule
  • viewing a clinic schedule
  • signing dictated documents
  • viewing imaging reports

It won't be too long till many EMRs have "an app for that".

Principles Of Effective Design - C.R.A.P.

Most EMRs don't have good visual design. Graphic artists, layout editors, and other visual communicators get taught the basic principles of visual design early in their careers. Most software engineers and managers may never get taught them. Here is a really terse presentation of 4 basic design principles that should go into every page design in an application.

The principles are: C.R.A.P.

  • Contrast
  • Repetition
  • Alignment
  • Proximity

One of my favorite Macintosh authors, Robin Williams, articulates these more fully in her book, Non-Designer's Design Book.

Check out this SlideShare Presentation to see good visual examples:

Testing & Rating EMR Usability

I just finished writing a white paper for HIMSS titled "Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating". It's publicly available at this link.

It has been a great team to work with. Many thanks to my Human-Computer Interaction co-authors, Rebecca Grayson and Janey Barnes. They brought experience with clinical systems and their body of user-centered design knowledge to the task. Thanks also to the team leaders Penn White MD and Tiana Thomas for harnessing the power of a cadre of volunteer contributors to the effort.

Briefly, this paper describes how poor EMR usability has hindered user adoption among physicians and hospitals. We describe a number of usability principles that apply to EMRs in particular, and then offer evaluation and testing methods for finished EMR products, and suggest ways to rate the EMRs.

Our hope is that certifying and rating organizations such as Certification Commission for Healthcare Information Technology (CCHIT) or the American Academy of Family Physicians (AAFP) will be able to use this work in developing their own rating methods that can help EMR purchasers.

Don't Make Me Think

I love this line.

It's the title of one of my favorite books on software usability, written by Steve Krug.

The human-computer interaction pros refer to this principle as "reducing cognitive load." Don't waste precious brain resources on stuff the application should be able to do quickly, accurately, and invisibly.

Here's a prime example.

In displaying lab results, why not do the math for the clinician user? Don't make me calculate how long ago the last lab result was obtained. Tell me it was about 2 weeks ago. The precision can get more relaxed the longer ago the result was obtained.

The same principle applies to displaying the patient's age. Don't just show me the date of birth. Do the math for me.

I have plenty of more important things to think about.