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The clinician in the driver's seat: part 2 - intelligent uses of space in a drag/drop user-composable electronic health record.

ABSTRACT: User-composable approaches provide clinicians with the control to design and assemble information elements on screen via drag/drop. They hold considerable promise for enhancing the electronic-health-records (EHRs) user experience. We previously described this novel approach to EHR design and our illustrative system, MedWISE. The purpose of this paper is to describe clinician users' intelligent uses of space during completion of real patient case studies in a laboratory setting using MedWISE. Thirteen clinicians at a quaternary academic medical center used the system to review four real patient cases. We analyzed clinician utterances, behaviors, screen layouts (i.e., interface designs), and their perceptions associated with completing patient case studies. Clinicians effectively used the system to review all cases. Two coding schemata pertaining to human-computer interaction and diagnostic reasoning were used to analyze the data. Users adopted three main interaction strategies: rapidly gathering items on screen and reviewing ('opportunistic selection' approach); creating highly structured screens ('structured' approach); and interacting with small groups of items in sequence as their case review progressed ('dynamic stage' approach). They also used spatial arrangement in ways predicted by theory and research on workplace spatial arrangement. This includes assignment of screen regions for particular purposes (24% of spatial codes), juxtaposition to facilitate calculation or other cognitive tasks ('epistemic action'), and grouping elements with common meanings or relevance to the diagnostic facets of the case (20.3%). A left-to-right progression of orienting materials, data, and action items or reflection space was a commonly observed pattern. Widget selection was based on user assessment of what information was useful or relevant. We developed and tested an illustrative system that gives clinicians greater control of the EHR, and demonstrated its feasibility for case review by typical clinicians. Producing the simplifying inventions, such as user-composable platforms that shift control to the user, may serve to promote productive EHR use and enhance its value as an instrument of patient care.

SUBMITTER: Senathirajah Y

PROVIDER: S-EPMC5926811 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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The clinician in the driver's seat: part 2 - intelligent uses of space in a drag/drop user-composable electronic health record.

Senathirajah Yalini Y Kaufman David D Bakken Suzanne S

Journal of biomedical informatics 20141024

User-composable approaches provide clinicians with the control to design and assemble information elements on screen via drag/drop. They hold considerable promise for enhancing the electronic-health-records (EHRs) user experience. We previously described this novel approach to EHR design and our illustrative system, MedWISE. The purpose of this paper is to describe clinician users' intelligent uses of space during completion of real patient case studies in a laboratory setting using MedWISE. Thi ...[more]

PMID: 25445921

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Project description:BackgroundChallenges in the design of electronic health records (EHRs) include designing usable systems that must meet the complex, rapidly changing, and high-stakes information needs of clinicians. The ability to move and assemble elements together on the same page has significant human-computer interaction (HCI) and efficiency advantages, and can mitigate the problems of negotiating multiple fixed screens and the associated cognitive burdens.ObjectiveWe compare MedWISE-a novel EHR that supports user-composable displays-with a conventional EHR in terms of the number of repeat views of data elements for patient case appraisal.Design and methodsThe study used mixed-methods for examination of clinical data viewing in four patient cases. The study compared use of an experimental user-composable EHR with use of a conventional EHR, for case appraisal. Eleven clinicians used a user-composable EHR in a case appraisal task in the laboratory setting. This was compared with log file analysis of the same patient cases in the conventional EHR. We investigated the number of repeat views of the same clinical information during a session and across these two contexts, and compared them using Fisher's exact test.ResultsThere was a significant difference (p<.0001) in proportion of cases with repeat data element viewing between the user-composable EHR (14.6 percent) and conventional EHR (72.6 percent).Discussion and conclusionUsers of conventional EHRs repeatedly viewed the same information elements in the same session, as revealed by log files. Our findings are consistent with the hypothesis that conventional systems require that the user view many screens and remember information between screens, causing the user to forget information and to have to access the information a second time. Other mechanisms (such as reduction in navigation over a population of users due to interface sharing, and information selection) may also contribute to increased efficiency in the experimental system. Systems that allow a composable approach that enables the user to gather together on the same screen any desired information elements may confer cognitive support benefits that can increase productive use of systems by reducing fragmented information. By reducing cognitive overload, it can also enhance the user experience.

Project description:In 2005, the Ministry of Health (MoH) in Mongolia initiated the process of developing its Health Sector Strategic Master Plan (HSSMP), using a wide-ranging consultative process, driven by the MoH, and requiring participation from all levels of health facilities, other ministries, donor agencies and NGOs. Among other objectives, the MoH sought to coordinate the disparate inputs from key donors through the HSSMP, aligning them with the Plan's structure. This research explores the extent to which the HSSMP process served as a mechanism for effective aid coordination while promoting ownership and capacity building and the lessons learned for the wider international development community. The study is based on document review, key-informant interviews and authors' experience and participation in the MoH planning processes. The HSSMP process improved alignment and harmonisation. It enabled a better local understanding of the benefits of aid coordination, and the recognition that aid coordination as not only a mere administrative task, but a strategic step towards comprehensive management of both domestic and external resources. The process was not challenge free; the fractious political environment, the frequent turnover of key MoH staff, the resistance of some donors towards MoH scrutiny over their programmes and the dismantling of the central coordination and return of seconded staff following completion of the HSSMP, has slowed the pace of reform. Despite the challenges, the approach resulted in positive outcomes in the areas of ownership and better aid coordination, with HSSMP development emphasising ownership and capacity building. This contrasted with the usual outcomes focus, and neglect of the capacity building learning processes and structural and policy changes needed to ensure sustainable change. The largest and most influential programmes in the health sector are now largely aligned with HSSMP strategies, enabling the MoH to utilize these opportunities to optimise the HSSMP outcomes. The lessons for Ministries of Health in similar Post-Soviet countries--or other emerging economies where government capacity and local policy processes are relatively strong--are clear: the development of solid governance and technical infrastructure in terms of planning and evaluation provide a solid structure for donor coordination and insure against local political change.

Project description:Language WorkBenches (LWBs) are software engineering tools that help domain experts develop solutions to various classes of problems. Some of these tools focus on non-technical users and provide languages to help organize knowledge while other workbenches provide means to create new programming languages. A key advantage of language workbenches is that they support the seamless composition of independently developed languages. This capability is useful when developing programs that can benefit from different levels of abstraction. We reasoned that language workbenches could be useful to develop bioinformatics software solutions. In order to evaluate the potential of language workbenches in bioinformatics, we tested a prominent workbench by developing an alternative to shell scripting. To illustrate what LWBs and Language Composition can bring to bioinformatics, we report on our design and development of NYoSh (Not Your ordinary Shell). NYoSh was implemented as a collection of languages that can be composed to write programs as expressive and concise as shell scripts. This manuscript offers a concrete illustration of the advantages and current minor drawbacks of using the MPS LWB. For instance, we found that we could implement an environment-aware editor for NYoSh that can assist the programmers when developing scripts for specific execution environments. This editor further provides semantic error detection and can be compiled interactively with an automatic build and deployment system. In contrast to shell scripts, NYoSh scripts can be written in a modern development environment, supporting context dependent intentions and can be extended seamlessly by end-users with new abstractions and language constructs. We further illustrate language extension and composition with LWBs by presenting a tight integration of NYoSh scripts with the GobyWeb system. The NYoSh Workbench prototype, which implements a fully featured integrated development environment for NYoSh is distributed at http://nyosh.campagnelab.org.

Dataset Information

The clinician in the driver's seat: part 2 - intelligent uses of space in a drag/drop user-composable electronic health record.

Publications

The clinician in the driver's seat: part 2 - intelligent uses of space in a drag/drop user-composable electronic health record.

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