Andrew Ho wrote:
On Wed, 6 Oct 2004, Thomas Beale wrote:well, as a dedicated non-extremist, you are right. But...I have been spending more time with clinicians lately, and trying to think more deeply about user input, ergonomics of data capture & seeing patients, workflow and so on. I don't have any earth-shattering analysis at this stage (probably never will;-), but a few things have been filtering through:
...
'raster images of text'. I would have thought the latter should be
avoided at all costs apart from signatures and a few other odd
situations;
Thomas, This is exactly the paradigm that we are challenging. Maybe "at all costs" is too extreme a position to hold?
a) I recently spent some time at Mayo clinic in Rochester. They have an excellent clinical record system, and a pretty efficient way to use it in wards, going by my visit to St Mary's. They have a small PC bolted to the wall outside most rooms, with a flatscreen and keyboard at appropriate height for a standing person to use. The design of the EHR is such that everything relevant about the patient can be brought up and reviewed quickly before entering the room (the same system is used in conference rooms for group review purposes before seeing patients); after seeing the patient (no hand-helds in sight; there are laptops on trolleys, but no-one that I met was vastly enthusiastic about them) which seemed to be a human / human experience, they would leave the room and make a note or adjust medications etc at the workstation outside the room, and move on to the next patient. The major annoyance, if any, was that login could be faster given that each user had to login again on each workstation. I imagine that RF proximity keys could be used to help this situation. The GUI design of the system(s) seemed pretty efficient without being amazing, but I had the impression that it wasn't the main factor in efficient use of it; accessibility on the ward and in rooms was. These observations are anecdotal of course and undoubtedly not representative, but interesting nonetheless, since I had been expecting to see the latest pocket computers, or else bedside devices all over the place.
b) as our work on archetypes and templates advances, our tools have gotten better. Sam Heard has done a lot of work with the Clinical Editor tool (there is a windows download at http://www.OceanInformatics.biz; before Andrew and others eat me alive for offering such an obscenity, yes the source is open, see http://www.openEHR.org; yes Linux and mac versions are coming, yes the way it is presented on the website will improve). We are starting to find that if clinical people can model their data and workflow in clear simple, but nevertheless powerful ways, uncluttered by any technical looking IT/modelling details, they are very interested in doing the modelling. I suspect that they will be much happier with screens based on their own models, built either automatically from the templates, or custom designed with their input. We will have to wait 6+ months before we get the first data on this, but I will be surprised not to see an improvement over IT-developed screens.
I don't have any experience in developing country contexts, but would be very interested to know what people like Calle Hedberg think a good EHR "looks & feels" like. E.g. would graphical longitudinal timeline displays on a per-problem/per-issue basis be useful for chronic patients?
- thomas beale
