Sharpc 2012 annual meeting proj4 final

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Presentation on SHARP projects: Medication reconciliation, tracking medical lab tests, systematic yet flexible systems analysis, and preventing wrong patient errors. Houston, TX April 4, 2012

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Sharpc 2012 annual meeting proj4 final

  1. 1. Project 4: Cognitive Information Design & VisualizationProject Leaders: Project Co-Is: Consultants: Postdocs, GRAs, Programmers:Todd R. Johnson Jorge Herskovic John FlachBen Shneiderman Elmer Bernstram Eliz MarkowitzCatherine Plaisant Surreya Tarkan Tiffany ChaoProject manager:Chitra Shriram w w w. s h a r p c . o r g
  2. 2. Top 3 Accomplishments inYears 1-2 Medication Reconciliation: Spatial Layout with Animated Transitions Test Result Management: Table Design & Retrospective Analysis Systematic Yet Flexible Systems Analysis: Framework for analyzing HIT interface design
  3. 3. Medication Reconciliation: Spatial Layout with Animated Transitions  What’s unique?  What’s identical?  What’s equivalent?
  4. 4. Medication Reconciliation: Spatial Layout with Animated Transitions LEVELS OF EQUIVALENCE Equivalenc Criteria Example e Form Identical except for Advil = Ibuprofen brand vs. generic Senormin = Atenolol Functional Same therapeutic intent Atenolol & Propanolol both betablockers Partial Form or functional equivalence, Advil 100 mg but Acetaminophen 200mg differ in dosage, frequency, route None Unique in form & function “Automated medication reconciliation and complexity of care transitions” Bozzo Silva, Bernstam, Markowitz, Johnson, Zhang and Herskovic, AMIA 2011
  5. 5. Medication Reconciliation: Spatial Layout with Animated Transitions DEMOPrototype by Tiffany ChaoVIDEO AVAILABLE ATwww.cs.umd.edu/hcil/sharp
  6. 6. Medication Reconciliation: Spatial Layout with Animated TransitionsTwinlist running on Microsoft Amalga Platform Twinlist adapted for problem list reconciliation inContact: Hank Rappaport cancer risk assessment software (Hughes riskApps™)“Best medication reconciliation interface I Contact: Kevin S. Hughes, Massachusetts General Hospitalhave seen” Shawn Murphy, MD, PhD, HarvardUniversity“A sigh of relief when I saw Twinlist”Melinda Jenkins, PhD, FNP
  7. 7. Test Result Management: Table Design & Retrospective AnalysisGOALS:Help clinicians see what needs attention  Rich tabular displaysFacilitate taking action  Clarify responsibility  Embed operations to save timeAllow retrospective analysis
  8. 8. Test Result Management: Table Design & Retrospective AnalysisSampleCurrentDesignVAViewAlerts
  9. 9. Test Result Management: Table Design & Retrospective AnalysisSampleCurrentDesignVAViewAlerts
  10. 10. Test Result Management: Table Design & Retrospective AnalysisSampleCurrentDesignVAViewAlerts
  11. 11. Test Result Management: Table Design & Retrospective Analysis
  12. 12. Test Result Management: Table Design & Retrospective Analysis Color-Coding, Icons, and Ranking
  13. 13. Test Result Management: Table Design & Retrospective Analysis Compact Layouts
  14. 14. Test Result Management: Table Design & Retrospective Analysis Improved Headers
  15. 15. Test Result Management: Table Design & Retrospective Analysis Integrated Actions
  16. 16. Test Result Management: Table Design & Retrospective Analysis DESIGN GUIDELINES: sample of 28 in total  Rank the table according to one or more column attribute(s), arranged vertically down (Few, 2004)  Use color coding of columns to show the ranking, by default the most severe value must appear at the top of the table while ensuring that the most important values are still visible  Round data displayed in table cells entries where it is not misleading to do so (MSCUI, 2008) but show more precision if space permits  Avoid a heading that is significantly wider than the data it is indicating (MSCUI, 2008) by splitting such headers into two or more lines  If a certain column always has the same value, it could be removed to save space  Keep table structure consistent from table to table, for example, distinct columns in tables should be placed at the rightmost end to allow for alignment of the same columns on the left side
  17. 17. Test Result Management: Table Design & Retrospective Analysis
  18. 18. Test Result Management: Table Design & Retrospective Analysis
  19. 19. Systematic Yet Flexible Systems Analysis: Framework for analyzing HIT interface20 design  Systematic, consistent approaches  Can improve  Efficiency, Safety, Effectiveness  Examples  Standard operating procedures, Clinical guidelines  Decision support, Hard stops in EHRs  But flexibility is needed to accommodate variation
  20. 20. SYFSA in a Nutshell21 Idealized: Logical constraints on the work, independent of any system System: A redesigned system that matches logical constraints as closely as Natural: How possible the current system supports and constrains the work
  21. 21. Idealized Space for Medication Ordering Procedural Flexibility: 3 bits Functional Flexibility: Approximately 14.58  Estimate from RxNorm: ~ 24,000 prescribable drugs, including those not in RxNorm Refills Quantity Form FrequencyConfirm Dose Name Quantity Refills Frequency Form
  22. 22. Open Vista Natural Space
  23. 23. OpenVista: Natural SpaceOpenVista –The Natural SpaceToo much proceduralflexibility: 9.5 bits
  24. 24. Natural Space of “Droogle” By Peter V. Killoran M.Dan e-Prescription demonstration project inspired by Google DEMO  Droogle  Procedural Flexibility close to ideal: 1 bit Dose Form Ingredient Quantity Frequency Duration Refills Confirm Form Dose
  25. 25. RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH From: http://rxterms.nlm.nih.gov:8080/ Keystrokes: war
  26. 26. RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Keystrokes: war TAB
  27. 27. RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Keystrokes: war TAB 5
  28. 28. RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Keystrokes: war TAB 5 TAB 182 different drugs require only 4 keystrokes: letter TAB number TAB Functional flexibility matches ideal
  29. 29. RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIHProcedural flexibility: 5.1bitsMaximum interface efficiency: ~ 68% (4 keystrokes)Minimum interface efficiency: ~ 5% (50 character free text entry)
  30. 30. Reducing Wrong Patient Errors: BONU Animated Transitions & Photos S
  31. 31. Reducing Wrong Patient Errors: Animated Transitions & Photos
  32. 32. Reducing Wrong Patient Errors: Animated Transitions & Photos
  33. 33. Reducing Wrong Patient Errors: Animated Transitions & Photos
  34. 34. Reducing Wrong Patient Errors: Animated Transitions & Photos Error Recognition Rate for each Group 0.7 63% 0.6 0.5 43% 36% 0.4 0.3 0.2 7% 0.1 0 Control Control Animation Animation Photo Photo Combined CombinedThe combination of animation & photo resulted in a significant increasein error recognition rate relative to the control & animation groups  Dramatic implications for commercial systems (Taieb-Maimon, Plaisant & Shneiderman, 2012)
  35. 35. Year 3 & 4 PlannedDeliverablesMedication ReconciliationLab TrackingSystematic Yet Flexible Systems AnalysisVisualization Guidelines
  36. 36. Anticipated Challenges in Years 3-4Clinical User TestingIndustry Collaboration in TechnologyTransferResources for Widening Impact
  37. 37. Join us for HCIL symposium May 22-23, 2012Includes Medical Informatics Workshop on Day 2 www.cs.umd.edu/hcil/soh

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