HxRefactored 2015: Jeff Belden "Inspired EHRs: Designing for Clinicians"

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Jeff Belden introduces his book: Inspired EHRs: "Designing for Clinicians" designed for vendor developer teams wanting to improve their user experience.

Healthcare

Inspired EHRs:
Designing for Clinicians
inspiredEHRs.org

Jeff Belden MD
Usability & Design Geek
University of Missouri
Family physician

Inspired EHRs: Designing for Clinicians is a
free, online, interactive e-book for vendor developer
teams wanting to improve their user experience. It
offers clinically inspired, generously illustrated,
inspirational examples to work from.

Demo
The Interactive Table
inspiredEHRs.org

Demo
Medication Timeline
inspiredEHRs.org

How we
see, read, think, decide
And how we interact with our machines

Vendor participation
including EHRA support & encouragement

Core
Advisory Panel
Vendor
Workshop
Guests &
Reviewers
Health IT vendor
Vendor

Core
Advisory Panel
Vendor
Workshop
Guests &
Reviewers
Clinically inspired
Physician Nurse PharmD

Core
Advisory Panel
Vendor
Workshop
Guests &
Reviewers
Designer & HF guided
Designer Human Factors

EHR Vendor?
Help with ONC Requirements
Meaningful Use 2
Safety-enhanced design

Quick-Start Guide
for
Medication List
Medication Reconciliation
Allergy List
Drug Alerts (and Clinical Decision Support)
e-Prescribing (and CPOE)

Future Reference
‘Field Guide’
for
Human Factors Principles
Design Guidelines

Confirming Impact
from the Health IT community

Take it home
Show your team.
Show your leaders.
inspiredEHRs.org

Take your pick
Web | PDF | Lulu.com
Add to the codebase
at GitHub Repo

Invest
More chapters
• Problem List
• Lab Trends Display
• Dashboards
• Clinical Decision Support
• and more…
Contact me at
feedback@inspiredEHRs.org

Thanks
Funding sponsors
California HealthCare Foundation
SHARP-C project of ONC
In-kind sponsorship
EHRA Clinician Experience Workgroup
EHRA Board
Participating vendors at design workshops

Questions
Contact us
University of Missouri-Columbia Jeff Belden
Richelle Koopman
Joi Moore
Nathan Lowrance
Involution Studios Juhan Sonin
Jen Patel
Shreeya Gangwal
University of Maryland Catherine Plaisant
University of Texas-Houston Todd Johnson
feedback@inspiredEHRs.org toomanyclicks.com

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Basics of Electrocardiogram CONTENTS ●Conduction System of the Heart ●What is ECG or EKG? ●ECG Leads ●Normal waves of ECG. ●Dimensions of ECG. ● Abnormalities of ECG CONDUCTION SYSTEM OF THE HEART ECG: ●ECG is a graphic record of the electrical activity of the heart. ●Electrical activity precedes the mechanical activity of the heart. ●Electrical activity has two phases: Depolarization- contraction of muscle Repolarization- relaxation of muscle ECG Leads: ●6 Chest leads ●6 Limb leads 1. Bipolar Limb Leads: Lead 1- Between right arm(-ve) and left arm(+ve) Lead 2- Between right arm(-ve) and left leg(+ve) Lead 3- Between left arm(-ve) and left leg(+ve) 2. Augmented unipolar Limb Leads: AvR- Right arm AvL- Left arm AvF- Left leg 3.Chest Leads: V1 : Over 4th intercostal space near right sternal margin V2: Over 4th intercostal space near left sternal margin V3:In between V2 and V4 V4:Over left 5th intercostal space on the mid clavicular line V5:Over left 5th intercostal space on the anterior axillary line V6:Over left 5th intercostal space on the mid axillary line. Normal ECG: Waves of ECG: P Wave •P Wave is a positive wave and the first wave in ECG. •It is also called as atrial complex. Cause: Atrial depolarisation Duration: 0.1 sec QRS Complex: •QRS’ complex is also called the initial ventricular complex. •‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave. ‘R’ wave is followed by a small negative wave, the ‘S’ wave. Cause:Ventricular depolarization and atrial repolarization Duration: 0.08- 0.10 sec T Wave: •‘T’ wave is the final ventricular complex and is a positive wave. Cause:Ventricular repolarization Duration: 0.2 sec Intervals and Segments of ECG: P-R Interval: •‘P-R’ interval is the interval between the onset of ‘P’wave and onset of ‘Q’ wave. •‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node. Duration:0.18 (0.12 to 0.2) sec Q-T Interval: •‘Q-T’ interval is the interval between the onset of ‘Q’ wave and the end of ‘T’ wave. •‘Q-T’ interval indicates the ventricular depolarization and ventricular repolarization, i.e. it signifies the electrical activity in ventricles. Duration:0.4-0.42sec S-T Segment: •‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave. Duration: 0.08 sec R-R Interval: •‘R-R’ interval is the time interval between two consecutive ‘R’ waves. •It signifies the duration of one cardiac cycle. Duration: 0.8 sec Dimension of ECG: How to find heart rhytm of the heart? Regular rhytm: Irregular rhytm: More than or less than 4 How to find heart rate using ECG? If heart Rhytm is Regular : Heart rate = 300/No.of large b/w 2 QRS complex = 300/4 =75 beats/mins How to find heart rate using ECG? If heart Rhytm is irregular: Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec 5×6=30 10×7 = 70 Beats/min Abnormalities of ECG: Cardiac Arrythmias: 1.Tachycardia Heart Rate more than 100 beats/min

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HxRefactored 2015: Jeff Belden "Inspired EHRs: Designing for Clinicians"

1. Inspired EHRs: Designing for Clinicians inspiredEHRs.org

4. Jeff Belden MD Usability & Design Geek University of Missouri Family physician

5. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from.

6. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …free, online…

7. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …interactive eBook…

8. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …vendor developer teams…

9. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …who want to improve UX…

10. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …clinically inspired…

11. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …generously illustrated…

12. Inspired EHRs: Designing for Clinicians is a free, online, interactive e-book for vendor developer teams wanting to improve their user experience. It offers clinically inspired, generously illustrated, inspirational examples to work from. …inspirational examples…

13.

14.

15.

16.

17. Demo The Interactive Table inspiredEHRs.org

18. Demo Medication Timeline inspiredEHRs.org

19. Why design like that?

20. Human Factors

21. How we see, read, think, decide And how we interact with our machines

22. Human Factors chapter inspiredehrs.org

23.

24. How we made inspiredEHRs.org

25. Vendor participation including EHRA support & encouragement

26. Workshops 1 2 3 Health IT vendor

27. Workshops

28. Core Advisory Panel Vendor Workshop Guests & Reviewers Health IT vendor Vendor

29. Core Advisory Panel Vendor Workshop Guests & Reviewers Clinically inspired Physician Nurse PharmD

30. Core Advisory Panel Vendor Workshop Guests & Reviewers Designer & HF guided Designer Human Factors

31.

32. What’s in it for you? Inspired EHRs

33. EHR Vendor? Help with ONC Requirements Meaningful Use 2 Safety-enhanced design

34. Quick-Start Guide for Medication List Medication Reconciliation Allergy List Drug Alerts (and Clinical Decision Support) e-Prescribing (and CPOE)

35. Future Reference ‘Field Guide’ for Human Factors Principles Design Guidelines

36. Win Arguments over design decisions

37. Inspiration my example

38. Timeline inspiration Hipmunk

39. Timeline inspiration Hipmunk

40. Timeline inspiration Hipmunk

41. Timeline inspiration Hipmunk

42.

43.

44.

45. Collecting Feedback

46.

47. Confirming Impact from the Health IT community

48.

49.

50. Take action

51. Take it home Show your team. Show your leaders. inspiredEHRs.org

52. Take your pick Web | PDF | Lulu.com Add to the codebase at GitHub Repo

53. Invest More chapters • Problem List • Lab Trends Display • Dashboards • Clinical Decision Support • and more… Contact me at feedback@inspiredEHRs.org

54. Thanks Funding sponsors California HealthCare Foundation SHARP-C project of ONC In-kind sponsorship EHRA Clinician Experience Workgroup EHRA Board Participating vendors at design workshops

55. Questions

56. Questions Contact us University of Missouri-Columbia Jeff Belden Richelle Koopman Joi Moore Nathan Lowrance Involution Studios Juhan Sonin Jen Patel Shreeya Gangwal University of Maryland Catherine Plaisant University of Texas-Houston Todd Johnson feedback@inspiredEHRs.org toomanyclicks.com

Editor's Notes

-> The product -> The process
Let’s imagine a story. You are a patient (or with parent) w several chronic diseases. • Your medication list is not simple. • The data drives decisions that you and your doctor or other provider make together. • We all need to be on the same page. • New symptoms could be side effects ◦ When did symptoms begin? ◦ What medications were recently changed? Details?
Let’s take a look. Open the Med List chapter. Jump to 2.2, The Interactive Table.
- Note across the top. The Med List chapter has 3 sections, and a summary. Before we jump to the Interactive Table, you should know that EHR Med Lists can be painfully awkward. We thought we could do better.
— Go to Med list chapter. Jump to Section 2.2 on The Interactive Table. — Here's one of the prototypes. (2.2 The Interactive Table) • Isn't it great? I love these mini-timelines. I was delighted and surprised one morning to see these. Thanks to the design team! • And this is a powerful tool for finding answers ◦ What is recent? Sort date ◦ Which drugs cause dizziness? Filter ◦ Which drugs may need refills today? Only ones from Dr Barnes. (sort, then filter) ◦ And these tools would work for patients, too. (Big sister, little sister) Take a look at the mini-timelines again, • The mini-timelines are enough to have the big picture without all the detail. ◦ Sometimes, we just need to know if we're in Kansas or Missouri. ◦ Other times you need more detail – is the upcoming third intersection a left or right-hand exit ramp? • Let’s take a look at the full-size timeline.
Go to Timeline • See doses, gaps, dose change timing with more granularity • Time travel (expand range, move backwards to ‘shorter list’.)
What principles drove the design? Let’s take a look.
Go to Med List Chapter, section 2.2 [show journey from text, to inline deeper dive, to jump to HF chapter] What principles drove the design? User empathy and research We list the physician’s tasks. We illustrate cognitive load. We account for the fact that humans have limited working memory We invite you to read more, if you have time and interest. For example, let’s explore working memory. Click through to Working Memory in HF chapter.

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