Tag Archives: healthcare

Next Five Years of Healthcare

This insight is related to all of you and your children and relatives. It is about the health and healthcare. I feel confident to envision the progress for five years, but cautious to guess for longer. Even next five years seem pretty exciting and revolutionary. Hope you will enjoy they pathway.

We have problems today

I will not bind this to any country, hence American readers will not find Obamacare, ACO or HIE here. I will go globally as I like to do.

The old industry of healthcare still sucks. It sucks everywhere in the world. The problem is in uncertainty of our [human] nature. It’s a paradox: the medicine is one of the oldest practices and sciences, but nowadays it is one of least mature. We still don’t know for sure why and how are bodies and souls operate. The reverse engineering should continue until we gain the complete knowledge.

I believe there were civilisations tens of thousands years ago… but let’s concentrate on ours. It took many years to start in-depth studying ourselves. Leonardo da Vinci did breakthrough into anatomy in early 1500s. The accuracy of his anatomical sketches are amazing. Why didn’t others draw at the same level of perfection? The first heart transplant was performed only in 1967 in Cape Town by Christiaan Barnard. Today we are still weak at brain surgeries, even the knowledge how brain works and what is it. Paul Allen significantly contributed to the mapping of the brain. The ambitious Human Genome project was performed only in early 2000s, with 92% of sampling at 99.99% accuracy. Today, there is no clear vision or understanding what majority of DNA is for. I personally do not believe into Junk DNA, and ENCODE project confirmed it might be related to the protein regulation. Hence there is still plenty of work to complete…

But even with the current medical knowledge the healthcare could be better. Very often the patient is admitted from the scratch as a new one. Almost always the patient is discharged without proper monitoring of the medication, nutrition, behaviour and lifestyle. There are no mechanisms, practices or regulations to make it possible. For sure there are some post-discharge recommendations, assignments to the aftercare professionals, but it is immature and very inaccurate in comparison to what it could be. There are glimpses of telemedicine, but it is still very immature.

And finally, the healthcare industry in comparison to other industries such as retail, media, leisure and tourism is far behind in terms of consumer orientation. Even automotive industry is more consumer oriented than healthcare today. Economically speaking, there must be transformation to the consumer centric model. It is the same winning pattern across the industries. It [consumerism] should emerge in healthcare too. Enough about the current problems, let’s switch to the positive things – technology available!

There could be Care Anywhere

We need care anywhere. Either it is underground in the diamond mine, or in the ocean on-board of Queen Mary 2, or in the medical center or at home, at secluded places, or in the car, bus, train or plane.

There is wireless network (from cell providers), there are wearable medical devices, there is a smartphone as a man-in-the-middle to connect with the back-end. It is obvious that diagnostics and prevention, especially for the chronical diseases and emergency cases (first aid, paramedics) could be improved.

care anywhere

I personally experienced two emergency landings, once by being on-board of the six hour flight, second time by driving for the colleague to another airport. The impact is significant. Imagine that 300+ people landed in Canada, then according to the Canadian law all luggage was unloaded, moved to X-ray, then loaded again; we all lost few hours because of somebody’s heart attack.

It could be prevented it the passenger had heart monitor, blood pressure monitor, other devices and they would trigger the alarm to take the pill or ask the crew for the pill in time. The best case is that all wearable devices are linked to the smartphone [it is often allowed to turn on Bluetooth or Wi-Fi in airplane mode]. Then the app would ring and display recommendations to the passenger.

4P aka Four P’s

The medicine should go Personal, Predictive, Preventive and Participatory. It will become so in five years.

Personal is already partially explained above. Besides consumerism, which is a social or economic aspect, there should be really biological personal aspect. We all are different by ~6 million genes. That biological difference does matter. It defines the carrier status for illnesses, it is related to risks of the illnesses, it is related to individual drug response and it uncovers other health-related traits [such as Lactose Intolerance or Alcohol Addiction].

Personal medicine is an equivalent to the Mobile Health. Because you are in motion and you are unique. The single sufficiently smart device you carry with you everywhere is a smartphone. Other wearable devices are still not connected [directly into the Internet of Things]. Hence you have to use them all with the smartphone in the middle.

The shift is from volume to value. From pay to procedures to pay for performance. The model becomes outcome based. The challenge is how to measure performance: good treatment vs. poor bedside, poor treatment vs. good bedside and so on.

Predictive is a pathway to the healthcare transformation. As healthcare experts say: “the providers are flying blind”. There is no good integration and interoperability between providers and even within a single provider. The only rationale way to “open the eyes” is analytics. Descriptive analytics to get a snapshot of what is going on, predictive analytics to foresee the near future and make right decisions, and prescriptive analytics to know even better the reasoning of the future things.

Why there is still no good interoperability? Why there is no wide HL7 adoption? How many years have gone since those initiatives and standards? My personal opinion is that the current [and former] interoperability efforts are the dead end. The rationale is simple: if it worth to be done, it would be already done. There might be something in the middle – the providers will implement interoperability within themselves, but not at the scale of the state or country or globally.

Two reasons for “dead interop”. First is business related. Why should I share my stuff with others? I spent on expensive labs or scans, I don’t want others to benefit from my investments into this patient treatment. Second is breakthrough in genomics and proteomics. Only 20 minutes needed to purify the DNA from the body liquids with Zymo Research DNA Kit. Genome in 15 minutes under $100 has been planned by Pacific Biosciences by this year. Intel invested 100 million dollars into Pacific Biosciences in 2008. Besides gene mechanisms, there are others, not related to DNA change. They are also useful for analysis, predicting and decision making per individual patient. [Read about epigenetics for more details]. There is a third reason – Artificial Intelligence. We already classify with AI, very soon will put much more responsibility onto AI.

Preventive is very interesting transformation, because it is blurring the boarders between treatment and behaviour/lifestyle/wellness and between drugs and nutrition. It is directly related to the chronic diseases and to post-discharge aftercare, even self aftercare. To prevent from readmission the patient should take proper medication, adjust her behaviour and lifestyle, consume special nutrition. E.g. diabetes patients should eat special sugar-free meal. There is a question where drug ends and where nutrition starts? What Coca Cola Diet is? First step towards the drugs?

Pharmacogenomics is on the rise to do proactive steps into the future, with known individual’s response to the drugs. It is both predictive and preventive. It will be normal that mass universal drugs will start to disappear, while narrowly targeted drugs will be designed. Personal drugs is a next step, when the patient is a foundation for almost exclusive treatment.

Participatory is interesting in the way that non-healthcare organisations become related to the healthcare. P&G produce sun screens, designed by skin type [at molecular level], for older people and for children. Nestle produces dietary food. And recall there are Johnson & Johnson, Unilever and even Coca Cola. I strongly recommend to investigate PWC Health practice for the insights and analysis.

Personal Starts from Wearable

The most important driver for the adoption of wearable medical devices is ageing population. The average age of the population increases, while the mobility of the population decreases. People need access to healthcare from everywhere, and at lower cost [for those who retired]. Chronic diseases are related to the ageing population too. Chronic diseases require constant control, interventions of physician in case of high or low measurements. Such control is possible via multiple medical devices. Many of them are smartphone-enabled, where corresponding application runs and “decides” what to tell to the user.

Glucose meter is much smaller now, here is a slick one from iBGStar. Heart rate monitors are available in plenty of choices. Fitness trackers and dietary apps are present as vast majority of [mobile health] apps in the stores. Wrist bands are becoming the element of lifestyle, especially with fashionably designed Jawbone Up. Triceps band BodyMedia is good for calories tracking. Add here wireless weight… I’ve described gadgets and principles in previous posts Wearable Technology and Wearable Technology, Part II. Here I’d like to distinguish Scanadu Scout, measuring vitals like temperature, heart rate, oxymetry [saturation of your hemoglobin], ECG, HRV, PWTT, UA [urine analysis] and mood/stress. Just put appropriate gadgets onto your body, gather data, analyse and apply predictive analytics to react or to prevent.

anything_s

Personal is a Future of Medicine

If you think about all those personal gadgets and brick mobile phones as sub-niche within medicine, then you are deeply mistaken. Because the medicine itself will become personal as a whole. It is a five year transition from what we have to what should be [and will be]. Computer disappears, into the pocket and into the cloud. All pocket sized and wearable gadgets will miniaturise, while cloud farms of servers will grow and run much smarter AI.

Everybody of us will become a “thing” within the Internet of Things. IoT is not a Facebook [it’s too primitive], but it is quantified and connected you, to the intelligent health cloud, and sometimes to the physicians and other people [patients like you]. This will happen within next 5-10 years, I think rather sooner or later. The technology changes within few years. There were no tablets 3.5 years ago, now we have plenty of them and even new bendable prototypes. Today we experience first wearable breakthroughs, imagine how it will advance within next 3 years. Remember we are accelerating, the technology is accelerating. Much more to come and it will change out lives. I hope it will transform the healthcare dramatically. Many current problems will become obsolete via new emerging alternatives.

Predictive & Preventive is AI

Both are AI. Period. Providers must employ strong mathematicians and physicists and other scientists to create smarter AI. Google works on duplication of the human brain on non-biological carrier. Qualcomm designs neuro chips. IBM demonstrated brainlike computing. Their new computing architecture is called TrueNorth.

Other healthcare participatory providers [technology companies, ISVs, food and beverage companies, consumer goods companies, pharma and life sciences] must adopt strong AI discipline, because all future solutions will deal with extreme data [even All Data], which is impossible to tame with usual tools. Forget simple business logic of if/else/loop. Get ready for the massive grid computing by AI engines. You might need to recall all math you was taught and multiply it 100x. [In case of poor math background get ready to 1000x efforts]

Education is a Pathway

Both patients and providers must learn genetics, epigenetics, genomics, proteomics, pharmacogenomics. Right now we don’t have enough physicians to translate your voluntarily made DNA analysis [by 23andme] to personal treatment. There are advanced genetic labs that takes your genealogy and markers to calculate the risks of diseases. It should be simpler in the future. And it will go through the education.

Five years is a time frame for the new student to become a new physician. Actually slightly more needed [for residency and fellowship], but we could consider first observable changes in five years from today. You should start learning it all for your own needs right now, because you also must be educated to bring better healthcare to ourselves!

 

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Mobile EMR, Part V

Some time ago I’ve described ideation about mobile EMR/EHR for the medical professionals. We’ve come up with tablet concept first. EMR/EHR is rendered on iPad and Android tablets. Look & feel is identical. iPad feels better than Samsung Galaxy. Read about tablet EMR from four previous posts. BTW one of them contains feedback from Edward Tufte:) Mobile EMR Part I, Part II, Part III, Part IV.

We’ve moved further and designed a concept of hand-sized version of the EMR/EHR. It is rendered on iPhone and Android phones. This post is dedicated to the phone version. As you will see, the overall UI organization is significantly different from tablet, while reuse of smaller components is feasible between tablets and phones. Phone version is totally SoftServe’s design, hence we carry responsibility for design decisions made there. For sure we tried to keep both tablet and phone concepts consistent in style and feel. You could judge how good we accomplished it by comparing yourself:)

Patients

The lack of screen space forces to introduce a list of patients. The list is vertically scrolled. The tap on the patient takes you to the patient details screen. It is possible to add very basic info for each patient at the patient list screen, but not much. Cases with long patient names simply leave no space for more info. I think that admission date, age and sex labels must be present on the patient list in any case. We will add them in next version. Red circular notification signals about availability of new information for the patient. E.g. new labs ready or important significant event has been reported. The concept of interaction design supposes that medical professional will click on the patient marked with notifications. On the other hand, the list of patients is ordered per user. MD can reorder the list via drag’n’drop.

Patient list

Patient list

MD can scan the wristband to identify the patient.

Wristband scanning

Wristband scanning

Patient details

MD goes to the patient details by tapping the patient from the list. That screen is called Patient Profile. It is long screen. There is a stack of Vital Signs right on top of the screen. Vital Signs widget is totally reused from tablets on the phones. It fits into the phone screen width perfectly. Then there is Meds section. The last section is Clinical Visits & Hospitalization chart. It is interactive (zoomable) like on iPad. Within single patient MD gets multiple options. First options is to scroll the screen down to see all information and entry points for more info available there. Notice a menu bar at the bottom of the screen. MD can prefer going directly to Labs, Charts, Imagery or Events. The interaction is organized as via tabs. Default tab is patient Profile.

Patient profile

Patient profile

Patient profile, continued

Patient profile, continued

Patient profile, continued

Patient profile, continued

Labs

There is not much space for the tables. Furthermore, labs results are clickable, hence the size of the rows should be relative to the size of the the finger tap. Most recent labs numbers are highlighted with bold. Deviation from the normal range is highlighted with red color. It is possible to have the most recent labs numbers of the left and on the right of the table. It’s configurable. The red circular notification on the Labs menu/tab informs with the number how many new results available since last view on this patient.

Labs

Labs

Measurements

Here we reuse ‘All Data’ charts smoothly. They perfectly fit into the phone screen. The layout is two-column with scrolling down. The charts with notifications about new data are highlighted. MD can reorder charts as she prefers. MD can manage the list of charts too by switching them on and off from the app settings. There could be grouping of charts based on the diagnosis. We consider this for next versions. Reminder about the chart structure. Rightmost biggest part of the chart renders most recent data, since admission, with dynamics. Min/max depicted with blue dots, latest value depicted with red dot. Chart title also has the numeric value in red to be logically linked with the dot on the chart. Left thin part of the chart consist of two sections: previous year data, and old data prior last year (if such data available). Only deviations and anomalies are meaningful from those periods. Extreme measurements are comparable thru the entire timeline, while precise dynamics is shown for the current period only. More information about the ‘All Data’ concept could be found in Mobile EMR, Part I.

Measurements in 'All Data' charts

Measurements in ‘All Data’ charts

Tapping on the chart brings detailed chart.

Measurement details

Measurement details

Imagery

There was no a big deal to design entry point into the imagery. Just two-column with scroll down layout, like for the Measurements. Tap on the image brings separate screen, completely dedicated to that image preview. For the huge scans (4GB or so) we reused our BigImage solution, to achieve smooth image zoom in and zoom out, like Google Maps, but for medical imagery.

Imagery

Imagery

Tissue scan, zoom in

Tissue scan, zoom in

Significant events & notes

Just separate screen for them…

Significant events

Significant events

Conclusion: it’s BI framework

Entire back-end logic is reused between tablet and phone versions on EMR. Vital Signs and ‘All Data’ charts are reusable as is. Clinical Visits & Hospitalization chart is cut to shorter width, but reused easily too. Security components for data encryption, compression are reused. Caching reused. Push notification reused. Wristband scanning reused. Labs partially reused. Measurements reused. BigImage reused.

Reusability is physical and logical. For the medical professional, all this stuff is technology agnostic. MD see Vital Signs on iPad, Android tablet, iPhone and Android phone as a same component. For geeks, it is obvious that reusability happens within the platform, iOS and Android. All widgets are reusable between iPad and iPhone, and between Samsung Galaxy tab and Samsung Galaxy phone. Cloud/SaaS stuff, such as BigImage is reusable on all platforms, because it Web-based and rendered in Web containers, which are already present on each technology platform.

Most important conclusion is a fact that mEMR is a proof of BI Framework, suitable for any other industry. Any professional can consume almost real-time analytics from her smartphone. Our concept demonstrated how to deliver highly condensed related data series with dynamics and synergy for proper analysis and decision making by professional; solution for huge imagery delivery on any front-end. Text delivery is simple:) We will continue with concept research at the waves of technology: BI, Mobility, UX, Cloud; and within digitizing industries: Health Care, Biotech, Pharma, Education, Manufacturing. Stay tuned to hear about Electronic Batch Record (EBR).

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Mobile EMR, Part III

This is continuation of previous posts Mobile EMR, Part I and Mobile EMR, Part II

We’ve met with Mr.Tufte and demo’ed this EMR concept. He played with it for a while and suggested list of improvements, from his point of view.

‘All Data’ charts

Edward Tufte insists that sparklines work better than dots. It is OK that sparklines will be of different sizes. It is natural that each measurement has its own normal range. Initially we tried to switch the charts to the lines, but then we rolled back. Seems that we should make this feature configurable, and use sparklines by default. But if some MD wants dots, she can manually switch it in app settings.

Partially our EMR concept has been switched to sparklines – for display of Vital Signs. Below is a snapshot:

Vital Signs

One more thing related to the Vital Signs, we did great by separating on the widget on top, and grouping them together. It adds much value, because they are related to each other. It is important to see what happened to them at each moment. Our approach, based on user testing, appeared to be a winning one!

Space

Current use of the space could be improved even more. First reason is that biggest value of that research was keeping ‘All Information’ on single screen. Human eye recognizes perfectly which type of information is needed. All space is tessellated into multiple locuses of attention. Then human eye locks the desired locus and then focuses within that locus. Second reason is iPad resolution. We can squeeze more from retina resolution without degradation of usability (like size of labels and numbers). It is possible to scale to the newspaper typography on iPad, hence fit more information into the screen estate.

Genogram

This confirms the modern trend to genetics and genetic engineering. Genogram is a special type of diagram, visualizing patient’s family relationships and medical history. In medicine, medical genograms provide a quick and useful context in which to evaluate an individual’s health risks. Many new treatments are tailored by genotype of the patients. E.g. Steve Jobs’s cancer was periodically sequenced and brand new proteins where applied, to prevent disease spread. All cells are built from the proteins, reading other proteins as instructions. This is true for the cancer cells. Thus if they read instructions from fake proteins, then they can not build themselves properly. We like this idea immediately, because its value is instant and big, its importance is as high as allergy. Below is sample genogram, using special markers for genetically influenced diseases.

Sample Genogram

There are other cosmetic observations which will be improved shortly. We continue usability testing with medical doctors. More to come. It could be Mobile EMR on iPhone. Stay tuned.

UPDATE: Continued on Mobile EMR, Part IV.

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Mobile EMR, Part II

On 27th of August I’ve published Mobile EMR, Part I. This post is a continuation.

The main output from initial implementation was feedback from users. They just needed even more information. We initially considered mEMR and All Information vs. Big Data. But it happened that some important information was missing from the concept relied on Powsner/Tufte research. Hence we have added more information and now ready to show the results of our research.

First of all, data is still slightly out of sync, so please be tolerant. It is mechanical piece of work and will be resolved as soon as we integrate with hospital’s backend. The charts on the default screen will show the data most suitable for the each diagnosis. This will be covered in Part III when we are ready with data.

Second, quick introduction for redesign of the initial concept. Vital Signs had to go together, because they deliver synergetically more information when seen relatively to each other. Vital Signs are required for all diagnosis. Hence we have designed a special kind of chart for vital signs and hosted it on top of the iPad. Medications happened to be extremely important, so that physician instantly see what meds are used right now, reaction of vital signs, diagnosis and allergy, and significant events. All other charts are specific to the diagnosis and physician should be able to drag’n’drop them as she needs. It is obvious that diabetes is cured differently than Alzheimer. Only one chart has its dedicated place there – EKG. Partially, EKG is connected to the vital signs, but historically (and technically too) the EKG chart is complemently different and should be rendered separately. Below is a snapshot of the new default screen:

Default Screen (with Notes)

Most important notes are filtered as Significant Events and could be viewed exclusively. Actually default screen can start with Significant Events. We just don’t have much data for today’s demo. Below is a screenshot with Significant Events for the same patient.

Default Screen (with Significant Events)

Charts are configurable like apps on iPad. You tap and hold the one, then move to the desired place and release it. All other charts are ordered automatically around it. This is very useful for the physician to work as she prefers. It’s a good opportunity to configure the sets according to diagnosis. Actually we embedded pre-sets, because it is obvious that hypertension disease is cured differently than cut wound. Screenshot below shows some basic charts, but we are working on its usability. More about that in Part III some time.

Charts Configuration

According to Inverted Pyramid , default screen is a cap of the information mountain. When many are hyping around Big Data, we move forward with All Information. Data is a low-level atoms. Users need information from the data. Our mEMR default screen delivers much information. It can deliver all information. It is up to MD to configure the charts that are most informative in her context. MD can dig for additional information on demand. Labs are available on separate view, groupped into the panels. Images (x-rays) are available on separate view too. MD can click onto the tab IMAGERY and switch to the view with image thumbnails, which correspond to MRIs, radiology/x-ray and other types of medical imagery. Clicking on any thumbnail leads to the image zoomed to the entire iPad screen estate. The image becomes zoomable and draggable. We use our BigImage(tm) IP to empower image delivery of any size to any front end. The interaction with the image is according to Apple HIG standard.

Imagery (empowered by BigImage)

I don’t put here a snapshot of the scan. because it looks like standard full screen picture. Additional description and demo of the BigImage(tm) technology is available at SoftServe site http://bigimage.softserveinc.com. If new labs or new PACS are available, then they are pushed to the home screen as red notifications on the tab label (like on MEASUREMENTS tab above) so that physician can notice and click to see them. It is common scenario if some complicated lab required, e.g. tissue research for cancer.

Labs are shown in tabular form. This was confirmed by user testing. We have grouped the labs by the corresponding panels (logical sets of measurements). It is possible to order labs by date in ascending (chronological) and descending (most recent result is first) orders. Snapshot below shows labs in chronological order. Physician can swipe the table to the left (and then right) to see older results.

Labs

Editing is possible via long tap of the widget, until corresponding widget goes into the edit mode. Quick single click will return the widget to preview mode. MD can edit (edit existing, delete existing and assign new) medications, enter significant sign, notes. Audit is automatic, according to HIPAA, time and identity is captured and stored together with edited data.

Continued in Mobile EMR, Part III.

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Mobile EMR, Part I

At SoftServe we do some researches, I’m in charge of them. This time I’d like to describe one of our researches. It is called Mobile EMR. EMR stands for Electronic Medical Record. This research is intended to find what will hospitals, agencies, practitioners will use tomorrow. Mobile EMR aka mEMR is a hot intersection of booming Mobility, Big Data, Touch Interface, Cloud trends. Today we research it, tomorrow they will use it. SoftServe works with multiple ISVs which build solutions for hospitals, agencies, hence we have influence on evolution of medical solutions.

Part I will be about how we started and what we get up to date, with conclusion for next steps, which will be described later in Part II.

Beginning

It has started some time ago during UX research for medical data visualization. Then famous government initiative has been launched to transfer healthcare industry to EMR. Mixing that soup we figured out that it is possible to propose really new concept for the EMR for physicians. We found research by Seth M. Powsner and Edward R. Tufte, “Graphical Summary of Patient Status” published in far 1994. They work at Yale University. One of them is MD, another is PhD in statistics and guru of presenting data. It was oriented onto All Data paradigm that Mr.Tufte loves. I love it too. I love the idea of having All Data on single pager. As soon as Apple released iPad we understood that it is perfect one pager to put the EMR onto. In 2011 I attended E.Tufte one-day course, and found a moment to speak about healthcare data visualization. Mr.Tufte confirmed there was nothing done in the industry still! He pointed to the printed copy of mentioned research and proposed to implement it. After that we had one more face-to-face contact with Mr.Tufte on that research, we god some additional clarifications and recommendations (mainly related to low level details such as sparklines). Below is a snapshot of the proposed visualization by Powsner/Tufte:

Seth M. Powsner and Edward R. Tufte, “Graphical Summary of Patient Status”, The Lancet 344 (August 6, 1994), 386-389.

All Data has to be handled by special kind of chart, that shows three periods of data. Rightmost biggest part shows week or 10 days, middle narrow part shows previous year, and leftmost part shows all possible data prior to last year. Having such data presentation we are capable to display all anomalies and trends for the whole period that has data logs.

'All Data' chart

“All Data” chart. Seth M. Powsner and Edward R. Tufte, “Graphical Summary of Patient Status”, The Lancet 344 (August 6, 1994), 386-389.

 

We were aware there was web implementation. It was 100 percent copy of the research (charts part of it). Below is a screenshot from the browser:

Web EMR by KavaChart

First Version

We took our Mobile IP and SDK (such as authentication, cache, cryptography etc reusable blocks; Big Image(tm), SaaS SDK) and built first app for iPad. Obviously we lacked deep domain knowledge, hence first version is not perfect. But idea was to do technology feasibility rather than ready-made solution (because we work with healthcare ISVs who keep deep domain expertise). There were few cycles for visualization and layout of the charts and other UI elements. As a result, we got this “first version”:

mEMR Default Screen

All remarks and proposed improvements will be listed herein a bit later! Right now I’d like to show few more screenshots what we have got. Physicians identify the patients by MRN or by name, if the patient stays at the hospital for some time. Hence, we introduced two-way patient identification: via My Patients list, and via wristband/MRN scan. Below are screenshots: My Patients and Wristband/MRN Scan. First one is My Patients:

mEMR My Patients

This one is Wristband/MRN Scan:

mEMR Wristband Scan

User Testing and Recommendations

“First Version” has been shown to MD from New York large hospital. Impressions were mixed :-O
In general – idea of such mEMR is good. But using it with its current data is not so valuable. I’ve got recommendation for data presentation improvements. They are listed in unsorted order below. The format is the following: subheader represents an issue or proposal for improvement. The text after it describe reasoning and clarifies details.

User Info

In the left top corner next to the photo we show basic patient information. It happened that both DOB and age is required simultaneously. Year serves as additional identification for multiple Johm Smiths. Ok, the information about age should be like 56 y.o. F, where F stands for female. M stands for male. Sex must follow the age, and must be encoded into single letter F or M. It should be next to the patient name. DOB should be on second line. Look below:

Photo    John Smith  62 y.o. M

    DOB 05/24/1950

In the right top corner we shown Discharged. It happened that nobody cares about discharge, while everybody needs Admitted. Hence, right below the MRN we have to add new line. MRN and Admitted record must be kept together. Look below:

MRN: 221881-5

Admitted: 08/24/2012

Those requirements are related to the integrity of  the data, what is kept with what. There is no requirements to UI layout. Current layout was confirmed as good.

Diagnosis

There is a widely used abbreviation for diagnoses. It is OK to use smth like HTN and MDs will understand it. Writing Depression is also good, but often names are long and abbreviation works better. Important information that is mission in our “first version” is Allergy. It is “the must” that complements the diagnosis. We have to allocate some space below Diagnosis and specify there Allergy. If Allergy is present, then it must be very contrast, may be highlighted in red. Look below:

HTN, Depression

Allergy: Aspirin (rash)

Medication

The patient can be currently on some medications. They must be listed on top of our single pager. Current Medication is such important as Diagnosis. We can specify it as a simple list of what the patient takes. Look below:

Metoprolol 50 daily [sorry, I can’t put units here right now]

Norvase 5 mg daily

Paroxetine 20 mg daily

Medication can be labeled as Meds. It should be in the upper area of the screen, as well as improved User Info and Diagnosis. Other info such as hospitalization and clinic visits should be kept within the upper area of the screen. Later sections describe the middle area of the screen.

I will provide typical medications for those 4 diagnosis: HTN, CAD/HLD, CHF, Asthma. Please update patients data to those 4 diagnosis only. This is our restriction for demo purposes. Medications will take max 4 lines on text, each line up to 25-30 chars.

Vital Signs

We shown then as separate charts: chart per temperature, chart per pressure, chart per heart rate. It sucks. The reason is that it does not represent information. What MDs see as information from vital signs? The relation between all signs together! Hence we must pack all 5 vistal signs into single chart so that all peaks or dropdowns are visible relatively to each other. The labeling for vital signs is the following: t for temperature, HR for heart rate, BP for blood pressure, RR for respiratory, SpO2 for something I don’t remember right now. The order of vital signs should be as listed with t on top and SpO2 at the bottom. Chart should be from sparklines, not for dots. All mins and maxs should be visualized properly. Now I understood what Mr.Tufte explained to our UX designer about use of sparklines. We though it was for all charts, but it happened it is only for vital signs. Look here for visualization spec. The chart with vital signs must be on top. Let’s keep it alwas in left top corner. If there is insufficient space, stretch it to the width of two charts.

Notes

They suck. Usually doctors put a lot of secondary info there. Hence there is no place for such irrelevant notes on the Home Screen. All doctors need is an entry point into the Notes. Doctors read them on demand. As a secondary screen opened intentionally. Implement it if possible.

Significant Events

Those are important! Significant Event is some even that is related to the life of the patient. E.g. patient fall and got head injury. In other words, non-typical events according to the diagnosis. If vomiting is common for that diagnosis, then vomiting is not a significant event, hence not worth big attention.

Probably we can redesign the right pane to show Medication on top, then Significant Events on top and in the middle, and has Notes as entry point at the bottom. If Medication takes too much space, then we can group it with Vital Signs (increased horizontally chart) and keep them together on top as a separate section. All other charts and Significant Events should be below them. Personally I like first alternative better – to use current right pane for both Medications and Significant Events.

EKG

Electrocardiology is “the must” on home screen. Add it as a separate chart, as in Tufte’s research and in web demo (see links above). It is OK to keep EKG on same place, hence keep it hear Vital Signs for example, at same horizontal level.

Imaging (aka Radiology)

This is a section of all scans. MDs call them interchangeably Imaging and Radiolody.  They have it as secondary information. Hence we have to put probably 1 or 2 images on the Home Screen, but implement separate screen with thumbnails to all imagery available for that patient. For our demo we can keep few images on Home Page, then we will see. But they (images) should be organised in some group labelled as Imaging.

Labs

Our “first version” doesn’t have Labs data at all. How Labs look like? It is a list of text and numbers. Furthermore, MDs get used to the order how to read the labs (BTW I confirm the same for vital signs). E.g. Labs called Hepatic Panel is shown as a sequence of AST, ALT, Alkaline Phosph. Labs called Coagulation is shown as PT, PTT, INR. It is common that Labs list contains 5+ sets of results (named as Panel here). Superscripts are used to represent K+, Na+, Cl-, CO3-, Ca2+ and so on.

We can allocate the space at the bottom of the Home Screen to visualize Labs and Imaging. Labs should grab more space than Imaging. As I’ve told, having 2 thumbnails as an entry point to Big Image is sufficient. Then physician should click either title Imaging or “…” next to the title, to get to the separate screen with all other images. Re Labs, they could be shown in tab format. Look below:

              date1  date2  date3

Erythr.    4.5    4.3    2.8

HGB    140    138    100

Disease Profiles

It could be useful to have layout presets for chronic diseases like Diabetes etc.

Continued on Mobile EMR, Part II.

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WHERE 2.0, Wednesday, Part II – Healthcare & Location

Healthcare session

INTRO highlights from four panelists.

Geomedicine is emerging. Location data needed “to make medical records more enriched”. Environment is a critical player, environment is related to the geography significantly. New medical framework needed.

Place information to be brought into the story. Bring mobility into the story, as a location traces. Location over time (physical activity) matters. How I communicate chronical disease. Traces of daily lives. Pulling features out of daily traces. Looking for standardised platforms to use. Looking for mobilized innovations in healthcare.

Intersection of mobile activity data to deconstruct human genome why people do and how they do. Get data from telecoms, twitter, facebook and analyze the data. Track diseases from social and location networks. Incorporate into doctors’ diagnosis tools.

Tools for healthy behavior changes. How tools change daily behavior patterns. Places, environment, time etc matters. How to utilize technology in healthcare. Location data seems very attractive for unlocking hidden patterns in disease and people data.

APPLICATIONS of new approaches to healthcare.

Eating. If smbd prohibited to eat fast food, the app will discover smbd goes to Taco Bell and warns to not eat there. May be app will tell the doctor about that patient violating the rules of nutrition. Therapy tools. Tools keep track and make recommendations. Tool knows you spent 5h in shopping mall and how it affects insomnia. There are 20,000 toxic places in the states. 10M pounds chemicals per day produced… it is issue for environment. Public health. You are informed, you make decisions. Further: how we bring other specific points of data into the framework?

BARRIERS in geomedicine

Privacy in healthcare is a huge barrier. Overwhelm with information. He-he, BigData comes to healthcare:) Sensemaking out of the data. Profession of data scientist comes to healthcare. Ecosystem needed.

OPPORTUNITIES

Location is an opportunity. In long term – understanding human activity at the level of context to encourage doing smth. Change people awareness, people attitude. Autonomous tracking of behavior patterns. Sensors do not really working. Where do you go? Whom you contact with? You can understand people, their health related behavior. E.g. if you eat in front of TV, how often do you eat home, how
fast do you eat, time of eating, gym facilities. Interventions are bound to the context – what exactly to push to the patient. In-door locations within hospitals and clinics. Geodistance of your day. Those things impact medication. analysis of daily and weekly traces give answers. Parkinson disease is location specific. Self-diagnosis via summarizing information. For medical tools: “one size does not fit all anymore”. Different personalities, research done.

CONCLUSION

conclusion for mHealth – Public Health, Disease Management, Mobile EMR confirmed and distinguished categories (from other ~10 categories) as mHealth solutions.

 

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