Tag Archives: Powsner

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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