Cognitive Information Design & Visualization Cognitive Information Design & Visualization

Project 4: Cognitive Information Design & Visualization Project 4: Cognitive Information Design & Visualization Project Leaders: Todd R. Johnson Ben Shneiderman Catherine Plaisant Project manager: Chitra Shriram Project Co-Is: Jorge Herskovic Elmer Bernstram Consultants: John Flach Postdocs, GRAs, Programmers: Eliz Markowitz Surreya Tarkan Tiffany Chao

Top 3 Accomplishments in Years 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

Whats unique? Whats identical? Whats equivalent? Medication Reconciliation: Spatial Layout with Animated Transitions

Automated medication reconciliation and complexity of care transitions Bozzo Silva, Bernstam, Markowitz, Johnson, Zhang and Herskovic, AMIA 2011 EquivalenceCriteriaExample FormIdentical except for brand vs. generic Advil = Ibuprofen Senormin = Atenolol FunctionalSame therapeutic intentAtenolol & Propanolol both betablockers PartialForm or functional equivalence, but differ in dosage, frequency, route Advil 100 mg Acetaminophen 200mg NoneUnique in form & function LEVELS OF EQUIVALENCE

Medication Reconciliation: Spatial Layout with Animated Transitions Prototype by Tiffany Chao VIDEO AVAILABLE AT DEMO

Twinlist running on Microsoft Amalga Platform Contact: Hank Rappaport Twinlist adapted for problem list reconciliation in cancer risk assessment software (Hughes riskApps) Contact: Kevin S. Hughes, Massachusetts General Hospital Medication Reconciliation: Spatial Layout with Animated Transitions Best medication reconciliation interface I have seen Shawn Murphy, MD, PhD, Harvard University A sigh of relief when I saw Twinlist Melinda Jenkins, PhD, FNP A sigh of relief when I saw Twinlist Melinda Jenkins, PhD, FNP

Test Result Management: Table Design & Retrospective Analysis GOALS: Help clinicians see what needs attention Rich tabular displays Facilitate taking action Clarify responsibility Embed operations to save time Allow retrospective analysis

Sample Current Design VA View Alerts Test Result Management: Table Design & Retrospective Analysis

Sample Current Design VA View Alerts Test Result Management: Table Design & Retrospective Analysis

Sample Current Design VA View Alerts Test Result Management: Table Design & Retrospective Analysis

Color-Coding, Icons, and Ranking

Compact Layouts Test Result Management: Table Design & Retrospective Analysis

Improved Headers Test Result Management: Table Design & Retrospective Analysis

Integrated Actions 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 Test Result Management: Table Design & Retrospective Analysis

Systematic Yet Flexible Systems Analysis: Framework for analyzing HIT interface 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

SYFSA in a Nutshell Idealized: Logical constraints on the work, independent of any system Natural: How the current system supports and constrains the work System: A redesigned system that matches logical constraints as closely as possible 21

Idealized Space for Medication Ordering Procedural Flexibility: 3 bits Functional Flexibility: Approximately Estimate from RxNorm: ~ 24,000 prescribable drugs, including those not in RxNorm

Open Vista Natural Space

OpenVista: Natural Space OpenVista – The Natural Space Too much procedural flexibility: 9.5 bits OpenVista – The Natural Space Too much procedural flexibility: 9.5 bits

Natural Space ofDroogle an e-Prescription demonstration project inspired by Google By Peter V. Killoran M.D Droogle Procedural Flexibility close to ideal: 1 bit Droogle Procedural Flexibility close to ideal: 1 bit DEMO

RxTerm Medication Entry Demo App from The National Library of Medicine, NIH Keystrokes: war From:

Keystrokes: war TAB RxTerm Medication Entry Demo App from The National Library of Medicine, NIH

Keystrokes: war TAB 5 RxTerm Medication Entry Demo App from 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 182 different drugs require only 4 keystrokes: letter TAB number TAB Functional flexibility matches ideal RxTerm Medication Entry Demo App from The National Library of Medicine, NIH

Procedural flexibility: 5.1bits Maximum interface efficiency: ~ 68% (4 keystrokes) Minimum interface efficiency: ~ 5% (50 character free text entry) Procedural flexibility: 5.1bits Maximum interface efficiency: ~ 68% (4 keystrokes) Minimum interface efficiency: ~ 5% (50 character free text entry) RxTerm Medication Entry Demo App from The National Library of Medicine, NIH

Reducing Wrong Patient Errors: Animated Transitions & Photos BONUS

Reducing Wrong Patient Errors: Animated Transitions & Photos

( Taieb-Maimon, Plaisant & Shneiderman, 2012) The combination of animation & photo resulted in a significant increase in error recognition rate relative to the control & animation groups Dramatic implications for commercial systems Control Photo Combined 36% Animation 7% 43% 63%63%

Year 3 & 4 Planned Deliverables Medication Reconciliation Lab Tracking Systematic Yet Flexible Systems Analysis Visualization Guidelines

Anticipated Challenges in Years 3-4 Clinical User Testing Industry Collaboration in Technology Transfer Resources for Widening Impact

Join us for HCIL symposium May 22-23, 2012 Includes Medical Informatics Workshop on Day 2