1. Flowsheet Analysis Design Concepts Introduction Acknowledgements Proposed Design By studying PICU flowsheets in the context of their actual use, we have defined requirements based on how clinicians track patient data. In the pediatric intensive care unit (PICU), large amounts of data are generated by distributed sources. Paper flowsheets bundle data in a central location, but may not be the optimal design for electronic systems. Electronic medical records have the potential to extend health care providers’ abilities to view, integrate and share information. However, the available electronic products have largely been designed to replicate paper-based systems without taking advantage of what we know about human perception and decision making and the “user centered design process.” The prototype electronic flowsheet surpasses the capabilities of available systems. The proposed design enables better tracking of patient state by providing and showing relationships among variables. Novel graphical elements have been developed for visualizing data trends, acid-base balance, fluid balance, and the Glasgow Coma Scale. The purpose of this study was to apply user-centered design principles to create an electronic flowsheet for pediatric intensive care units that will address the shortcomings of available paper and electronic systems. Developing an Electric Flowsheet for Pediatric Intensive Care Units David Bauer and Stephanie Guerlain* University of Virginia Department of Systems and Information Engineering School of Engineering and Applied Science, Charlottesville, VA 22904-4747 *Co-Director, Medical Informatics Training Program guerlain@virginia.edu  Paper flowsheets are designed for ease of data entry, grouping data by source.  Physician daily notes are grouped by system, integrating lab values, medications, vital signs, etc.  Strengths  Bundles and summarizes key information  Both structured and flexible  Portable (locally)  Weaknesses  Static  Spatial constraints  Determining trends and ranges requires many comparisons Consolidate as much information on a single screen as possible Use graphics that provide an overview with details-on-demand Place related data elements on the same time scale Show the relationships among data Objective This work was supported by the National Science Foundation under Grant No. 0092985 and by the National Library of Medicine Medical Informatics Training Grant A sample page from a flowsheet containing arterial blood gas and other laboratory results. A graphic for hourly and cumulative fluid balance. Trend and range graphics for lab data and vital signs. Click-and-drag target value. Data points resize based on distance from target Axes show data range Zones for common diagnoses Mouse-over data points for time and values. Adjusted (purple) and normal O 2 -Hemoglobin dissociation curves. Data point shade one indicator of time Acid-base map and O2-Hemoglobin Curve Faces represent GCS and other nursing assessments Mouth = verbal response Eyes = eye response Pupils = pupil dilation Eyebrows = pain Ears = motor response Nose = turn/position Reference ranges appear on mouse over Grey bar (normal range) is a 24 hour timeline. Lighter grey shows 48 hours. Critical values appear in red. Most recent value, or value for time period on mouse over Black lines is the patient’s range over a given time period, and the dot is the currently selected value. The text is also the patient’ range. Design Goals Continue to add functionality for filtering and customizing views Create patient cases for a formative evaluation with attending physicians and for an experiment with residents Develop training scenarios for residents, particularly focused on acid-base, electrolyte and fluid balance Future Work In addtion to the design concepts shown above, the interface contains a list of most recent values of significant variables, a timeline for events and data collection, and problem, event, and medication lists. Drips Other input Urine Other output Cumulative Slider for finding cumulative totals of any time range