cognitive information design & visualization cognitive information design & visualization

Project 4: Cognitive Information Design

& Visualization

www.sharpc.org

Project Leaders: Todd R. JohnsonBen ShneidermanCatherine Plaisant

Project manager:

Chitra Shriram

Project Co-Is: Jorge HerskovicElmer Bernstram

Consultants: John Flach

Postdocs, GRAs, Programmers: Eliz MarkowitzSurreya TarkanTiffany 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

What’s unique? What’s identical? What’s equivalent?

Medication Reconciliation: Spatial Layout with Animated Transitions

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

Equivalence

Criteria Example

Form Identical except for brand vs. generic

Advil = IbuprofenSenormin = Atenolol

Functional Same therapeutic intent Atenolol & Propanolol both betablockers

Partial Form or functional equivalence, but differ in dosage, frequency, route

Advil 100 mgAcetaminophen 200mg

None Unique in form & function

LEVELS OF EQUIVALENCE

Medication Reconciliation: Spatial Layout with Animated Transitions

Prototype by Tiffany Chao

VIDEO AVAILABLE AT www.cs.umd.edu/hcil/sharp

DEMO

Twinlist running on Microsoft Amalga PlatformContact: 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

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

Test Result Management: Table Design & Retrospective Analysis

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

Test Result Management: Table Design & Retrospective Analysis

Test Result Management: Table Design & Retrospective Analysis

20

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

21

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

Idealized Space for Medication Ordering

Procedural Flexibility: 3 bitsFunctional Flexibility: Approximately 14.58

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

Natural Space of “Droogle”an e-Prescription demonstration project inspired by Google

By Peter V. Killoran M.D

Droogle Procedural

Flexibility close to ideal: 1 bit

DEMO

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH

Keystrokes: war

From: http://rxterms.nlm.nih.gov:8080/

Keystrokes: war TAB

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH

Keystrokes: war TAB 5

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH

Keystrokes: war TAB 5 TAB

182 different drugs require only 4 keystrokes: letter TAB number TABFunctional flexibility matches ideal

RxTerm Medication Entry Demo Appfrom 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)

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH

Reducing Wrong Patient Errors: Animated Transitions & Photos

BONUS

Reducing Wrong Patient Errors: Animated Transitions & Photos

Reducing Wrong Patient Errors: Animated Transitions & Photos

Reducing Wrong Patient Errors: Animated Transitions & Photos

Reducing Wrong Patient Errors: Animated Transitions & Photos

Error Recognition Rate for each Group

63%

43%

36%

7%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

CombinedPhotoAnimationControl

(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%

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, 2012Includes Medical Informatics Workshop on Day 2

www.cs.umd.edu/hcil/soh