designing an open source presentation layer for the patient

PIIM PIIM IS A RESEARCH AND DEVELOPMENT FACILITY AT THE NEW SCHOOL

DESIGNING AN OPEN SOURCE PRESENTATION LAYER FOR THE PATIENT-CENTERED MEDICAL HOME [PAGE 1]

Designing an Open Source Presentation Layer for the Patient-Centered Medical Home CHRISTOPHER GORANSON, DIRECTOR, PARSONS INSTITUTE FOR INFORMATION MAPPING

JIHOON KANG, MFA, ASSOCIATE DIRECTOR, PARSONS INSTITUTE FOR INFORMATION MAPPING

ABSTRACT

The Parsons Institute for Information Mapping (PIIM) through funding provided by the Telemedicine & Advanced Technology Research Center (TATRC) is developing a widget-based prototype for the Patient- Centered Medical Home (PCMH) environment. Througha collaboration with the Walter Reed National Military Medical Center (WRNMMC), the prototype provides both a patient and provider portal. This presentation layer is streamlined for easy access to medical information and interaction between patients and healthcare providers.We hope to show how through an Open Source environ-ment and a better mapping of data sources and providers, better design can contribute to more manageable EHR environment. This presentation will show some resultsof our recent usability testing efforts and demonstratethe prototype. The designs, code base, and documentation are planned for an Open Source release in December2012 through the OSEHRA framework.

INTRODUCTION

The Parsons Institute for Information Mapping (PIIM),of The New School is developing a widget-based prototype for the Patient-Centered Medical Home (PCMH) Environ-ment. The prototype, Healthboard, is being developedin Flex/Flash and will serve to provide a one-stop visual dashboard for patients and providers. Developed specifi-cally to enhance the communication of information through better visualization of medical data, the tool strives to make difficult data much easier to understandby utilizing best-practice design principles and standard-ization of information provided through the system.

Healthboard is scheduled for a planned release within the Open Source Electronic Health Record Agent (OSEHRA) platform. We hope to establish Healthboard as an alternative presentation layer for electronic medical records (EMR) or for use directly within the PCMH environment. The prototype and design documents will be provided to assist developers in providing an enhanced level of support, better user experience and a streamlined interface between patients and their healthcare providers. Because the system follows a modular structure, some or all of Healthboard may be implemented depending on

Isaac Goodman LogoutSettings Available

3:45 pmYesterdayApr 2Feb 7

PhysicianAdministrationFront DeskLorem Ispum

Chronic painProblem sleep...Persist coughDel Damar

...plus 6 more messages. View All »

MMRPolioTetanus & DiphtheriaYellow Fever

due 40 days agodue 40 days agodue in 15 daysdue in 15 days

Immunizations (4)

Next Appt.in 12 days

Last Appt.8 days ago

THURSDAY 10:00 AMPhysical ExaminationDr. Gregory Berg(999) 999-9999View Map »

OCTOBER

27

Physical Examination · Oct 12, 2011Dr. Gregory Berg

Start the Physical Rehabilitation regimen we spoke about. Our Gentle Chair Yoga class would be bene�cial if you �nd the time.

Recommendation: Gentle Chair Yoga Clas

Thr Fri Sat

Lisinopril (Prinivil/Zestril) PO 40mg Tab

HCTZ (Esidrex/Oretic) PO 25mg Tab - Oct 12: Your renewal request was approved.

HCTZ (Esidrex/Oretic) PO 25mg Tab

Acetaminophen (Tylenol® PM)

Ferrous Sulfate PO 325mg Tab

Lipodrene

Jiang Ya Piam

Mon Tue WedSun

1,532-0

Calories ConsumedCalories Burned

1,532 of 2,000 Total Daily Calories

Fruits

Protein

Grains

Dairy

Vegetables

Alcohol

Fats & Oils

Sodium

SugarsWeight

Score1.5 Mile Run

Curl UpsPush Ups

Most Recent PRT (Last: Mar 11, 2011)

Personal (Last: Oct 19, 2011)

30

Physician-assigned (Last: Oct 19, 2011)

35 minutes2.8 miles

110 mg/dL

Glucose Level (Last: Oct 19, 2011)35

36 times

Average PRT Score

MedicationsMessages (10)

Appointments (3)

Vital Signs

Nutrition Wed, Oct 12 Exercise

Medical Records

My Food Plan My Food Journal

Learn more about Nutrition: Educational Resources

Summary

Nutrition You have no new noti�cation.

September 8, 2011

My Health Focus

Did you take your Medications today? Last update: Today – 08:45 am

Did you excercise today? Log your Exercise

Check or view your weight in Vital Signs

My Food Plan

My Goal is to:

Grains: 7-8 daily servings

Vegetables: 4-5 daily servings

Fruits: 4-5 daily servings

Low-fat or fat-free dairy: 2-3 daily servings

Meat, poultry and �sh: 2 or less daily servings

Nuts, seeds & dry beans: 4-5 servings per week

Fats and oils: 2-3 daily servings

Sweets: limit to less than 5 servings per week

Record Water Intake

more than8 cups

+

My Food JournalToday

800400 1200 1600 2000 cals.0

Total Calories1700 cals.

Calories from Extras (fats & oils, sugars, and alcohol) 515 cals. I’m exceeding my calories budget from extras.

My Plate

Search Nutrition

Record a Meal

DinnerDinner

Or submit a new food.

Submit

Search

Or add a saved mealAdd a saved meal

600 cal.400 5003002001000

Protein

GrainsDairy

Fruits

Vegetables

Sugars

less than1 servings

Alcohol

less than2 drinks

Sodium

2 - 3 servings

Fats & Oils

Learn how to improve your diet »

What can I eat?

Remember, get most of calories from fruits, vegetables and starches.

Food to Limit

Food to Increase

View More »

View More »

??

2,000 mg.

Read Comment

Isaac Goodman LogoutSettings Available

Search Appointments

Michael RobinsonIsaac Goodman

Appointments You have 3 requests in need of con�rmation.

Dr. Gregory Berg LogoutSettings Available

October 2011

M T W T F SS

1

3 4 5 6 7 8

11 12 13 14 15

ClassesVisits/Teleconsults

17 18 19 20 21 22

10

2

9

16

24 25 26 27 28 2923

3130

Wednesday, October 12

OCT

12

1100

2011Requests

0700

0600

0800

0900

1000

Walter Glover

Berg, MD – Visit

Wed, Oct 12, 2011 at 0930

View | Accept | Decline

Michael Robinson

Berg, MD – Teleconsult

Sat, Oct 15, 2011 at 1100


Edward Alexander

Berg, MD – Visit

Tues, Oct 18, 2011 at 1145


Appointment Details

Oct 12, 2011 at 0930

Oct 12, 2011 at 1000

From

To

Neil Green�eld, MD

Patient

Telephone

Email

Type

Reason

Michael Wunderlich

(212) 111-2222

[email protected]

Web Conference

Follow-up

Location The New York Clinic99 Main St.New York, NY 11111

Prerequisite None

Send Message

Michael Robinson0830–0900 hrs

Berg McKinleyGreen�eld

Show: Three Doctors+ Add Appointment Print Appointments

John S. Cloud0630–0730 hrs

Michael Wunderlich0930–1000 hrs

Berg Lee1030–1130 hrs

Lance Robinson0700–0800 hrs

Conference0730–0830 hrs

Anna W. Chang1000–1100 hrs

Walter Glover0930–1000 hrs

Visits Web Conferences Others Pending Requests

figure 1: Screen shots from Patient Portal and Providers Portal of Healthboard


PARSONS INSTITUTEFOR INFORMATION MAPPING

68 5th AvenueRoom 200New York, NY 10011

T: 212 229 6825F: 212 414 4031http://piim.newschool.edu

the need of the particular program.

BACKGROUND

In 2008, PIIM began a project with the Telemedicine & Advanced Technology Research Center (TATRC) to develop an enhanced graphic user interface (GUI) for the Armed Forces Health Longitudinal Technology Application (AHLTA).1 PIIM’s work was to identify opportunities to improve the GUI and the overall visual-ization of medical information available in AHLTA. PIIM was also responsible for performing a review of the usability of the system and provide recommendations for improving the system’s use amongst end users. Finally, PIIM developed a prototype that represented all of these areas to demonstrate the effect that a redesigned GUI could have on the system.

In 2009, PIIM began working on the Visual Dashboard and Heads-up Display of Patient Conditions award, which ultimately created the Healthboard system described herein. The project involved developing a visual style for the patient and provider dashboards used within a Patient-Centered Medical Home Environment, developing a user experience strategy, engineering a prototype, and finally performing usability testing and redesigning the interface based on user feedback.

2 4

4

3

Isaac Goodman(1964− )

Jenny Curran(1944− )

Horace Curran( −2007)

4

Lynn Grant( )

Kane Goodman( )

Mara Nome( −1995)

1

John Goodman(1944− )

maximum3 servings

5-6 servings

maximum 3 servings

5-6 servings

4-5servings

Fruits

VegetablesProtein

Grains

DairyWeight 1.5 Mile Run

Curl UpsPush Ups

Average PRT Score

DEVELOPMENT OF THE HEALTHBOARD PROTOTYPE

The goal of Healthboard was to ultimately provide a way for active duty military personnel and their spouses to interact with their own personal health information and electronic medical records. Furthermore, Healthboard was to provide a streamlined mechanism for patients and providers to interact. Our development effort began with the following high-level requirements:

•To enhance communication between the patient and providers

•To allow the patient to gain easy assess to his/her own health records

•To enable heath data self-reported by the patient

•To help the patient gain health literacy and awareness

By integrating best-practice design principles and data visualization strategies, the enhanced GUI design and its attention to user friendliness and usability targets should provide a better overall user experience for patients as they interact with medical information. As a result,

figure 2: UI components related to data visualization





medical information could be streamlined. To some degree, the intimidation factor of viewing such information could be partially mitigated for non-medically trained users.COLLABORATION

Working with project stakeholders and Military Health System (MHS) representatives, PIIM developed a Product Requirements Document (PRD) and Project Management Plan (PMP). Developing iterative versions of three primary documents, the Detailed GUI Design Volume,2 Information Strategy Volume,3 and Engineering Volume,4 these projects served to provide the basis and backb one for the eventual prototype.5 As the Patient-Centered Medical Home Environment within Walter Reed National Military Medical Center (WRNMMC) was identified as the primary use case for the development of the Healthboard prototype, PIIM worked with the medical home program at WRNMMC and Telemedicine & Advanced Technology Research Center (TATRC). The following experts in each organization have contributed towards the successful completion of this project:

Parsons Institute for Information Mapping (PIIM)

GUI Designers

UX Designers

Information Designers

Usability Specialists

Medical Informatics Specialists

Engineers

Walter Reed National Military Medical Center

Physicians

Nurses

Dietitians

Pharmacists

IT Specialists

Hospital Administrators

Telemedicine & Advanced Technology Research Center

MHS Subject Matter Experts

Program Mangers

Grant Managers

PIIM developed user requirements and use cases based off of feedback from collaborators. In addition, feedback was received through weekly teleconferences held with a team of reviewers, where the iterative GUI designs and other works were shared. Each module was presented as it was being developed, and additional medical expertise was consulted as necessary to inform the design team.6

DESIGN OUTCOMES

PIIM successfully delivered GUI/UX models satisfying the high-level requirements listed above through the design iterations. The following modules/UI features have been identified and designed to enhance communication between the patient and providers:

•Messages

•Live Chat (video, audio, text)

•Appointments

•Reminders

•Medications (requesting renewals)

figure 3: Examples of modules and components designed to enhance communication between patients and providers





The following modules/UI features have been identified and designed to allow the patient to gain easy assess to his/her health records:

•Medical Records (visit summary, test results, procedure/surgery records)

•Immunization

•Medications (prescription medications)

•Vital Signs (taken during visits)

The following modules/UI features have been identified fied and designed to enable heath data self-reported by the patient:

•Vital Signs (taken by the patient)

•Nutrition

•Medications (over-the-counter, supplements, herbal medicines)

•Exercise

The following modules/UI features have been identified and designed to help the patient gain health literacy and awareness:

•Educational Resources

•Nutrition (provider-entered recommendations and nutrition guides)

•Context-sensitive help and tips

Isaac Goodman Michael Robinson

Isaac Goodman » Nutrition Search Nutrition

Dr. Gregory Berg LogoutSettings Available

Food Plan Food JournalSummary

September 8, 2011

Food Plan

Patient’s goal is to:

Grains: 7-8 daily servings

Vegetables: 4-5 daily servings

Fruits: 4-5 daily servings

Low-fat or fat-free dairy: 2-3 daily servings

Meat, poultry and �sh: 2 or less daily servings

Nuts, seeds & dry beans: 4-5 servings per week

Fats and oils: 2-3 daily servings

Sweets: limit to less than 5 servings per week

Food JournalToday

800400 1200 1600 2000 cals.

Total Calories1700 cals.

Calories from Extras (fats & oils, sugars, and alcohol) 515 cals. I’m exceeding my calories budget from extras.

600 cal.400 5003002001000

Protein

GrainsDairy

Fruits

Vegetables

Sugars

less than1 servings

Alcohol

less than2 drinks

Sodium

2 - 3 servings

Fats & Oils

Learn how to improve your diet »

What can the patient can eat?

Remember, get most of calories from fruits, vegetables and starches.

Food to Limit

Food to Increase

View More »

View More »

?

2,000 mg.

Patient’s Plate

Set Food Plan + Add Comments

Read Comment

4.5 cups

Patient’s Water Intake

+

Recent Meals

9/08/11Breakfast1 piece spinach quiche2 slices canadian bacon2 eggs

Lunch16 oz. ribeye steak16 pieces fried calamari2 cups tomato juice

Dinner2 �llets trout1 bowl caesar salad1 serving of chocolate cake

Snack1 bag of chips

9/07/11Breakfast1 piece spinach quiche2 slices canadian bacon

Display meals7

Patient Pro�le Nutrition (2) | View All Alerts (15)

figure 4: Screen shots from modules supporting self-reported data and context-sensitive help and tips

Isaac Goodman Michael Robinson

Isaac Goodman » Vital Signs Search Vital Signs

Patient Pro�le

Isaac GoodmanPatient ID:

SSN:DOB:

Sex:Rank/OS:

000704190213-55-423201/01/1965 (46 Years)MaleSCPO, Navy

Urgency Time Alert

Blood Pressure

Weight

March 11

March 11

Description

Stage 2 Hypertension

+10 pounds

Vital Signs (2) | View All Alerts (15)Type

Vital Signs

Vital Signs

PATIENT’S VITALS

All

Height

Weight

Blood Pressure

Heart Rate

Respiratory

Temperature

+ Add Tracker

?Patient’s Blood Pressure

155 / 120 mmHg 15 / 30 mmHg

March 11, 2011 from February 3, 2010

Systolic Patient Entry Provider EntryDiastolic Reference:Goal

Time Range: 1d 1w 1m 3m 1y 3y All Custom

View History

Diastolic

90.00

120.00

140.00

160.00

105.00

180.00

Hypotension

Normal

Prehypertension

Type 2 Hypertension

Hypertensive Crisis

Type 1 Hypertension

+ Set Goals

LogoutSettings Available Dr. Gregory Berg

PIIM IS A RESEARCH AND DEVELOPMENT FACILITY AT THE NEW SCHOOL





MOVING TOWARDS AN OPEN SOURCE ENVIRONMENT

Following conversations with project stakeholders, PIIM made a decision in early 2012 to begin planning for the eventual move of the Healthboard prototype to an open source environment. In August 2012, PIIM began conver-sations with representatives of the Open Source Electronic Health Record Agent project (OSEHRA). OSEHRA is built on the notion of facilitating the development, improvement, and maintenance of EMR platforms, making them freely available for medical beneficiaries.7

In December 2012, PIIM plans to release the prototype and design documents through the OSEHRA framework, making them available as an alternate presentation layer. This presentation layer may ultimately prove useful as an informative tool to the development and designs of future MHS systems and initiatives, as well as to the development of systems outside the U.S. Military.

CONCLUSION

Healthboard is a unique system designed to serve both patients and providers with a better user experience among other things through intuitive interface, data visualization (for better comprehension of information and decision-making), and end-user support while respecting the workflow of the remote patient-care process. As PIIM continues with the usability testing and related research on Healthboard, we hope that the final prototype and its supporting documents will help establish a benchmark for how patients and healthcare providers can interact through better design by December 2012. The system has met most of the requirements that were defined at the initiation of the project, as well as the requirements stated during the iterations. We expect the health professionals will continuously provide quality healthcare while limiting the number of doctor’s visits once this system is successfully deployed and utilizedin reality. The system would help patients stay healthy, prevent illnesses, gain health literacy and awareness, and monitor their own health records, as well as allow them to self-report health-related activities and educate themselves through online resources. The key to achieving such meaningful goals is a collaborative effort; the designers play a significant role in an EMR system’s design or redesign, they cannot take the task alone, and neithercan the engineers nor the clinical experts. It was successful only through the successful formation of a team of clinical experts, designers, usability experts, engineers, IT experts, and administrative experts. Ultimately, we hope that the collaborative effort contributed by PIIM, WRNMMC, and TATRC will become a major precedence for the practiceof designing the EMR system.

ACKNOWLEDGEMENTS

The author would like to thank our TATRC and WRNMMC project stakeholders who have provided invaluable guidance during our design and development process. We would also like to thank the PIIM Design and Engineering teams for their continued support and hard work during the development of this project.

This work is supported by the Telemedicine and Advanced Technology Research Center (TATRC) at the U.S. Army Medical Research and Materiel Command (USAMRMC) through award W81XWH-11-2-0025.

NOTES

1 Award No. W81XWH-09-1-0456: Leveraging the PIIM Process to Advance Health IT. The Telemedicine and Advanced Technology Research Center (TATRC).

2 Jihoon Kang et al. The Visual Dashboard & Heads-up Display of Patient Conditions: GUI Design Volume. New York: Parsons Institute for Information Mapping, The New School, 2012.

3 J Kang and D Bendersky. The Visual Dashboard & Heads-up Display of Patient Conditions: Information Strategy Volume. New York: Parsons Institute for Informa-tion Mapping, The New School, 2012.

4 D Bendersky and J Kang. The Visual Dashboard & Heads-up Display of Patient Conditions: Engineering Volume. New York: Parsons Institute for Information Mapping, The New School, 2012.

5 B. Willison. “Quarterly Report: Leveraging the PIIM Process to Advance Health IT.” Quarterly Report, Parsons Institute for Information Mapping, New York, NY, June– September, 2009.

6 J Kang, S Yoshida, A Ina. The Visual Dashboard & Heads-up Display of Patient Conditions: Assessment Volume. New York: Parsons Institute for Information Mapping, The New School, 2012.

7 OSEHRA, “About OSEHRA,” About Us, http://www.osehra.org/page/about-us, 2012.

designing an open source presentation layer for the patient

Documents