The Text-Based Workaround
I have tried to make the case that the Snapshot-in-Time design, although rarely used as a high-level EHR paradigm, does a much better job than the widely adopted Overview-by-Category design for two reasons:
1) Clinicians think of the patient’s health as a story – a narrative of how things got to be the way they are. Each patient’s story is rich, complex, and unique. By presenting the patient’s story as a series of snapshots in time, this rich narrative gradually unfolds, a little like turning the pages of a picture book.
2) The Snapshot-in-Time design, when combined with assigning each category of data to a fixed location on the screen or page (see Why T-Sheets Work), allows us to take it in and process information using the fast visual processing part of our brain. In contrast, the Overview-by-Category design compels us to use slower cognitive processing.
In my last post, I wrote that perhaps due to the limitations inherent in the Overview-by-Category design, most EHRs that employ it also provide a workaround solution. This workaround is nothing other than a text-based chart note generated by the EHR.
For each patient encounter, the EHR can generate a single, relatively comprehensive text-based document assembled from the previously-entered structured data.
These text-based documents are typically in Microsoft Word or PDF format. They can be viewed on the monitor from within the EHR application, printed, or sent electronically as PDFs.
Although these text-based EHR chart notes are snapshots in time (unlike the Overview-by-Category EHR screens), they usually have significant problems, including:
- low data density
- non-interactive design
- poor spatial organization and layout
In this and the next several posts, I will address these issues by presenting mockups of text-based chart notes, based on the design of several well-known EHRs.
The mockups use the same patient database that I used for the Snapshot-in-Time and the Overview-by-Category mockups. While these examples are for an ambulatory patient, similar designs are common in hospital-based EHR systems.
Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.