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EHR Design Talk with Dr. Rick 5/13/13

May 13, 2013 Rick Weinhaus 2 Comments

The Data-Ink Ratio

In the last several posts, we’ve been considering the two major high-level user interface designs for organizing a patient’s EHR record over time – the Snapshot-in-Time Design that formed the core of much paper-based charting and the Overview-by-Category Design that has been much more widely adopted by EHR vendors.

Despite the widespread adoption of the Overview-by-Category design, it does a poor job of helping the physician understand the patient’s record as a narrative that unfolds over time. As a result, most EHRs employing the Overview-by-Category design also provide a workaround that does, in fact, provide the physician with a snapshot-in-time view – The Text-Based Workaround.

In my last post, we saw a major problem with the text-based chart notes generated by most EHRs – they have an exceedingly low data density. In addition, they often have a second problem –a low data-ink ratio.

The concept of the data-ink ratio was introduced in 1982 by Edward Tufte, a pioneer in the field of data visualization – the field of how to present abstract information graphically in formats optimized to take advantage of our high-bandwidth visual processing system.

Tufte defined the data-ink ratio as the amount of ink used to display data divided by the total amount of ink used in the graphic or display. He proposed that, within reason, good visual designs maximize the data-ink ratio, both by devoting a large share of the graphic to actual data and by pruning unnecessary and redundant non-data. Think of the data-ink ratio as the signal-to-noise ratio for graphics.

Let’s return to the same EHR-generated text-based chart note we’ve been considering and investigate how well it maximizes the data-ink ratio. The mockups shown below are a composite design based on several widely used EHRs.

In order to see the mockups and read the accompanying text, enlarge them to full screen size by clicking on the ‘full screen’ button clip_image001in the lower right corner of the SlideShare frame below.

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.

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2 Responses to “EHR Design Talk with Dr. Rick 5/13/13”

  1. 1
    Bignurse Says:

    Dr Rick, I am SO glad you are publishing your analysis of the user interface, i.e. the fundamentals of usability. Too bad the industry didn’t begin with these insights, instead of playing catch-up. Even though usability improvements may be a priority for vendors, often the programming simply does not provide the flexibility needed.

  2. 2
    Rick Weinhaus, MD Says:

    Hi Bignurse,
    Thanks so much for your support and observation. I agree with you completely. The underlying data structure and initial design of an EHR often make it difficult or impossible to make major improvements in the usability of the user interface after the fact. As a result, over the next several years, we will probably be seeing a lot of smaller companies developing new, more usable front-ends for the enterprise systems.
    Rick

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