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EHR Design Talk with Dr. Rick 4/4/12

April 4, 2012 Rick Weinhaus 3 Comments

The Problem with Scrolling

Imagine that you are a member of an EHR software development team. Your team has been given the task of designing a new user interface that will provide an overview of an entire patient encounter in a single screen view.

Your current user interface requires clinicians to navigate to multiple screens to enter and review data for a single patient encounter. Many clinicians find that the navigation interferes with focusing on patient issues. Even worse, they can’t keep the relevant data in their working memory as they navigate from screen to screen (see my last post).

Your team starts out by drawing a rough sketch of what the new screen view might look like:

4-4-2012 3-57-15 PM


Each pane will display data. Your problem is how to display each category of data within the areas of these small panes.

Your team decides to start with the redesign of the medication pane. Your EHR’s current medication screen is shown below for a particular patient who is taking nine medications. I have resized your screen view to fit the width of this post, but in your EHR application you can easily see the entire medication table on a single screen without scrolling.

4-4-2012 3-58-24 PM


How do you display the medication data above using a much smaller pane size? One of your team members suggests a commonly used EHR design — vertical and horizontal scrollbars for each pane. Your team decides to explore this scrolling option first.

You sketch a pane with vertical and horizontal scrollbars, as below. The example below displays the upper left portion of the medication screen above. The red arrow to the right shows the position of the vertical scrollbar.

4-4-2012 3-58-56 PM


Right away you and your team realize that this design has problems. First of all, a clinician using this design would have to scroll down to two additional locations in the table (only one shown below) just to see the complete list of meds:

4-4-2012 3-59-58 PM


Similarly, she would have to scroll across to two additional locations in the table (only one shown below) to see the complete data for any particular medication:

4-4-2012 4-00-47 PM

She would have to navigate to nine different views within the pane to see all the data! As Alan Cooper points out in About Face 3: The Essentials of Interaction Design, scrolling is a form of navigation even though we don’t usually think of it as such.

Furthermore, the scrollbar design doesn’t solve the working memory problem. As soon as the clinician scrolls to a new position in the table, the previous information is gone from view. She might as well navigate to the full screen medication window.

You and your team note additional problems with the pane with scrollbars design:

  • It does not display a summary list of all nine medications.
  • The clinician can inadvertently scroll past critical information.
  • Using the scrollbars requires fine motor skills and eye-hand coordination, interfering with the clinician’s ability to focus on patient issues.
  • Text can be truncated both horizontally and vertically, making it difficult to read.
  • The scrollbars and header bar waste valuable screen real estate.
  • Depending on operating system speed, there can be latency between the scrolling action and the updated screen.

Despite the fact that the pane with scrollbars is a common EHR design element, the result is a computer-centered, not a user-centered design.

It’s back to the drawing board. In my next post, I will show some better EHR software designs for presenting multiple categories of data in a single screen view.

Next Post

Overview with Details on Demand — a Versatile Design

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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Currently there are "3 comments" on this Article:

  1. I would propose that most of the medication information is extraneous. You should list only the name of the drug, and then provide a “hint balloon” when the mouse hovers over the drug. This balloon would give additional detail about the drug under the cursor.
    I believe that hint balloons are a UI element that are underutilized. For some reason, there seems to be a need on the part of UI designers to include everything in a data presentation. The KISS principle would suggest keeping initial views short, sweet and with plenty of white space to allow easy assimilation.
    In the above example, many drugs have common prescribing patterns. The simple listing of “Janumet” with a balloon popup that says “50/1000 BID” is all you need. (As long as you have a drill down link).

  2. I imagine this is what crack is like. I feel unfulfilled and need more faster 🙂 can you email me the next post now? I will gladly pay you tomorow.

  3. Medbob —
    I agree completely with your comments — both that the default view should be kept short and sweet and that the expanded “hint balloon” view does not need to be comprehensive as long as there is a drill down link. I think one could also make the argument for a default view of “Janumet 50/1000 bid”, especially if the information was formatted as a table, the med name was given prominence, and there was sufficient white space.

    MoreFasterPlease —
    Thanks so much! Feedback like yours makes all the work of formulating and preparing these posts worth it.


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