EHR Design Talk with Dr. Rick 4/23/12

Overview with Details on Demand — A Versatile Design

Let’s return to the EHR design problem we were considering in my last post. You’re a member of an EHR development team working on a new high-level EHR user interface design that displays an overview of an entire patient encounter in a single screen view. Your current user interface requires clinicians to navigate to multiple screens.

In the new design, each category of patient data (Problem List, Medications, Exam, etc.) is assigned to a relatively small pane on a single screen. Your problem is how use these small panes to display each category of data in a way that still makes sense to clinicians.

Your team discovers that a design based on small panes with horizontal and vertical scrollbars doesn’t work. Now it’s back to the drawing board.

Instead of trying to design in the abstract, it becomes clear that you need to start by looking at actual patient data and finding out how clinicians use it. You again start with the redesign of the medication pane.

Your current EHR design requires clinicians to navigate to a separate screen to see a patient’s full medication data. Such a screen is shown below for a particular patient who is taking nine medications. I have broken it into two parts so that it’s readable in this blog format.

If you want to provide an overview for your users, how would you proceed? What information is most important? What information is only occasionally needed?

Here is where you need input from your clinician users — in technical jargon, your subject matter or domain experts. You observe and talk to clinicians using your product.

Some of them want to see just the names of the medications in the summary view, while others want to see the medication name, the dose, and the instructions. Most clinicians agree that the start date, the notes, and the prescribing physician data are less important, but that they should still be readily available on demand.

So, with this input, what information would you display in a summary view? How would you display more information on demand?

Clearly, there is no single design solution to this problem. Any design will require lots of trade-offs and compromises. One possible solution is show below:

In this summary view, only the names of the medications are listed. By hovering with the mouse cursor in the header row, the clinician gets an expanded view, displaying the dose and instructions, as below:

When the cursor is moved off of the header row, the pane contracts to its original size.

Alternatively, by keeping the mouse cursor within the header row, moving it to the right and again hovering (or by a similar gesture), the clinician could get the view below displaying the complete medication data:

Note that this view has the same information content as the full screen view shown at the beginning of this post. Again, when the cursor is moved off the header row, the pane contracts to its original size.

There will be times when the clinician needs to keep an expanded view open while working with a different part of the screen. This could be accomplished by clicking with the mouse instead of hovering.

There will also be times when the clinician wants to retrieve information for just one data element or data field in a pane. The same convention of hovering with the mouse to get a temporary view or clicking to keep that view open until closed could be used:

Again, by using a mouse hover or click, further details can be viewed without expanding the entire pane:

And so forth:

These expanding pane and pop-up designs are of course familiar to users in other contexts, but many widely used EHRs, even newer and cloud-based ones, don’t support them or don’t support them consistently.

All too often, the EHR interfaces that clinicians use on a day-to-day basis are based either on small panes with scrollbars or require navigation to multiple different screens. Such designs overload working memory, leaving little for patient care issues.

Unfortunately, guidelines for EHR usability can only address these kinds of high-level design choices in general terms. Furthermore, usability testing protocols do not provide a mechanism for comparing one design pattern to another. Hence EHRs that rely on small panes with scrollbars or require navigation to multiple different screens can still get good usability ratings.

While the overview with details on demand design pattern is versatile and powerful, a major potential problem comes with it — when a pane or data field expands, it obscures information in adjacent panes. I look forward to addressing this issue in my next post.

Next Post:

Pane Management

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.