Home » Rick Weinhaus » Currently Reading:

EHR Design Talk with Dr. Rick 4/1/13

April 1, 2013 Rick Weinhaus 3 Comments

The Text-Based Workaround

We have been considering two fundamentally different designs for presenting a patient’s past and present medical issues over time — the Snapshot-in-Time design and the Overview-by-Category design.

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.

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_image001 in 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.

View/Print Text Only View/Print Text Only


HIStalk Featured Sponsors

     

Currently there are "3 comments" on this Article:

  1. Hi Dr. Weinhaus – could not get the slide viewer to render your material large enough to actually be able to read it. Would you be so kind to send me a ppt, PDF, or whatever so I could look it over?? Then I can provide comments.

    Many thanks

    Hank Mayers

  2. You don’t need to read what’s in the documents to get his point if you go though the whole thing.

  3. Hank and Robert,

    Thanks so much for your comments.

    By showing some of the documents at reduced scale, I was trying to emphasize the amount of unused real estate on the page or screen.

    Hank, I’d be happy to send you the original documents.

    You could send your email address to me at drrickweinhaus@gmail.com

    Rick







Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • Mr. HIStalk: I was going for the $49 deal, but I got a popup on the company's site for the $36 price. Maybe because I had download th...
  • Layni: Thanks for pointing out PDF Architect - it seems like a good product from what you say & the website's description. ...
  • Code Jockey: "For starters, they are doing custom Epic development so once they make certain changes in the system, they will then ma...
  • Associate CIO: I can only give my opinion and I say that because people love to shred opinions without ever giving a solid opposing arg...
  • SIW: Good analysis. Do you think Providence or John Muir's strategy will work?...
  • Cherry Garcia: Trust me, you were never cool....
  • Associate CIO: While you can make a legitimate argument that no one knows anything in healthcare, these to situations are quite differe...
  • Nobody Knows Anything: John Muir outsources its IT and analytical functions while Providence bought an entire consulting company to go deeper i...
  • Robert Smith: I hope the outsource deals works out for John Muir and goes better than most outsourcing. Typically the client never ...
  • AI lover: Re: Memorial Sloan Kettering Cancer Center AI paper: 1. It is not unsupervised as you've mention and it is not "weakl...

Sponsor Quick Links