EHR Design talk with Dr. Rick 11/9/15

The TimeBar: A Timeline-Based, Interactive Graphical User Interface for the Electronic Health Record

Dear Friends and HIStalk Readers:

Once again I can’t begin to tell you how happy I am to start blogging again and to resume sharing ideas about improving EHR User Interface design. I am very grateful to have this opportunity.

Had I been born half a century earlier, I would not be alive. As you recall from my last blog in May, I was recovering well from acute myelogenous leukemia (AML) and was just starting to resume blogging, introducing my concept of a timeline-based, interactive GUI for the EHR.

Life is never simple. Although I continue to have no evidence of recurrence of my acute myelogenous leukemia, about two weeks after my last post I developed unstable angina with dyspnea on exertion requiring urgent coronary artery bypass grafting, which went very well.

Unfortunately, immediately post-operatively I developed Acute Respiratory Distress Syndrome (ARDS – the etiology is still not entirely clear). After surgery, I was in the Beth Israel Deaconess Medical Center (BIDMC) ICU in Boston on a mechanical ventilator and heavily sedated for 48 days, followed by some improvement, a setback, and then a slow weaning from the ventilator. I am getting much better. My tracheostomy tube was removed about a month ago and I am now at home and am doing very well.

Although I had initially wanted to introduce my ideas for a timeline-based, interactive graphical user interface for the EHR in sequential order as a series of blogs, given the uncertainties of life, now more than ever I have decided to post my entire TimeBar design as it stands right now. It is a work in progress and comments and suggestions are most welcome. As I wrote before, I would love nothing more than to see some of the TimeBar concepts developed, improved, and expanded as an open source application.

Aside from being with my family and friends, nothing is more fulfilling for me than collaborating on the development of new cognitive tools to improve the usability of EHRs, especially given my medical history and seeing firsthand how much cognitive work my doctors and nurses expend on unnecessary EHR tasks.

New cognitive tools do not come automatically. Recall that true alphabetic writing only developed about four thousand years ago, after a very rocky start. The Arabic numeral system was only invented a little more than a thousand years ago. After Euclid described the mathematics of the triangle, it took two thousand years for Newton and Leibniz to do the same thing for the circle by inventing calculus. The first accurate timeline was only invented and published about 250 years ago. As Donald Norman famously wrote, “The power of the unaided mind is highly overrated.”

And now, despite being in the computer age, many of our EHR workflows and tools are still leftovers from the mechanical age – the age of the paper chart. Unfortunately, the electronic versions of paper charts tend to retain the worst aspects of the paper chart without taking advantage of new designs better suited to electronic charting. Specifically, I am interested in human-computer interaction designs which shift the balance of mental effort from cognition to perception, allowing us to use our extremely fast, high bandwidth visual processing system to perceive much of the data, sparing our working memory and capacity for abstract reasoning for actual patient care issues.

The document above describes the EHR TimeBar. Click the two-headed arrow bar icon to display it full screen since it will be hard to see otherwise. It can also be downloaded as a PDF file here.

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.