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Redesigning The Patient Medical Record, the Healthcare Challenge’s Results

Posted on January 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Carl Bergman from EHR Selector.

The Obama administration’s, Challenge.gov site encourages the public to submit suggestions that solve specific, public policy questions. To do this, it’s set up dozens of contests or challenges. For example, the FTC has a $50,00 challenge for a solution to illegal robo calls that often come from off shore.

In healthcare, the VA and the ONC recently ran a Health Design Challenge for a better patient health record announcing the winners a few days ago.

The challenge asked for a record that:

  • Improves the visual layout and style of the information from the medical record
  • Makes it easier for a patient to manage his/her health
  • Enables a medical professional to digest information more efficiently
  • Aids a caregiver such as a family member or friend in his/her duties and responsibilities with respect to the patient

The entries were judged by a twelve person panel ranging from Wired Magazine’s Executive Editor, Thomas Goetz to Facebook’s Product Designer, Nicholas Felton to Dr. Sophia Chang, the director of the Chronic Disease Care program of the California Health Care Foundation. They looked at several features of a revamped record from overall appeal to how readily it shows important information and how accessible it is for physicians, patients, etc.

The Winners

The judges picked three big winners and three winners in the Problem History, Medication and Lab Summaries areas. Here’s a brief look at the top entries, but the submissions should be looked at more as a resource than a race result, as I’ll discuss.
Nightingale
First place went to Nightingale an anonymous group that won $16,000. Others won smaller amounts. In the next few months, elements of the winning designs will be put together and put up on Github.

Nightingale’s design stressed that health was a continuing concern and that a user should be able to see an improving or declining trend without having to dig for the data. They did this by integrating the often disparate information in visits, exams and lab results. You can see this emphasis in their lipid panel screen. Sliders place each test result for each test’s in a range. Good results slide to green while poorer result move to red.
StudioTACK
Second place StudioTACK took a somewhat similar approach to creating a problem history, which they call a medical strategy rather than a record. They did this by bringing their findings into a body map with references to location and organ.

Matthew Sanders’ CCD scored the best Problem History section award. Sanders rearranged and redesigned the traditional note not by condition nor by past chronology, but into a timeline of past, present and future actions. While he admits that his approach is somewhat redundant for meds, he emphasizes that this arrangement helps all the users maintain a focus on the most important areas for action. Sanders presentation notably describes how he implemented his approach. To do this, he stripped out standard label text, clarified terms and gave the remaining items visual emphasis. This type of analysis makes going through the submissions worth it.
Sanders CCD
This isn’t to say that the way the contest was run and the approach of many submissions  — including some prize winners — were without shortcomings. There were some notable problems.

The Contest’s Problems

The contest’s operators needed to be far more specific about what they wanted and how they judged the results.

The challenge’s purpose was far from clear:

The purpose of this effort is to improve the design of the medical record so it is more usable by and meaningful to patients, their families, and others who take care of them. This is an opportunity to take the plain-text Blue Button file and enrich it with visuals and a better layout. Innovators will be invited to submit their best designs for a medical record that can be printed and viewed digitally.

A medical record is an on going repository of a person’s health context, status, prognosis, plans, etc. It has many contributors and users. The VA’s Blue Button is a snapshot of the person’s status for their use. However, the contest uses these terms interchangeably. Due to this muddle, many of the submissions sent in designs for a medical record, while others, a minority, only redid the Blue Button’s outline. Thus, not all submissions were developed on the same basis. Indeed, the judges seem to acknowledge this since they gave first place to Nightingale, which claims, “to be a new take on health records.” The contest would have done much better if it asked for particular types of screens putting everyone on the same page, as it were.

The contest judging panel while distinguished, had no practicing physicians, nurses or practice managers, a significant failing. While three of the twelve judges are MDs, not one is a practicing physician.

Finally, if you’re going to hand out $50,000 in public funds, you might just want to say why you thought the winners stood out.

The Submissions

The contestants almost universally got one thing right. They designed their entries for desktops/laptops, pads and phones. They showed a great understanding that we don’t work on just one platform, but move from one to the other almost continuously. In this, they deserve much praise. However, all this cross platform awareness is done in by an appalling over, under and misuse of font color, and size. As one post noted about Nightingale:

The text is too small and medium gray on light gray is very hard to see, especially for older people and people on cheap computers with low contrast displays. How can this possibly be the first place winner?

The comment is generous. Nightingale’s gray on gray font is almost unreadable. Granted their submission is a PDF of a prototype, nonetheless the possibility of staring at their screens all day would give me a headache.

They are not alone in color misuse. Second place winner, Studio TACK, goes to excess the other way with a white text on red iPhone screen. It’s more suited to public safety than health.
StudioTack Mobile
Going through the submissions, however, can be most rewarding. I found a gem of a summary page in Uncorkit’s submission. Their infographic approach puts not only labs and weight history on timelines, but also includes BP, conditions and meds. It gives you a great overview and a logical place to drive down for detail information without overwhelming your senses.

The Health Challenge submissions have much to recommend them. Just remember how they came about and what they may or may not include.
Uncorkit

All I Want for Christmas…

Posted on December 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My family and I are in final preparations for Christmas. It’s an exciting time for me. I love everything about the season. I don’t stress over gift giving. I wallow in the joy of getting to spend money on someone I love. I don’t mind the crowds at the mall. I love the hustle, bustle, excitement and energy with everyone running around. Add in some Christmas music that reminds me of many wonderful Christmas’ past. It’s a wonderful time to me.

As I consider Christmas, my two favorite parts of Christmas is giving someone something they’ve always wanted and dreaming of the things that I would love to get for Christmas. So, in that vain, let’s dream about what I’d want for Christmas from an EMR and Healthcare IT perspective.

1. Open EHR Systems – I wish that every healthcare IT system would embrace truly open APIs and that the healthcare data would start flowing. I can only imagine the amazing benefits to healthcare if vendors would just embrace open exchange of healthcare data. It’s the right thing to do and can also be a tremendous business opportunity.

2. Remove Healthcare’s Perverse Incentives – It always pains me to see so many perverse incentives in healthcare. I applaud the many many doctors who do the right thing regardless of the incentive. However, we’d be in a lot better position if we had more than the good nature of doctors driving things. One simple example, can we finally reimburse a doctor for their time spent on an email or video visit on a website? In a large percentage of cases that’s more than sufficient. Yet, the current healthcare incentives “force” a doctor to have you come to the office in order to get paid. That’s perverse and sad.

3. Beautiful EHR User Interfaces – I must acknowledge that we’ve made some real progress on the EHR UI. You should have seen the UI’s we were dealing with when I started blogging 7 years ago. We’re measurably ahead of where we were then. However, with 300+ EHR companies we still have a lot of room to improve the EHR user interface. EHR is the heart of a practice and the better the UI the better the heart. We all know how important a heart is to your health.

4. More Empowered and Trusted Patients – Imagine where the patient was a full participant in their healthcare. That includes being trusted and listened to by their doctor and a patient who thoughtfully considers and listens to their doctor. This is not a one sided issue. This is something that both patients and doctors can improve. There are as many belligerent patients as their are arrogant doctors. We need a good dose of humility, care and trust re infused into healthcare. I think they only way we’ll get there is for the lines of communication to open up on an unprecedented level.

Those are a few of my Christmas wishes. Whether you celebrate Christmas or some other Holiday tradition, I’d love to hear what you’d love to see happen in healthcare. And to those of you who do enjoy Christmas, Merry Christmas!

Meaningful Use and Certified EHR’s Impact on EMR User Interfaces

Posted on May 31, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a previous post, Anthony made this basically off the cuff comment which hit me:
“many a time, the functional requirements take priority over UI”

We see this all over the software development world. In fact, it takes a really unique company to be willing to keep UI over functionality. Ask any salesperson and they’ll tell you that new functions are easier to sell than a great UI. So, it makes sense why this happens. Unfortunate, but makes some sense.

However, this comment also had me asking myself the question, “I wonder how many meaningful use and/or EHR certification requirements caused issues with an EMR UI?

I’ve already had a few EMR demos where I said, what’s that button/function doing there. The response was, oh that was to meet meaningful use/EHR certification requirements. I’m sure many other doctors that use an EMR have seen the same thing. They wonder why an EMR has certain functions since they don’t provide better patient care. Certainly meaningful use and EHR certification is likely to blame for a lot of these possible UI issues. However, I’m sure that many more have to do with EMR software vendors that want to be all things to everyone. When you go down that path, it’s hard to maintain a great UI.

I’ve been starting to think more and more about various EMR UI. Especially with the recent launch of an EMR screenshots website. I’m grateful for the EMR vendors that have been great about sending over their screenshots. It provides an interesting view into the various EMR UI’s. I’m hoping to do some future posts where I take one or more of the screenshots and analyze some of the details. We’ll see how well that goes with an EMR screenshot.