~ SharpC at Maryland ~
Improving the quality, safety and efficiency of Electronic Health Record systems

User Interface Designs for
Electronic Health Record Systems

Maryland Participants

• Catherine Plaisant, (Co-PI) - Research Scientist, UMIACS, Associate Director of Research at HCIL
• Ben Shneiderman, (Co-PI) - Professor, Computer Science, Researcher (and Founding Director) at HCIL

Past participants:
• Johnny Wu, MS Graduate Student in the Department of Computer Science, University of Maryland
• Lyndsey Franklin, MS Graduate Student in the Department of Computer Science, University of Maryland
• Awalin Sopan, Graduate Student in the Department of Computer Science, University of Maryland
• Sureyya Tarkan, Graduate Student in the Department of Computer Science, University of Maryland
• Tiffany Chao, Graduate Student in the Department of Computer Science, University of Maryland
• Kostas Pantazos, Visiting Graduate Student from Software and Systems, IT University of Copenhagen, Denmark
• Meirav Taieb-Maimon, Visiting Professor from the Department of Information Systems Engineering, Ben-Gurion University of the Negev
• Darya Filippova, Graduate Student in the Department of Computer Science, University of Maryland
• Sumit Arora, Graduate Student in the iSchool, University of Maryland

University of Texas (SharpC) Participants

• Todd Johnson, Eliz Markovitz, Jorge Herskovic, Elmer V Bernstam, Jiaje Jang and Muhammad Walji (and many more providing feedback)

NEWS

June 2015: Story on our Twinlist prototype for medication reconciliation appears in User Experience, the Magazine of the User Experience Professionals Association.

Dec 2014: eBook summarizes results from entire Sharp-C project: Better EHR: Usability, workflow and cognitive support in electronic health records

June 2014: Inspired EHRs: Designing for Clinicians , an eBook for developers of Electronic Health Record systems is now released. You will find clinical scenarios, designs, interactive prototypes, and introductory materials on human factors, design and usability.

Our paper on interfaces techniques to avoid wrong patient selection was accepted at AMIA 2014.
Come listen to the presentation, planned ofr the Tuesday Nov 18, 3:30pm session (use the final program to confirm).

Ben Shneiderman was on the NPR Kojo Nnamdi Show on Improving Electronic Health Records (Kojo Nnamdi Show, WAMU for NPR, 10-30-2013)

Our Twinlist paper on interfaces for medication reconciliation received a Distinguished Paper award at AMIA 2013.

Project Description

The University of Maryland is one of the nine institutions participating in the National Center for Cognitive Informatics and Decision Making in Healthcare (NCCD) led by The University of Texas Health Science Center at Houston. NCCD is funded by the Office of the National Coordinator for Health IT under the Strategic Health IT Advanced Research Projects (SHARP) Program. This program seeks to support improvements in the quality, safety and efficiency of health care through advanced information technology. The NCCD award was one of four presented by the Office of the National Coordinator for Health Information Technology (ONC) through the American Recovery and Reinvestment Act of 2009 to address key barriers to health information technology. NCCD's research focus area is Patient-Centered Cognitive Support.

~~~ NOTE: The source code of all our SHARPC prototypes is available open source. Look for information in the individual project page. ~~~

The PROJECT 4 of SharpC is Maryland studying and proposing novel interfaces for the following problems:

Medication reconciliation

The Medication Reconciliation project (including Twinlist) focuses on how visual layout and animation can help users see similarities in drug lists and rapidly make decisions about what to keep and what to discontinue. Several prototypes were developed (e.g. Twinlist) and evaluated.

Results management

The Result Management project focuses on how to avoid missing results when ordering labs, tests or referals.

Reducing Wrong Patient Selection Errors

The Wrong Patient Selection project focuses on interface improvements to reduce the problem. It demonstrates multiple interface suggestions.

Survey of visualization techniques for EHR data

Our literature review has now been published:

Rind, A., Wang, T., Aigner, W., Miksch, S., Wongsuphasawat, K., Plaisant, C., Shneiderman, B., Interactive Information Visualization for Exploring and Querying Electronic Health Records: A Systematic Review

Visual comparison of treatment outcomes

In the Treatment Explorer Project we designed a new visualization to present summaries of outcome data to patients (or to the patient-provider team). We reviewed the literature and propose a new framework for design and developped an interactive web-based prototype showing several alternative designs.

Understanding Patterns in Patient Discharge Summaries

In this very exploratory project we applied network analysis and visualization tools to study a corpus of patient discharge summaries, exploring the relationships between patients and their associated symptoms, diseases, drugs, and procedures. Cody Dunne used the technology he had been developing in his PhD thesis (including motif simplification and group-in-a-box layouts) to reduce clutter as well as interactive text displays to show the origin of each relationship.

Paper

Dunne, C., Understanding Patterns in Patient Discharge Summaries using Network Analysis.
Tech report version

~~~ In addition HCIL is also contributing to those projects:

Design Guidelines for EHR interfaces

This project is led by colleagues in Houston and Missouri.
See the main NCCD website for:

Safety Enhanced Design Briefs

EHR Style Guide iBook

Framework for Systematic Yet Flexible Systems Analysis (SYFSA)

[A project from our SharpC Project 4 partners at the University of Kentucky and the University of Texas] Contact: Todd R Johnson
This research on the Systematic Yet Flexible Systems Analysis (SYFSA) framework guides interface design even as it is continuously refined by our practical experience in applying it. We expect that SYFSA will enable the creation of Healthcare IT systems that encourage best practices while simultaneously accommodating the tremendous variety of real-world healthcare workflow. Systematic Yet Flexible Systems can provide visual and other cues to encourage evidence-based best practices along with visual feedback of progress while simultaneously supporting the need to deviate from these standards in some cases.

Paper

Johnston, T. and Markowitz, E., A Framework for Systematic Yet Flexible Systems Analysis, to appear in Journal of Biomedical Informatics.
Online version - Publisher website

Software

A Mathematica notebook containing code to automate SYFSA analysis
Available on request (Todd R Johnson)

Pan-SHARP project

PanSharp is a collaboration between all Sharp projects, coordinated by Project 4 partner from the University of texas Jorge R. Herskovic, and demonstrating interoperability in a SmartApp.

Demo Available at http://pansharp.smartplatforms.org, contact Jorge R. Herskovic for login information.

Other Project related activities

• Special Section of ACM Interactions (Nov/Dec 2011) was edited by Harry Hochheiser and Ben Shneiderman. Including:
  • Electronic medical records: usability challenges and opportunities, Harry Hochheiser, Ben Shneiderman
  • Simplicity and usability: lessons from a touchscreen electronic medical record system in Malawi, Gerald P. Douglas, Zach Landis-Lewis, Harry Hochheiser
  • Usability testing EHRs: examples from the front lines, Art Swanson, Scott Lind
  • Tragic errors: usability and electronic health records, Ben Shneiderman (PDF)
• Steve Lohr's article on the usability of Electronic Health Records (EHRs) systems appeared in Sunday NY Times Business Section July 17, 2011. This article strongly supports our efforts to promote public, industry, and government awareness of usability in EHRs. Ben Shneiderman, who guided Steve Lohr on this topic with interviews and emails, is mentioned in the opening.
• Ben Shneiderman spoke at the National Institute of Standards and Technology (NIST): A Community-Building Workshop: Measuring, Evaluating and Improving the Usability of Electronic Health Records on June 7, 2011 (slides)
• Ben Shneiderman testified in front of the ONC/SHARP HIT Policy Committee: Certification/Adoption Workgroup: April 21, 2011 (Text of Testimony)

RELATED EVENTS WE ORGANIZED

• 2012 Electronic Health Record Informatics Workshop, and event of the HCIL Symposium, May 2012
• 2011 Electronic Health Record Informatics Workshop, and event of the HCIL Symposium, May 2011

LECTURES (sample)

• Lecture slides: Houston, December 2010, Information Visualization (introduction)
• Lecture slides: Houston, December 2010, Project Summary for Medication Reconciliation, Missed Labs and Drug Interaction

See also

• A very useful resource: NIST Health IT Usability
• Or this talk at the Pew foundation on how to improve EHR usability and patient safety

Videos

Downloadable MP4

Sponsorship

This work is supported in part by Grant No. 10510592 for Patient-Centered Cognitive Support under the Strategic Health IT Advanced Research Projects Program (SHARP) from the Office of the National Coordinator for Health Information Technology.

Related Projects from HCIL

	Lifelines - Visual summary of a single patient record (1996-1998)
	Lifelines2 :  Discovering Temporal Categorical Patterns Across Multiple Records +++NEWS+++ Oct.2011: Lifelines2 is now integrated in i2b2 and BTRIS (see UMd news story).
	EventFlow :  Visualization of event sequences