Human-computer Interaction in Healthcare: A National Priority

Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine

Titus Schleyer, DMD, PhD

Carnegie Mellon University, Human-Computer Interaction Institute

September 14, 2011

Denia, Spain © Titus Schleyer 2011

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Center for Dental Informatics

University of Pittsburgh School of Dental Medicine

Today’s talk

• a fundamental question for usability

• the federal case for usability in healthcare

• the health care process and health records

• a brief tour of an electronic dental record

• sample projects in user-centered design

• getting you involved

Medical Devices: The Therac-25

Nancy LevesonUniversity of Washington

1 IntroductionBetween June 1985 and January 1987, a computer-controlled radiation therapy machine, called the Therac-25, massively overdosed six people. These accidents have been described as the worst in the 35-year history of medical accelerators [6].

Can poor usability kill?

4 Casual Factors• Overconfidence in Software. …

• Lack of Defensive Design. …

• Inadequate Software Engineering Practices. …

• Save versus Friendly User Interfaces. …

Leveson NG. Medical devices: the Therac-25. In: Safeware: system safety and computers. Boston: Addison-Wesley; 1995. p.515-53.

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The situation today …

• “Some unintended consequences of information technology in health care: the nature of patient care information system-related errors”

• “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system”

• “Identifying and quantifying medication errors: Evaluation of rapidly discontinued medication orders submitted to a computerized physician order entry system”

• “Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors”

• and 10s of other papers

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The federal case for usability in healthcare

Oxford, MD © T. Schleyer 2011

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Tasks and workflow of healthcare

• healthcare decisions that require reasoning in the face of uncertainty

• complex non-transparent workflow

• increasing complexity of the care provided to patients in a time-pressured environment

Stead WW, Lin HS and editors. Computational technology for effective health care: immediate steps and strategic directions, Washington, DC:National Academies Press, 2009.

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Principles of change (of 9)

• Principle 4: Design for human and organization factors

• Principle 5: Support the cognitive functions of all caregivers, including health professionals, patients, and their families

• Principle 8: Seek and develop technologies that identify and eliminate ineffective work processes

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Health care process and health records

Paradise, Michigan © T. Schleyer 2011

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Dental care process

Regular patient

Emergency patient

Assessment and diagnosis

Treatment plan

Health status maintenance Treatment

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Clinical documentation

• medical and dental history, incl. chief complaint

• extraoral and intraoral exam• radiographs• images• problem list• treatment plan• progress notes

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Medical history

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Medication history

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Hard tissue exam and radiology report

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Periodontal exam

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Radiographs

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Images

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Treatment plan

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Progress notes

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A brief tour of an electronic dental record: EagleSoft

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Clinical Welcome Screen

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Patient Select

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Clinical Exam

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Clinical Exam: Perio

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Clinical Exam: Head

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Charting Interface

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Chart with Alert

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Chart: Entering Findings

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Clinical Notes

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Perio Exam

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Perio Comparison: Numeric

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Perio Comparison: Graphic

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Medical History

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Imaging: Patient Photo

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Imaging: Bitewings

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Imaging: Eagle Eye

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Electronic records: Medicine

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User-centered design in healthcare: Sample projects

T. Thyvalikakath

Thanks to:

Kochi, India © T. Thyvalikakath 2011

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Project 1: Usability of four dental computer-based patient records

Research questions:• Which usability problems are

common in dental software?• What is the rate of completed,

incorrectly completed and incomplete user tasks?

Thyvalikakath T et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc 2008 Dec;139(12):1632-42

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Results

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User adverse events

user gives

attempts negative

affect

design

suggestion

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Record a missing tooth – correct path

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User paths

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Usability of electronic dental records

• Significant usability problems due to:– complex information design– mismatch between system and user model– difficulty in finding functionality

• significant cognitive effort required that did not contribute to task completion

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Project 2: Cognitive task analysis of dental examinations

• What cognitive processes do dentists engage in and what information do they use when they examine a patient and develop a treatment plan?

• Methods– think-aloud method with 3 standardized patient cases – 5 dental faculty and 5 general dentists– analyze the sessions to determine:

• information that dentists requested

• sequence in which they reviewed information

• instances of concurrent review of information items

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Results

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Results (cont.)

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Visualization of information artifacts used over time

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Project 3: Cross-platform, modular UI design

• Microsoft Common User Interface (MSCUI – www.mscui.net)

• sample problem: pt. identifiers

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MSCUI: Designing for safety

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Sample design: Patient banner

(includes 26-page Design Guidance document)

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Project 4: The DMD Project

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A novel approach to designing EDRs

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Results

scale: 0 (least satisfaction) - 9 (most satisfaction)

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Results

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How do we meet these challenges?

By getting you involved!

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How can you get involved?

• join the Dental Informatics Online Community (www.dentalinformatics.org)

• participate in dental informatics research

• get an advanced degree in dental informatics (MS, PhD, postdoc – free for qualified applicants)

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Please visit us at:http://di.dental.pitt.eduTwitterFacebook /titusschleyerScribd }

Thank You for Your Attention!Questions, comments?

(Yeah!)

H. Torres-Urquidy

P. Hernandez J. Irwin A. Acharya

… and many others.

H. SpallekT. Thyvalikakath

Thanks to:

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This talk: http://scr.bi/nWfGai

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References

1. Leveson NG. Medical devices: the Therac-25. In: Safeware: system safety and computers. Boston: Addison-Wesley; 1995. p.515-53.

2. Ash JS, et al. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104-12.

3. Han YY, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116(6):1506-12.

4. Koppel R, et al. Identifying and quantifying medication errors: evaluation of rapidly discontinued medication orders submitted to a computerized physician order entry system. J Am Med Inform Assoc. 2008;15(4):461-5.

5. Cayot-Constantin S, et al. [Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors]. Ann Fr Anesth Reanim. 2010;29(3):204-8. French.

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References (cont.)

6. Stead WW, Lin HS, editors. Computational technology for effective health care: immediate steps and strategic directions, Washington, DC: National Academies Press; 2009.

7. Thyvalikakath TP, et al. Heuristic evaluation of clinical functions in four practice management systems: a pilot study. J Am Dent Assoc. 2007;138(2):209-18

8. Thyvalikakath TP, et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc. 2008;139(12):1632-42.

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