Human-computer Interaction in Healthcare: A National Priority
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Transcript of Human-computer Interaction in Healthcare: A National Priority
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?
Can poor usability kill?
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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University of Pittsburgh School of Dental Medicine
The federal case for usability in healthcare
Oxford, MD © T. Schleyer 2011
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University of Pittsburgh School of Dental Medicine
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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University of Pittsburgh School of Dental Medicine
Health care process and health records
Paradise, Michigan © T. Schleyer 2011
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University of Pittsburgh School of Dental Medicine
Dental care process
Regular patient
Emergency patient
Assessment and diagnosis
Treatment plan
Health status maintenance Treatment
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University of Pittsburgh School of Dental Medicine
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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University of Pittsburgh School of Dental Medicine
Medical history
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University of Pittsburgh School of Dental Medicine
Medication history
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University of Pittsburgh School of Dental Medicine
Hard tissue exam and radiology report
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University of Pittsburgh School of Dental Medicine
Periodontal exam
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University of Pittsburgh School of Dental Medicine
Radiographs
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University of Pittsburgh School of Dental Medicine
Images
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University of Pittsburgh School of Dental Medicine
Treatment plan
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University of Pittsburgh School of Dental Medicine
Progress notes
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University of Pittsburgh School of Dental Medicine
A brief tour of an electronic dental record: EagleSoft
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University of Pittsburgh School of Dental Medicine
Clinical Welcome Screen
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University of Pittsburgh School of Dental Medicine
Patient Select
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University of Pittsburgh School of Dental Medicine
Clinical Exam
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University of Pittsburgh School of Dental Medicine
Clinical Exam: Perio
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University of Pittsburgh School of Dental Medicine
Clinical Exam: Head
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University of Pittsburgh School of Dental Medicine
Charting Interface
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University of Pittsburgh School of Dental Medicine
Chart with Alert
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University of Pittsburgh School of Dental Medicine
Chart: Entering Findings
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University of Pittsburgh School of Dental Medicine
Clinical Notes
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University of Pittsburgh School of Dental Medicine
Perio Exam
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University of Pittsburgh School of Dental Medicine
Perio Comparison: Numeric
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University of Pittsburgh School of Dental Medicine
Perio Comparison: Graphic
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University of Pittsburgh School of Dental Medicine
Medical History
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University of Pittsburgh School of Dental Medicine
Imaging: Patient Photo
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Imaging: Bitewings
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University of Pittsburgh School of Dental Medicine
Imaging: Eagle Eye
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Electronic records: Medicine
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University of Pittsburgh School of Dental Medicine
User-centered design in healthcare: Sample projects
T. Thyvalikakath
Thanks to:
Kochi, India © T. Thyvalikakath 2011
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University of Pittsburgh School of Dental Medicine
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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University of Pittsburgh School of Dental Medicine
User adverse events
10
20
30
40
50
user gives
up> 3
attempts negative
affect
0
design
suggestion
60
ES
PW
DX
SD
70
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Record a missing tooth – correct path
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University of Pittsburgh School of Dental Medicine
User paths
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University of Pittsburgh School of Dental Medicine
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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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University of Pittsburgh School of Dental Medicine
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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University of Pittsburgh School of Dental Medicine
A novel approach to designing EDRs
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University of Pittsburgh School of Dental Medicine
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University of Pittsburgh School of Dental Medicine
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University of Pittsburgh School of Dental Medicine
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University of Pittsburgh School of Dental Medicine
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University of Pittsburgh School of Dental Medicine
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University of Pittsburgh School of Dental Medicine
Results
scale: 0 (least satisfaction) - 9 (most satisfaction)
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University of Pittsburgh School of Dental Medicine
Results
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University of Pittsburgh School of Dental Medicine
How do we meet these challenges?
By getting you involved!
licensed image © 123rf.com 2011
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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:
M. Song© CDI 2011
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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.