Human-Computer Interaction in Healthcare: A National Priority

Human-computer Interaction in Healthcare: A National Priority
Titus Schleyer, DMD, PhD

Carnegie Mellon University, HumanComputer Interaction Institute
September 14, 2011

Denia, Spain Titus Schleyer 2011
Center for Dental Informatics University of Pittsburgh School of Dental Medicine
Todays 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
2 of 69
Can poor usability kill?

Medical Devices: The Therac-25
Nancy Leveson University of Washington
Introduction
Between 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].

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.
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
Center for Dental Informatics University of Pittsburgh School of Dental Medicine 6 of 69
The federal case for usability in healthcare
Oxford, MD T. Schleyer 2011
7 of 69
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.
8 of 69
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
Health care process and health records
Paradise, Michigan T. Schleyer 2011
10 of 69
Dental care process

Emergency patient
Assessment and diagnosis

Regular patient
Treatment plan
Health status maintenance
Treatment
11 of 69
Clinical documentation
medical and dental history, incl. chief complaint extraoral and intraoral exam radiographs images problem list treatment plan progress notes
Medical history
13 of 69
Medication history
14 of 69
Hard tissue exam and radiology report
15 of 69
Periodontal exam
16 of 69
Radiographs
17 of 69
Images
18 of 69
Treatment plan
19 of 69
Progress notes
20 of 69
A brief tour of an electronic dental record: EagleSoft
21 of 69
Clinical Welcome Screen
22 of 69
Patient Select
23 of 69
Clinical Exam
24 of 69
Clinical Exam: Perio
25 of 69
Clinical Exam: Head
26 of 69
Charting Interface
27 of 69
Chart with Alert
28 of 69
Chart: Entering Findings
29 of 69
Clinical Notes
30 of 69
Perio Exam
31 of 69
Perio Comparison: Numeric
32 of 69
Perio Comparison: Graphic
33 of 69
Medical History
34 of 69
Imaging: Patient Photo
35 of 69
Imaging: Bitewings
36 of 69
Imaging: Eagle Eye
37 of 69
Electronic records: Medicine
38 of 69
User-centered design in healthcare: Sample projects

Thanks to:
T. Thyvalikakath
Kochi, India T. Thyvalikakath 2011
39 of 69
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
40 of 69
Results
41 of 69
User adverse events

70 60 50 40 30 20 10 0
ES PW DX SD
42 of 69
Record a missing tooth correct path
43 of 69
User paths
44 of 69
45 of 69
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
46 of 69
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
47 of 69
Results
Average of patient data accessed in 10 high complexity cases
35 Average number of times each patient data accessed 30
25
20
15
10
0 0% Start of 10% 20% 100% Average session time in percentage (normalized) for a case of high complexityEnd of session
Social History Medical Consult Radiographs Oral Pathology Consult Medical History Dental History Hard Tissue Chart Treatment Plan Notes
30%
40%
50%
60%
70%
80%
90%
Patient Demographics Medications Intra-oral Images Periodontal Exam
48 of 69
Results (cont.)
Average of patient data accessed in 10 low complexity cases
20 Average number of times each patient data accessed 18 16 14 12 10 8 6 4 2 0 0% Start 10% 20% 100% End of Average session time in percentage (normalized) for a case of low complexity sessio
Medical History Radiographs Treatment Plan Notes Dental History Hard Tissue Chart Extra-oral Images Periodontal Exam
30%
40%
50%
60%
70%
80%
90%
Patient Demographics Intra-oral Images Financial Informaton
49 of 69
Visualization of information artifacts used over time
50 of 69
Project 3: Cross-platform, modular UI design

Microsoft Common User Interface (MSCUI www.mscui.net) sample problem: pt. identifiers
51 of 69
MSCUI: Designing for safety
52 of 69
Sample design: Patient banner
(includes 26-page Design Guidance document)
53 of 69
Project 4: The DMD Project
54 of 69
A novel approach to designing EDRs
55 of 69
56 of 69
57 of 69
58 of 69
59 of 69
60 of 69
61 of 69
62 of 69
63 of 69
Results
scale: 0 (least satisfaction) - 9 (most satisfaction)
64 of 69
Results
65 of 69
How do we meet these challenges?
licensed image 123rf.com 2011
By getting you involved!

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)
67 of 69
Thank You for Your Attention!

Questions, comments?
Thanks to:
T. Thyvalikakath
Please visit us at: http://di.dental.pitt.edu Twitter Facebook /titusschleyer Scribd

H. Spallek
H. Torres-Urquidy
P. Hernandez
J. Irwin
A. Acharya
and many others.

CDI 2011 Center for Dental Informatics University of Pittsburgh School of Dental Medicine
M. Song
68 of 69 (Yeah!)
This talk: http://scr.bi/nWfGai
69 of 69
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.
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.
71 of 69

Human-Computer Interaction in Healthcare: A National Priority

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Human-Computer Interaction in Healthcare: A National Priority

Enviado por

Direitos autorais:

Formatos disponíveis

Human-computer Interaction in Healthcare: A National Priority

Titus Schleyer, DMD, PhD

September 14, 2011

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Can poor usability kill?

Can poor usability kill?

Can poor usability kill?

Inadequate Software Engineering Practices.

The situation today

The federal case for usability in healthcare

Oxford, MD T. Schleyer 2011

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Tasks and workflow of healthcare

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Principles of change (of 9)

Health care process and health records

Paradise, Michigan T. Schleyer 2011

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Dental care process

Assessment and diagnosis

Health status maintenance

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Hard tissue exam and radiology report

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

A brief tour of an electronic dental record: EagleSoft

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Clinical Welcome Screen

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Clinical Exam: Perio

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Clinical Exam: Head

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Chart with Alert

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Chart: Entering Findings

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Perio Comparison: Numeric

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Perio Comparison: Graphic

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Imaging: Patient Photo

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Imaging: Eagle Eye

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Electronic records: Medicine

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

User-centered design in healthcare: Sample projects

Center for Dental Informatics University of Pittsburgh School of Dental Medicine