Project 4: Cognitive Information Design & Visualization

Project 4: Cognitive Information Design • & Visualization Project Leaders: Todd R. Johnson Ben Shneiderman Catherine Plaisant Consultants: John Flach Postdocs, GRAs, Programmers: Eliz Markowitz Surreya Tarkan Tiffany Chao Project Co-Is: Jorge Herskovic Elmer Bernstram Project manager: Chitra Shriram www.sharpc.org

Top 3 Accomplishments in Years 1-2 • Medication Reconciliation: Spatial Layout with Animated Transitions • Test Result Management: Table Design & Retrospective Analysis • Systematic Yet Flexible Systems Analysis: Framework for analyzing HIT interface design

Medication Reconciliation: Spatial Layout with Animated Transitions • What’s unique? • What’s identical? • What’s equivalent?

Medication Reconciliation: Spatial Layout with Animated Transitions • “Automated medication reconciliation and complexity of care transitions”Bozzo Silva, Bernstam, Markowitz, Johnson, Zhang and Herskovic, AMIA 2011 LEVELS OF EQUIVALENCE

Medication Reconciliation: Spatial Layout with Animated Transitions DEMO Prototype by Tiffany Chao VIDEO AVAILABLE AT www.cs.umd.edu/hcil/sharp

Medication Reconciliation: Spatial Layout with Animated Transitions Twinlist adapted for problem list reconciliation in cancer risk assessment software (Hughes riskApps™) Contact: Kevin S. Hughes, Massachusetts General Hospital Twinlistrunning on Microsoft Amalga Platform Contact: Hank Rappaport “Best medication reconciliation interface I have seen” Shawn Murphy, MD, PhD, Harvard University “A sigh of relief when I saw Twinlist” Melinda Jenkins, PhD, FNP

Test Result Management: Table Design & Retrospective Analysis GOALS: Help clinicians see what needs attention • Rich tabular displays Facilitate taking action • Clarify responsibility • Embed operations to save time Allow retrospective analysis

Test Result Management: Table Design & Retrospective Analysis Sample Current Design VA View Alerts

Test Result Management: Table Design & Retrospective Analysis

Test Result Management: Table Design & Retrospective Analysis • Color-Coding, Icons, and Ranking

Test Result Management: Table Design & Retrospective Analysis • Compact Layouts

Test Result Management: Table Design & Retrospective Analysis • Improved Headers

Test Result Management: Table Design & Retrospective Analysis • Integrated Actions

Test Result Management: Table Design & Retrospective Analysis • DESIGN GUIDELINES: sample of 28 in total • Rank the table according to one or more column attribute(s), arranged vertically down (Few, 2004) • Use color coding of columns to show the ranking, by default the most severe value must appear at the top of the table while ensuring that the most important values are still visible • Round data displayed in table cells entries where it is not misleading to do so (MSCUI, 2008) but show more precision if space permits • Avoid a heading that is significantly wider than the data it is indicating (MSCUI, 2008) by splitting such headers into two or more lines • If a certain column always has the same value, it could be removed to save space • Keep table structure consistent from table to table, for example, distinct columns in tables should be placed at the rightmost end to allow for alignment of the same columns on the left side

Test Result Management: Table Design & Retrospective Analysis

Systematic Yet Flexible Systems Analysis: Framework for analyzing HIT interface design • Systematic, consistent approaches • Can improve • Efficiency, Safety, Effectiveness • Examples • Standard operating procedures, Clinical guidelines • Decision support, Hard stops in EHRs • But flexibility is needed to accommodate variation

SYFSA in a Nutshell

Idealized Space for Medication Ordering • Procedural Flexibility: 3 bits • Functional Flexibility: Approximately 14.58 • Estimate from RxNorm: ~ 24,000 prescribable drugs, including those not in RxNorm

Open Vista Natural Space

OpenVista: Natural Space • OpenVista – • The Natural Space • Too much procedural flexibility: 9.5 bits

Natural Space of “Droogle”an e-Prescription demonstration project inspired by Google By Peter V. Killoran M.D DEMO • Droogle • Procedural Flexibility close to ideal: 1 bit

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH From: http://rxterms.nlm.nih.gov:8080/ Keystrokes: war

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Keystrokes: war TAB

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Keystrokes: war TAB 5

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Keystrokes: war TAB 5 TAB 182 different drugs require only 4 keystrokes: letter TAB number TAB Functional flexibility matches ideal

RxTerm Medication Entry Demo Appfrom The National Library of Medicine, NIH Procedural flexibility: 5.1bits Maximum interface efficiency: ~ 68% (4 keystrokes) Minimum interface efficiency: ~ 5% (50 character free text entry)

BONUS Reducing Wrong Patient Errors: Animated Transitions & Photos

Reducing Wrong Patient Errors: Animated Transitions & Photos

Reducing Wrong Patient Errors: Animated Transitions & Photos 63% 43% 36% 7% Photo Animation Control Combined The combination of animation & photo resulted in a significant increase in error recognition rate relative to the control & animation groups  Dramatic implications for commercial systems (Taieb-Maimon, Plaisant & Shneiderman, 2012)

Year 3 & 4 Planned Deliverables Medication Reconciliation Lab Tracking Systematic Yet Flexible Systems Analysis Visualization Guidelines

Anticipated Challenges in Years 3-4 Clinical User Testing Industry Collaboration in Technology Transfer Resources for Widening Impact

Join us for HCIL symposium May 22-23, 2012 Includes Medical Informatics Workshop on Day 2 www.cs.umd.edu/hcil/soh

Project 4: Cognitive Information Design & Visualization