scholarly journals User-Centered Clinical Display Design Issues for Inpatient Providers

2020 ◽  
Vol 11 (05) ◽  
pp. 700-709
Author(s):  
Thomas A. Lasko ◽  
David A. Owens ◽  
Daniel Fabbri ◽  
Jonathan P. Wanderer ◽  
Julian Z. Genkins ◽  
...  
Keyword(s):  
Pattern Recognition ◽  
Clinical Picture ◽  
Mental Model ◽  
Time Pressure ◽  
Clinical Information ◽  
Ethnographic Study ◽  
Medical Providers ◽  
Display Design ◽  
Information Display ◽  
Hide Data

Abstract Background Suboptimal information display in electronic health records (EHRs) is a notorious pain point for users. Designing an effective display is difficult, due in part to the complex and varied nature of clinical practice. Objective This article aims to understand the goals, constraints, frustrations, and mental models of inpatient medical providers when accessing EHR data, to better inform the display of clinical information. Methods A multidisciplinary ethnographic study of inpatient medical providers. Results Our participants' primary goal was usually to assemble a clinical picture around a given question, under the constraints of time pressure and incomplete information. To do so, they tend to use a mental model of multiple layers of abstraction when thinking of patients and disease; they prefer immediate pattern recognition strategies for answering clinical questions, with breadth-first or depth-first search strategies used subsequently if needed; and they are sensitive to data relevance, completeness, and reliability when reading a record. Conclusion These results conflict with the ubiquitous display design practice of separating data by type (test results, medications, notes, etc.), a mismatch that is known to encumber efficient mental processing by increasing both navigation burden and memory demands on users. A popular and obvious solution is to select or filter the data to display exactly what is presumed to be relevant to the clinical question, but this solution is both brittle and mistrusted by users. A less brittle approach that is more aligned with our users' mental model could use abstraction to summarize details instead of filtering to hide data. An abstraction-based approach could allow clinicians to more easily assemble a clinical picture, to use immediate pattern recognition strategies, and to adjust the level of displayed detail to their particular needs. It could also help the user notice unanticipated patterns and to fluidly shift attention as understanding evolves.

Abstract TP51: When Can Aspects be Read Reliably?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sadanand Dey ◽  
James Evans ◽  
Carol Tham ◽  
Zarina Assis ◽  
Ericka Teleg ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Pressure ◽  
Real Life ◽  
Clinical Information ◽  
Motion Artifact ◽  
Patient Specific ◽  
Ischemic Change ◽  
Minimum Interval ◽  
Contrast Ct

Introduction: Alberta Stroke Program Early CT Score (ASPECTS) is a systematic approach to assess early ischemic change on non-contrast CT (NCCT). Concerns have however been expressed about its reliability when making clinical decisions in patients with acute ischemic stroke. We chose to systematically assess technical, environmental and patient specific variables that potentially affect ASPECTS interpretation. Methods: We randomly selected 150 patients with acute ischemic stroke from the PRoveIT database. All patients had baseline NCCT and CT angiography head and neck. Three raters (expert, fellow and trainee) read ASPECTS on the same NCCT three times (Sessions 1-3) at minimum interval of 10-14 days. Raters were kept blinded to follow-up data throughout the study. No baseline clinical information was provided in Session 1. Raters were provided clinical information (age, baseline NIHSS and side of stroke) in session 2 and additional multiphase CTA in session 3. Reading environment [room light and time pressure (<60 s for interpretation) vs. core lab] was altered during readings. Data on motion artifact, leukoaraiosis, old infarcts on NCCT were collected. Time taken for ASPECTS interpretation was collected across all the readings. Reliability was assessed using Intra-cluster correlation coefficient (ICC). Results: The highest inter-rater reliability was found in session 3 (ICC 0.47; p<0.001). The rest of the analyses was restricted to session 3. Reliability in session 3 was not affected by time pressure or ambient light settings (all p<0.01). In session 3, patient motion (ICC 0.35 present vs. 0.49 absent) and old infarcts (ICC 0.42 present vs. 0.48 absent) worsened reliability; however presence of leukoaraiosis did not affect reliability (ICC 0.48 present vs. 0.46 absent). Mean time for ASPECT interpretation by trainee, fellow and expert were 38.9 s (+/-12.8s), 49.8 s (+/-15.4s) and 38.9 s (+/-14s) respectively. Conclusion: ASPECTS interpretation on NCCT is most reliable when clinical and CTA information is available. Interpretation with this information is reliable even in a well-lit room and under time pressure, the environment that mimics real life acute stroke.

Operator Stress and Display Design

2003 ◽  
Vol 11 (2) ◽  
pp. 13-18 ◽  
Author(s):  
Peter A. Hancock ◽  
James L. Szalma
Keyword(s):  
Decision Making ◽  
Information Overload ◽  
Time Pressure ◽  
Design Guidelines ◽  
Team Cohesion ◽  
Combined Effects ◽  
Jigsaw Puzzle ◽  
Display Design ◽  
Situational Stress ◽  
And Task

These design guidelines, based on knowledge of how operators perform under time and task pressure, can lead to better decision making in emergencies. IT IS NEAR THE END OF A LONG SHIFT, some hours past midnight, and the combined effects of caffeine, nicotine, and sugared snacks are no longer sufficient to sustain the alertness of tired and weary operators. Circadian rhythms are at their lowest ebb while oppressive, routine operations have so long persisted that chronic boredom reigns supreme. Suddenly a warning sounds, then another, then another — the systems displays are producing a cascade of flashing lights and tone alarms. Operators rush to workstations, where information begins to overflow like a virtual Niagara of bytes. The apprehension in the air is tangible. It is evident to everyone that a coherent response must be made soon if the situation is to be recovered. As a result, time pressure is now added to anxiety and information overload and rapidly shifts the situation from boredom to terror (Hancock, 1997a). The answers to the problem are somewhere in the system, but a massive noise-to-signal problem is building by the minute. Unfortunately, the resolution is spread across a tapestry of displays. Like pieces of a dynamic jigsaw puzzle, the solution resides in separate parts distributed across many minds, but team communication and team cohesion are rapidly failing, overwhelmed by the demands of information overload and the destructive effects of situational stress. If someone doesn't do something soon…

scholarly journals Patients Are Knowledge Workers in the Clinical Information Space

2021 ◽  
Vol 12 (01) ◽  
pp. 133-140
Author(s):  
Elizabeth Lerner Papautsky ◽  
Emily S. Patterson
Keyword(s):  
Human Factors ◽  
Clinical Picture ◽  
Health Informatics ◽  
Clinical Information ◽  
Patient Centered Care ◽  
Information Space ◽  
Patient Knowledge ◽  
Patient Centered ◽  
Historical Perspectives ◽  
Centered Care

Abstract Background Limited research exists on patient knowledge/cognition or “getting inside patients' heads.” Because patients possess unique and privileged knowledge, clinicians need this information to make patient-centered and coordinated treatment planning decisions. To achieve patient-centered care, we characterize patient knowledge and contributions to the clinical information space. Methods and Objectives In a theoretical overview, we explore the relevance of patient knowledge to care provision, apply historical perspectives of knowledge acquisition to patient knowledge, propose a representation of patient knowledge types across the continuum of care, and include illustrative vignettes about Mr. Jones. We highlight how the field of human factors (a core competency of health informatics) provides a perspective and methods for eliciting and characterizing patient knowledge. Conclusion Patients play a vital role in the clinical information space by possessing and sharing unique knowledge relevant to the clinical picture. Without a patient's contributions, the clinical picture of the patient is incomplete. A human factors perspective informs patient-centered care and health information technology solutions to support clinical information sharing.

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