Visualisation of Integrated Patient-Centric Data as Pathways: Enhancing Electronic Medical Records in Clinical Practice

Routinely collected data in hospital Electronic Medical Records (EMR) is rich and abundant but often not linked or analysed for purposes other than direct patient care. We have created a methodology to integrate patient-centric data from different EMR systems into clinical pathways that represent the history of all patient interactions with the hospital during the course of a disease and beyond. In this paper, the literature in the area of data visualisation in healthcare is reviewed and a method for visualising the journeys that patients take through care is discussed. Examples of the hidden knowledge that could be discovered using this approach are explored and the main application areas of visualisation tools are identified. This paper also highlights the challenges of collecting and analysing such data and making the visualisations extensively used in the medical domain. This paper starts by presenting the state-of-the-art in visualisation of clinical and other health related data. Then, it describes an example clinical problem and discusses the visualisation tools and techniques created for the utilisation of these data by clinicians and researchers. Finally, we look at the open problems in this area of research and discuss future challenges

Guidelines for the user interface design of electronic medical records in optometry

With the prevalence of digitalisation in the medical industry, e-health systems have largely replaced the traditional paper-based recording methods. At the centre of these e-health systems are Electronic Health Records (EHRs) and Electronic Medical Records (EMRs), whose benefits significantly improve physician workflows. However, provision for user interface designs (UIDs) of these systems have been so poor that they have severely hindered physician usability, disrupted their workflows and risked patient safety. UID and usability guidelines have been provided, but have been very high level and general, mostly suitable for EHRs (which are used in general practices and hospitals). These guidelines have thus been ineffective in applicability for EMRs, which are typically used in niche medical environments. Within the niche field of Optometry, physicians experience disrupted workflows as a result of poor EMR UID and usability, of which EMR guidelines to improve these challenges are scarce. Hence, the need for this research arose, aiming to create UID guidelines for EMRs in Optometry, which will help improve the usability of the optometrists’ EMR. The main research question was successfully answered to produce the set of UID Guidelines for EMRs in Optometry, which includes guidelines built upon from literature and made contextually relevant, as well as some new additions, which are more patient focused. Design Science Research (DSR) was chosen as a suitable approach, and the phased Design Science Research Process Model (DSRPM) was used to guide this research. A literature review was conducted, including EHR and EMR, usability, UIDs, Optometry, related fields, and studies previously conducted to provide guidelines, frameworks and models. The review also included studying usability problems reported on the systems and the methods to overcome them. Task Analysis (TA) was used to observe and understand the optometrists’ workflows and their interactions with their EMRs during patient appointments, also identifying EMR problem areas. To address these problems, Focus Groups (FGs) were used to brainstorm solutions in the form of EMR UID features that optometrists’ required to improve their usability. From the literature review, TAs and FGs, proposed guidelines were created. The created guidelines informed the UID of an EMR prototype, which was successfully demonstrated to optometrists during Usability Testing sessions for the evaluation. Surveys were also used for the evaluation. The results proved the guidelines were successful, and were usable, effective, efficient and of good quality. A revised, final set of guidelines was then presented. Future researchers and designers may benefit from the contributions made from this research, which are both theoretical and practical

Usability flaws of medication-related alerting functions: A systematic qualitative review

AbstractIntroductionMedication-related alerting functions may include usability flaws that limit their optimal use. A first step on the way to preventing usability flaws is to understand the characteristics of these usability flaws. This systematic qualitative review aims to analyze the type of usability flaws found in medication-related alerting functions.MethodPapers were searched via PubMed, Scopus and Ergonomics Abstracts databases, along with references lists. Paper selection, data extraction and data analysis was performed by two to three Human Factors experts. Meaningful semantic units representing instances of usability flaws were the main data extracted. They were analyzed through qualitative methods: categorization following general usability heuristics and through an inductive process for the flaws specific to medication-related alerting functions.Main resultsFrom the 6380 papers initially identified, 26 met all eligibility criteria. The analysis of the papers identified a total of 168 instances of usability flaws that could be classified into 13 categories of usability flaws representing either violations of general usability principles (i.e. they could be found in any system, e.g. guidance and workload issues) or infractions specific to medication-related alerting functions. The latter refer to issues of low signal-to-noise ratio, incomplete content of alerts, transparency, presentation mode and timing, missing alert features, tasks and control distribution.Main conclusionThe list of 168 instances of usability flaws of medication-related alerting functions provides a source of knowledge for checking the usability of medication-related alerting functions during their design and evaluation process and ultimately constructs evidence-based usability design principles for these functions

Interactive Surgical Depiction for the Electronic Medical Record

Prior to the adoption of the electronic medical record (EMR), the written documentation of operations in patients’ paper charts were frequently supplemented by a sketch by the surgeon. is image enhanced the understanding of the operation, especially for complex or re-operative procedures. With the recent transition to comprehensive EMR systems, traditional paper charts are seldom used and less accessible to clinicians. Surgeons currently lack a means to include a drawing in the patient record to aid in the communication of post-operative anatomy. An accurate understanding of post-operative anatomy is critical to providing optimal care. Deprived of this knowledge, subsequent care providers expend considerable time and resources attempting to understand the patient’s current anatomy. is is particularly true when the patient falls under the care of a di erent doctor or team, or is transferred from another hospital. Ultimately, the patient’s safety is compromised, as they may be subjected to greater periods of time under anesthesia and unnecessary radiation dedicated solely to visualizing their altered anatomy. No tools are currently available that allow a meaningful depiction of post-operative anatomy to be included in the medical record. is thesis explores the design of a digital interactive tool to enable surgeons to quickly and accurately document the patient’s post- procedural anatomy in an image. is tool is unique in that it presents a pre-existing 3D model which the user may split, remove, move, and reconnect to represent changes to the patient’s GI tract. rough an intuitive interface, the surgeon will manipulate a 3D model of normal anatomy to accurately depict resections and reconnections of bowel at appropriate distances and con gurations and include elements such as drains, measurements, and annotations. e surgeon can then save the image with the post-operative note to follow the patient. As a part of the EMR, the image is available for viewing by practitioners responsible for post-operative care and subsequent diagnoses and procedures, contributing to overall patient safety. Over thirty user interviews provided feedback vital to the design of the user interface and features list during the development stage of this novel resource

The Impact of CPOE Medication Systems’ Design Aspects on Usability, Workflow and Medication Orders

Objectives: To examine the impact of design aspects of computerized physician order entry (CPOE) systems for medication ordering on usability, physicians’ workflow and on medication orders. Methods: We systematically searched Pub - Med, EMBASE and Ovid MEDLINE for articles published from 1986 to 2007. We also evaluated reference lists of reviews and relevant articles captured by our search strategy, and the web-based inventory of evaluation studies in medical informatics 1982–2005. Data about design aspects were extracted from the relevant articles. Identified design aspects were categorized in groups derived from principles for computer screen and dialogue design and user guidance from the International Stan-dard Organization, and if CPOE-specific, from the collected data. Results: A total of 19 papers met our inclusion criteria. Sixteen studies used qualitative evaluation methods and the rest both qualitative and quantitative. In total 42 CPOE design aspects were identified and categorized in seven groups: 1) documentation and data entry components, 2) alerting, 3) visual clues and icons, 4) drop-down lists and menus, 5) safeguards, 6) screen displays, and 7) auxiliary functions. Conclusions: Beside the range of functionalities provided by a CPOE system, their subtle design is important to increase physicians’ adoption and to reduce medication errors. This requires continuous evaluations to investigate whether interfaces of CPOE systems follow normal flow of actions in the ordering process and if they are cognitively easy to understand and use for physicians. This paper provides general recommendations for CPOE (re)design based on the characteristics of CPOE design aspects found

My Crohn’s disease on real-time information - User experience improvement through cross-platform applications

Reducing hospital institutionalization of citizen with chronic diseases is a major priority of western countries priorities. The more complex the health condition, the harder it is to coordinate clinical care. To improve the disease management and control, most patients need to use mobile applications that are available in online stores or web services because of the difficulty that a personal mobile phone has to get real time access to clinical data outside of a hospital. In terms of IBD - Inflammatory Bowel Disease - existing mobile phone solutions are very complex, because visually the interfaces communicates with the user through inadequate use of symbols in clinical features, which are inconsistent and have poor legibility. They also presents a lack of visual optimization between multiplatform systems. This increases the user's learning curve in terms of how to interpret and interact with these systems, generating an opportunity for these patients with abilities to innovate through the creation and development of solutions that solve their own problems related to the management and coordination of the disease. This thesis aims to analysis IBD patients behaviour related to disease management, identify the type of problems, both functional and communication, which occur in existing IBD m-Health and e-Health systems, and introduces two topics – communication and design studies – in the "User Innovator" model of Von Hippel (1976) which consists of users, that are, for example, patients with chronic diseases, and who innovate by creating solutions to solve personal problems because of unfavourable healthcare conditions. To validate in the design process the three perspectives – design, innovation and patient – were considered, and the framework “Human-social Interaction Model for e-Health Interfaces” was created, enabling a sustainable approach to research, with inputs from personal experience being used, introducing relevant feedback for the final goal of the preliminary studies, when creating the interface for mobile phone application particularly for Crohn’s disease, one of the IBD, with a new healthcare user experience. To reach the objective, a set of studies were conducted that were divided into two stages. The first, a literature review of the relationship between semiotics and interactive communication; the meaning of symbolic representation in interactive projects; new design research guidelines that define interfaces and features and that are more approachable for users; user perspectives towards technology for health supporting and controlling; the design and communication space on technological projects; the challenge for users/ patients who try to create systems to solve personal problems. The second part, presents the practical research that includes a survey of 279 participants with IBD; the empirical analysis of six case studies – mobile applications and multiplatform: context, features, design principles lifting, and usability testing A/B with the design features and principles of design on two of the six systems being compared. The results from the thesis challenge the concepts of mobile interface usability in health, providing users with a structured interpretation of medical information design and a guideline for designers with chronic diseases that would like to create solutions to monitor health problems.Reduzir a institucionalização hospitalar de cidadãos com doenças crónicas é uma das prioridades para os países ocidentais. Quanto maior for a complexidade das condições de saúde, mais difícil se torna a coordenação dos cuidados clínicos. Para melhorar o controle e a gestão da doença, a maioria destes pacientes recorre às aplicações para telemóvel disponíveis em lojas online e aos serviços na web pois, é difícil obter permissão para aceder a dados clínicos em tempo real no telemóvel pessoal a partir do hospital. No contexto da DII – Doença Inflamatória do Intestino – as soluções existentes apresentam níveis de complexidade visual elevados pois, a interface comunica com o utilizador através de símbolos clínicos inadequados em funcionalidades convencionais – fraca legibilidade e inconsistência; Apresenta também, fraca coerência visual entre sistemas multiplataforma. Estes cenários promovem no utilizador, um aumento da curva de aprendizagem relativamente à forma como estes interagem com os sistemas criando assim, uma abertura para o desenvolvimento de soluções pelos que têm habilidade para inovar através da criação e desenvolvimento de sistemas que resolvem os seus problemas com a gestão e coordenação da doença. Esta tese tem como objetivo analisar o comportamento dos pacientes com DII relativamente à gestão da sua doença. Identificar que tipo de problemas – funcionais e de comunicação – existem nas soluções atuais para telemóvel e web no contexto da DII, introduzindo novos temas – estudos em comunicação e design – no modelo "User Innovator" de Von Hippel (1976) que consiste em, utilizadores, como por exemplo, pacientes com doenças crónicas, que inovam ao criarem soluções para resolver os problemas pessoais, tais como, condições de saúde adversas. Para validar no processo de design a integração das três áreas – design, inovação e paciente – criamos a framework “Human-social Interaction Model for e-Health Interfaces” que nos permitiu uma abordagem sustentável à investigação, quando foram aplicados inputs provenientes de experiência pessoal das três perspectivas introduzindo feedback relevante para o objetivo final dos estudos preliminares, também quando criada a interface para dispositivos móveis focada na doença de Crohn, uma das DII, com uma nova experiência de utilizador na área da saúde. Para atingir o objectivo, realizou-se um conjunto de estudos que se encontram divididos em dois momentos: o primeiro, com revisão de literatura sobre a relação da semiótica com a comunicação interativa; o significado da representação simbólica em projetos interativos; as novas linhas de reflexão do Design que definem interfaces e funcionalidades mais próximas do utilizador; a perspectiva dos utilizadores perante a tecnologia como meio de suporte e controle da saúde; o espaço do design e da comunicação em projetos tecnológicos; o desafio para utilizadores/ pacientes que tentam criar sistemas para solucionar problemas pessoais. A segunda parte apresenta a investigação de campo com, um inquérito a 279 participantes com DII; análise empírica de seis casos de estudo – aplicações para telemóvel e multiplataforma: contexto, funcionalidades, levantamento de princípios do design, e testes de usabilidade A/B onde comparamos em dois dos seis sistemas, a articulação entre as funcionalidades e os princípios do design. Os resultados obtidos desafiam a usabilidade das interfaces para telemóvel no contexto da saúde, proporcionando aos utilizadores uma interpretação mais coerente do ponto de vista formal do design de informação médica e um caminho para designers com doenças crónicas que pretendem criar soluções para resolver problemas de monotorização da saúde

EDGE Mentoring App

The EDGE Mentoring Program helps incoming freshmen transition more easily into Worcester Polytechnic Institute (WPI). In the EDGE Program, mentees are paired with sophomore, junior, and senior mentors, who guide incoming students in three areas: academic, social, and personal wellness. Additionally, in today’s college environment, mobile applications (apps) assist college students in areas such as time management, sleep, fitness, and social networking. The goal of this interactive qualifying project (IQP) was to develop a mobile app that will help peer mentors in the EDGE Program. The mentors in the EDGE Program could then use the app to help their mentees succeed

Processus de validation d’une base de données haute résolution dans une unité de soins intensifs pédiatriques

Objectif : Notre objectif était d’évaluer la qualité des données de la base de données haute résolution (BDHR) implantée dans l’unité de soins intensifs pédiatriques (USIP) de l’Hôpital Sainte-Justine (HSJ). Type d’étude : Un rapport descriptif et une analyse d’une étude prospective de validation d’une BDHR. Environnement : Une USIP de 32 lits, adaptée aux soins médicaux, chirurgicaux et cardiaques dans un centre tertiaire mère-enfant du Canada. Population : Tous les patients admis à l’USIP et ayant un monitorage d’au moins 1 signe vital par un moniteur cardio-respiratoire. Mesures et résultats principaux : Entre juin 2017 et août 2018, les données de 295 jours de patients ont été enregistrées à partir des appareils médicaux et 4465 données ont été filmées et comparées aux données correspondantes dans la BDHR de l’USIP de l’HSJ. Les analyses statistiques ont démontré en général une bonne corrélation, une excellente fiabilité et un bon agrément. Les graphiques de Bland-Altman ont aussi démontré l’exactitude et la précision entre les données récoltées et les données filmées selon les limites d’agrément cliniquement significatives préalablement définies. Conclusions : Cette étude de validation exécutée sur un échantillon représentatif a démontré que la qualité des données était globalement excellente.Objective: Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in the pediatric intensive care unit (PICU) of HSJ. Design: A descriptive report and analysis of a prospective validation of a HRDB. Setting: A 32 beds pediatric medical, surgical and cardiac PICU in a tertiary care free-standing maternal-child health center in Canada. Population: All patients admitted to the PICU with at least one vital sign recorded using a cardiorespiratory monitor connected to the central monitoring station. Measurements and Main Results: Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4,645 data points were video recorded and compared to the corresponding data collected in the HSJ-PICU HRDB. Statistical analysis showed excellent overall correlation, agreement and reliability. Bland-Altman analysis showed excellent accuracy and precision between recorded and collected data within clinically significant pre-defined limits of agreement. Conclusions: This prospective validation study performed on a representative sample showed excellent overall data quality

Doctor of Philosophy

dissertationPreventable adverse events are one of the leading causes of hospitalized patient deaths. Many of these adverse events occur in Intensive Care Units (ICUs) where nurses often work under cognitive, perceptual, and physical overloads. Contributing to these overloads are spatially separated devices which display treatment relevant information such as orders, monitoring information, and equipment status on numerous displays. If essential information of these separate devices was integrated into a single display at the bedside, nurses could potentially reduce their workload and improve their awareness of the patients' treatment plans and physiological status. We conducted a set of three studies for the purpose of designing an efficient and effective ICU display. We observed ICU nurses during their shifts and found that task-relevant information was often presented in the wrong format, unavailable at the point of care or laborious to obtain. Additionally, nurses were sometimes unaware of significant changes in their patient's status and equipment operation. Based on nurses' feedback, we designed an integrated information display that presents all of the information that nurses need at the patient bedside. Nurses selected a display based on the information organization of existing patient monitors, with added medication management and team communication features. The evaluation of paper-based prototypes of both the integrated display and existing ICU displays showed that nurses could answer questions about the patient's status and treatment faster (p<<0.05) and more accurately (p<<0.05) using the integrated display. The number of adverse events in the ICU could potentially be reduced by integrated displays, but to implement them into clinical practice will require significant engineering efforts