Custom Information status board for Iowa health systems Dec10-11 Colin Ryan Tyler Rykhoek Cory Schwarting Kyle Stephan Client Dennis McInerney Advisors Dr. Arun Somani Dr. Manimaran Govindarsu Kyle I’d like to welcome everyone to our design review. My name is Kyle Stephan [names]. Our project is to create a Custom Information Status Board for Iowa Health Systems. Our client contact is Dennis McInerney. Our advisors are Dr. Somani and Professor Manimaran.

Problem Statement Difficult to track: A need for: Constant flow of patients Patient data A need for: Real-time patient information Enhance communication between patient and personnel A way to analyze previous patient data Kyle Within a hospital environment, it is critical to have up-to-date patient information that is easily accessible at all times. Having to wait for patient information costs both the patient and hospital money and directly impacts patient care. In order to improve patient flow, IHS has tasked us with creating a custom status board that could be installed in areas like nursing stations in order to allow nurses and doctors to quickly see patient information and to take action. These boards would be a great improvement over the currently used marker boards by providing real-time information. This display board, since it is electronic, could be viewed elsewhere throughout the operating environment, further improving communication between patients and personnel. Another aspect of our system would be to provide a way for hospital managers to analyze previous patient data in order to improve patient flow by allowing them to view the critical events that a patient goes through, such as diagnosis, registration, and lab tests.

Conceptual Sketch Kyle Here is our conceptual sketch showing our expected end system. It will consist of three primary components: a server, client, and a system running the visual display. The server will function to take input from the client systems and to feed this information to the visual display component. The client will be running in two different ways: on a workstation in the patient rooms or nursing areas and a mobile device. This will allow users to view and update the system from throughout the hospital. The client running on the mobile device will be limited in functionality compared to the workstation due to the limitations of screen size and input speed. The client will also have access to visual display component in order to allow users to see the status of all patients in their area.

Functional Requirements Event Entry and Display Laptop workstations Mobile devices Privacy Interactions Database Track Performance Reports Manage Users Colin

Non-Functional Requirements Quick interaction 10 seconds or 7 keystrokes Easy to learn Improve overall patient flow Colin

Assumptions/Limitations Users will be hospital personnel The network will be reliable Display board will be viewable by personnel only HIPAA Colin – Users will include Nurses & Doctors, Clinical Quality Staff, and Administrators. These are the primary people we are creating the system for and needs are to be oriented to their preferences. Network will be reliable meaning that we are under the assumption that we can access our database using the local wireless internet and obtaining and updating information. A limitation we have is restricting the Display Board to being viewed by personnel only. If we do not restrict the viewing, we may be violating the patients HIPAA rights (Rights to have their personal information concealed and not seen in public).

Market Survey Current display at Methodist West: Display at Methodist: Lacking accessibility No event tracking Current Board is restricting Display at Methodist: Marker board Rarely updated Viewable at a single location Kyle

Risks & Mitigation Interaction with SunQuest Independent Software Users manually update HIPAA patient confidentiality Allow users to hide patient information Kyle - We have identified 2 major risks with this project. Number 1 being interaction with an existing system called SunQuest. SunQuest is a system used in the hospital where nurses and staff can interact with the lab. They can submit lab orders (blood test, etc.) and view results of these orders. We would like to be able to interact with this system, but currently we have not gotten the appropriate documentation for that system. So if interaction with this system is not possible we will require users to manually enter lab data for a patient, such as what test they submitted and when. The 2nd risk we have is that we want the system to show private patient information on a main screen, but HIPAA limits who can see what. To minimized the potential violation of patient information our system will have required credentials to view and edit information as well as a manual and timed hiding of important patient information.

Hardware & Software Tech. Workstation Windows XP Java 5.0 Server MySQL Mobile Device Android OS Touch screen Tyler

Cost Estimate Laptop/Computer in patient room $500 Mobile Device $400 - Number of Devices/Computers 10-50 Display Board $800-1,000 Hardware Total ~$6,000-25,000 Total $14,000-33,000 Tyler - As you can see here, we have a list of costs for this system. We are averaging $500 for each laptop and $400 for each mobile device running the Android OS. Each hospital will need a different number of these devices so we have a rough estimate from 10-50 devices. We will also need a main large display for the area of the hospital implementing our system, so we are estimating around $1000 for that. We have also approximated that we will each put in around 100 hours of work into this system. Overall we have a cost estimate of 15 thousand to 30 thousand dollars.

HealthCare Board GUI Three main users Each with their own main display Normal User (Doctors and Nurses) Administrator Clinical Quality Each with their own main display HealthCare Display Report Generation Form Cory – Users will include Nurses & Doctors, Clinical Quality Staff, and Administrators. These are the primary people we are creating the system for and needs are to be oriented to their preferences. 11

Implementation - GUI Tools Learning Experience Netbeans IDE MySQL Workbench Learning Experience Swing based programming Window Integration Database Communication Cory 12

HealthCare Display Cory This is a screenshot of what will be shown on the display board used in the nursing areas. It shows basic patient information such as name, room, why they are at the hospital, the last time they were visited by staff, when they arrived, their current status, tests that have been ordered with the results shown in color (WHAT DOES BLUE MEAN), events that have occurred for the patient, and whether they have been registered. It also provides a way for users to hide the display if necessary through this button. Users can get more information about a patient by double clicking on their name.

Administrator Add Test Add User Allows admin to dynamically enter tests into the system Add User Allows admin to add users to database and give system rights Cory

Administrator Edit Windows Allows admin to modify changes to the system All windows are similar in using them Cory

Clinical Quality Display Report Creation Filter Report Date Times Data retrieved Name Tests Event Times Cory: One of the main ideas behind this project is the tracking of critical events that occur throughout the day at the hospital. As nurses and staff use the display to keep track of the many patients, all the interactions are logged as events and stored in our database. This is the display a clinical quality user would see when they are requesting a report. As you can see here the user can select the events they wish to be gathered, then select the start and end dates that these events occurred and press create report. This will generate an excel style report that can be used to determine things such as patient flow bottlenecks, such as why do blood tests take longer in the afternoon, etc.

GUI Evaluation Initial Limitation Bugs Bug Identification and Remedy System Programming without Database Bugs Main Display Coloring Automatic Column Resizing Bug Identification and Remedy Custom Cell Renderer Improper Code Conversion Cory 17

Database Implementation MySQL server – community version 5.1.50 Total of 7 databases tables login_info patient_info test_definition event_definition patient_stages patient_events patient_tests Created through MySQL Workbench Kyle 18

Database Testing Interactions with database Visually through Workbench Kyle 19

Mobile Device Implementation Used by Doctors and Nurses Simple subset of main display functions Secure log in List of current patients Single patient details Application settings Tyler 20

Mobile Device Screens Tyler: I have been working with the mobile device that will be running the Android OS. This touch screen device will allow the people that carry them to have a miniaturized version of the main display and they will have the ability to update simple information from anywhere in the hospital through the wireless network. As you can see from these screen shots I have developed the login screen for security, the patient list screen, which shows the critical patient information automatically sorted by the longest waiting time, and the detailed patient screen where the user can edit patient status, round the patient which is a reset of the waiting time between critical events and more will be added necessary.

Mobile Device Testing Developed in Eclipse Initial testing on “Android Virtual Device” Manual testing on real Android devices Limited number of possible operations Tyler 22

Mobile Device Evaluation Issues and Remedy User feedback during interaction “Loading” spinner Working with Android Widgets Limitations Availability of Android devices User’s willingness to learn and use the application More functionality Tyler Working with the new android API I ran into a few issues, namely getting the widget, i.e. buttons, text fields, images, and lists to be displayed how I wanted them. I then worked with implementing multiple screens or activities into one program. After getting all that to work, I worked on improving user feedback and learned how to add loading spinners to the screen. A few of the limitations of the mobile device are the availability of the devices in the hospitals, the users willingness to learn and use the application on the device, and adding more functionality to the application without making to complicated to use. 23

Testing Frameworks JUnit Abbot Costello Java unit testing Allows runtime extraction of GUI objects Programmatic/repeatable testing Costello Rapid development of Abbot scripts Colin 24

Testing Techniques Gray-box Edge cases Regression Smoke tests during integration Colin 25

Testing Results Fixed bugs without creating more Made code more robust to handle inconsistent database states Colin 26

Implementation Issues Could not connect MySQL database directly to Android device Fixed by creating server that mobile devices connect to Colin 27

Client Evaluation Successful Implementation Future Features System Installation Colin This past Wednesday Kyle and I presented our project to Iowa Health Systems in Des Moines and they deemed it a success. The next step is to get the system installed in the hospital and discuss future possible features. 28

Questions? Custom Information Status Board for Iowa Health Systems Client: Dennis McInerney Team: Colin Ryan, Tyler Rykhoek, Cory Schwarting, Kyle Stephan Advisors: Dr. Arun Somani, Dr. Manimaran Govindarasu Cory – Do you have any questions?