1. Cognitive Information Design & Visualization Cognitive Information Design & Visualization

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

3. 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

4. Whats unique? Whats identical? Whats equivalent? Medication Reconciliation: Spatial Layout with Animated Transitions

5. Automated medication reconciliation and complexity of care transitions Bozzo Silva, Bernstam, Markowitz, Johnson, Zhang and Herskovic, AMIA 2011 EquivalenceCriteriaExample FormIdentical except for brand vs. generic Advil = Ibuprofen Senormin = Atenolol FunctionalSame therapeutic intentAtenolol & Propanolol both betablockers PartialForm or functional equivalence, but differ in dosage, frequency, route Advil 100 mg Acetaminophen 200mg NoneUnique in form & function LEVELS OF EQUIVALENCE

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

7. Twinlist running on Microsoft Amalga Platform Contact: Hank Rappaport Twinlist adapted for problem list reconciliation in cancer risk assessment software (Hughes riskApps) Contact: Kevin S. Hughes, Massachusetts General Hospital Medication Reconciliation: Spatial Layout with Animated Transitions 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 A sigh of relief when I saw Twinlist Melinda Jenkins, PhD, FNP

8. 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

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

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

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

13. Color-Coding, Icons, and Ranking

14. Compact Layouts Test Result Management: Table Design & Retrospective Analysis

15. Improved Headers Test Result Management: Table Design & Retrospective Analysis

16. Integrated Actions Test Result Management: Table Design & Retrospective Analysis

17. 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

20. 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 20

21. SYFSA in a Nutshell Idealized: Logical constraints on the work, independent of any system Natural: How the current system supports and constrains the work System: A redesigned system that matches logical constraints as closely as possible 21

22. 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

23. Open Vista Natural Space

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

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

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

27. Keystrokes: war TAB RxTerm Medication Entry Demo App from The National Library of Medicine, NIH

28. Keystrokes: war TAB 5 RxTerm Medication Entry Demo App from The National Library of Medicine, NIH

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

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

31. Reducing Wrong Patient Errors: Animated Transitions & Photos BONUS

32. Reducing Wrong Patient Errors: Animated Transitions & Photos

35. ( Taieb-Maimon, Plaisant & Shneiderman, 2012) 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 Control Photo Combined 36% Animation 7% 43% 63%63%

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

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

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