1. PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

2. PubMed on Tap a pilot R&D project of the Communications Engineering Branch, Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Health and Human Services Goal –Develop a stable system to study design principles for delivery of medical information to handheld devices at the point-of-care Designers/Developers –Susan Hauser, project leader –Glenn Ford –Dina Demner-Fushman

3. Outline Motivation PubMed at a glance Design questions Usability study Next steps

4. Why patients need just-in-time information for clinicians: Patient Fact Sheet 20 Tips to Help Prevent Medical Errors ….Medical errors are one of the Nation's leading causes of death and injury. A recent report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. This means that more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS….. Ask your doctor if your treatment is based on the latest evidence AHRQ Publication No. 00-PO38, February 2000. Agency for Healthcare Research and Quality http://www.ahrq.gov/consumer/20tips.htm motivation  PubMed  design  usability  future

5. Doctors are encouraged to search for evidence based answers to their questions about patient care but most go unanswered Fifty nine obstacles were found while attempting to answer clinical questions with evidence 3. Obstacles related to seeking information 3.1.3. Lack of time to initiate search 3.2.1. Uncertainty about where to look for information 3.3.1. Resource physically distant 3.3.9. Resource not current 3.3.10. …. Most general resources do not allow real time interaction with the searcher (Ely et al., British Medical Journal. 2002) motivation  PubMed  design  usability  future

6. Where to look for information motivation  PubMed  design  usability  future

7. Current interactive resource at hand Speed up search –Navigation –Presentation Provide expected PubMed functionality motivation  PubMed  design  usability  future

8. PubMed Search motivation  PubMed  design  usability  future

9. Advanced Search ("variola virus"[MeSH Terms] OR "smallpox"[MeSH Terms]) AND hasabstract[text] AND Clinical Trial[ptyp] AND jsubsetaim[text] AND "adult"[MeSH Terms] AND ("hominidae"[MeSH Terms] OR "Human"[MeSH Terms]) AND ("2000"[PDAT] :"2004"[PDAT]) motivation  PubMed  design  usability  future

10. Clinical Queries motivation  PubMed  design  usability  future

11. Search Results motivation  PubMed  design  usability  future

12. Working with Search Results Navigating results pages motivation  PubMed  design  usability  future

13. Working with Search Results Viewing selected citations and links motivation  PubMed  design  usability  future

14. Working with Search Results Saving selected citations motivation  PubMed  design  usability  future

15. Saving Search Strategy Use the Cubby to store search strategies and LinkOut preferences. Access Cubby on the PubMed sidebar. You need to register for the Cubby and then login whenever you want to use it. Your web browser must be set to accept cookies. motivation  PubMed  design  usability  future

16. Interface Design Challenges Maximize utilization of 160x160 pixels, but don’t lose readability Decide what information is essential for an overview and how to organize ‘detail on demand’ Organize content in an easy to navigate manner, avoid scrolling Find clear graphical metaphors for task objects and actions Maximally approximate users’ model of the existing desktop application motivation  PubMed  design  usability  future

17. Our Approach Identify most likely target user’s tasks Develop a working prototype, and present to potential users for feedback Develop a stable system with a usable interface and sufficient features to be useful Conduct usability study Release the improved system to health care professionals, listen to users’ feedback, and study aggregate user statistics motivation  PubMed  design  usability  future

18. Organizing Content motivation  PubMed  design  usability  future usability studyusability study prototype presentation

19. Organizing Content continued motivation  PubMed  design  usability  future

20. Finding Metaphors is Hard motivation  PubMed  design  usability  future

21. Maintaining common feel and look for different platforms and operating systems is hard motivation  PubMed  design  usability  future

22. Usability Study Conducted at the National Cancer Institute (NCI) usability laboratory, facilitator Gregory Alexander, RN 9 subjects (informatics students, nurses, physicians, and medical librarians) 3 test tasks embedded in clinical scenarios 6 observers taking “stream of consciousness” notes, while viewing participant’s face and the PDA projected on a large screen Post-test questionnaire motivation  PubMed  design  usability  future

23. Usability Study Results All participants were able to find Medline citations containing answers to questions described in all test scenarios motivation  PubMed  design  usability  future There is strong correlation between time to completion and problems in locating functions and navigation

24. Usability Study Observations 234 unique observations Most frequent observations. Participants: Found brief mode (more titles per screen) useful Were confused by the related articles icon Did not know how to get back to the search tab from the profiles Did not know how to drill down to a citation Expected more information messages, e.g. on saving profiles Hesitated tapping the search globe motivation  PubMed  design  usability  future

25. Next Steps Organize content using key points of clinical scenario Conduct usability testing of all alternative layouts Include other NLM resources, e.g. practical guidelines motivation  PubMed  design  usability  future

26. PMOT home http://archive.nlm.nih.gov/proj/pmot/pmot.php Contact: demner@cs.umd.edu ddemner@mail.nih.gov