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Reviewing literature on medical records allows for two emerging themes that illustrate how medical records are usually used. EMRs take two related yet distinctive roles:

1. Communication tool role.

2. Intellectual tool role (Supports cognitive processes).

Communication tool

Medical records transfer patients’ information across time and space. Projects that focus on this role of medical records focus on legibility and availability of patients’ data. Yet, ignoring the second role of medical records _intellectual tool_ compromises EMRs being effective communication tools. (You can check this reality by reviewing Weir and Nebeker (2007) study. This is a link to my summary). This study illustrated that when the legibility and availability was overemphasized over the clarity and brevity of communicated data, the usefulness of medical records was compromised.

Intellectual tool

Medical records support cognitive processes. This was the final conclusion of Nygren and Henriksson (1992) study. (This is a link to my summary) They realized that the four goals found for the use of paper medical records fall under cognitive processes support.

There are other goals for medical records. Yet, from a user point of view, the above two goals/roles are the most critical. For EMR to be good communication and intellectual tools they do need to perform myriad of other functions, yet these functions should be the worry of designers and not users.

Image via Wikipedia

I am reading a document by the information designer David Sless. He describes the process of designing usable medicines information. The medicine information is to be placed on medicine packaging and medicine leaflets. In the introduction, he described the shift of Australian regulators form focusing on the content of medicine labeling to the performance of these labels. This meant the shift from what labels should contain to what consumers should be able to do with labels. Labels had to meat benchmarks. The key benchmark put by Communication Research Institute of Australia for medicine labeling is:

100% of literate people tested should be able to find and use at least 80% of the information they look for.

Within EMR interfaces and documents, there is a focus on what these documents should contain. An example what should a laboratory report contain, or what should a discharge summary contain. Should we also focus on the performance of EMRs instead of contents of EMRs?

If we do go ahead with focusing on the performance and not the content of EMRs, we may end up with similar EMRs. This is because of varied reasons. However, this shift of the way of thinking should be a good exercise that has the potential to transform EMRs. This exercise will lead us to agree on user related metrics to assess EMRs. Even more important, we would need to agree on the true goal of EMRs.

In the coming post I will try to find out the true goal of EMRs.

I came across this revolutionary technology as I was investigating e-readers with e-ink technology. Pixel Qi  T3 screens have many of the advantages of e-ink screens and solves their draw backs I presented in my previous post.

Pixel Qi  T3 screens are screens manufactured using current standard manufacturing materials. These screens work in two modes. One is a regular LCD color saturated mode that adds no advantage to current screens. The second mode is basically a  very clear black and white mode that requires ambient light similar to e-ink screens.

The advantage of Pixel Qi T3 screen is its readability and tremendous power saving. These two advantages are already offered by e-readers as the Kindle. However, Pixel QI screens, also, solve the two draw backs of current e-books with e-ink technology I mentioned in my previous posts. These are:

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Before reading this post you must read this earlier post. This is a continuation.

Affordance of P-MR means what is made possible by the the use of P-MR. (Walsh 2006) The purpose is the final goal of the carried act. Are the above mentioned points affordances of P-MR or purposes? Or is it important to make this distinction?

I believe that we do need to make this distinction. Affordances are things specific to the tools we use. for example that affordance for chairs that they allow us to sit one. The affordance of icons on computer desktops that they allow us to move them around. While purposes should be our ultimate goals. We try to reach our purposes with any feasible tool (at least sometimes!)

The four ways physicians use P-MR mentioned in my previous post are affordances which we may or may not be able to mimic using EMR. But, if we can mimic the purpose of P-MR using superior methods than those offered by P-MR that would be even better.

Walsh,  M. 2006. The ‘textual shift’: examining the reading process with print, visual and multimodal texts. Australian Journal of Language and Literacy. Vol 29, NO. 1, pp. 24-37.

Image by Getty Images via Daylife

Amazon’s Kindle pulled the attention of the market to e-readers. There are two promising technologies currently in the market; electronic ink (e-ink) and electronic paper. E-ink provides black and white displays. I myself was a skeptical of this technology. But after holding Kindle 2 in my hand, I stand beside those who admire this technology. In the past, I could not imagine the ease of reading off e-ink screens. But, reading off my Kindle 2 is pretty close to reading off paper. Wikipedia page on e-reader mention other devices using this technology. (Including the new large screen Kindle DX).

Electronic paper is developed by Fujitsu. This provides color. Yes, color. The devise is called FLEPia.

In my view there are two points that still need to be solved for these devices to be adapted in medicine:

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If you go along with my definition of medical records, computerized clinical narratives would constitute the major part of electronic medical records (EMR). EMR offers many benefits as better accessibility and increased legibility. However, concerning patterns emerged when full computerization of medical documents was carried out. I will present Weir and Nebeker (2007) qualitative study done to assess Veterans Affairs EMR computerized clinicians’ narratives. The studied system offered clinicians with multiple methods to enter data:

1. dictation (only 1% of documents were dictated)
2. manual entry facilitated by:
• templates
• objects. objects are parts of documentation that could be used multiple times as patient identification, medication lists and problem lists.
• copy and paste

Negative effect on work process was one of the emerging themes. This is usually noticed with any sort of computerization. However, much more concerning themes, that can undermine the purpose of clinician documentation appeared. These themes are:

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At last I got my hands on the landmark article by Nygren and Henriksson (1992). According to Google Scholar this article was sited only 101 times. I believe that the research presented in this article is underappreciated. This qualitative study offers the best insight into how paper medical records are actually used by physicians. This article studied what physicians do in out-patient setting. I find this rare in the study of Medical records in general. Most studies focus on in-patient services. The use of paper medical record (P-MR) by Swedish physicians  was studied. Yet, the findings are generalizable to the places I practiced; Canada and Saudi Arabia.   Seven physicians with at least 5 years of experience were interviewed. These physicians represented the following specialties: general practice (2), cardiology (1), gynecology(1), surgery (1), plastic surgery(1), clinical physiology (1), and psychiatry(1).

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In my previous post: achieving interface consistency in EMRs, I presented Nygren, Wyatt and Wright (1998) view of EMR interfaces components. These are documents, data contained within these documents and cues. In this post, would like to place a reminder to the types of data that may be contained within EMRs documents. Data can be textual, numeric, graphs, images and other multimedia forms as audio and video. Excluding audio and video, These types were presented by Wright, Jansen and Wyatt(1998) in their excellent article titled: how to limit clinical errors in interpretation of data.

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Another term used to describe the working memory is short term-memory. Short-term memory is sometimes only thought of as a temporary information storage area; (Klahr & Kotovsky, p. 32) as keeping a phone number until we dial it. However, in reality, short-term memory is much more important. We need our short-term memory for vital cognitive processes as reasoning, language understanding, and mental arithmetic. Short-term memory is also used as a stepping point for information to be later stored in long-term memory. (Klahr & Kotovsky, p. 32)

Klahr, D. & Kotovsky, K., eds., 1989,’Complex Information Processing: The Impact of Herbert A. Simon’, Lawrence Erlbaum Associates,Hillsdale, NJ, USA.

The significance of design cannot be underemphasized. The width of partograms (graphical representation of cervical dilatation against time for women during childbirth) changed the quality of obstetricians’ decisions. This could have an effect on the incidence of Caesarean sections performed. Just imagine, the design of a graph playing a role of weather a woman has a major surgery as Caesarean section! (Tay and Yong 1996)

After reading and blogging on humans’ dual information processing capacity and the significance of training and seeing consistent designs with consistent meaning, I started asking myself: why do we react to designs the way we do? Is this because we have been trained to react in this way or are our reactions something hardwired into our brains?

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