Titin.net

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:

Read more »

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:

Read more »

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:

Read more »

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).

Read more »

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.

Read more »

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?

Read more »

In previous posts, I illustrated the benefits of having consistent interfaces. Consistent interfaces uses our brains’ dual information processing capacity. In my tacit knowing post, I presented need for care for the smallest details in interface design. This post is the how. How should we design these interfaces? Do we need domain specific guides? Two examples of healthcare interface guides are Microsoft Healthcare Common User Interface (MSCUI) guide being developed with UK’s National Health Services (NHS) and the European Helios project. These two projects were perused for practical and economical reasons. Yet, there is significant cost for developing such standards. More, there are unwanted side effects that need to be minimized. Examples of these side effects are decreasing flexibility and decreasing ownership. (Nielsen 1989 p)

One benefit of having healthcare design guidelines is to speed up the development cycle, and still ending up with high quality interfaces. A significant part of the design decisions will have been set by the guidelines developers. This does mean that these developers carry a huge responsibility.

At least for now, UK’s National Health Services (NHS) is going with the guidelines route and mandating the compliance to these guides for systems to be used by NHS. It will be interesting to see how things will unfold.

Nielsen, J., 1989. Coordinating User Interfaces for Consistency, Academic Pr.

EMRs’ use cases can be broadly classified into data entry and data retrieval. Being a clinician who is frustrated with informaticians overly focus on data entry, I will only present data retrieval use cases.

There are only two use cases:

1. gaining an overview of a patient.

2. searching for specific data.

Nygren, Johnson and Henriksoon (1992) presented these two use cases based on their research of how physicians read medical records. They present a third use case: hypotheses testing. This third use case can be included under ‘searching for specific data’ use case.

Nygren, E. & Henriksson, P., Reading the medical record. I. Analysis of physicians’ ways of reading the medical record. Computer Methods and Programs in Biomedicine, 39(1-2), 1-12.