human-computer interaction in healthcare: a national priority
DESCRIPTION
Forty years of computerization in healthcare have yielded significant, albeit highly uneven, progress. Computer systems provide value to many clinics and physician offices day by day, but many benefits of computerization remain yet to be realized. A recent report of the National Research Council entitled “Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions” singled out human-computer interaction (HCI) as one of the most important improvements for electronic health records. As several recent studies have shown, information technology applications in healthcare can cause significant clinical errors, for instance in the prescription and administration of medications. Addressing the sources of these errors, and improving the support for the cognitive tasks and workflow of clinicians, is a critical need for the ongoing national implementation of health information technology. This talk will highlight current electronic health record implementations, as well as present HCI studies conducted by the Center for Dental Informatics at the University of Pittsburgh.TRANSCRIPT
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Human-computer Interaction in Healthcare: A National Priority
Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine
Titus Schleyer, DMD, PhD
Carnegie Mellon University, Human-Computer Interaction Institute
September 14, 2011
Denia, Spain © Titus Schleyer 2011
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Today’s talk
• a fundamental question for usability
• the federal case for usability in healthcare
• the health care process and health records
• a brief tour of an electronic dental record
• sample projects in user-centered design
• getting you involved
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Medical Devices: The Therac-25
Nancy LevesonUniversity of Washington
1 IntroductionBetween June 1985 and January 1987, a computer-controlled radiation therapy machine, called the Therac-25, massively overdosed six people. These accidents have been described as the worst in the 35-year history of medical accelerators [6].
Can poor usability kill?
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Can poor usability kill?
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Can poor usability kill?
4 Casual Factors• Overconfidence in Software. …
• Lack of Defensive Design. …
• Inadequate Software Engineering Practices. …
• Save versus Friendly User Interfaces. …
Leveson NG. Medical devices: the Therac-25. In: Safeware: system safety and computers. Boston: Addison-Wesley; 1995. p.515-53.
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
The situation today …
• “Some unintended consequences of information technology in health care: the nature of patient care information system-related errors”
• “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system”
• “Identifying and quantifying medication errors: Evaluation of rapidly discontinued medication orders submitted to a computerized physician order entry system”
• “Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors”
• and 10s of other papers
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
The federal case for usability in healthcare
Oxford, MD © T. Schleyer 2011
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Tasks and workflow of healthcare
• healthcare decisions that require reasoning in the face of uncertainty
• complex non-transparent workflow
• increasing complexity of the care provided to patients in a time-pressured environment
Stead WW, Lin HS and editors. Computational technology for effective health care: immediate steps and strategic directions, Washington, DC:National Academies Press, 2009.
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Principles of change (of 9)
• Principle 4: Design for human and organization factors
• Principle 5: Support the cognitive functions of all caregivers, including health professionals, patients, and their families
• Principle 8: Seek and develop technologies that identify and eliminate ineffective work processes
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Health care process and health records
Paradise, Michigan © T. Schleyer 2011
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Dental care process
Regular patient
Emergency patient
Assessment and diagnosis
Treatment plan
Health status maintenance Treatment
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Clinical documentation
• medical and dental history, incl. chief complaint
• extraoral and intraoral exam• radiographs• images• problem list• treatment plan• progress notes
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Medical history
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Medication history
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Hard tissue exam and radiology report
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Periodontal exam
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Radiographs
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Images
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Treatment plan
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Progress notes
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
A brief tour of an electronic dental record: EagleSoft
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Clinical Welcome Screen
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Patient Select
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Clinical Exam
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Clinical Exam: Perio
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Clinical Exam: Head
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Charting Interface
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Chart with Alert
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Chart: Entering Findings
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Clinical Notes
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Perio Exam
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Perio Comparison: Numeric
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Perio Comparison: Graphic
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Medical History
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Imaging: Patient Photo
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Imaging: Bitewings
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Imaging: Eagle Eye
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Electronic records: Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
User-centered design in healthcare: Sample projects
T. Thyvalikakath
Thanks to:
Kochi, India © T. Thyvalikakath 2011
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Project 1: Usability of four dental computer-based patient records
Research questions:• Which usability problems are
common in dental software?• What is the rate of completed,
incorrectly completed and incomplete user tasks?
Thyvalikakath T et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc 2008 Dec;139(12):1632-42
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Results
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
User adverse events
10
20
30
40
50
user gives
up> 3
attempts negative
affect
0
design
suggestion
60
ES
PW
DX
SD
70
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Record a missing tooth – correct path
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
User paths
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Usability of electronic dental records
• Significant usability problems due to:– complex information design– mismatch between system and user model– difficulty in finding functionality
• significant cognitive effort required that did not contribute to task completion
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Project 2: Cognitive task analysis of dental examinations
• What cognitive processes do dentists engage in and what information do they use when they examine a patient and develop a treatment plan?
• Methods– think-aloud method with 3 standardized patient cases – 5 dental faculty and 5 general dentists– analyze the sessions to determine:
• information that dentists requested
• sequence in which they reviewed information
• instances of concurrent review of information items
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Results
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Results (cont.)
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Visualization of information artifacts used over time
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Project 3: Cross-platform, modular UI design
• Microsoft Common User Interface (MSCUI – www.mscui.net)
• sample problem: pt. identifiers
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
MSCUI: Designing for safety
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Sample design: Patient banner
(includes 26-page Design Guidance document)
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Project 4: The DMD Project
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
A novel approach to designing EDRs
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Results
scale: 0 (least satisfaction) - 9 (most satisfaction)
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Results
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
How do we meet these challenges?
By getting you involved!
licensed image © 123rf.com 2011
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
How can you get involved?
• join the Dental Informatics Online Community (www.dentalinformatics.org)
• participate in dental informatics research
• get an advanced degree in dental informatics (MS, PhD, postdoc – free for qualified applicants)
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
Please visit us at:http://di.dental.pitt.eduTwitterFacebook /titusschleyerScribd }
Thank You for Your Attention!Questions, comments?
(Yeah!)
H. Torres-Urquidy
P. Hernandez J. Irwin A. Acharya
… and many others.
H. SpallekT. Thyvalikakath
Thanks to:
M. Song© CDI 2011
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
This talk: http://scr.bi/nWfGai
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
References
1. Leveson NG. Medical devices: the Therac-25. In: Safeware: system safety and computers. Boston: Addison-Wesley; 1995. p.515-53.
2. Ash JS, et al. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104-12.
3. Han YY, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116(6):1506-12.
4. Koppel R, et al. Identifying and quantifying medication errors: evaluation of rapidly discontinued medication orders submitted to a computerized physician order entry system. J Am Med Inform Assoc. 2008;15(4):461-5.
5. Cayot-Constantin S, et al. [Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors]. Ann Fr Anesth Reanim. 2010;29(3):204-8. French.
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Center for Dental Informatics
University of Pittsburgh School of Dental Medicine
References (cont.)
6. Stead WW, Lin HS, editors. Computational technology for effective health care: immediate steps and strategic directions, Washington, DC: National Academies Press; 2009.
7. Thyvalikakath TP, et al. Heuristic evaluation of clinical functions in four practice management systems: a pilot study. J Am Dent Assoc. 2007;138(2):209-18
8. Thyvalikakath TP, et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc. 2008;139(12):1632-42.