Technology report

Microsoft health patient journeydemonstratorKirsten Disse PGCHE MAUser Experience Consultant, Microsoft Campus, Thames Valley Park, Reading, UK

Introduction

The MSCUI programme, developed by Microsoft and

the NHS, was born out of the need to standardise

display elements to promote patient safety and clinical

efficiency. It creates guidance and controls designed to

increase patient safety and clinical effectiveness through

consistent interface treatments (Box 1).1

The MSCUI patient journey demonstrator isfounded on MSCUI patient safety principles2 (Box 2)

and combines outputs from the MSCUI programme

with clinical functionality, excellence in user interface

design and new Microsoft technologies to offer en-

hanced visualisation, understanding and engagement

with clinical data. The demonstrator looks to the

future, is speculative and is designed to promote ‘the

art of the possible’.Assimilation and interpretation of clinical data,

often from multiple sources and in different forms,

underpins the clinical decision-making process. In

creating the demonstrator, we are also taking advan-

tage of modern technological visualisation capabilities

ABSTRACT

Background As health care becomes more reliant

on electronic systems, there is a need to standardise

display elements to promote patient safety and

clinical efficiency. The Microsoft1 Health Common

User Interface (MSCUI) programme, developed by

Microsoft and the National Health Service (NHS)

was born out of this need and creates guidance andcontrols designed to increase patient safety and

clinical effectiveness through consistent interface

treatments.

Objective The Microsoft Health Patient Journey

Demonstrator is a prototype tool designed to pro-

vide exemplar implementations of MSCUI guidance

on a Microsoft platform. It is a targeted glimpse at a

visual interface for the integration of health-relevantinformation, including electronic medical records.

Method We built the demonstrator in Microsoft

SilverlightTM 2, our application technology which

brings desktop functionality and enriched levels of

user experience to health settings worldwide via the

internet. We based the demonstrator on an easily

recognisable clinical scenario which offered us the

most scope for demonstrating MSCUI guidance

and innovation.

Output The demonstrator is structured in threesections (administration, primary care and secondary

care) each of which illustrates the activities asso-

ciated within the setting relevant to our scenario.

The demonstrator is published on the MSCUI

website www.mscui.net

Conclusion The MSCUI patient journey demon-

strator has been successful in raising awareness and

increasing interest in the CUI programme.

Keywords: common user interface, health infor-

mation, patient journey

Box 1 Microsoft Health Common UserInterface (MSCUI)

The MSCUI programme, developed by Microsoft

in alliance with the NHS and a growing world-

wide community of healthcare providers and

developers, creates guidance and controls to enable

a common look and feel for patient-critical

clinical information system functions. The over-

all goal is increased patient safety and clinicaleffectiveness, reduced training and support costs

and reduced time and expenditure for healthcare

application developers and their customers.

Informatics in Primary Care 2008;16:297–302 # 2008 PHCSG, British Computer Society

K Disse298

and offering clinicians holistic and enhanced ways of

accessing and assessing patient data.Method of development

The demonstrator describes an end-to-end journey or

care pathway through a specific clinical scenario. A

male patient with a history of essential hypertensionvisits his general practitioner with chest pain. The

consultation is recorded along with observations, the

patient’s clinical history is assessed and he is referred

on to the hospital where an angiogram and angio-

plasty (taking a picture of and then removing the

obstruction in a coronary artery) is performed. This

scenario allowed us to show a complete care journey

and illustrate a proposal for an integrated care recordwhich is patient-centric and in which the transitions

between care settings are seamless. Data can be accessed

and input from all care sources at any point along the

patient journey. The demonstrator is structured in

three sections – administration (see Figure 1), primary

care (see Figure 2) and secondary care (see Figure 3) –

each of which illustrates the activities associated within

the setting relevant to our scenario.An important aspect of our method is the choice of

a tightly controlled dataset. As we were working in a

hypothetical situation, we were able to craft our data

Box 2 MSCUI patient safety principles

MSCUI patient safety principles

1 The correct identification of a patient and the

matching of patients to their care elements.

2 Prevention of patient care handover errors and

safety during transitions of care.

3 Assuring medication accuracy during the giv-

ing of care to a patient.4 Performance of correct procedure at correct

body site.

The MSCUI patient safety principles, created in

partnership with the NHS, are derived from theWorld Health Organization patient safety initiat-

ives, the National Patient Safety Agency, the Joint

Commission 2008 National Patient Safety Goals

and the Agency for Healthcare Research and

Quality.

Figure 1 Administration demonstrator

Microsoft health patient journey demonstrator 299

Figure 2 Primary care demonstrator

Figure 3 Secondary care demonstrator

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to tell a very clear and aligned clinical story. This

supported our design and innovation approaches in

illustrating format and content contextualisation of

patient data, such as the ‘consultation dock’ and

‘patient charts’.

We held ongoing workshops and reviews with clin-icians in primary and secondary care to ensure devel-

opment remained focused on clinical functionality,

which we delivered in technologically innovative

ways. With the help of a small team of user experience

and technology experts, we adopted an agile, iterative

design and development process that allowed us to be

highly responsive and productive.

The technology

The demonstrator is built in Microsoft Silverlight 2, a

cross-browser, cross-platform and cross-device plug-

in designed for delivering the next generation of mediaexperiences and rich interactive applications for the

Web.3 We also incorporated its ‘deep zoom’ func-

tionality, which allows users to magnify data extremely

quickly at high visual resolution.

The features of the demonstrator which are attract-

ing clinical interest are as follows:

. Primary care – consultation dock. Working in

conjunction with a configurable timeline of consul-

tations, clinicians can drag individual or groups of

consultations into a docking area for fast and easy

cross-consultation comparison, facilitating trackingof conditions or comparing observations from dif-

ferent consultations over time.. Primary care – patient charts. Observations such

as blood pressure measurements are presented in

chart form, overlaid with related medication and

other observations such as cholesterol levels. Clin-

icians and patients can quickly see a medication’s

impact over time. Includes a scalable timeline, tableview toggle and the ability to show or hide and

reorder the data shown.. Primary care – MedsListView. Medications man-

agement is a key focus area of the MSCUI programme

and this available control embodies verified and

accepted guidance. The MedsListView control pre-

sents medication lists that can be sorted, grouped,

filtered and reordered.. Secondary care – deep zoom. Deep zoom is used

to explore and analyse electrocardiogram data. This

allows users to very quickly see an overview of all

data output and then to zoom into any detailed view,

while maintaining high visual resolution.. Secondary care – angiogram. The demonstrator

presents a selection of angiogram videos to allow

multiple views into an angiogram procedure. These

are aligned with a 3D model of the heart to indicate

the angle from which the angiogram video is taken.

Traditional video player controls, including a drag-

and-drop scroll bar, are incorporated as well as a

magnification and measurement viewer.. Care pathways. Building on well-received work from

previous care pathways demonstrators this offers the

opportunity to manage an entire pathway through a

consistent interface.

Discussion

The demonstrator successfully indicates how future

clinical user interfaces might appear.

Implications for practice

As this is a provocative technology demonstrator and

not an application prototype, there has been no in situ

testing. We are seeking a balance between implemen-

tation of MSCUI design guidance, subject to rigorous

testing and evaluation, and the presentation of new

and emerging concepts yet to be exposed to the same

levels of exploration and scrutiny.

Initial feedback from the online community indi-cates advantages in areas such as rapid understanding

and sharing of a person’s medical history, clinical data

analysis, trending and training. We are particularly

interested in receiving feedback from this journal’s

readership on implications for practice.

Comparison with existing interfacedesign

The demonstrator is a graphically rich interface com-

pared with existing clinical interface design, much of

which is entirely text based.

Limitations of the method

Our small team and very tight timescales meant that

some aspects of the demonstrator received more atten-

tion than others. Some of the limitations of this

approach include:

. We did not illustrate the full end-to-end journey but

only a selection of vignettes of key innovations.. We aggregated and integrated data in a way that has

wider implications for software infrastructure.. We worked with a small, crafted data set.

Microsoft health patient journey demonstrator 301

. We relied heavily on a small number of clinicians

and want to engage a wider group for input.. A full analysis of existing clinical software systems

was not performed in this case. Instead, we relied on

primary research and input from those who have

experience with multiple clinical systems.. We worked with one specific clinical scenario. It is

not clear whether this demonstration would be

suitable for other clinical care settings – clinicians

may require different data displays for differentclinical contexts.4

Call for further research: next steps

We are currently planning the next stage of the

demonstrator project and are evaluating potentialproblems and real-life scenarios to build this upon.

Feedback from the clinical community will be invaluable

in helping to conceptualise and create new ways of

using technology to support safe and efficient care.

Graphical display of clinical information is not a

new concept and much existing work is available for

investigation.5,6 Since writing, the MSCUI programme

has released new guidance7 on the display of graphsand tables which we are now incorporating.

As the demonstrator is designed as a provocation

piece and not conceived as an actual clinical system,

full usability and evaluation has not taken place. Prior

to clinical use additional evaluation would be required

using established techniques.8–11

Conclusion

As an initial experiment, the MSCUI patient journey

demonstrator has successfully attracted interest from

the clinical and technical communities. Innovative

features such as the ‘patient charts’ have inspired new

areas for guidance within the MSCUI programme and

are being refined into downloadable, customisablecontrols for clinical software companies, and anyone

else, to incorporate into their software.

We are moving towards presenting the next gener-

ation of MSCUI guidance in areas such as medications

administration, medication management and clinical

noting. We welcome all feedback and input either via

our discussion forum12 or directly to the project

mailbox.13

ACKNOWLEDGEMENTS

Our principal clinical consultants Dr Shaun O’Hanlon(EMIS), concept and scenario development, and Dr

Sami Omar (cardiology) and the CUI CAPS team.

REFERENCES

1 Microsoft Health. Common User Interface (CUI).

www.mscui.net/

2 Microsoft Health. CUI: patient safety. www.mscui.net/

Introduction/PatientSafety.aspx

3 Wikepedia. Microsoft Silverlight. en.wikipedia.org/wiki/

Silverlight

4 Chan WS, Stevenson M and McGlade K. Do general

practitioners change how they use the computer during

consultations with a significant psychological component?

International Journal of Medical Informatics 2008;77:

534–8.

5 Dayhoff R, Kirin G, Pollock S, Miller C and Todd S.

Medical data capture and display: the importance of

clinicians’ workstation design. Proceedings of the Annual

Symposium of Computer Application in Medical Care

1994:541–5.

6 Musser RC and Tcheng JE. Quantitative and qualitative

comparison of text-based and graphical user interfaces

for computerized provider order entry. American Medi-

cal Informatics Association Annual Symposium Proceed-

ings 2006:1041.

7 Microsoft Health. CUI: methods for displaying tables

and graphs. www.mscui.net/DesignGuide/TablesGraphs

Display.aspx

8 Refsum C, Kumarapeli P, Gunaratne A, Dodds R, Hasan

A and de Lusignan S. Measuring the impact of different

brands of computer systems on the clinical consultation:

a pilot study. Informatics in Primary Care 2008;16:119–27.

9 Benson T. Prevention of errors and user alienation in

healthcare IT integration programmes. Informatics in

Primary Care 2007;15:1–7.

10 Pearce C, Dwan K, Arnold M and Phillips C. Analysing

the doctor–patient–computer relationship: the use of

video data. Informatics in Primary Care. 2006;14:221–6.

11 de Lusignan S, Kumarapeli P, Chan T et al. The ALFA

(Activity Log Files Aggregation) toolkit: a method for

precise observation of the consultation. Journal of Medi-

cal Internet Research 2008;10:e27. www.jmir.org/2008/4/

e27/

12 Microsoft Health. CUI: patient journey demonstrator live!

www.codeplex.com/mscui/Thread/View.aspx?ThreadId=

26807

13 Microsoft Health. CUI. Email contact: mscui@

microsoft.com

CONFLICTS OF INTEREST

None.

ADDRESS FOR CORRESPONDENCE

Kirsten Disse

c/o Microsoft Campus

Thames Valley Park

Reading

Berkshire RG6 1WG

UK

Tel: +44 (0)7903 183 949Email: mscui@microsoft.com

K Disse302

Accepted October 2008

The MSCUI guidance and controls are freely available for all to use from www.mscui.net

The MSCUI Patient Journey Demonstrator is available at: www.mscui.net/PatientJourneyDemonstrator/

Further information about the Microsoft Health Common User Interface can be found at: www.mscui.net