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

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

PubMed on Tap: Access PubMed on Handheld, Wireless Devices

Dina Demner-Fushman

University of Maryland, College Park

and

CEB/LHNCBC/NLM/NIH/HHS

Page 2: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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

Page 3: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Outline

• Motivation

• PubMed at a glance

• Design questions

• Usability study

• Next steps

Page 4: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Why patients need just-in-time information for clinicians:

Patient Fact Sheet20 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

motivationPubMeddesignusabilityfuture

Page 5: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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 evidence3. Obstacles related to seeking information3.1.3. Lack of time to initiate search3.2.1. Uncertainty about where to look for information3.3.1. Resource physically distant3.3.9. Resource not current3.3.10. …. Most general resources do not allow real time interaction with the searcher

(Ely et al., British Medical Journal. 2002)

motivationPubMeddesignusabilityfuture

Page 6: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Where to look for information

motivationPubMeddesignusabilityfuture

Page 7: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Current interactive resource at hand

• Speed up search – Navigation– Presentation

• Provide expected PubMed functionality

motivationPubMeddesignusabilityfuture

Page 8: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

PubMed Search

motivationPubMeddesignusabilityfuture

Page 9: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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])

motivationPubMeddesignusabilityfuture

Page 10: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Clinical Queries

motivationPubMeddesignusabilityfuture

Page 11: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Search Results

motivationPubMeddesignusabilityfuture

Page 12: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Working with Search Results Navigating results pages

motivationPubMeddesignusabilityfuture

Page 13: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Working with Search ResultsViewing selected citations and links

motivationPubMeddesignusabilityfuture

Page 14: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Working with Search ResultsSaving selected citations

motivationPubMeddesignusabilityfuture

Page 15: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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.

motivationPubMeddesignusabilityfuture

Page 16: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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

motivationPubMeddesignusabilityfuture

Page 17: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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

motivationPubMeddesignusabilityfuture

Page 18: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Organizing Content

motivationPubMeddesignusabilityfuture

usability study

prototype presentation

Page 19: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Organizing Content continued

motivationPubMeddesignusabilityfuture

Page 20: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Finding Metaphors is Hard

motivationPubMeddesignusabilityfuture

Page 21: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Maintaining common feel and look for different platforms and operating systems is hard

motivationPubMeddesignusabilityfuture

Page 22: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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

motivationPubMeddesignusabilityfuture

Page 23: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Usability Study Results All participants were able to find Medline citations containing answers to

questions described in all test scenarios

motivationPubMeddesignusabilityfuture

Time to complete three scenarios

0

10

20

30

40

50

min

ute

s

There is strong correlation between time to completion and problems in locating functions and navigation

Page 24: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

Usability Study Observations234 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

motivationPubMeddesignusabilityfuture

Page 25: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

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

motivationPubMeddesignusabilityfuture

Page 26: PubMed on Tap: Access PubMed on Handheld, Wireless Devices Dina Demner-Fushman University of Maryland, College Park and CEB/LHNCBC/NLM/NIH/HHS

PMOT homehttp://archive.nlm.nih.gov/proj/pmot/pmot.php

Contact:[email protected]@mail.nih.gov