A Prototype User Interface for a Mobile Electronic Clinical Note Data. Entry System. Atif Zafar, MD. 1,2. , Mark Lehto, Ph.D. 3. , Jongseo Kim, MA. 3. 1.
A Prototype User Interface for a Mobile Electronic Clinical Note Data Entry System 1
Atif Zafar, MD 1,2, Mark Lehto, Ph.D.3, Jongseo Kim, MA3 Indiana University, 2Regenstrief Institute for Health Care, Indianapolis, IN 3 Purdue University School of Industrial Engineering, Lafayette, IN
Abstract: Recent advances in mobile computing technologies have made electronic medical records (EMRs) on handheld devices an attractive possibility. However, data entry paradigms popular on desktop machines do not translate well to mobile devices1,2. Based on a review of the literature on mobile device usability1-4, we built a prototype user interface for mobile EMRs and held focus groups with clinician users whose feedback provided useful insight about design choices, functionality and optimal workflow integration. Description of the Problem: Much of the day-to-day patient-clinician interactions occur in inherently mobile settings3. Traditional fixed workstation based EMR systems are therefore time and workflow inefficient. A significant body of research exists on optimizing the interface between clinician workflows and EMR access and mobile devices are an attractive platform for best integrating EMR related tasks with patient care. However, the traditional data entry paradigms (keyboard/mouse/speech) currently popular on desktop devices do not translate well into equivalent mobile device user interfaces1,2. Methods: Our objective was to review the current literature and prototype multi-modal paradigms for data entry on mobile devices. We used readily-available tools (Microsoft Visual Basic.NET and Tablet PCs) to develop a simple EMR interface that demonstrated several different data entry techniques using multi-modal input mechanisms. We held focus groups with 2 sets of potential clinician users, those with an informatics background and those without, hoping that the informatics trained physicians would provide specific feedback about design choices. Results: Our prototype system consisted of a set of tabbed data display and data entry panes that organized information into logical workgroups with an underlying controlled vocabulary for specifying complaints/problems, diagnoses, physical exam findings, medications, lab and radiology tests and specialty care. A data entry mechanism based on body-part specification and hierarchical choice lists with modifiers was used to enter clinical SOAP notes. Handwriting recognition on the Tablet PC was also supported as a means to enter freetext data when necessary. We held 2 focus groups and received specific feedback about design choices,
functionality and the optimal methods for workflow integration. The informatics trained users had concerns about using hierarchical choice lists as a means to enter data. They also had specific recommendations regarding interface layout, consistency, “look-and-feel” and functionality. The non-informaticians, on the other hand, were quite enthusiastic about the note-taking capability and recommended that template-based approaches would work better for them. They also had specific recommendations about order entry (standing orders for preventive care), results lookup and patient traffic within the clinic (display current patient registration status, location (which room), and if they are with a nurse at the moment). Conclusions: The initial reaction from a user community with broad experiences has been mixed. Most users are enthusiastic about clinical note taking and results lookup. The non-informaticians welcomed order entry and workflow features. Both groups felt that a multi-modal input paradigm would take practice to use and may dissuade some users. All felt that mobile devices for EMRs are preferable over comparable fixed-workstations. Selected References: 1.
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Grasso, MA, “Clinical Applications of Handheld Computers”, Proceedings of the 17th IEEE Symposium on Computer Based Medical Systems, 2004:141-146 Fischer, S, MD, Stewart TE, MD, FRCPC, Meeta, S, MD, et. al., “Handheld Computing in Medicine”, JAMIA, 10(2):139-149 Poon, AD, Fagan, LM, “PEN-Ivory: the design and evaluation of a pen-based computer for structured data entry”, Proc Annu Symp Comput Appl Med Care. 1994;:447-51 Wojtek, M, Ph.D., “Design and Development of a Mobile System for Supporting Emergency Triage”, Meth of Inf in Med, 44(1): 14-24
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