Physicians would prefer that an EMR computer screen emulate a tri-fold flow sheet that inspires a "gestalt feel" for the whole clinical situation. Instead, data split among multiple screens with the need for numerous mouse clicks and excessive scrolling in order to see all the information tends to frustrate clinicians. The frustration comes as a result of the fragmentation of our thought processes and patterns which have developed over time. In addition, "user interface" issues can become a patient safety risk. The following case study provides an example of such an issue.
Case Study: A small practice had their EMR vendor develop a custom report called the Patient Summary that “pulls in” EMR data including lab and radiology results. This report is useful while on-call because they can remotely access it from home over the Internet. Over one weekend the on-call physician discovered that some of the lab results for one of his patients did not show up on the Patient Summary. He checked several other patients and found another example of missing results. He decided that this report was unreliable and that he would not use it until the issue was understood. The EMR vendor was notified on Monday. They quickly determined that the report was working normally and no data was missing. They suspected the doctor forgot that this report displays a little <+> symbol at the bottom of the screen if there are additional lab results that will not fit in the space provided. At that point the physician realized that he had used his new iPhone for the first time and that the small viewing display had made it very difficult to for him to see the small <+> symbol.
- Displaying medical data on a computer screen in a manner that meets the cognitive challenge at hand is difficult and can fragment a physician’s thought processes
Since tri-fold computer screens are not a practical solution today, physicians need to involve themselves in the development of the EMR content screens that they will be using on a day-to-day basis. For most EMR products these screens can be configured and used in various ways. In this case the small display inherent to smart phones was inadequate when viewing the report. But this is because it was not designed with the small viewing area and resolution of a smart phone in mind. If presenting this data on a smart phone is a requirement for this physician, a new report will have to be developed in order to meet that new need.
- “Think simple” when developing EMR screens that clinicians interact with
Complexity makes EMR use even more difficult and less safe. Most EMRs allow modifications to some EMR screens that physicians interact with such as documentation templates, reports, orders and order sets. Good advice to those who develop these screens is to “think simple”. For example, if six gastroenterologists decide to each create their own list of 25 order sets to accommodate personal preferences, their EMR order set screen will display 150 order sets. Creating a screen that displays 125 choices for physicians has a pre-determined fate. They would be better served by collaborating on 25 evidence-based order sets to share. The result will be less frustration, less variation from evidence-based medicine and less work when annually reviewing the content of order sets.