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From Paper to Computer Screen

From Paper to Computer Screen. Jeannie Yuhaniak Dental Informatics University of Pittsburgh. St. Thomas, Caribbean. Outline. Introduction / Background Else Nygren Paper Related Research Connection to Dentistry Future. Utah, USA. Introduction/Background. Human Information Processing

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From Paper to Computer Screen

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  1. From Paper to Computer Screen Jeannie Yuhaniak Dental Informatics University of Pittsburgh St. Thomas, Caribbean

  2. Outline • Introduction / Background • Else Nygren Paper • Related Research • Connection to Dentistry • Future Utah, USA

  3. Introduction/Background • Human Information Processing • Human Computer Interaction • Electronic Medical Records Ayers Rock, Australia

  4. Human Information Processing • The changing (processing) of information in any manner detectable by an observer • Arose 1940s & 1950s: The essence of the approach is to see cognition as being essentially computational in nature, with mind being the software and the brain being the hardware. • Cognitivism (Psychology): mental function can be understood as the internal manipulation of symbols http://en.wikipedia.org/wiki/Information_processing

  5. Human Information Processing • Functionalism (Philosophy): • Data input (the senses in humans) • Data output (both behavior and memory) • Functional states (mental states) • The ability to move from one functional state into another • The definition of functional states with reference to the part they play in the operation of the entire entity • Sequential or parallel • Centralized or decentralized (distributed) http://en.wikipedia.org/wiki/Information_processing

  6. What is your Information Processing During Patient Charting? Centralized or Decentralized Sequential or Parallel

  7. Human Computer Interaction CHI – Computer Human Interaction Vs. HCI – Human Computer Interaction • The human’s needs should be considered first, and are more important than the machine's. • This notion became increasingly relevant towards the end of the 20th century http://en.wikipedia.org/wiki/Human-computer_interaction

  8. Information technology Computer science Aesthetics Anthropology Artificial intelligence Cognitive science Design Ergonomics Human factors Library and information science Psychology Social Psychology Sociology Multiple Disciplines of HCI http://en.wikipedia.org/wiki/Human-computer_interaction

  9. Human Computer Interaction Goals: • Improve interaction between user and computers • Make computers more user-friendly and easier to use http://en.wikipedia.org/wiki/Human-computer_interaction

  10. Human Computer Interaction Focus on: • Methodologies and processes for designing interfaces • User-centered design • Developing new interfaces and interaction techniques • Developing descriptive and predictive models and theories of interaction http://en.wikipedia.org/wiki/Human-computer_interaction

  11. Clinical Computing Direct use of computer systems by clinicians • Improves patient outcomes • Increases compliance with clinical guidelines • Reduces medical errors • Increases efficiency President's Information Techology Committee. Revolutionizing Health Care Through Information Technology. Arlington, VA: National Coordination Office for Information Technology Research and Development; 6-30-2004. Thompson, TG and Brailer, DJ. The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. U.S. Department of Health and Human Services; 7-21-2004.

  12. Electronic Medical Records • 1948 - National Health Service Central Register in United Kingdom • 2005: one of the largest countrywide projects • goal of NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010 • Cerner, UPMC, 19 hospitals and 225 affiliated physician practices • Dental practice management systems http://www.nhsia.nhs.uk/def/pages/nhsweek2002/historical.asp; http://newsbureau.upmc.com/Medsurg1/CernerUserGroup.htm

  13. From Paper to Computer:Else Nygren Paper • Paper Chart • Interface Design Issues • Goals of Interface Design • Conclusions

  14. From Paper to Computer:Else Nygren Paper • Computerized medical record is an information tool for physicians in clinical practice • Poor user interface factor contributing directly to problems of computerized medical records The user-interface challenge

  15. Paper-based Medical Record:Else Nygren Paper Strong aspects of the paper-based medical record must not be neglected when we computerize it • Shifting rapidly between reading, skimming and skipping parts of the contents • Patterns • Memory triggering • Sensation of weight of chart • Name and seniority of doctor responsible for notes

  16. Subtle differences between presentation formats may result in average reading times that differs by as much as 100% Be aware of data becoming “pattern dead” Risk of information overload is marginal But risk of cognitive tunnel vision is much greater (because of too little data) Interface Design Issues:Else Nygren Paper Disposition of the screen area

  17. Interface Design Issues:Else Nygren Paper Dedicated overview formats • Rich overview of information (first screen) • Only a mouse-click away is still away • One entry multiple views - Patterns

  18. Reduce time of information extraction Natural working language Colors, type font, symbols, icons Reading continuous text slower on screen & skimming rates on computer take 40% more time than paper Length of text, first word indicator for relevance Hidden information should be indicated Interface Design Issues:Else Nygren Paper Multiple pages of textual descriptions displayed efficiently

  19. Point-click, checkbox Easy to learn but slow in long run Fine-tuned keyboard entry (Administration) Hard to learn but fastest in long run Physicians enter by dictation, cleric typing Entry layout not same as information viewing Interface Design Issues:Else Nygren Paper Design of Data Entry Methods

  20. Goals of interface Design:Else Nygren Paper • Short learning time • Efficacy of daily work • Accommodate excellence

  21. Conclusions:Else Nygren Paper • The paper-based medical record is really an efficient and extremely flexible information tool for the physician • Task of constructing a user interface to a computerized version of this tool will be difficult

  22. Related Research and Connection to Dentistry • Usability with EMR • Integration into the dental office • Future Work

  23. Usability Study on EMR • Longitudinal Medical Record • Web-based EMR • 2005, Boston • Quasi Contextual Inquiry with Think Aloud • Focus Groups Rose, A., Schnipper, J., Park, E., Poon, E., Li, Q., Middleton, B. Using qualitative studies to improve the usability of an EMR. Journal of Biomedical Informatics. 38. 51-60. 2005

  24. Usability Study on Longitudinal Medical Record Findings: • “Too many clicks & screen flips” • Small screen real estate • Either one click away • Too busy • Customizable templates useless • Workflow – blocks of time Rose, A., Schnipper, J., Park, E., Poon, E., Li, Q., Middleton, B. Using qualitative studies to improve the usability of an EMR. Journal of Biomedical Informatics. 38. 51-60. 2005

  25. Relating to Dentistry • Usability testing has not been a routine part of designing clinical computing systems • It’s still possible to practice dentistry without computers, but information technology is quickly becoming quintessential in practices • Direct use of computer systems by clinicians improves patient outcomes Rose, A., Schnipper, J., Park, E., Poon, E., Li, Q., Middleton, B. Using qualitative studies to improve the usability of an EMR. Journal of Biomedical Informatics. 38. 51-60. 2005 Schleyer, T. Why integration is key for dental office technology. JADA. 135.4S-10S. 2004

  26. Likes Dislikes What is your Experience with Dental Practice Management Systems? Barriers

  27. From Paper to Computer in Dentistry • Reluctance to adopt clinical computers is largely related to lack of integration with the work environment • Very few Dental Software companies use user-centered design techniques • Powsner & Tufte’s results from patient information display • Screen real estate, cognitive limitations, ergonomic consideration, minimal effective interaction design Schleyer, T. Why integration is key for dental office technology. JADA. 135.4S-10S. 2004

  28. From Paper to Computer in Dentistry • Paper-based – comfortable, cumbersome to review comprehensively • Both Paper & Computer – synchronization is hassle • Fully Computerized – organized, limitations and idiosyncrasies Schleyer, T. Why integration is key for dental office technology. JADA. 135.4S-10S. 2004

  29. Future of Dental EMR • Adopt user-centered design principles • Promote the development of standards for adoption of dental technology • Evaluation of new designs Schleyer, T. Why integration is key for dental office technology. JADA. 135.4S-10S. 2004

  30. Thank You Questions or Comments? Jeannie Yuhaniak Collaboratory Manager Center for Dental Informatics University of Pittsburgh 412.383.9081 jeannie@dental.pitt.edu

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