Electronic Medical Records

It doesn't take a research study to tell you that state-of-the-art electronic medical records (EMR) are less than stellar. Providers spend more time in front of computers than they do in front of their patients. Doctors report that digital interfaces lower the attentiveness that they want to give. Devices in the room also lessen the value that patients hope to receive.

Maxilofacial Surgeons want Electronic Medical Records that work with their business. And Carestream wants to deliver a great experience, not just features. This project, detailed below, would inform the design of many products at Carestream Dental.

Please note, some details and design artifacts have been omitted due to NDA.

Dentist Chair

How might we design a tool that helps Doctors connect with patients?

Carestream knows EMRs are central to providing patient care today. This 6-month project at Carestream Dental, required formative research, working with product line managers to understand the product space, and the design explorations of an EMR system for Oral & Maxilofacial Surgeons.

There was a lot to learn about Oral Surgeons, what they do, how they think, and what matters to them. Before this project, I was working on product design for General Dentists, so one of my first questions was, "What's the difference between the records a General Dentist uses and that of an Oral Surgeon?"

Dentist Chair

“You're never going to outperform paper”—Oral Surgeon

User Research and Modeling

Often, General Dentists refer patients to Oral Surgeons, but the EMRs from one provider to the next are so varied and the ways they export data, so spotty, that most clinicians consider them unreliable.

Contextual inquiry revealed that most of the time, Oral Surgeons would create new records, including new medication and health history forms, for all incoming patients rather than rely on external records.

When asked why the records they received were not usable, most providers said they believed the information was likely incomplete, outdated, and inaccurate.

For example, an assistant said, “[One of my biggest frustrations is] finding the correct medication in a huge list of medications.”

Knowing that they are ultimately responsible for the outcome and safety of their patient, it was worth the extra time to start from scratch.

User flow diagram with blur effect

“Patient safety is paramount, you can’t have a practice and survive without patient safety.”—Oral Surgeon

Principles

After documenting the requirements and workflow of Oral Surgeons, I refined and developed a UX Vision that would set the stage for our initial product design.

While many design principles will be used to shape the Carestream EMR experience, some of the most important were defined from interviews and contextual inquiry.

The design principles are as follows:

  • SAFE
  • SMALL
  • CONNECTED
  • FOCUSED
  • NIMBLE
  • FORTHCOMING
  • FAST

These design principles will structure the design of the EMR to help providers find the system easier to use and be more pleasurable.

Person writing in notebook at desk

“If I type [on the computer] in the room, my back faces the patient, it takes away from patient care, like, just typing while they sit there.”—Assistant

Template Design

Clinicians are skilled healers who must do many things beyond providing the best care for their patients. Current trends in medicine ask that providers move from “volume” and into “value” or “evidence based” treatment in an effort to reduce costs, improve outcomes, and guarantee reimbursement.

More and more of this reimbursement requires the documentation and measurement of patient data. And more documentation means more time spent in front of screens, and less time face-to-face with patients. To help ease this burden, EMRs must become streamlined to help clinicians do their work and be flexible enough to account for real-life unpredictability.

Medical records have specific formats for information that must be collected and analyzed. In most of medicine, templates for collecting information are common, and when done properly, will not impact patient safety.

Major concerns surround copy and paste, or the use of “snippets,” where providers use pre-formatted text to input common phrases. Therefore, to be useful and valuable, this EMR design depends on templates that clinicians can customize to fulfill their documentation needs.

Wireframe from project at Carestream Dental

“If they make the text any smaller, they are going to have to provide a magnifying glass.”—Oral Surgeon

Product Vision and Report

Toward the end of my time at Carestream Dental, I wrapped up my part on this project and submitted my report. Some wireframes were drafted and I collected feedback from representative users (oral surgeons and their assistants).

Because of the NDA nature of this work, I will not share specifics or examples of the wireframes, but I can say that there was some helpful feedback from our users who viewed some of the designs. There is a lot of work left to do in the world of EMRs, not only in Oral Surgery, but in all medical fields.

Image of EMR Heuristics example

“How can we automate more of this work?”—Oral Surgeon

Conclusions

Some findings and design recommendations were used to inform the design of CS-WinOMS. Check out the press release on Carestream's website.

The wireframes and report focus primarily on information architecture and include some iterative design informed by users. The usability of the designs were not tested, and would be required after more design iterations. I recommended that the NISTR 7804 technical evaluation be used to accomplish the preliminary check as well as evaluated with usability experts for in conjunction with actual subject-matter experts (i.e. Clinical Users).

See: (NISTIR 7804) Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records

And: www.inspiredehrs.org

YEAR

2015

DELIVERABLES & METHODS

Product Vision
Functional Requirements
EMR Information Prioritization
User Flow Diagrams
Wireframes
Usability Testing Protocol
EMR Specific Heuristic
Ethnographic Inspired Research