GR2 - Design Document

Table of Contents

Scenario

We designed this scenario to exemplify all of the user classes and use cases of our application. After interviewing members of the user classes involved, we can conclude that this scenario is a realistic representation of what they might use the application for.

  • Mr. Z, a 55 year old male, is at work in Building 66 when he notices a sudden pain in his chest and left arm. 
  • He calls 911 and waits in his office until the local paramedics arrive. 
  • When the paramedics arrive, they record:
    • his name,
    • age,
    • ECG,
    • and medical history.
  • The paramedics bring Mr. Z to the hospital at fast as they can and deliver him to the local triage nurse, to whom they transfer the patient information and the electrocardiogram (ECG) results.
  • The nurses perform an ECG of their own on Mr. Z.
  • The nurses determine that he is having a heart attack. 
  • The nurses quickly ask for a few details about:
    • the history of the pain,
    • the symptoms,
    • any allergies they should be aware of.
  • They note down only the most important things, like allergies or current treatments that might interfere with treatment.
  • They will record the other information on his medical history once they have the time. 
  • As Mr. Z is was not allergic to aspirin; the nurses quickly administer a dose,.
  • The Doctor reads the nurses notes and sends Mr. Z into the coronarography room to have a balloon catheter inserted into his blocked artery (percutaneous coronary intervention, aka angioplasty). 
  • The Doctor prescribes Heparin to prevent blood clotting.
  • Over the next few days after the angioplasty Mr. Z. is also monitored, but less closely.
  • The nurses come by to:
    • dispense medications,
    • note his medical status,
    • take samples ordered by the doctors,
    • record ECG data to assess his heart function,
    • monitor blood pressure,
    • and perform blood tests to check for infection.
  • The nurses note other kinds of information important to taking care of  the patient
    • E.g. his shellfish allergy.
  • Two different doctors stop by visit Mr. Z everyday day:
    • one in the morning,
    • and one at the end of the afternoon.
  • The doctors read through any pertinent notes left by the other doctor, and the nurses.
  • The doctors then examine the patient and make adjustments to the orders.
  • At the end of the stay (typically a few days for a heart attack), a doctor reviews Mr. Z's information to ensure that no other problems are present.
  • The Doctor decides that Mr. Z is well enough to leave the ICU. 
  • When Mr. Z leaves, the doctor reviews the medications prescribed and procedures performed by the hospital to send an accurate bill to his insurance provider.

Design Sketches 

As individuals, each member of our group generated three different preliminary designs for the EZ-ICU user interface. Each design is represented by one or more sketches below. While these designs are not fully fleshed out, they are primarily designed with consideration towards the tasks in the above scenario. In an attempt to facilitate breadth in our design thinking, we each proposed an extreme design as one of our three design sketches.

Click any of the images to enlarge, or open the image independently for a full-size view.

Design Sketches by Mohammad Ghassemi

Design 1: 

Sketch

Description


This design utilizes a common two-pane display to allow for the taxonomy hierarchy structuring the data to be conveyed. By making fields editable in-place, the design promotes quick and accurate updating of patient records. The design also provides all of the information needed on a single screen, without any switching of contexts required.

Design 2:

Sketch

Description


This design provides different views of the application for the three main user classes. Paramedics, nurses, and doctors each have a view tailored to their needs when using the application. Data is structured intuitively and fields are editable to, again, promote quick and accurate updating of patient records.

Extreme Design 1: Ultra-efficient

Sketch

Description


This non-computer interface uses a tool that the users are likely already familiar with: a whiteboard. By wirelessly syncing information from a smart-board to a centralized system, nurses and doctors can interact with the application in a mode that is very familiar to them. Networked medical equipment can feed data directly into the application, and identifying pens help tie inputed data to its authoring nurse or doctor.

Design Sketches by Franck Dernoncourt

Design 3: 

Sketch

Description


This design focuses on textual information, and information density. In order to make decisions, the medical staff need to have access very quickly to a lot of data. To avoid overwhelming the users by information, the default view presents a synopsis for every element of the patient's folder. If the medical staff need more information, they can simply click on "more details."

Design 4:

Sketch

Description


In opposition to the previous design, this sketch focuses on visual information. Currently, the whiteboards the medical staff are using do not allow easy display of visual information with precision. However precision can be key to detect anomalies in the patient, and thus the existing solutions are inadequate.

Extreme Design 2:  Hands-free Interface

Sketch

Description


This last design handles a common issue with medical staff: they don't have the time to type everything and/or their hands are already busy. Using voice recognition to navigate through the application using voice commands and to input text could be extremely useful for them. 

Rough statistics:

  • The average rate for transcription is 33 words per minute, and 19 words per minute for composition.
  • An average professional typist types usually in speeds of 50 to 80 words per minute.
  • Using speech recognition, one can easily achieve over 100 words per minute with more than 95% accuracy. The accuracy is further improved when using a restricted dictionary, in our case the medical dictionary.

Design Sketches by Kamran Khan

Design 5:

Sketch

Description


This design allows for nurses and doctors to see all of the data that they need in one screen. It provides an overview of all of the patients managed, and allows for quick diving into each of the patient's records. Important demographic and historical information about each patient is accessible in a consistently placed sidebar, and nurses and doctors can add notes and other information to each patient's record. Rich media is embedded into the interface, allowing doctors to review test results and images directly in the interface. Medicine distribution information is also clearly presented, as are real-time patient vitals and potential alerts.

One shortcoming of this design is the lack of an interface for paramedics, and the friction of entering data into the system.

Design 6:

Sketch

Description


This design takes a different approach, using different screens for different views of the data. The screens are split functionally, but due to the definitions of our user classes, this partitioning also matches well with our partitioning of users. The screen shown at the top left is for initializing a patient record, and is most suited for paramedics on the field. It allows for quick entry of patient data, including demographic information, field notes, and medical history. The screen at the bottom left is an overview screen which provides the status of every patient managed---this screen is targeted towards the nurse user class. Nurses can quickly see which patients need tending to (for administration of medication, etc.) and they can monitor vitals and other status metrics. Doctors may also use this screen for oversight over the ICU. The screen on the right shows the detail view of a specific patient, and will be used by both nurses and, especially, doctors.

The screen provides multiple views of the patient data, each designed to make a specific user task as efficient as possible. The timeline provides an overview of the patient's entire history in the ICU, and also conveys tasks required (medicine administration, etc.). Notes, data, and history are also prominently displayed.

Extreme Design 3:  Non-computer, Location-based Interface

Sketch

Description


This "extreme" design breaks outside of the bounds of the computer and uses specialized hardware and sensors to collect data about patients, doctors, nurses, and paramedics.

This interface is designed to be displayed on a whiteboard-type interface, replacing the whiteboards used by most ICUs today. The majority of the board is dedicated to a top-down map of the ICU which displays the location and status of all patients, doctors, nurses, and paramedics in the ICU. Patient information can be pulled up and added to with a special sidebar which uses touch-based interactions and handwriting recognition to preserve the fluidity of the manual whiteboard model used today.

Planning and management of resources is made easy with a central map-based board, and individual boards networked together in patient rooms can be used to explore patient data efficiently.

Design Sketches by Robin Deits

Design 7:

Sketch

Description


This design is centered around fast entry of textual information and the display of relevant information to all the hospital staff. Primary information about the patient is presented at the top of the display at all times, and below that is a list of notes from hospital staff. Each note is tagged with the date and the name of the person who provided the information, and can be expanded to show additional detail. A checkbox on the right side of each note will automatically include that note's title in the central "whiteboard" display, so that doctors and nurses can easily see a record of treatments and medications for all patients.

This design is meant to ease the synchronization of information between the central board and the patient charts, without adding significant overhead to the entry of simple information. 

Design 8:

Sketch

Description


This design is focused on consistency with the timeline metaphor. When viewing a single patient's record, each piece of information is presented along a vertical timeline. Previous interactions, drugs, etc. are presented along the left side of the timeline and orders for future treatments are presented on the right. Alternate views of the patient information maintain consistency with the timeline: 

  • Horizontal timeline, with selectable real-time chart data (pulse, blood pressure, etc.) above and aligned with the time scale of the timeline
  • Multi-patient view, with stacked timelines for all patients in a ward or under a particular doctor's care

Extreme Design 4:  Non-Computer Interface

Sketch

Description


This design is meant to solve many of the problems presented in hospital information-tracking without requiring any form of computer interface. It consists of self-duplicating stickers with unique, easily human-readable codes to identify all the pieces of information belonging to a patient. More information about this interface is included in the Storyboard Design 2.

Storyboard Designs

Next, as a group, we synthesized our individual design ideas to generate three different proposed designs for our user interface. These designs synthesized the best parts of the individual designs that each of our group members developed. Below we explain each design and include a storyboard showing how it works for the above scenario. The storyboard combines words with sketches to show how the interface would look over the course of the scenario. After each storyboard, we present an analysis that considers the design's good and bad points for learnability, efficiency, and safety.

Be sure to click through to the individual pages for the storyboards below, which include diagrams and descriptions of each of the proposed designs.

 

Proposed Design 1

Storyboard

EZ-ICU - Design 1 Storyboard

Analysis

(plus)  Learnability: Good

(minus) Learnability: Bad

  • The logo at the top of the screen updates, depending on the user class. This allows the user to know that they are in the correct configuration. This feature is more important for doctors, who will be able to inspect the nurse and paramedic views.
  • Menus are signified with pictures which alert the user of their content. This will help new users adjust to the interface.
  • Users are given information in manageable sizes. The Medications window, for instance, only contains information on medications, this allows the user to build an clearly partitioned mental model of each menu and it's role.
  • The interface follows an app-like format that many users may already be familiar with.
  • There is no guidance for new users about how to navigate the menus.
  • Similar menu tabs function differently for different user classes, this might confuse a user who wants to investigate another user class's view.

(plus)  Efficiency: Good

(minus)  Efficiency: Bad

  • The user can navigate back to the home screen by clicking their user class icon. For instance, a paramedic can click the ambulance Icon in the bottom left corner to be returned to the main menu.
  • The format of the user interface will allow it to work on a computer screen, tablet or smartphone, allowing doctors and nurses to have easier access to the patient information.
  • The user can search for content on any page by clicking the magnifying glass icon on the bottom right.
  • A user cannot compare multiple pieces of information, side by side, without navigating through the menus.
  • some of the menus, like medication, contain tables which are sorted by time, the user may want to sort these by some other feature and the current manifestation of the interface does not allow for that.
  • Items added to the menu such as medications or interventions may be removed or edited from the same place that they were added.

(plus)  Safety: Good

(minus)  Safety: Bad

  • All menus contain a forward and back button, allowing users to recover their view if they accidentaly click something they didn't intend to and would like to recover.
  • Items such as medications or interventions may added to the menu may be removed or edited from the same place that they were added.
  • There is no way for a doctor to cancel an order.
  • There is no way for a nurse to cancel an acknowledgement or orders.

Proposed Design 2

Storyboard

EZ-ICU - Design 2 Storyboard

Analysis

(plus)  Learnability: Good

(minus)  Learnability: Bad

  • Requires no computer familiarity and is very similar to existing system. New users should be able to use the system with almost no training.
  • Pen-and-paper style direct-manipulation has high learnability.
  • Users must learn to read and quickly identify object codes.

(plus)  Efficiency: Good

(minus)  Efficiency: Bad

  • Non-computer interface means no overhead of starting up a computer or program, so small amounts of information can be rapidly entered.
  • Handwriting interface means non-textual data can be quickly entered.
  • Lookup requires reading through written notes, and searching for a particular piece of information is impossible.

(plus)  Safety: Good

(minus)  Safety: Bad

  • Unique object codes ensure that all patient records, from patient history to charts to individual dosings of drugs are linked together.
  • Duplicating stickers ensure that information is not lost between the patient's chart and the main board.
  • The problems of sloppy handwriting and misread writing, two major safety concerns of the existing solutions, are still unsolved by this system.

Proposed Design 3

Storyboard

EZ-ICU - Design 3 Storyboard

Analysis

(plus)  Learnability: Good

(minus)  Learnability: Bad

  • The interface is consistent with the majority of computer applications.
  • The vast majority of the buttons are labeled with text. As a result, the user doesn't have to learn the meaning of icons, but as a user becomes more acquainted with the interface, he or she can use the visual clues to speed up usage.
  • This application is complex: menu, tabs, etc. A new user might find it difficult to guess where to find the information he's looking for.

(plus)  Efficiency: Good

(minus)  Efficiency: Bad

  • The application takes full benefit of the size of the screen.
  • Any information is accessible within 1 or at worst 2 clicks (click on the tab + click on 'More details').
  • A user cannot compare multiple pieces of information, side by side, without navigating through the menus/tabs.

(plus)  Safety: Good

(minus)  Safety: Bad

  • Virtually any operation can be reversed.
  • The menu item 'Log history' allows the user to analyze the history of the operations that users have performed. Logging is extremely important given the medical environment.
  • By requiring logging in, authentication is handled seamlessly and user actions can always be traced back to the paramedic, nurse, or doctor who originated them.
  • The user might forget to disconnect, giving the system an inaccurate representation of the sources of data, etc.
  • No labels

1 Comment

  1. Unknown User (jks@mit.edu)

    Excellent job overall, exploring designs and organizing your ideas about visualizing patient information. Since you're all contending with organizing and presenting all of a patient's information, there is almost no consideration about how to efficiently input specific kinds of information (other than the voice recognition sketch and handwriting in the non-computer interface). For example, how does a doctor or nurse input medication type, dosage and timing? How do EKGs get into the system? In other cases, where the user just has to type, are there opportunities for autocomplete to increase efficiency? Narrowing your scope will allow you to focus on issues like this, which are a huge part of the usability of your system.

    • Scenario: Excellent scenario, with lots of details and concrete tasks.
      • Would have been good to categorize the tasks into groups/sections to identify the high-level problems your designs will address. Just feels unwieldy right now as this laundry list of things that happen in the ICU.
      • For example: paramedics create patient record, nurses note detailed patient information and administer drugs, Mr. Z reviews patient information and administers treatment and prescribes drugs.
    • Preliminary designs: Excellent variety of preliminary individual designs.
      • Awesome sketches from Kamran. 
    • Design 1:
      • Navigation seems inefficient for paramedics - would a more wizard-like approach be appropriate to automate this process?
      • The doctor-nurse-paramedic logo is a good idea and I love the icons, but this seems prone to mode errors, where the user never actually looks at the logo cause they're data-focused.
      • Users don't seem to have a way to look at an overview of the ICU in this design, or an overview of patient-related info (like a history of recent events).
    • Design 2:
      • Self-duplicating stickers seem like an awesome idea, and patient identification codes seem like a huge safety plus, albeit a bit impersonal in terms of patient-doctor relations.
      • Would be interesting to see whether ideas from this design could be used in a computer interface - for example a sticker metaphor for recording a history of all events, or ID codes.
      • Handwriting efficiency is a definite pro.
    • Design 3
      • I would argue that the learnability of this design is very low.
      • Reading through very similar looking tab labels is tedious, there's no notion of a flow through the application for any particular task.
      • Information scent seems weak - why are prescriptions listed under the observations tab?
      • Inconsistencies - why is the intervention pulled out of the tabbed views?
      • Efficiency could be high, once users adopt the system, but the barrier is high for this in hospitals.