- “Niche” Computer Systems
- Meaningful Use
- “Wrong Patient”
- Cognitive Friction
- Dialog-Box Rooms
- What’s in a word?
- Cost Disease
- Model T
- Signal-to-Noise Ratio
- Anti-Data Pixels
- Fitts’s Law
- Bad Apple
Information Design is the art and science (or perhaps engineering) of presenting information so it can be easily interpreted without error. Sometimes it seems that the presentation of data in electronic medical record systems is the art and science of presenting information so that it is difficult to interpret and highly likely to cause error. There may be what seem on first blush to be good reasons for presenting data this way – responding to legal concerns, regulatory abreactions to specific medical errors that occurred, or that might occur – but the end result can be ugly and dangerous.
Let me give a specific real-world example from a few weeks ago, from an EMR that shall remain nameless to protect the guilty. This is the way the EMR reports a fingerstick glucose:
GLUCOSE  GLUCOSE : 331 mg/di Abnormal High (GLUCOSE NON-FASTING Ref Range:80 to 180 mg/di Critical Low:70 Critical High:400) Fingerstick right 3rd digit. ac,rn non fasting
Here are some exercises for the reader.
First, critique this in at least the following ways.
- How easy is it to pick out the actual lab result?
- How likely will you accidentally read one of the other numbers instead of the actual test result?
- What does the  mean, and why should you care? Should this be shown in information presented to a physician or other provider?
- How does this presentation differentiate between most-important and less-important information?
- What is the unit “mg/di”? Is this just a misspelling of “dL” (US, Canada, Australia) or “dl” (in the rest of the world)?
Second, think about how you would make this better; here are a few ideas to get you started.
- The most classic text in English about writing, Strunk and White’s The Elements of Style, posits the essential rule of writing: Omit Needless Words. To redesign this information, which words would you omit?
- Which words would you hide and present only on demand? Which ones would you subordinate (de-emphasize) so they’re not so obvious?
- Which words (or perhaps just one word, or perhaps just a number) should be in red, and when should it be in red?
- This information may be presented on computer, tablet or phone screens that may be very different sizes. Should the entire paragraph word-wrap to the screen size? Or should you put in some “hard” carriage returns (paragraph breaks) so that, even on a big screen, certain portions always appear on a new line? How many of these carriage returns would you insert, and where would you insert them?
- Which words should be in UPPERCASE and why? Is there any evidence whether Mixed Case is more readable than UPPER CASE/ALLCAPS?
- There are several ways to emphasize text on a computer screen. It can be can be in bold, it can be in italics, it can be in ALLCAPS, or some COMBINATION thereof. In addition to red (which some color-blind men might not appreciate), which should you use, and how much of it should you use?
- You can also use white space, between lines or between words to emphasize text items. Would white space help in this particular situation?
- There is a user-interface device called a tooltip. When you hover your mouse cursor over the item, a small box pops up with additional information. If you have access to a computer with Microsoft Word, hover the mouse cursor over the Paste word below the clipboard icon and you’ll see a tooltip with information about it; the 2015 version of Word shows this text: “Paste (Ctrl+V) Pick a paste option, such as keeping formatting or pasting only content.” Would it be worthwhile to move any of this information into a tooltip?
If you are interested in how to use typography (that’s what we’re talking about above) effectively, based on 560 years of experimentation, you can’t do better than to get Bob Bringhurst’s book and read it from cover to cover. A great read.
Please feel free to copy the text in the glucose report above, paste relevant portions into a comment, and suggest how you would make that lab report better.