Calendar

This is not directly related to medical informatics, but it is a user-interaction topic, and has some lessons for the usability of medical software.

First: Unlike many nerds, I like Microsoft Word. It’s a mature product and works well. It has many complications into which one may delve, and for those who want to delve, there is a wealth of online information resources. Yes, I have UltraEdit and I know that some writers prefer a simple editor like UltraEdit for creating books and articles. But I still like Word best for this.

I also use Microsoft Outlook. Not for email – it’s so insecure unless you’re behind a solid corporate firewall. I use Pegasus Mail instead. It’s one of the hacker’s email programs.Outlook 2016 Logo

I use Outlook as a personal information manager. Not because it’s the best PIM – it’s not. But if you want compatibility, Outlook has it. I can use gSyncit to sync my contacts between Outlook and Google Contacts, which is what my Android phone uses. I can sync my notes and tasks and calendar with my Android phone using CompanionLink and the Android app, DejaOffice.

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Dialog-Box Rooms

This entry is part 13 of 44 in the series Words

An experimental study recently (late 2011) ballyhooed in the press looks at how we tend to forget things as we move into a doorway, and that walking back into the room doesn’t help you recover the memories. (Duh. I could have told anyone this. As could everyone.) Not sure why prior studies on the same topic haven’t been so widely reported. And does this have something to do with the fact that those with Parkinson’s Disease get stuck in doorways?

Combine this with Alan Cooper’s dictum, from the first edition of About Face: The Essentials of User Interface Design: “A dialog box is another room. Have a good reason to go there.”Doorways

We get another heuristic (rule of thumb) for usability: “The more pages or dialog boxes a user has to traverse to accomplish a task, the less likely they are to remember what they were thinking at the beginning.”

In settings where distractions are rife, this effect is more likely to result in error, as you don’t have the cueing of the original screen to remind you where you were. The high degree of interruptions in the Emergency Department is a classic example.

Therefore, for applications for such environments should use techniques such as breadcrumb trails.

Again, duh. But the point is that the transition from page to page, or page to dialog box, is the transition where most of the forgetting occurs.

It’s not just you.

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Cognitive Friction

This entry is part 12 of 44 in the series Words

The Whorf-Sapir hypothesis says that our language shapes how we think. It’s been moderately debunked in recent decades, but it’s likely true, at least in small part. And one of those small parts is when someone coins a new word that encapsulates a new idea. There has been a debate within philosophy since Plato’s time about whether words (names) – such as “circle” – correspond with some sort of actual ideal thing in some abstract realm – such as the one ideal circle of which our best drawn circles are only a pale imitation. Plato said yes, establishing the philosophical school known as Realism: “real” in this case means that there really, truly is an ideal circle somewhere out there. Nominalism says no, that “circle” is just a name, but Conceptualism, thanks to Peter Abelard, says that “circle” refers to something real, but that what’s real is about “circle” is that it’s a concept held in our brains. (If you’re a philosopher, I apologize for the gross oversimplification; but I’m a scientist, and as Bacon said: We are more likely to reach the truth through error than confusion.) And coining a new phrase can do just that – create new concepts in our brains. And that can change how we think about things.

And  if all those corporate executives who are responsible for our medical software were to get one particular concept into their brains, all of us in the medical field would find our lives a lot easier and error-free.

Cognitive friction is that term, coined by Alan Cooper in The Inmates Are Running the Asylum: Why High Tech Products Drive Us Crazy and How to Restore the Sanity.

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Scribes

This entry is part 1 of 3 in the series Charting

“This job would be great if I didn’t have to chart.” Physicians say this all the time. One way to not have to chart (much) is to work with a Federal Disaster Medical Assistance Team (DMAT) team. Although the National Disaster Medical System now has an electronic medical record (EMR) system, it used to just use scribbling on paper charts. And, since you have sovereign immunity against lawsuits, and you aren’t using your charts for billing, charting could be quite minimal. I have personal knowledge of a medical team in the field, after Hurricane Katrina, in a small, isolated town for a several-hour medical clinic; the team used 8.5×11″ paper on a clipboard for charting, and each patient got one line.Scribe

This isn’t feasible for most real-life physician medical charting. We do have to use our charts for billing, and for protection against lawsuits. (“If you didn’t chart it, it wasn’t done.”)

We also are sometimes faced with the demand for charting so that, instead of a narrative string of ASCII text, our charts are a small database of discrete, labeled elements (e.g., Chief Complaint: chest pain. Duration: 1 day.) This latter is known as structured charting, and is eagerly promoted by researchers, who want structured data, and billing companies, who enjoy the resulting ease of assuring compliance with billing and coding rules. Read the rest of this entry »

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“Wrong Patient”

This entry is part 11 of 44 in the series Words

Updates, December 2014, October 2016: short addenda at end.

Speaking of “Bad Design Killing” a big part of the discussion at the ACEP Informatics Section meeting in San Francisco this month was about one particular usability problem with CPOE: entering orders on the wrong patient. I’ve done this myself – as far as I know I’ve always caught it before anything bad occurred. Many of my partners have had the same problem, and so have many of those at the Section meeting, with widely-different CPOE systems.Banana Peel

There are a variety of suggestions for why this is so, and what to do about it. Read the rest of this entry »

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