Natural Mapping, Search and Affordance

Make things visible: bridge the gulfs of execution and evaluation.
Use technology to make visible what would otherwise be invisible, thus improving feedback and the ability to keep control.

–Donald A. Norman, The Design of Everyday Things

Norman states: Mapping is a technical term meaning the relationship between two things, in this case between the controls and their movements and the results in the world. [He goes on to describe the mapping of a car’s steering wheel to its direction of travel.] Natural mapping, by which I mean taking advantage of physical analogies and cultural standards, leads to immediate understanding.

Norman: Natural Mapping of Stove Controls

Norman: Natural Mapping of Stove Controls

 

In his landmark The Design of Everyday Things, Norman gives examples of the relationship of stove burner controls to the burners. Later in the book, as an example of an unnatural mapping, he gives an example of a clock whose numbers run counter-clockwise. Read the rest of this entry »

Downtime

“Downtime.”

What an ugly word. Wiktionary defines it as The amount of time lost due to forces beyond one’s control, as with a computer crash.

Just the thought makes one down, makes one depressed.

Most “niche” (best-of-breed) Emergency Department Information Systems (EDISs) are justly proud that they don’t go down.

That is, unless there is a massive problem like a power failure with both backup generators failing. That actually happened at Mercy Hospital of Pittsburgh once. Luckily I do cave and mountain rescue and always have some spare headlights in my truck. I was able to get them from the truck and they certainly helped us keep going. If you’re interested in the topic of emergency lighting for hospital disasters, check out my essay on the topic.

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isEDIS

The Pennsylvania College of Emergency Physicians and the national American College of Emergency Physicians (ACEP) held an international symposium on ED computer systems, November 12-15 2010 in Miami. This was the fifteenth year for the conference. The focus was on how to effectively and efficiently use computer technology for ED process improvement. There were attendees from the 6000-bed Chang Gung Memorial Hospital in Taipei, and from the UK. Reviews from the attendees and from the vendors seemed quite positive. In 2009, there was no conference due to the worldwide recession. The 2010 conference’s attendance was below projections. There are various theories as to why this was so: the continued economic slump, the transition in many hospitals to being forced to use the ED module of an enterprise system rather than a niche system, and others. Regardless, PACEP and national ACEP have determined not to offer this conference in the future. This website documents some of the important ideas discussed at these conferences, still relevant in 2025.

“Niche” Computer Systems

Shaker Cabinet:Woodgrain Vinyl::"niche" ED system:HIS ED module

Shaker Cabinet:Woodgrain Vinyl::"niche" ED system:HIS ED module

At the EDIS Symposium each year, a big question for attendees is “should we install the ED module of our hospital-wide information system (HIS), or should we install a ‘niche’ system that’s designed specifically for the ED?”

Traditional wisdom has it that the “niche” systems, also known as “best-of-breed,” will work better than the ED-specific module of a big HIS. This is true. Surveys by KLAS show this, and certainly my personal experiences with four or five different EDISs bears this out.

However, there are reasons why the ED module of a HIS can actually be better, at least in some ways, than a dedicated niche/best-of-breed ED system – integration. For instance, where I worked in the ED at Mercy Hospital of Pittsburgh (~60,000/year ED visits, Level I Trauma/Burn/tertiary care teaching center), we had Wellsoft, the KLAS top-ranked niche EDIS. We used it for tracking, nurse charting but not physician charting (we use Dictaphone EWS for physician charting), and a whole host of other purposes in the ED. It was extremely well-liked by all. However, the hospital was doing poorly (in financial terms) and it merged with University of Pittsburgh Medical Center, becoming UPMC Mercy. The ED was forced to abandon Wellsoft and adopt Cerner FirstNet, the ED tracking module of the UPMC-wide Cerner HIS. Users complained about this “downgrade” and of how “klunky” FirstNet was compared to Wellsoft – and indeed this is borne out by FirstNet having a much lower KLAS rating than Wellsoft. Read the rest of this entry »

Lessons from Tufte

Most users (myself included) spend most of their time in front of a computer in a kind of fuzzy autopilot mode, and anything that creates ripples on that placid lake of unawareness is going to be noticed as a disproportionately significant problem.
–David Harris, creator of Pegasus Mail

In Icons, Pegagogic Vectors, Forms Design and Posture, I said

ED tracking systems should adopt a … kiosk or coke machine posture. The soft drink companies want you to be able to, for example, continue a conversation with friends or on your cellphone as you buy a soft drink without error – so coke machines  have low cognitive friction … and part of this is that they all look the same. We want you to walk up to any computer in the ED and check the tracking screen without error – while you continue your conversation about the tPA or heparin or some other medication dosage.

Current computer displays, though improving, are of a much lower resolution than that of a well-printed page, by an order of magnitude.

Tufte points this out: when presented with a high-resolution graphic, like a detailed map, we can distinguish down to the 0.1 mm level. For instance, the screen used for printing Tufte’s book is very fine. I did some calculations, and my 1280×1024-resolution 19″ computer screen should have about 3.4 pixels/mm. Measuring on the screen with a fine ruler and a magnifying glass, I can indeed see 3-4 very-blurry pixels per mm. But looking similarly at the halftone screen of a figure on page 27 of Tufte’s Envisioning Information, I can count some 20-30 dots per mm. So my little experiment confirms nearly a 10-fold difference in print and screen resolution. As higher-resolution displays such as the Amazon Kindle arrive, resolution of computer displays is improving. But the Kindle, with 150-167 PPI (pixels per inch) still only has about 6 pixels/mm – about twice as good as my 19″ “high-resolution” monitor, but still significantly below high-quality printing.

Read the rest of this entry »

//commented out L sidebar 7/26/11 //