Mar
05

History, How Bad Design Kills, Posture and Metaphors

By kconover Posted in Tutorials | Comments Off on History, How Bad Design Kills, Posture and Metaphors

The following historical account is based on personal experience as a child being taken to ERs in the 1950s, as an observer in ERs in the 1960s, an EMT and then street medic training in ERs in the 1970s, and then as an emergency physician since the 1980s. Some names may have been changed or ambiguated to protect the innocent (or guilty).

1950s Emergency Room

1950s Emergency Room

In the 1960s and before, the emergency room (“ER”) was just that – a big room, with some curtains to divide the stretchers. The ER was staffed by a nurse or two, and at the bigger hospitals, there would be more nurses and an intern or two, and maybe an upper-level resident would supervise from time to time. There was no standard of care, nor any quality improvement (QI) processes.

Emergency Room circa 1924

Emergency Room circa 1924

Gradually, medical technology improved, and we could do more (a lot more) for patients, especially in the acute setting. Primary physicians started referring (and deferring) patients to the ER rather than seeing emergencies in the office; indeed, now that emergency medicine is a specialty, many primary care doctors don’t think it’s appropriate for them to care for anything except minor emergencies in the office. Primary care doctors now don’t leave time each office day for add-on emergencies, as they used to back in the 1950s and 1960s. And ERs gradually morphed into busy, high-tech EDs, with lots of patients, and with nurses and doctors who specialize in emergency care. A standard curriculum in emergency medicine evolved, as well as postgraduate emergency medicine residency training programs for MDs and DOs.

But EDs became so busy that they made the job of an Air Traffic Controller look easy. And, as with air traffic control, specialized management tools evolved. Read the rest of this entry »

Feb
28

Anticryptography

By kconover Posted in Tutorials | Comments Off on Anticryptography

We all know what cryptography is:

cryp·tog·ra·phy, n.
1.    the science or study of the techniques of secret writing, esp. code and cipher systems, methods, and the like. Cf. cryptanalysis (def. 2).
2.    the procedures, processes, methods, etc., of making and using secret writing, as codes or ciphers.
3.    anything written in a secret code, cipher, or the like.
[1635–45; CRYPTO- + -GRAPHY]

But do you know what anticryptography is?

In its most glamorous guise, it is the art and science of designing easy-to-understand messages to send into space for alien civilizations to read. More mundanely, it is the art and science of designing messages, usually visual, that may be easily interpreted by those of widely-varying language and culture.

Graphic designers have been practicing anticryptography for a long time, designing easy-to-understand signs. The idea of standard signs, with similar shapes and forms, appears multiple times – most recently and obviously in the icons developed for the Olympics, and in the set of 50 standard transportation-oriented signs developed by AIGA.

Read the rest of this entry »

Feb
12

Data Display

By kconover Posted in Tutorials | Comments Off on Data Display

One feature of most tracking systems is data display for an individual patient in the Emergency Department.

Beth Israel ED Patient View

Beth Israel ED Patient View

In most tracking systems, we can double-click on the patient’s name, and then we see a pop-up window, populated with things that the nurses have entered and that are found in the patient’s electronic medical record (EMR) entry: ED triage note, medications, allergies, past medical history, and the like.

This is the electronic equivalent of looking at printed nurses’ notes. As with any electronic medical record, it has the advantage of being visible from any computer. However, for many EMR implementations, we can’t see these notes until the ED triage nurse completes the note and closes it. Allowing individual bits of the nurse’s note to populate the ED patient view early would allow physicians to see the notes early, rather than often going to see the patient without the benefit of reviewing the nurse’s already-entered information.

Unlike other parts of tracking systems, which involve complex user interaction, an ED Patient View may be simple display of data, providing a straightforward exercise in information design. Read the rest of this entry »

Feb
11

Search

By kconover Posted in Tutorials | Comments Off on Search

To find something using the Google search engine, or a location using Google Maps, we simply type in a few words and then browse the results. This is so much better than what was available before that it has made Google one of the richest corporations in the history of the world.

Autocomplete, Stedman's Medical Dictionary

Autocomplete, Stedman’s Medical Dictionary

However, many programs’ search functions still require you to enter the first name in this box, the last name in that box, and the gender in this other box. Faugh.

Users of Cerner, including their ED tracking system, Firstnet, are lucky as regards search (though perhaps not so lucky in other respects). There is indeed a set of boxes where we can type in a variety of identifiers (name, FIN NBR, MRN, CMRN, SSN, Birthdate, and/or Gender). But, we can simply type, in the “name” search box, either “Lastname, Firstname” or “Firstname Lastname.” Then, we are presented with a list of matches, with information such as SSN and birthdate, that we can use to identify the correct patient. Simple. Elegant. Fast.

Google Autocomplete

Google Autocomplete

The Google method – entering just enough information to get a good set of possible matches, then presenting them for review – has now been voted (by user’s choice of search engines) as the standard for searching. As Donald A. Norman says, if we want usable designs, we have to accept standards, even if we don’t like them, and since user expectations are molded by Google, we might as well resign ourselves to it.

There are other ways to make searching easier, and they are starting to become standards as well. Autocomplete is when the program predicts a word or phrase that the user wants to type in, without the user actually typing it in completely. This is effective when there are a limited number of possible or commonly used words, as is the case with most medical software. Autocomplete can speed up user interactions significantly, especially for those who type slowly.

Firefox Search Box

Firefox Search Box

Autocomplete has been available for many years in some programs – for instance, the financial program Quicken, or Stedman’s Medical Dictionary. In these implementations, the autocomplete appears after the cursor as one types, often in grey, or may fill in multiple fields, as in Quicken. However, autocomplete is more familiar from the ubiquitous search engine Google, and the web browsers Internet Explorer and Firefox. Read the rest of this entry »

Feb
11

Mental Models, Input Modes and Cognitive Friction

By kconover Posted in Tutorials | Comments Off on Mental Models, Input Modes and Cognitive Friction

If the point of contact between the product and the people becomes a point of friction, then the Industrial Designer has failed.
–Henry Dreyfuss, Designing for People, 1955

Mental Models

In the first edition of About Face, one of the first design/usability texts (and a great read, much more personal, personable and readable than subsequent, more formal, editions) , Cooper speaks of the difference between the programmer’s mental model of the program (“implementation model”) and the user’s mental model.

User Mental Models vs. Implementation Models

User Mental Models vs. Implementation Models

Generic Tracking Board Example

Generic Tracking Board Example

Programmers (coders) deep in the intricacies of the program’s code understandably find it very hard to put themselves in our shoes. As a result, much software – medical and otherwise – reflects the underlying structure of the program rather than the processes the program is supposed to automate. One common process in the ED  is a good example of an implementation model and we will consider it here.

A common tracking-system task is to indicate that something needs to be done. In line with Cooper’s persona method, discussed in Computers in the ED 5), we will assume this is a first-year emergency medicine resident named Jack who is new to this tracking system. Let us start by asking how a naïve user like Jack might expect to perform the task of “add a green dot to the patient care box of Ima Klutz.” (For this tracking system, this will indicate it’s OK for the nurse to discharge Mr. Klutz, whose laceration Jack has repaired.) We will learn about Jack’s use of a generic tracking board, one I’ve created, modeled on several middle-of-the-pack tracking systems available in 2009, through Jakob Nielsen’s “discount usability testing.” Read the rest of this entry »

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