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  •   over 13 years ago

Miscellaneous Ramblings

How are you going to guarantee that the designs that are submitted aren't "borrowing" from preexisting EMRs? There are quite a few out there that might already accomplish what this project is looking to do. To name a few: Cerner, Epic, NextGen, Allscripts, eClinicalWorks, Meditech, Siemens and McKesson just to name some of the most used ones.

Also I understand the importance of patient centered design, but at what point will you begin looking at the provider's usage of the system? It does no good for the patient when the provider won't use the system, so the user interface is just as important if not more important than the patient interface.

Also what is the goal of this? A redesign of just the VA system, which actually has an open source side called openVistA or WorldVistA or is this some effort to try to compete with some of the EHRs mentioned above? Is it just to integrate with other systems or to overtake them?

And if this will be open source, why not build upon some of the open source EHRs that already exist? Why reinvent the wheel?

I'm just curious as to what the scope of this whole project is and how much research into the EHR world has actually been done. I hope you have providers that will be helping with this, and not only primary care, but the providers under specialty departments too.

This seems to be an expansive effort that many companies have years of experience doing and they are still learning and constantly improving. This isn't your typical software design.

  • 13 comments

  • Manager   •   over 13 years ago

    Hi Jason,

    The focus of this design challenge is not the EMR. It is the printed health record that is produced by them.

    There is plenty of innovation happening on the software side by many of the companies you mentioned.

    If this challenge/effort is successful, we can see how to adapt it to be more provider-specific.

    The work produced by this challenge is for the entire Health IT industry to use. A potential consumer would be the VA.

    Best,
    Ryan

  •   •   over 13 years ago

    So this is just the redesign of the information that is given to patients without an actual redesign of VistA? My apologies then, I misread this.

    I would still be wary of people taking ideas from some of the above companies I mentioned. I know that some of the printouts for patient instructions, after visits summaries, medications, etc have evolved quite a lot in the private world, what the VA has as far as patient printouts is concerned is quite outdated, so I can see the want to update it.

    On a side note, to reduce misunderstandings, you might want to change lines like this: "The purpose of this effort is to improve the design of the medical record so it is more usable..." To perhaps say "the VA's medical record". Similarly with this line that was used on the title of a techcrunch article "It's time for the patient medical record to get a refresh", should probably say "the VA's patient medical record" As stated above, not everyone's patient facing information is plain text like the VAs. Primarily this challenge is for the VA and then it will be open sourced so others can use it if they choose to adapt it.

  •   •   over 13 years ago

    It is for everything - not just the VA.

    Blue Button is an existing text-only format for medical records and histories, primarily intended for take-home use by patients, most notably (though not exclusively) used by the VA. It can be output by any EMR or PHR (or insurance company, or pharmacy, etc) that decides to support it.

    This challenge is to design a non-text-only format for Blue Button that is patient- and provider-friendly. That looks less like gobbledy-gook than anything the EMRs you've mentioned are putting out for patients. Something they can take from the hospital to their PCP with confidence. Something they can store on their hard drive, or in dropbox, or wherever they like, and print whenever they need it.

    The only interface here is the final design, since it can be output out of any of the EMRs you mentioned. How the information gets into the system in the first place is a task left to the EMRs. Perhaps we'll have a challenge in the future to kick their butts into gear on that too.

    Based on how generally terrible the companies you've mentioned are, I don't imagine many people participating in this challenge will be taking too many of their ideas.

  •   •   over 13 years ago

    The design of this discussion forum leaves the roles of the contributors to the discussion entirely ambiguous.

    M. Jackson W's response to Jason C is very helpful to my team. One key to doing a great job on this challenge is having a clear understanding of the constraints we should work within. With that in mind, it would be very helpful if M. Jackson W would let us know if he is a participant in the challenge with good ideas or if he is a representative of the Office of the National Coordinator Health Information Technology.

    In either case, thank you for the comment.

  •   •   over 13 years ago

    @Paul: I'm not a representative. I have discussed this challenge before with representatives, but certainly don't speak for them. Thanks for asking for clarification!

  • Manager   •   over 13 years ago

    Hi Paul,

    Please keep asking us for more clarification. We're doing our best to describe this challenge the best we can.

    Sometimes members of the community do a better job of describing it in their own words.

    I read over Jackson's response and it is 100% accurate. I'm glad you and your team have found it useful.

    Best,
    Ryan

  •   •   over 13 years ago

    I'm a little confused, if they're such horrible companies can you explain this? http://www.klasresearch.com/Best_In_KLAS/Software Although not all of the companies are on this list, a few of them are.

    Here's a list of hospitals and clinics that use a few of these companies:
    http://epic.usergroup.healthitsocial.com/page/epic-hospitals
    http://mckesson.usergroup.healthitsocial.com/page/mckesson-hospitals
    http://siemens.usergroup.healthitsocial.com/page/siemens-hospitals

    Also you should know that one of the Curators and Reviewers, Thomas Goetz, actually was present for a Cerner Conference only this last October: http://cerner.com/blog/chc12_day_one_recap/?langType=1033

    So yeah, people must think these companies are doing something right, even one of the curators does, he just believes there is a need for improvement. I believe there is room for improvement too when it comes to giving patients their medical information, but using the VA's blue-button to represent what can be given to a patient misrepresents what is actually available on the market, and makes it look more antiquated than it really is.

    As far as what they actually give to the patient, this varies based not only on the software, but what is the context from which the print is occurring. What a patient is given in an ambulatory context (after visit summary) will be different than what they are given in an inpatient context (discharge summary). This can even vary down to the departments, a specialist isn't going to give the same information as primary care provider, and there is good reason for that. But on many of the companies I've listed, plain text is a thing of the past, as well as RTF, quite a few are giving out HTML based printouts. But in most of the situations I've described, these are summaries, not the full medical record. The full medical record is generally given through a Release of Information from the HIM department or some similar process.

    And really what you give to an insurance company shouldn't be the same as what you give to a patient, nor should what is given to another provider. The provider's need to at least see the progress notes, something that is lacking in this particular design challenge, but then that's because patients don't always need to see that, although they are beneficial to an extent, they would end up being more confusing to the patient.

    I think there needs to be clarification, is this for a ROI, something that needs to be taken to another practice or is this for the patient, so they can try to understand their own record?

  • Manager   •   over 13 years ago

    Hi Jason,

    This isn't a critique of the EMRs or systems.

    We want you to focus on the printed record. Specifically, the Blue Button record that exists today.

    At the moment, it exists as a text file. It's simple like a cash register receipt, but we know it can be so much more.

    We are asking designers, like yourself, to reimagine it. We want you to design a record that is more useful to a patient, their family, and the people that take care of them.

    Best,
    Ryan

  •   •   over 13 years ago

    @Ryan Oh I'm not critiquing, I was just giving a rebuttal to M Jackson's statement that the companies I listed were terrible companies and only printed gobbeldy-gook. And then you actually said his statements were 100% accurate, which as a moderator may lead people to believe that you agree with those statements. Can they be improved upon? Yes and it's something that is continuously being done, especially as things like meaningful use and ICD10 are implemented. Are they gobbeldy gook? Some maybe, but each organization can generally customize what they print. Are they terrible companies? Evidence would show otherwise. But I'd like to assume you are agreeing with only part of what he said, not the parts where he made derogatory statements.

    So it would seem though that for this design process, it is all for the patient, not to be used as an official medical record printout for continuance of care or to be handed to another physician for official purposes, those would still end up being done through the normal ROI process or through referral letters.

  •   •   over 13 years ago

    So the goal of this challenge and the open-sourced GitHub project is to produce software that creates more visually cohesive printed documents?

    In terms of the project goals, a printed document seems a poor medium for addressing these issues... specifically:

    • Makes it easier for a patient to manage his/her health (more paper!)

    • Enables a medical professional to digest information more efficiently (more paper!)

    In my design I am focusing on visual enhancements, but my solution will be best realized digitally. Did I misinterpret the challenge goals?

  •   •   over 13 years ago

    (I am note a member of the committee)
    This entire discussion, in my opinion, is just as valuable than the generated solutions because, if this was sent to the kind of people in the AIGA and to graduate design programs like those at RISD, that skill has rarely been brought to the table to solve this problem.

    I want to make a comment on "the crap that the companies are doing".

    Healthcare IT is lacking the kind of people that do information design. The industry cares more about code than it does what is sometimes called the "user experience". The industry stuggles to even consider the user interface, let alone, understand the lifecycle and reuse of information, no matter what artifact it is presented in. They would solve a problem by hiring 100 programmers. This is because, it is all run by engineers.

    The fact is: many companies have programmers w/o information design training design do the presentation. Imagine a .NET programmer, in another country, determining what data to present, how to present it, and the information architecture and use of that presentation. Graphic design is typically about making buttons look pretty, or picking a color. It is called "UI Design" and often practitioners are computer engineers that know how to do "user interface code" in some ancient technology.

    Or, they simply give users a rich text editor and say here, you figure it out. That rarely translates to coherent, consistent, and meaningful information being transfered to an ER doctor that lives on the other side of the country using a different template. To compensate, they spend alot of time, money, and coding rat holes with what is called "Patient Education". THe funny thing is, the industry would literally save billions by having one good graphic designer /communication designer/information designer design a good document that anyone can read. THe patient has to be educated because when they look at their records, it is a bunch of gobelty gook. Imagine just taking your medical record and putting it into a long text string with some comas, colons, brackets. The dirty secret is that even the doctor can't understand it.

    Presentation is currently driven by "who screams the loudest" and that is the doctor. Sometimes, the doctor takes a job at the giant software company to make it look the way he/she wants at the expense of being understood by other doctors, let alone, patients.

    When you look at the goals of the project, you see alot of focus on people other than the doctor. This is a radical change in healthcare that is happening right now. In the past, some doctors felt like they "owned" the information. This leads to one of the biggest information failures points in in healthcare, what is called "transitions of care". Don't take this wrongly, doctors deeply care about the written word, about how they are expressing themselves, and gramatical constructs. It is an expression of their skill and professionalism. In a world of "innovation is technology" they spend time thinking about the quality of the paper, the impression of letterform on the page with it's roots in the 1800's. Making straight A's in organic chemistry is a different skill than information design. Human Factors practitioners often find that medical errors can be prevented simply by using colored folders to organize information.

    Getting back to the point, you will not find people like Lorraine Wild, Ellen Lupton, Moria Cullen, Meredith Davis, or Catherine McCoy working on this problem - designing the very hard presentation layer of medical information. This contest is to bring that kind of talent to healthcare.

    Side Note - I don't think any of them know about this contest, it should have been communicated through the AIGA which has national/government partnerships/ initiatives to design boring hard things like - how a ballot should be designed, the layout of polling stations, educational material for volunteers. I am surprised this was on Techcrunch, that isn't the right crowd.

    I challenge anyone coming onto this thread to look at the projects referenced in the brief. One was by IDEO (which didn't have a middle ground for anyone-thats what this contest appears to be trying to do), one was by a designer that now works for Milton Glaser and required systemic industry change (medication labeling) that took years. But it all started with the very kind of deliverables here. The kind of deliverables you do if you are a graduate design student at RISD, Cranbrook, NCState, Pratt, etc.

    I would think of it as a challenge to design a good billing statement, on paper.

  •   •   over 13 years ago

    Amen to that, Scott B.

  •   •   over 13 years ago

    I'm doing it just because I think it's fun and it will help people......don't make too many assumptions on why people are here......I am happy to give my design away. But I agree, there are many EHR designs that are less than functional. They generally are not for patient use however.

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