Electronic Health Records and Evidence-Based Practice: Solving the Little-Data Problem

Abstract

There is great excitement in the healthcare field about the prospects of digital medicine and the associated availability of Big Data for supporting new discoveries that lead to improved healthcare. However, less attention has been devoted to the problem of using the power of digital systems (e.g., EHRs) for communicating the results from these discoveries to practicing clinical healthcare workers. This is the Little Data Problem. This paper discusses how the frameworks of CSE and UXD are helping designers to address the Little Data Problem. The focus is on designing software and interfaces that function as cognitive tools improving situation awareness and supporting sensemaking. Work to develop an app to help people assess cardiovascular health is described as a concrete example of how CSE and UXD principles are being applied to design technologies that support evidence-based clinical practice.

References

Arndt

B.G.

Beasley

J.W.

Watkinsen

M.D.

Temte

J.L.

Tuan

W-J.

Sinsky

C.A.

Gilchrist

V.J.

(2017). Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine, 15(5), 419-426.

Amelink

H.J.M.

Mulder

van Paassen

M.M.

Flach

J.M.

(2005). Theoretical foundations for total energy-based perspective flight-path displays for aircraft guidance. International Journal of Aviation Psychology, 15, 205–231.

Anders

(2018). Prediction: Forgotten physicians continue to struggle in 2018. Health IT Outcomes Newsletter, January18, Guest Column. https://www.healthitoutcomes.com/doc/prediction-forgotten-physicians-continue-to-struggle-in-0001?vm_tId=2051812&user=c151fa94-dbba-4ff8-9187-a82ff608bc7a&utm_source=et_6231164&utm_medium=email&utm_campaign=HCIT_02-22-2018&utm_term=c151fa94-dbba-4ff8-9187-a82ff608bc7a&utm_content=Prediction%253a+Forgotten+Physicians+Continue+To+Struggle+In+2018

Bennett

K.B.

Flach

J.M.

(2011). Display and Interface Design: Subtle Science, Exact Art. Boca Raton, FL: CRC Press. ISBN-13: 978-1420064384

Billings

C.E.

(1997). Aviation Automation. The search for a human-centered approach. Mahwah, NJ: Erlbaum.

Buxton

(2007). Sketching User Experiences. Amsterdam: Elsevier.

Chatterjee

(2016). 10 Big Data visualization tools everyone in the industry should be using. (Feb 4, 2016). https://www.promptcloud.com/blog/6-big-data-visualization-tools-for-you

D’Agostino

R.B.

Vasan

R.S.

Pencina

M.J.

Wolf

P.A.

Cobain

Massaro

J.M.

Kannel

W.B.

(2008). General cardiovascular risk profile for Use in Primary Care: The Framingham Study. Circulation, Feb, 117, 743-753.

Flach

J.M.

Feufel

M.A.

Reynolds

P.L.

Parker

S.H.

Kellogg

K.M.

(2017). Decisionmaking in practice: The dynamics of muddling through. Applied Ergonomics, 63, 133-141.

10.

Gothelf

Seiden

(2013). Lean UX: Appling Lean Principles to Improve User Experience. Sebastopol, CA: O’Reilly Media, Inc.

11.

Hollnagel

Woods

D.D.

(1999). Cognitive Systems Engineering: New wine in new bottles. In. J. Human-Computer Studies, 51, 339-356.

12.

Kayyali

Knott

Van Kuiken

(2013). The big-data revolution in US health care: Accelerating value and innovation. (April). https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-big-data-revolution-in-us-health-care

13.

Lopes

L.L.

1982. Doing the impossible. A note on induction and the experience of randomness. J. Exp. Psychol. Learn. Mem. Cogn. 8 (6), 626-636.

14.

McEwen

T.R.

(2012). Development and evaluation of an ecological display for the detection, evaluation, and treatment of cardiovascular risk. Unpublished Dissertation. Dayton: OH. Wright State University. http://rave.ohiolink.edu/etdc/view?acc_num=wright1386593713

15.

McEwen

T.R.

Flach

J.M.

Elder

N.C.

(2012). Ecological interface for assessing cardiac disease. Proceedings of the ASME 2012 11th Biennial Conference on Engineering Systems Design and Analysis, ESDA2012, July 2-4, 881-888.Nantes, France. ASME ESDA2012-82974.

16.

McEwen

T.R.

Flach

J.M.

Elder

N.C.

(2014). Interfaces to medical information systems: Supporting evidence-based practice. IEEE: Systems, Man, & Cybernetics Annual Meeting, 341-346. San Diego, CA. (Oct 5-8).

17.

Middleton

Bloomrosen

Dente

M.A.

Hashmat

Koppel

Overhage

J.M.

Payne

T.H.

Rosenbloom

S.T.

Weaver

Zhang

(2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of the American Medical Informatics Association, 20(1), e2-e8.

18.

Miller

(2004). Developing an integrated information representation for medical intensive care unit patients: Generalising work domain analysis. Unpublished dissertation. University of Queensland.

19.

Mitre Corporation (2012). Enhancing access to prescription drug monitoring programs using health information technology: work group recommendations. Also available from URL: http://www.healthit.gov/sites/default/files/work_group_document_integrated_paper_final.pdf.

20.

Norman

D.A.

(1986). Cognitve Engineering. In Norman

D.A.

Draper

S.W.

(Eds). User-Centered System Design, 31-61, Hillsdale, NJ: Erlbaum.

21.

Ratwani

Fairbanks

R.J.

Hettinger

A.Z.

Brenda

N.C.

(2015). Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors, J Am Med Inform Assoc, 22, 1179-1182.

22.

Ridker

P.M.

Burning

J.E.

Rifai

Cook

N.R.

(2007). Development and validation of improved algorithms for the assessment of global cardiovascular risk in women. JAMA, 297(6), 611-619.

23.

Ridker

P.M.

Paynter

N.P.

Rifai

Gaziano

J.M.

Cook

N.R.

(2008). C-Reactive protein and parental history Improve global cardiovascular risk prediction. Circulation, Nov, 2243-2251.

24.

Rasmussen

(1986). Information Processing and Human-Machine Interaction: An Approach to Cognitive Engineering. New York: North Holland.

25.

Sanders

E. B-N

Stappers

P.J.

(2008). Co-creation and the new landscapes of design. Co-design, 4(1), 5-18.

26.

Schrage

(2000). Serious Play: How the world’s best companies simulate to innovate. Cambridge, MA: Harvard Business School Press.

27.

Wiener

E.L.

(1988). Cockpit Automation. In Wiener

E.L.

Nagel

D.C.

(eds.). Human Factors in Aviation, p.433-461, San Diego, CA: Academic Press.