Facebook-like EMR (Part I)

Facebook-like EMR (Part II)
In 2008, Bob Watcher wrote an article called “Why the medical record needs to become more like Facebook” where lay down the idea of having the social network as the mirror for a new Electronic Medical Record (EMR) User Experience (UX). A collaboration and social framework to provide better care to patients while keeping useful information between physicians and nurses. 
He was not the only one; already in 2007, Robert Nadler established a high-level model remarking out the core functionalities that it could have EMR software. However, it was not intended to get only a Facebook-like UI but a real social site to connect Patients and Doctors.
The idea is not new; many authors - doctors and software engineers - have continued talking about this idea with no final proposal.
After the latest Facebook re-design I don’t know if those authors would still maintain the same opinion about this topic, anyway I do think it’s a very very interesting approach even assuming any usability issue that Facebook could have. So here are my two cents.
A Design Proposal
Users & Profiles
If a clinical solution would need to completely work like Facebook, every user (physician, nurse, etc.) would have their own user porfile. However, the analysis of having a EMR looking like Facebook timeline suggests that the profile page is planned to show only patient data. Why would we need to see a nurse profile, then?
Following this idea, the Home page would be reserved for (primary) users and the Profile pages for showing the electronic medical records of patients (secondary users).
A possible extension would be allowing the access to the EMRz by Patients, so they could also check their own EMR online by themselves. In this case, we could consider them as secondary users not as part of the network community, but just to contribute to their own medical history and keep a direct communication between them and they’re care providers.
Social network
Social activity will be generated by clinicians considering patient-centred documentation based on Profiles. As suggested before, there are two main social groups: the one created by clinical staff only, and the one where patients and clinicians would interact.
Social interaction is the key point of this proposal and it underpins the main usaibility goals:
Meaningful use
Engagement
Collaboration
Simplification
Productivity
Profiles: Patient Timeline
Facebook profile pages have been re-design to look more like a real timeline where any important event is chronologically displayed. In this example, right side will be used to show a summary of the most important event types associated to the patient medical history like Health issues, Allergies, Diagnosis, Requests and Results, Progress Notes, Prescriptions and any other clinical subject. On the left side, any user (doctor, nurse and the patient) could add comments anytime.
Privacy
Privacy should have a strong presence here, since having restricted-access data is a valuable feature that doctors, nurses and patients. They all will need to control the visibility of the data they entered in a fashionable way. Although setting permission in Facebook is pretty hard and unclear to get control about which type of users see which type of patient data or personal comments is still a requirement. This could be done seeing users by their role, applications as domains, and groups as teams. Still, patients are a special kind of user which will have direct access to his own record.
Utility
There’s a weak line which separates the Facebook familiarity advantage into the most confusing UI for a productivity tool and it’s called “enjoyment”. The idea of this Facebook-like EMR was to promote some typical behavioural patter of users when interacting with a social network like:
Safe Exploration
Microbreaks
Habituation
News Stream
Other people’s advice 
Personal Recommendations
However, there are some other existing activities that the clinical staff usually does and this UI is not oriented to
Changes in Midstream
Keyboard only
Streamlined repetition activities
Nevertheless, the app integration approach of Facebook suggest me to become a good exercise to imitate outside the UX field.
Content
The content is not about what people think or feels, but what physicians and nurses make, diagnose, treat or provide to patients. The language of the user interface should be adapted to the purpose in order to ease the kind of content expected to be entered.
Data entry is one of the most challenging features in healthcare apps. The smarter the application, the quicker the data is entered. The whole phylosiphy of Facebook puttin atention into every single details should be adopted also to create content such as vital signs, prescriptions, a soap note, or a discharge letter. As an example, below there’s a list of content with different natures which depends on the context of use, the user role and the business model.
Task Oriented
Notifications
Lists of patients
Lists of tasks
Scheduled activities
Events

Content Oriented
Patient history summary
Patient evolution 
Patient current health status and diagnosis
Clinical decisions
Procedures

Process Oriented
Treatments
Protocol based care planning
Admissions and discharge
Scheduling
Follow-up

What’s next
This is only the first part of the exercise. For the second part I’ll try more mock-ups and the high-fidelity prototype adding more details also in the content used in this sketch to get a better idea about how crazy (or not) is the proposal of being inspired by Facebook to create an electronic medical record.
There’s also an important gap where Facebook has no direct answer: clinical safety and episode-related information. We’ll talk about it also for the next post.
By now, how realistic do you think it is?

Facebook-like EMR (Part I)

Facebook-like EMR (Part II)

In 2008, Bob Watcher wrote an article called “Why the medical record needs to become more like Facebook” where lay down the idea of having the social network as the mirror for a new Electronic Medical Record (EMR) User Experience (UX). A collaboration and social framework to provide better care to patients while keeping useful information between physicians and nurses. 

He was not the only one; already in 2007, Robert Nadler established a high-level model remarking out the core functionalities that it could have EMR software. However, it was not intended to get only a Facebook-like UI but a real social site to connect Patients and Doctors.

The idea is not new; many authors - doctors and software engineers - have continued talking about this idea with no final proposal.

After the latest Facebook re-design I don’t know if those authors would still maintain the same opinion about this topic, anyway I do think it’s a very very interesting approach even assuming any usability issue that Facebook could have. So here are my two cents.

A Design Proposal

Users & Profiles

If a clinical solution would need to completely work like Facebook, every user (physician, nurse, etc.) would have their own user porfile. However, the analysis of having a EMR looking like Facebook timeline suggests that the profile page is planned to show only patient data. Why would we need to see a nurse profile, then?

Following this idea, the Home page would be reserved for (primary) users and the Profile pages for showing the electronic medical records of patients (secondary users).

A possible extension would be allowing the access to the EMRz by Patients, so they could also check their own EMR online by themselves. In this case, we could consider them as secondary users not as part of the network community, but just to contribute to their own medical history and keep a direct communication between them and they’re care providers.

Social network

Social activity will be generated by clinicians considering patient-centred documentation based on Profiles. As suggested before, there are two main social groups: the one created by clinical staff only, and the one where patients and clinicians would interact.

Social interaction is the key point of this proposal and it underpins the main usaibility goals:

Profiles: Patient Timeline

Facebook profile pages have been re-design to look more like a real timeline where any important event is chronologically displayed. In this example, right side will be used to show a summary of the most important event types associated to the patient medical history like Health issues, Allergies, Diagnosis, Requests and Results, Progress Notes, Prescriptions and any other clinical subject. On the left side, any user (doctor, nurse and the patient) could add comments anytime.

Privacy

Privacy should have a strong presence here, since having restricted-access data is a valuable feature that doctors, nurses and patients. They all will need to control the visibility of the data they entered in a fashionable way. Although setting permission in Facebook is pretty hard and unclear to get control about which type of users see which type of patient data or personal comments is still a requirement. This could be done seeing users by their role, applications as domains, and groups as teams. Still, patients are a special kind of user which will have direct access to his own record.

Utility

There’s a weak line which separates the Facebook familiarity advantage into the most confusing UI for a productivity tool and it’s called “enjoyment”. The idea of this Facebook-like EMR was to promote some typical behavioural patter of users when interacting with a social network like:

  • Safe Exploration
  • Microbreaks
  • Habituation
  • News Stream
  • Other people’s advice 
  • Personal Recommendations

However, there are some other existing activities that the clinical staff usually does and this UI is not oriented to

  • Changes in Midstream
  • Keyboard only
  • Streamlined repetition activities

Nevertheless, the app integration approach of Facebook suggest me to become a good exercise to imitate outside the UX field.

Content

The content is not about what people think or feels, but what physicians and nurses make, diagnose, treat or provide to patients. The language of the user interface should be adapted to the purpose in order to ease the kind of content expected to be entered.

Data entry is one of the most challenging features in healthcare apps. The smarter the application, the quicker the data is entered. The whole phylosiphy of Facebook puttin atention into every single details should be adopted also to create content such as vital signs, prescriptions, a soap note, or a discharge letter. As an example, below there’s a list of content with different natures which depends on the context of use, the user role and the business model.

  • Task Oriented
    • Notifications
    • Lists of patients
    • Lists of tasks
    • Scheduled activities
    • Events
  • Content Oriented
    • Patient history summary
    • Patient evolution 
    • Patient current health status and diagnosis
    • Clinical decisions
    • Procedures
  • Process Oriented
    • Treatments
    • Protocol based care planning
    • Admissions and discharge
    • Scheduling
    • Follow-up

What’s next

This is only the first part of the exercise. For the second part I’ll try more mock-ups and the high-fidelity prototype adding more details also in the content used in this sketch to get a better idea about how crazy (or not) is the proposal of being inspired by Facebook to create an electronic medical record.

There’s also an important gap where Facebook has no direct answer: clinical safety and episode-related information. We’ll talk about it also for the next post.

By now, how realistic do you think it is?

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