The auto industry standardized critical control location in cars to allow anyone with knowledge on any car to operate all cars safely. But our EMR systems have been developed piecemeal, to the detriment of its users.
Hello! I'm Dr. Nick, the Incrementalist. And I'm here today to talk about Blunders & Wonders.
This week's Blunder: The EMR user interface and standardization. As I mentioned last week, the JAMIA-published study on the usability of electronic medical records showed there's 61 clicks required to prescribe Tylenol.
This week, I wanted to focus on the standardization and the incredible variation seen implemented in the same EMR systems in different facilities. For the same measurement of clicks and time for Tylenol prescribing, the authors found variability for a low of 14 clicks and 45 seconds, to a high of 61 clicks and 70 seconds for the same task.
The study included measurements from two of the leading EMR products in the marketplace from Epic and Cerner. And yet, they found wide variation in the time and clicks to complete similar tasks.
Can you imagine stepping into your car and not knowing where the key to start the engine goes? Or how to turn on the lights at night? Or operate the windscreen wipers? The answer, of course, is no.
The industry has long since standardized on critical control location and operation to allow anyone with knowledge acquired on any car to operate all cars safely.
But our EMR systems have developed over an extended period of time. Innovations and concepts arriving at different times through different vendors creating this smorgasbord of interfaces and interactions that challenges even the most technology adept users.
Some of this is perhaps mistakenly seen as differentiation and the marketing of a better product. Yet we know from cars that differentiation is clear between brands despite the standardization of the user interface.
We need to rethink the whole design of these interfaces and bring in experts in user-centered design. The people who start from the principle of "nothing is off limits to change," and importantly, your first ideas are more likely to be tossed out. In fact, all ideas are sacrificial lambs in a good design process that will ultimately end up so that things should be as simple as possible but no simpler.
This week's wonder: continuous blood pressure monitoring. Hypertension is a silent killer. One in three adults in the United States have hypertension. Thats approximately 70 million people. And by our best estimates some 13 million people aren't even aware that they have hypertension.
In what's a nice piece of lateral thinking, researchers at the University of California San Diego are working on a patch that continuously measures someone's central blood pressure using a silicon elastomer ultrasound patch that generates sound that penetrates the skin, reflects off the wearer's tissues and blood. The reflections are sent back to the sensor and the researchers were able to continuously and accurately monitor central blood pressure, which they compared to a tonometer - a pressure sensor on the skin - and the results between those two devices were in sync with a very small variance between the two methods.
In an interesting and potentially useful twist, the device can be placed in different locations. In the case of the study, at the neck, offering insights into blood pressure and flow in different parts of the body.
It's still early days, and since the device needs power it has to be connected to a laptop, and there remains the challenge of understanding the difference between the central blood pressure and its relationship to the peripheral arterial blood pressure that we measure in the arm, and what the predictive nature of these two measures are.
I know personally, I'm excited for any technology that can get to accurate measures of my blood pressure with a continuous, non-invasive technique to help understand the variability of this measurement, and to help manage and mitigate the associated cardiovascular disease that's killing so many people today.
Until next time, I'm Dr. Nick, the Incrementalist. Don't let perfection stand in the way of progress.
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