Table 3. Design recommendations to enhance usability for longitudinal critical care information display systems a .
| Topic | Finding | Recommendation |
|---|---|---|
| Core Design | Clinical notes were the most frequently viewed and navigated-to category | Information display should center on effective clinical notes presentation and allow on-screen persistence |
| Clinicians frequently switched back-and-forth between data screens to chronologically correlate data | Systems should allow efficient viewing of multiple data elements on the same screen and minimize use of single-category tabs/windows | |
| Clinical notes, imaging reports, diagnostic studies, medications, and labs were the most extensively reviewed and co-navigated categories | Give visual prominence (or co-display) for clinical notes, imaging reports, diagnostic studies, medications, and labs | |
| Clinicians took highly variable pathways to complete electronic chart review | Systems should accommodate user-defined customization of data display | |
| Data Presentation (see Table 2 ) |
Clinicians spent nearly 10% of the time searching/scrolling through lists of metadata | Systems should include robust visual prioritization schemes and search/sort support to expedite information seeking |
| Over 50% of the clinical notes viewed were one of five specific note subtypes | Give visual priority to the display of these 5 Clinical Note subtypes (see Table 2 ) | |
| Over 75% of the imaging studies viewed were one of: chest X-ray, chest CT, abdominal/pelvic CT, or head CT | Give visual priority to the display of chest X-rays, chest CTs, abdominal/pelvic CTs, and head CTs | |
| 80% of the diagnostic studies viewed were one of: echocardiograms, ECGs, and PFTs | Give visual priority to the display of echocardiograms, ECGs, and PFTs | |
| Data access (see Fig. 2 ) |
Clinicians frequently viewed clinical notes/diagnostic studies/imaging reports beyond 10 y in time | Systems should accommodate efficient query and display of historical clinical notes/diagnostic studies/imaging reports with a minimum availability of 10 y |
| Labs and microbiology data were rarely viewed beyond 5 y in time | Filter labs and microbiology data to a default of 5 y | |
| Vital sign data were never viewed beyond 1 y in time (rarely more than 1 mo) | Filter historical vitals data to a default of 1 mo b | |
| Intake/Output data and the MAR were never viewed beyond 1 mo in time (typically 1 wk) | Filter intake/output data and the MAR to a default of 1 wk b | |
| Navigation (see Fig. 3 ) |
Clinicians often leave one data screen and need to scroll the subsequent data screen to arrive at the corresponding date as the previously viewed data | When navigating between data screens, provide a mechanism to “jump-to” the same date viewed on the previous screen |
| After reading clinical notes, clinicians usually viewed imaging reports/diagnostic studies/labs | When viewing clinical notes, the system should provide multipane viewing of imaging reports/diagnostic studies/labs or visual prominence of links to these elements | |
| Vital sign viewing was commonly followed by intake/output data review | Vital sign data should be codisplayed with intake/output data |
Abbreviations: CT, computed tomography; ECG, electrocardiography; MAR, medication administration record; PFT, pulmonary function testing.
a
Findings and design recommendations for longitudinal EHR data presentation for the specific use-case of historical chart review in the medical ICU.
b
Findings based on relatively few total observations (see Fig. 2 ); recommendations should be considered preliminary.