Transcript 1996-Scamc-The Promises and Perils of

AM A '96
Just Tell Me What You Want!
The Promises and Perils of Rapid Prototyping
with the World Wide Web
James J. Cimino and Socrates A. Socratous
Department of Medical Informatics
Columbia University
AM A '96
Motivation for Web-Based
Clinical Information System
• Surgeons wanted customized display of
laboratory data
• We wanted to do research with linkages
to Internet-based information resources
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Key Architectural Components
• Clinical data server
• Controlled vocabulary server
• Web server
• Pre-Java
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Predicted Advantages
• Development and customization
• User interface already done
• External Web-based applications
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Predicted Disadvantages
• Inappropriateness of Web navigation
• Lack of basic computing resources
• "Connectionless" paradigm
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Methods
• PolyMed - as reported at SCAMC '95
• Data collection
– E-mail comments
– Log files
– User group meetings
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old screen shot from 1995
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Results: April 10 to March 24
• Users:
18
• Logons:
5,248
• Patients:
4,225
• E-mail:
9
• Log file:
22,000 lines
• User meetings:
• Attendance (avg):
2
21
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Results: E-mail
• Rarely used
• Usually supportive
• Sometimes started a dialogue
about enhancements
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Results: Log Files
• Showed who did what when
• Able to track use of specific features
• Able to recreate work flow
• Couldn't tell us what was happening in
the browser
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Results: User Group Meetings
• Explained reasons why features not used
• Little brainstorming for new features
• "We don't make cognitive rounds"
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Results: Features They Suggested
• Current antibiotics
• Patient descriptions
• Print function
• Pre-op checklist
• "Superspreadsheet"
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current screen shot
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Results: Original Features
• They liked:
– Ability to maintain patient lists
– Assignment of attending
• The didn't like:
– Assignment of chiefs
– Service-oriented data displays
– Access to clinical information system
– Access to on-line information services
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Results: New Features
• The liked:
– Patient descriptions
– Print function
– Pre-op checklist
– "Superspreadsheet"
• They didn't like:
– Current antibiotics
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Predicted Advantages
• Development and customization - Yes!
• User interface simplified - Yes!
• External Web-based applications - Yes!
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Predicted Disadvantages
• Web navigation paradigm - Not a problem!
• Lack of basic computing resources - Yes!
• "Connectionless" paradigm - Not a problem!
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Conclusions
• Users don't always know what they want
• Users don't always know what they do
• Log files tell us what users really do
• E-mail and meetings tell us why
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Conclusions
• Prototyping is easy
• Web approach allows experimentation
without heavy investment
• If you want to explore new techniques
for clinical decision support...
AM A '96
...don't use our surgical housestaff