TABLE C.1 Committee’s Observations from Its Site Visits

 

Observations—What Committee Members Saw

Consequences—Why the Observations Matter

Opportunities for Action—What We Can Do About Ita

Category 1. The Medical Record Itself

1

Patient records are fragmented

  • Computer-based and paper records co-exist

  • Computer records are divided among task-specific transaction-processing systems

  • Users have to know where to look

  • Individual manually annotated work lists are the norm

  • Synthesis depends on intra-team conversation

  • Problem recognition is left to chance

  • Team members waste time getting information in the form they want to use

  • Techniques to synthesize and summarize information about the patient in and across systems with drill-downs for detail (S/R)

  • Mechanisms to focus on a constellation of related factors (S/R)

  • Single search box that returns all appropriate information in the appropriate format (R)

  • Alerts to problems or trends for investigation (S/R)

  • “Virtual patient” displays leveraging biological and disease models to reduce multiple data inputs to intelligent summaries of key human systems (R)

2

Clinical user interfaces mimic their paper predecessors

  • The flow sheet is the predominant display construct

  • No standardization of location of information or use of symbols and color

  • Font size is challenging

  • Important information and trends are easily overlooked

  • Cognitive burden of absorbing the information detracts from thinking about what the information means

  • Design reflecting human and safety factors (S)

  • Automatic capture and use of context (what, who, when…) (S)

  • Techniques to represent and capture data at multiple levels of abstraction (Care—plan, order, charting; data—raw signal, concept derived from the signal; biology) (S/R)



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement