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


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)


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)

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