Making decisions about what clinical tasks to prepare for is multi-factored, and especially challenging in intensive care environments where resources must be balanced with patient needs. Electronic health records (EHRs) are a rich data source, but are task-agnostic and can be difficult to use as summarizations of patient needs for a specific task, such as "could this patient need a ventilator tomorrow?" In this paper, we introduce ClinicalVis, an open-source EHR visualization-based prototype system for task-focused design evaluation of interactions between healthcare providers (HCPs) and EHRs. We situate ClinicalVis in a task-focused proof-of-concept design study targeting these interactions with real patient data. We conduct an empirical study of 14 HCPs, and discuss our findings on usability, accuracy, preference, and confidence in treatment decisions. We also present design implications that our findings suggest for future EHR interfaces, the presentation of clinical data for task-based planning, and evaluating task-focused HCP EHR interactions in practice.
Care planning in the ICU is challenging; clinical signals are often irregularly sampled and contaminated by interference and human error. Information visualization and chart reviews become particularly meaningful for decision making in an environment like the ICU where clinicians must process patient information quickly @cite_11 , and there is near-constant information from multi-modal devices, and multi-disciplinary staff @cite_37 . Data complexity, and the difficulty of working with EHRs has introduced new threats to patient safety @cite_45 , including the introduction of error from fragmented displays and alert fatigue @cite_15 . Prior studies have demonstrated that 80
@cite_37 @cite_45 @cite_15 @cite_11
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PurposeTo describe how communication failures contribute to many medical mishaps.MethodIn late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design i Objective. In response to the landmark 1999 report by the Institute of Medicine and safety initi- atives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physi- cian order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hy- pothesis that CPOE implementation results in reduced mortality among children who are transported for spe- cialized care. Methods. Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary- care level children's hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical ap- plication platform was rapidly implemented hospital- wide over 6 days during this period. Retrospective anal- yses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed. Results. Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86 . Univariate analysis revealed that mortality rate signifi- cantly increased from 2.80 (39 of 1394) before CPOE implementation to 6.57 (36 of 548) after CPOE imple- mentation. Multivariate analysis revealed that CPOE re- mained independently associated with increased odds of mortality (odds ratio: 3.28; 95 confidence interval: 1.94- 5.55) after adjustment for other mortality covariables. Conclusions. We have observed an unexpected in- crease in mortality coincident with CPOE implementa- tion. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when imple- menting CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies. Pediatrics 2005;116:1506-1512; administration, computer software, health care delivery access, interhos- pital transport, outcome. On the morning of December 7, 1941, a radar station situated on Opana Point detected what appeared to be yet another routine flight on B17s or a naval patrol (1). The people in charge of monitoring this signal thought this was another false alarm generated by early radar. In fact, this signal was re