User Interface Guidelines for Implementing SNOMED CT

Presented by

Beverly Knight

Copyright © 2013 Canada Health Infoway Infoway has the exclusive right to make copies of this document. No alterations, deletions or substitutions may be made in it without the prior written consent of the owner. No part of it may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, email or any information storage and retrieval system, without the prior written consent of the Infoway.

©Canada Health Infoway 2013

2

Optimize your eHealth Solutions through Health Information Standards… Join the Infoway Standards Collaborative!

General membership is available at no cost and Premium Membership with expanded benefits at a very low rate. To learn more, visit the Standards Collaborative section at www.infoway-inforoute.ca or contact us at [email protected] ©Canada Health Infoway 2013

3

4

Objective Introduce the User Interface Guidelines including an overview of what they are, why they are needed and who would benefit from using them. Present some key design guidelines and suggested best practices for incorporating large clinical terminologies, such as SNOMED CT, into an eHealth Solution.

©Canada Health Infoway 2013

4

5

Background

• 

Canada Health Infoway engaged the Healthcare Human Factors at University Health Network for this work

• 

An environmental scan examined both national and international efforts including o  Literature search o  Reviewed existing guidelines (Microsoft Health Common User Interface Guidelines) o  Interviews with eHealth researchers and implementers o  Evaluations of existing coding implementations

©Canada Health Infoway 2013

5

6

What are the User Interface Guidelines?

• 

A series of design guidelines for incorporating SNOMED CT into a primary care Electronic Medical Record (EMR).

• 

The guidelines focus on the usability and safety aspects of clinician coding at the level of the user interface and addresses; •  Display and encoding of data at the point of care

• 

Since SNOMED CT is large, the objective is to present a manageable number of terms to the end user to ease clinical coding at the point of care.

©Canada Health Infoway 2013

6

7

Why are the User Interface Guidelines Needed? •  Data that is captured in a structured and coded format allows re-use of the information;

•  Offer providers new insights into patient populations and healthcare/ disease trends and patterns. •  The introduction of guidelines and alerts can be integrated into the clinician’s practice as they complete the record. −  Deliver better, faster decision-making.

• 

The interoperability of an EMR with the pan-Canadian Electronic Health Record (EHR) can provide many benefits, such as shared access to complete and accurate health records.

©Canada Health Infoway 2013

7

8

Why are the User Interface Guidelines Needed? •  To facilitate interoperability and analytics, Canada Health Infoway has specified the use of reference terminologies, including the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT).

• 

Although it is crucial for EMR vendors to leverage standardized codes, it is also critical that EMR vendors consider usability aspects to make it easier for clinicians to adopt the coding.

©Canada Health Infoway 2013

8

9

Who needs to use the User Interface Guidelines?

• 

Vendors •  The intended audience for these guidelines are designers of EMR system user interfaces. •  The key themes may be applicable across other domains and system user interfaces

• 

Jurisdictions / organizations •  Become more knowledgeable of options for capturing of coded data in their solutions •  Extract requirements from the guidelines to be used as needed in procurements when acquiring new systems

©Canada Health Infoway 2013

9

10

User Interface Design Guidelines There are 5 main areas which cover coding of Clinical Terminology at the user interface level: Area  

Area Description  

Interface Function  

1  

Context and Display (CD)  

Display  

2  

Structured Forms (SF)  

3  

Search (SR)  

4  

Elaboration (EL)  

5  

Free-text Parsing (FP)  

Input Approaches  

11

Context and Display (CD) Avoid truncation Exclude inactive concepts Limit the number of concepts presented to the user —  — 

Only include relevant concepts Exclude inappropriate content that will never be selected, e.g., veterinary medicine terms The use of subsets can reduce the content being searched upon

12

Context and Display (CD) cont. Use plain language in the user interface o  Do not show SNOMED CT jargon, such as “terminology axis”, “fully specified name”, preferred term”, “qualifier”, and ID numbers o 

Use the following user interface description principles: o  o  o 

User-friendly (e.g, “no” instead of “known absent”) Use of natural language reading order (“no cancer” instead of “cancer – no history of”) Logical order of terms in a form or pick list

13

Context and Display (CD) cont. When displaying encoded and unencoded information, repetition should be avoided to improve readability. •  Hierarchical headings can be used to logically group similar information, and indenting statements under the headings can improve comprehension

Canada Health Infoway

14

Context and Display (CD) cont. Use Graphical methods to ease comprehension & capturing of data •  E.g., instead of asking users to enter or select parts of the body, the system could present an image of the body from which users could simply click on the specific part of the body.

Canada Health Infoway

Lower back pain

15

Structured Forms (SF) Use structured forms when there are a limited number of possible terms (20 or less) •  Choose appropriate options and order them intuitively •  Use checkbox, radio button, and dropdown lists appropriately







Use logical order within the lists

16

Search (SR)

Use search for entering single concepts when there are a large number of possible terms (e.g., greater than 20). •  Browsing can be slow and overwhelming to users •  Search offers more flexibility than structured forms

•  Do not use if clinician is expected to enter rich set of notes with many concepts to be encoded

•  Use contextual limitation to increase relevancy of results.





17

Search (SR) cont. Provide progressive matching as the user types in text (feasibility permitting).





18

Search (SR) cont. •  Prioritize commonly used terms or provide favourites. •  Explicitly state when no results are found, and provide

assistance.





19

Search (SR) cont. Ensure that the search field and results list can hold sufficient characters o  The search entry field should display at least 32

characters simultaneously and hold up to 255

characters in total.



20

Elaboration (EL) Allow users to specify additional attributes for coded concepts when using Structured Forms, Search, and Free-text Parsing.



21

Elaboration (EL) cont. Allow users to edit elaborations prior to being committed to record



22

Free-text Parsing (FP) •  When tasks require the flexibility to enter a passage of notes, use free-text parsing (feasibility permitting). •  Show top matches, but allow users to choose other results.

23

Free-text Parsing (FP) cont. Provide progressive matching as the user types in text (feasibility permitting).

24

Free-text Parsing (FP) cont’d Upon confirming a match, replace the typed text and show that it has been encoded.

Allow users to edit and undo the confirmation of matches before the note is committed to record.

25

Free-text Parsing (FP) cont’d

Prompt for values associated with a concept.

26

Free-text Parsing (FP) cont’d Only allow users to confirm a base concept if its mandatory attributes have been completed.

27

•  The

User Interface Guidelines document can be found here

• 

https://infocentral.infoway-inforoute.ca/3_Tools_and_solutions/ User_Interface_Guidelines_for_Clinical_Coding_of_Data/ User_Interface_Guidelines

•  You

will need to sign up to be a SC member for complimentary access

Canada Health Infoway

28

Additional Online Resources

General •  Microsoft Health Common User Interface Guidelines http://www.mscui.net •  Windows User Experience Interaction Guidelines http://msdn.microsoft.com/en-us/library/windows/desktop/aa511258.aspx •  Mac OS X Human Interface Guidelines http://developer.apple.com/library/mac/#documentation/UserExperience/Conceptual/ AppleHIGuidelines/Intro/Intro.html •  useit.com: Jakob Nielsen on Usability and Web Design http://www.useit.com •  Usability.gov: Research-based Web Design and Usability Guidelines http://www.usability.gov/guidelines/ Forms •  Forms that work: Designing for Usability http://www.formsthatwork.com/ •  An Extensive Guide to Web Form Usability http://uxdesign.smashingmagazine.com/2011/11/08/extensive-guide-web-formusability/ •  Web Application Form Design http://www.lukew.com/resources/articles/web_forms.html Search •  useit.com: Search: Visible and Simple http://www.useit.com/alertbox/20010513.html •  User Focus: 20 search usability guidelines http://www.userfocus.co.uk/resources/searchchecklist.html •  Usability.gov: Search http://www.usability.gov/pdfs/chapter17.pdf Canada Health Infoway

29

Questions?

Canada Health Infoway

Optimize your eHealth Solutions through Health Information Standards… Join the Infoway Standards Collaborative!

The Standards Collaborative is your Canadian source for key standards that help ensure health information is available and understandable when needed. General membership is available at no cost and Premium Membership with expanded benefits at a very low rate. To learn more, visit the Standards Collaborative section at www.infoway-inforoute.ca or contact us at [email protected] ©Canada Health Infoway 2013

30