Database architecture, interface design key in researcher's aim for future EMR

The government wants everyone’s health history converted into electronic medical records (EMR). And to ensure they achieve their goal, they are providing $19 billion in stimulus money as part of the American Recovery and Reinvestment Act of 2009, to encourage physicians and others to adopt health IT.

In 2010, there were more than 300 software and hardware companies vying for the opportunity to sell their technology to the more than 5,000 hospitals in the United States.

The problem? None of the platforms talk to one another and each has its own set of commands, features, learning curve, and perhaps most challenging of all, individual flaws.

For graduate researcher Kyle Larkin from the Herberger Institute for Design and the Arts, and professor Aisling Kelliher of the School of Arts, Media and Engineering, the challenge of producing transparent and useful electronic medical records requires the implementation of an intelligent database architecture that communicates with many devices and the design of customizable interfaces that make the information sought accessible.

Larkin has been working with a family clinic for observations of interactions between patients and doctors, and the way doctors interact with technology. At the same time, Larkin and Kelliher are analyzing the plethora of interfaces available in the market to determine which ones work best, and which ones fall short of exemplary.

“We are seeing all kinds of things in our study," Larkin said. "We know of cases in which people use a tablet like a desktop because the interface was designed for a desktop. The interface disconnect has practical problems, because a doctor is sometimes having to turn away to type, when they could be paying attention to a patient.”

With the advent of multitouch devices (especially tablets) software manufacturers have been pressured to remain competitive, but instead of rethinking how the interface can be applied, most manufacturers have simply opted to resize their user interfaces for mobile phones or tablets.

Larkin and Kelliher are hoping to develop a digital architecture for medical database storing, management and exchange. In general terms, the creation of a database is not an extreme challenge, but how it behaves and allows for several customized experiences of information is a daunting task – one with major legal implications.

“We want people to have access to their personal information, but we don’t want them to have access to all of their doctor’s notes,” Larkin said. “Another issue is how do we make the information more readable to the patient and the doctor – each with their own needs.”

Larkin believes the database has to be able to hold all information securely, yet allow each individual to have access through different levels of privilege to the information recorded and be able to customize its views in any device.

“The value of this research is in the design and development of technologically efficient solutions that minimize intrusions in the doctor-patient relationship,” explains Kelliher. "Key proposed design innovations include context-aware note-taking and the automated generation of customizable patient-visit summaries."

Kelliher believes that the project's main benefit is a set of EMR software solutions that compliment authentic doctor-patient interactions, in which technology operates as a supportive partner in creating a productive, patient-centered experience.

Kelliher and Larkin have written a short paper describing their research and findings and have submitted it to the 2011 Conference on Human Factors in Computing Systems, a premier event sponsored by the National Science Foundation, Microsoft, Google and Bloomberg.

Their hope is not only for their work to be recognized, but to become players in the future of electronic health records in the United States.