I always like to gather insights from practicing clinical informaticists, whose job puts them at the crossroads where health IT and care delivery meet. I particularly like doing so when they find a way to share these insights in a user-friendly way. For this reason, I was delighted to discover a recent blog entry by Dirk Stanley, a board-certified hospitalist and informaticist who serves as CMIO for UConn Health. (Side Note: Check out this amazing story of Dirk Stanley during 9/11)
In this article, Dr. Stanley explains why it’s important to give careful consideration to terminology when managing your EHR. In doing so, he uses some metaphors which get his point across even to people like me who sit in the penny gallery observing what happens in HIT.
Dr. Stanley starts out with a storage image. “Managing an enterprise EMR is a lot like owning a closet,” he writes. “Information is stored in certain virtual ‘drawers’ where people (users) get used to storing and finding the information they need to do their jobs.”
The problem, he notes, is that how and where people store information is an intensely personal, cognitively-driven process. “If you have ever had to share a closet, you probably know how challenging it can be…” he says. “Now, imagine having to share a closet with 500 people.”
To dive deeper, he says, the first step would be to get all 500 people in a room and figure out where to keep the socks, the pants, the shirts and what have you. The people involved will end up making final group-based decisions.
The thing is, some people will end up being hired after the group makes these decisions and won’t have much context on how the information storing system works. To accomplish this, he says, not only will you have to have an easily-identifiable pattern for your information storage and retrieval but also label things correctly.
How can we do this? To illustrate, Dr. Stanley switches metaphors. By way of framing his argument, Dr. Stanley starts by literally looking at apples and oranges. He notes that in a terminology hierarchy, both could be part of a high-level concept “fruit” which can then be divided by the two lower-level granular lower-level concepts “apple” and “orange.”
The next step in structuring the data is to group the apples and oranges and specify how they relate to each other, Stanley says. One way to do so is to label the apples as “fruit’ and the oranges also as “fruit.” Then, the organizer could put all apples into a container known as “box of fruit” and all oranges into another container, also designated as “box of fruit.” This obviously leads to confusion among those who seek only apples or only oranges.
In another scenario, the apples will be grouped into a container labeled as “box of apples” and the other as “box of oranges.” Under these circumstances, it’s obviously easier for people to find which one of the two fruits that they’re seeking.
The lesson to be taken from this analysis is that when organizing information in an EMR, it’s important to understand and anticipate what the user is looking for, as well as the clinical terminology and associated hierarchies, Dr. Stanley concludes.
Another simple but powerful approach suggested by this analysis is that information designers should call things what they are. In other words, it’s going to be better to call an orange “orange” rather that group it with apples in a box labeled “fruit,” he says.
His overarching conclusion: “Especially when storing a large number of items it’s helpful to understand the clinical role, the clinical context, the clinical terminology and the higher/lower level concepts to identify the right term to label buttons in your EMR, for maximum efficiency and less clicks.”
In this case, better individual fruit baskets than a fruit salad.