microsoft health patient journey demonstrator › a389 › 0d8806032c95... · microsoft health...
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Technology report
Microsoft health patient journeydemonstratorKirsten Disse PGCHE MAUser Experience Consultant, Microsoft Campus, Thames Valley Park, Reading, UK
Introduction
The MSCUI programme, developed by Microsoft and
the NHS, was born out of the need to standardise
display elements to promote patient safety and clinical
efficiency. It creates guidance and controls designed to
increase patient safety and clinical effectiveness through
consistent interface treatments (Box 1).1
The MSCUI patient journey demonstrator isfounded on MSCUI patient safety principles2 (Box 2)
and combines outputs from the MSCUI programme
with clinical functionality, excellence in user interface
design and new Microsoft technologies to offer en-
hanced visualisation, understanding and engagement
with clinical data. The demonstrator looks to the
future, is speculative and is designed to promote ‘the
art of the possible’.Assimilation and interpretation of clinical data,
often from multiple sources and in different forms,
underpins the clinical decision-making process. In
creating the demonstrator, we are also taking advan-
tage of modern technological visualisation capabilities
ABSTRACT
Background As health care becomes more reliant
on electronic systems, there is a need to standardise
display elements to promote patient safety and
clinical efficiency. The Microsoft1 Health Common
User Interface (MSCUI) programme, developed by
Microsoft and the National Health Service (NHS)
was born out of this need and creates guidance andcontrols designed to increase patient safety and
clinical effectiveness through consistent interface
treatments.
Objective The Microsoft Health Patient Journey
Demonstrator is a prototype tool designed to pro-
vide exemplar implementations of MSCUI guidance
on a Microsoft platform. It is a targeted glimpse at a
visual interface for the integration of health-relevantinformation, including electronic medical records.
Method We built the demonstrator in Microsoft
SilverlightTM 2, our application technology which
brings desktop functionality and enriched levels of
user experience to health settings worldwide via the
internet. We based the demonstrator on an easily
recognisable clinical scenario which offered us the
most scope for demonstrating MSCUI guidance
and innovation.
Output The demonstrator is structured in threesections (administration, primary care and secondary
care) each of which illustrates the activities asso-
ciated within the setting relevant to our scenario.
The demonstrator is published on the MSCUI
website www.mscui.net
Conclusion The MSCUI patient journey demon-
strator has been successful in raising awareness and
increasing interest in the CUI programme.
Keywords: common user interface, health infor-
mation, patient journey
Box 1 Microsoft Health Common UserInterface (MSCUI)
The MSCUI programme, developed by Microsoft
in alliance with the NHS and a growing world-
wide community of healthcare providers and
developers, creates guidance and controls to enable
a common look and feel for patient-critical
clinical information system functions. The over-
all goal is increased patient safety and clinicaleffectiveness, reduced training and support costs
and reduced time and expenditure for healthcare
application developers and their customers.
Informatics in Primary Care 2008;16:297–302 # 2008 PHCSG, British Computer Society
K Disse298
and offering clinicians holistic and enhanced ways of
accessing and assessing patient data.Method of development
The demonstrator describes an end-to-end journey or
care pathway through a specific clinical scenario. A
male patient with a history of essential hypertensionvisits his general practitioner with chest pain. The
consultation is recorded along with observations, the
patient’s clinical history is assessed and he is referred
on to the hospital where an angiogram and angio-
plasty (taking a picture of and then removing the
obstruction in a coronary artery) is performed. This
scenario allowed us to show a complete care journey
and illustrate a proposal for an integrated care recordwhich is patient-centric and in which the transitions
between care settings are seamless. Data can be accessed
and input from all care sources at any point along the
patient journey. The demonstrator is structured in
three sections – administration (see Figure 1), primary
care (see Figure 2) and secondary care (see Figure 3) –
each of which illustrates the activities associated within
the setting relevant to our scenario.An important aspect of our method is the choice of
a tightly controlled dataset. As we were working in a
hypothetical situation, we were able to craft our data
Box 2 MSCUI patient safety principles
MSCUI patient safety principles
1 The correct identification of a patient and the
matching of patients to their care elements.
2 Prevention of patient care handover errors and
safety during transitions of care.
3 Assuring medication accuracy during the giv-
ing of care to a patient.4 Performance of correct procedure at correct
body site.
The MSCUI patient safety principles, created in
partnership with the NHS, are derived from theWorld Health Organization patient safety initiat-
ives, the National Patient Safety Agency, the Joint
Commission 2008 National Patient Safety Goals
and the Agency for Healthcare Research and
Quality.
Figure 1 Administration demonstrator
Microsoft health patient journey demonstrator 299
Figure 2 Primary care demonstrator
Figure 3 Secondary care demonstrator
K Disse300
to tell a very clear and aligned clinical story. This
supported our design and innovation approaches in
illustrating format and content contextualisation of
patient data, such as the ‘consultation dock’ and
‘patient charts’.
We held ongoing workshops and reviews with clin-icians in primary and secondary care to ensure devel-
opment remained focused on clinical functionality,
which we delivered in technologically innovative
ways. With the help of a small team of user experience
and technology experts, we adopted an agile, iterative
design and development process that allowed us to be
highly responsive and productive.
The technology
The demonstrator is built in Microsoft Silverlight 2, a
cross-browser, cross-platform and cross-device plug-
in designed for delivering the next generation of mediaexperiences and rich interactive applications for the
Web.3 We also incorporated its ‘deep zoom’ func-
tionality, which allows users to magnify data extremely
quickly at high visual resolution.
The features of the demonstrator which are attract-
ing clinical interest are as follows:
. Primary care – consultation dock. Working in
conjunction with a configurable timeline of consul-
tations, clinicians can drag individual or groups of
consultations into a docking area for fast and easy
cross-consultation comparison, facilitating trackingof conditions or comparing observations from dif-
ferent consultations over time.. Primary care – patient charts. Observations such
as blood pressure measurements are presented in
chart form, overlaid with related medication and
other observations such as cholesterol levels. Clin-
icians and patients can quickly see a medication’s
impact over time. Includes a scalable timeline, tableview toggle and the ability to show or hide and
reorder the data shown.. Primary care – MedsListView. Medications man-
agement is a key focus area of the MSCUI programme
and this available control embodies verified and
accepted guidance. The MedsListView control pre-
sents medication lists that can be sorted, grouped,
filtered and reordered.. Secondary care – deep zoom. Deep zoom is used
to explore and analyse electrocardiogram data. This
allows users to very quickly see an overview of all
data output and then to zoom into any detailed view,
while maintaining high visual resolution.. Secondary care – angiogram. The demonstrator
presents a selection of angiogram videos to allow
multiple views into an angiogram procedure. These
are aligned with a 3D model of the heart to indicate
the angle from which the angiogram video is taken.
Traditional video player controls, including a drag-
and-drop scroll bar, are incorporated as well as a
magnification and measurement viewer.. Care pathways. Building on well-received work from
previous care pathways demonstrators this offers the
opportunity to manage an entire pathway through a
consistent interface.
Discussion
The demonstrator successfully indicates how future
clinical user interfaces might appear.
Implications for practice
As this is a provocative technology demonstrator and
not an application prototype, there has been no in situ
testing. We are seeking a balance between implemen-
tation of MSCUI design guidance, subject to rigorous
testing and evaluation, and the presentation of new
and emerging concepts yet to be exposed to the same
levels of exploration and scrutiny.
Initial feedback from the online community indi-cates advantages in areas such as rapid understanding
and sharing of a person’s medical history, clinical data
analysis, trending and training. We are particularly
interested in receiving feedback from this journal’s
readership on implications for practice.
Comparison with existing interfacedesign
The demonstrator is a graphically rich interface com-
pared with existing clinical interface design, much of
which is entirely text based.
Limitations of the method
Our small team and very tight timescales meant that
some aspects of the demonstrator received more atten-
tion than others. Some of the limitations of this
approach include:
. We did not illustrate the full end-to-end journey but
only a selection of vignettes of key innovations.. We aggregated and integrated data in a way that has
wider implications for software infrastructure.. We worked with a small, crafted data set.
Microsoft health patient journey demonstrator 301
. We relied heavily on a small number of clinicians
and want to engage a wider group for input.. A full analysis of existing clinical software systems
was not performed in this case. Instead, we relied on
primary research and input from those who have
experience with multiple clinical systems.. We worked with one specific clinical scenario. It is
not clear whether this demonstration would be
suitable for other clinical care settings – clinicians
may require different data displays for differentclinical contexts.4
Call for further research: next steps
We are currently planning the next stage of the
demonstrator project and are evaluating potentialproblems and real-life scenarios to build this upon.
Feedback from the clinical community will be invaluable
in helping to conceptualise and create new ways of
using technology to support safe and efficient care.
Graphical display of clinical information is not a
new concept and much existing work is available for
investigation.5,6 Since writing, the MSCUI programme
has released new guidance7 on the display of graphsand tables which we are now incorporating.
As the demonstrator is designed as a provocation
piece and not conceived as an actual clinical system,
full usability and evaluation has not taken place. Prior
to clinical use additional evaluation would be required
using established techniques.8–11
Conclusion
As an initial experiment, the MSCUI patient journey
demonstrator has successfully attracted interest from
the clinical and technical communities. Innovative
features such as the ‘patient charts’ have inspired new
areas for guidance within the MSCUI programme and
are being refined into downloadable, customisablecontrols for clinical software companies, and anyone
else, to incorporate into their software.
We are moving towards presenting the next gener-
ation of MSCUI guidance in areas such as medications
administration, medication management and clinical
noting. We welcome all feedback and input either via
our discussion forum12 or directly to the project
mailbox.13
ACKNOWLEDGEMENTS
Our principal clinical consultants Dr Shaun O’Hanlon(EMIS), concept and scenario development, and Dr
Sami Omar (cardiology) and the CUI CAPS team.
REFERENCES
1 Microsoft Health. Common User Interface (CUI).
www.mscui.net/
2 Microsoft Health. CUI: patient safety. www.mscui.net/
Introduction/PatientSafety.aspx
3 Wikepedia. Microsoft Silverlight. en.wikipedia.org/wiki/
Silverlight
4 Chan WS, Stevenson M and McGlade K. Do general
practitioners change how they use the computer during
consultations with a significant psychological component?
International Journal of Medical Informatics 2008;77:
534–8.
5 Dayhoff R, Kirin G, Pollock S, Miller C and Todd S.
Medical data capture and display: the importance of
clinicians’ workstation design. Proceedings of the Annual
Symposium of Computer Application in Medical Care
1994:541–5.
6 Musser RC and Tcheng JE. Quantitative and qualitative
comparison of text-based and graphical user interfaces
for computerized provider order entry. American Medi-
cal Informatics Association Annual Symposium Proceed-
ings 2006:1041.
7 Microsoft Health. CUI: methods for displaying tables
and graphs. www.mscui.net/DesignGuide/TablesGraphs
Display.aspx
8 Refsum C, Kumarapeli P, Gunaratne A, Dodds R, Hasan
A and de Lusignan S. Measuring the impact of different
brands of computer systems on the clinical consultation:
a pilot study. Informatics in Primary Care 2008;16:119–27.
9 Benson T. Prevention of errors and user alienation in
healthcare IT integration programmes. Informatics in
Primary Care 2007;15:1–7.
10 Pearce C, Dwan K, Arnold M and Phillips C. Analysing
the doctor–patient–computer relationship: the use of
video data. Informatics in Primary Care. 2006;14:221–6.
11 de Lusignan S, Kumarapeli P, Chan T et al. The ALFA
(Activity Log Files Aggregation) toolkit: a method for
precise observation of the consultation. Journal of Medi-
cal Internet Research 2008;10:e27. www.jmir.org/2008/4/
e27/
12 Microsoft Health. CUI: patient journey demonstrator live!
www.codeplex.com/mscui/Thread/View.aspx?ThreadId=
26807
13 Microsoft Health. CUI. Email contact: mscui@
microsoft.com
CONFLICTS OF INTEREST
None.
ADDRESS FOR CORRESPONDENCE
Kirsten Disse
c/o Microsoft Campus
Thames Valley Park
Reading
Berkshire RG6 1WG
UK
Tel: +44 (0)7903 183 949Email: [email protected]
K Disse302
Accepted October 2008
The MSCUI guidance and controls are freely available for all to use from www.mscui.net
The MSCUI Patient Journey Demonstrator is available at: www.mscui.net/PatientJourneyDemonstrator/
Further information about the Microsoft Health Common User Interface can be found at: www.mscui.net