Facebook-like EMR (Part I)

In 2008, Bob Watcher wrote an article called “Why the medical record needs to become more like Facebook” which lay down the idea of having the social network as the mirror for a new Electronic Medical Record (EMR) User Experience (UX). A collaboration and social framework to provide better patient care while keeping useful information between physicians and nurses.

He was not the only one; already in 2007, Robert Nadler established a high-level model remarking on the core functionalities that it could have EMR software. However, it was not intended to get only a Facebook-like UI but a real social site to connect Patients and Doctors.

The idea is not new; many authors - doctors and software engineers - have continued talking about this idea with no final proposal.

After the latest Facebook re-design I don’t know if those authors would still maintain the same opinion about this topic, anyway I do think it’s a very very interesting approach even assuming any usability issue that Facebook could have. So here are my two cents.

A Design Proposal

Users & Profiles

If a clinical solution would need to completely work like Facebook, every user (physician, nurse, etc.) would have their own user profile. However, the analysis of having an EMR looking like Facebook timeline suggests that the profile page is planned to show only patient data. Why would we need to see a nurse profile, then?

Following this idea, the Home page would be reserved for (primary) users and the Profile pages for showing the electronic medical records of patients (secondary users).

A possible extension would be allowing access to the EMRz by Patients, so they could also check their own EMR online by themselves. In this case, we could consider them as secondary users, not as part of the network community, but just to contribute to their own medical history and keep a direct communication between them and their care providers.

Social network

Social activity will be generated by clinicians considering patient-centred documentation based on Profiles. As suggested before, there are two main social groups: the one created by clinical staff only, and the one where patients and clinicians would interact.

Social interaction is the key point of this proposal and it underpins the main usability goals:

• Meaningful use
• Engagement
• Collaboration
• Simplification
• Productivity

Profiles: Patient Timeline

Facebook profile pages have been re-design to look more like a real timeline where any important event is chronologically displayed. In this example, the right side will be used to show a summary of the most important event types associated with the patient medical history like Health issues, Allergies, Diagnosis, Requests and Results, Progress Notes, Prescriptions and any other clinical subject. On the left side, any user (doctor, nurse and patient) could add comments anytime.

Privacy

Privacy should have a strong presence here, since having restricted-access data is a valuable feature that doctors, nurses and patients have. They all will need to control the visibility of the data they enter in a fashionable way. Although setting permission on Facebook is pretty hard and unclear to get control about which type of users see which type of patient data or personal comments is still a requirement. This could be done by seeing users by their role, applications as domains, and groups as teams. Still, patients are a special kind of user who will have direct access to their own records.

Utility

There’s a weak line which separates the Facebook familiarity advantage into the most confusing UI for a productivity tool and it’s called “enjoyment”. The idea of this Facebook-like EMR was to promote some typical behavioural patter of users when interacting with a social network like:

• Safe Exploration
• Microbreaks
• Habituation
• News Stream
• Other people’s advice
• Personal Recommendations

However, there are some other existing activities that the clinical staff usually does and this UI is not oriented to

• Changes in Midstream
• Keyboard only
• Streamlined repetition activities

Nevertheless, the app integration approach of Facebook suggests this becomes a good exercise to imitate outside the UX field.

Content

The content is not about what people think or feel, but what physicians and nurses make, diagnose, treat or provide to patients. The language of the user interface should be adapted to the purpose in order to ease the kind of content expected to be entered.

Data entry is one of the most challenging features in healthcare apps. The smarter the application, the quicker the data is entered. The whole philosophy of Facebook putting attention to every single detail should be adopted also to create content such as vital signs, prescriptions, soap notes, or a discharge letter. As an example, below there’s a list of content with different natures which depends on the context of use, the user role and the business model.

• Task-Oriented
  • Notifications
  • Lists of patients
  • Lists of tasks
  • Scheduled activities
  • Events
• Content Oriented
  • Patient history summary
  • Patient evolution
  • Patient current health status and diagnosis
  • Clinical decisions
  • Procedures
• Process Oriented
  • Treatments
  • Protocol-based care planning
  • Admissions and discharge
  • Scheduling
  • Follow-up

What’s next

This is only the first part of the exercise. For the second part, I’ll try more mock-ups and the high-fidelity prototype adding more details also in the content used in this sketch to get a better idea about how crazy (or not) the proposal of being inspired by Facebook to create an electronic medical record.

There’s also an important gap where Facebook has no direct answer: clinical safety and episode-related information. We’ll talk about it also for the next post.

By now, how realistic do you think it is?