Interactive Visual Displays for Results Management in Complex Medical Workflows

Abstract

Clinicians manage medical orders to ensure that the results are returned promptly to the correct physician and followed up on time. Delays in results management occur frequently, physically harm patients, and often cause malpractice litigation.

Better tracking of medical orders that showed progress and indicated delays, could result in improved care, better safety, and reduced clinician effort. This dissertation presents novel displays of rich tables with an interaction technique called ARCs (Actions for Rapid Completion). Rich tables are generated by MStart (Multi-Step Task Analyzing, Reporting, and Tracking) from a workflow model that defines order processes. Rich tables help clinicians perceive each order's status, prioritize the critical ones, and act on results in a timely fashion. A second contribution is the design of an interactive visualization called MSProVis (Multi-Step Process Visualization), which is composed of several PCDs (Process Completion Diagrams) that show the number and duration of in-time, late, and not-completed orders. With MSProVis, managers perform retrospective analyses to make decisions by studying an overview of the order process, durations of order steps, and performances of individuals.

I visited seven hospitals and clinics to define sample results management workflows. Iterative design reviews with clinicians, designers, and researchers led to refinements of the rich tables, ARCs, and design guidelines. A controlled experiment with 18 participants under time pressure and distractions tested two features (showing pending orders and prioritizing by lateness) of rich tables. These changes statistically significantly reduce the time from nine to one minute to correctly identify late orders compared to the traditional chronologically-ordered lists. Another study demonstrated that ARCs speed performance up by 25% compared to state-of-the-art systems. A usability study with two clinicians and five novices showed that participants were able to understand MSProVis and efficiently perform representative tasks. Two subjective preference surveys suggested new design choices for the PCDs.

This dissertation provides designers of results management systems with clear guidance about showing pending results and prioritizing by lateness, and tested strategies for performing retrospective analyses. It also offers detailed design guidelines for results management, tables, and integrated actions on tables that speed performance for common tasks.