Task-specific authoring functions for end-users in a Hospital information System

computer methods and programs in biomedicine

ELSEVIER

Computer Methods and Programs in Biomedicine 48 (1995) 1455150

Task-specific authoring functions for end-users in a Hospital Information System L. Gierl, M. Feistle, H. Miil.ler, K. Sliva, D. Varnholt, Data

Processing

Cerme,

Medical

Famlty,

Unifiersity

qf Mukh.

Mmich,

S. Villain Gerrrzarz?,

AbstracfAuthoring functions ~ integrated in a Hospital Information System (HIS) - provide a means for physicians and nurses to adapt partly their man/machine interface. We successfully implemented task-specific authoring functions that enable end-users to comprehend and structure a large body of multimedia documents, to focus attention during medical decision making, to speed up medical tasks and to standardise the drafting of documents. Key;zartis:

Hospital

information

system; User interface

1. Introduction NIost. functions in a HIS have to compete with the feeling of many users that hand-crafted work

is an easier and faster way in doing their daily medical tasks. Many people have learned to deal very efficiently with repetitive tasks in wards and outpatient clinics. They have developed the ability to fmd necessary information quickly from a bulk of data, note events or facts on a sheet of paper in an indvidual manner. Therefore, it is not only necessary to provide functions in a HIS to support medical tasks with a graphic user interface, but also to provide the user with tools - author-

* Corresponding author.

ing functions ~ which allow hirn to adapt the user interface to the task-specific requirements. Then the advantages of computers such as performance, storage capacity, connectivity, accuracy etc., are more convincing for sceptical or anxious users. A second problem arisesfrom the man/machine interaction itself [l]: ‘When a human user has to interact with a computer system, he needs to develop a mental model of the system. This model is the source of the expectation the user has about the effects of his actions towards the system and the reaction of the system to his behaviour.’ Authoring functions enable the user to formulate the reactions. Winograd and Flores [2] stressthe more general background of this problem. Applying an i.dea of the German philosopher Heidegger. they

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Fig. 1.

User interface

of the tree structure of multimedia documents (screen dump in German).

argue that people are ‘thrown’ into the world (here the medical world). By doing something, people become aware the world. Acting in the world is accompanied by expectations of the worlds behaviour. If these expectations are violated {e.g., simply by a failure situation in man/ machine interaction) then people encounter a ‘breakdown’. They are confronted with event,3 from a world that they are not familiar with. This is typically a situation in a HIS environment where the computer system reacts in a way that is beyond the medical and organisational world of a physician. or a nurse. Authoring functions make possible the design of a familiar world of task-specific man./machine interactions. Task-specific, because the end-user is focused on his concrete medical task rather than being able to formulate abstract general processes.

2. Authoring functions for end-users

Authoring functions in a HIS must be distinguished from authoring systems for tutorial purposes such as BRAIN-WORK II [3] or StackMaker 141. Authoring functions in a HIS facilitate and standardise the creation and development of an efficient task-specific user interface. They are not complicated tools for professional designers of multimedia projects but, rather, simple means for adapting selected functions by a physician or a nurse. An important component of some authoring functions are templates. A template is a standardised arrangement of various media that allow them to be easily added, changed, and moved in an establi.shed process. Authoring functions are embedded in a 3-level architecture consisting of (I) the model of the user,

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Fig. 2. Authoring

function

to generate

structured

(2) the on-line authoring system and (3) the adapted user-interface. In our HIS (which we call MK.KS, the German acronym for Miinchner Klinik.-Kommunikations-System) we have developed four types of authoring functions covering the following tasks. 1. Comprehending and structuring a large body of multimedia documents. 2. Focusing of attention during medical decision rnaking by defining user-profiles for visual presentation. 3. Speeding up medical tasks by defining userprofiles for order entry 4. Standardising and increasing efficiency in producing documents by generating document templates

multimedia

documents

3. Comprehending documents

(screen

dump

in Gern.an).

and structuring

of multimedia

Our system BEST has been implemented as part of the MKKS to form a ward- or clinic-specific body Iof multimedia documents. This includes nursing istandards, instructions for order entry, guidance for appointment of patients in ancillary systems such ;as radiology, legal rules, information about preparations of patients undergoing diagnostic or therapeutic procedures, etc. In short, BEST should (comprise all information in a war’d that has been #distributed in the minds of specialists, senior staff members, by various notices posted on the wall, etc., in a well structured and easily accessible way. An example in Fig. 1 shows the tree structure of the access to the documents. Each leaf of the tree is a

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Fig. 3. Authoring

function

to define

pointer to a multimedia document, a text, a graphic, an image, a video sequence. Fig. 2 shows the authoring function corresponding to Fig. 1. The end-user has functions to ad’d new nodes, to delete nodes, to extend or change items. in each node of the tree of documents. The scrol’iable window on the right side provides editing of the window on Fig. 1. BEST enables the integrati’an of all callable external software. It is only necessary to assign a shorthand name like ‘msw’ for Microsoft Word to the program to call. In thlz right window each document is connected to the appropriate program which has been used to generate it. Until now users have generated some hundreds of documents structured in BEST. 4. Fo~cusingof attention during medical decision making by defining user-profiles for visual presentation Especially results of clinical chemistry form a

user profiles

(screen

dump

in German)

large spaceof information about a patient. Instead of browsing through many sources for this information, most physicians like to focus their attention on typical ward-specific or disease-specificsets of clinical-chemistry methods. Fig. 3 depicts an authoring function for defining user profiles of results of clinical chemistry. The user chooses a domain (‘Kategorien’ in Fig. 3) such as serum chemistry or endocrinology and selects those attached methods (‘Verfahren’ in Fig. 3) which he wants to assign to an user-profile (‘Verfahrensa.uswahl’in Fig. 3). Fig. 4 shows the corresponding example of the presentation of this profile. 6. Standardising and increasing efficiency in drafting documents by generating document templates This authoring function enables a user-directed flexible integration of text modules, icons and pictures as static elements into a textual docu-

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Fig. 4. An example

of the focused

ment. The user has to mark static elements from a set of available elements for integrating them into a document template on the spot where he wants it. Dynamic elements are variables of a medical record in a SQL-database. Variables are inserted freely by the user as # variable-name # labels. Qur end-users have generated dozens of such templates, because we are far from the dream of a paper-less hospital. One step towards this dream is to draft documents in a standardised and efficient manner accessing data partly from a medical record. up of medical tasks by defining user5. Speeding profiles for order entry The main purpose of user-profiles for order entry is to speed up and structure highly repetitive tasks in daily medical practice. For instance, order entry for supply goods is easier if the user is able to generate typical sets of goods he wants to

presentation

corresponding

to Fig. 3

order. This is accomplished by functions for searching and selecting supply goods in a large catalogue or a sub-catalogue. A sub-catalogue contains those goods which have been stored in a special cupboard or compartment in a ward or operating room. 6. Discussion We observed, on the one hand, that users need little or no training in employing the described authoring functions. On the other hand, we had to realise that collecting and selecting relevant objects which should be included in the authoring functions is a time-consuming process. Finding an agreement with the staff involved is an especially tedious task. One important advantage of authoring functions is that the user himself is able and motivated - to a certain degree - to decompose, formulate and structure medical knowledge and medical tasks.

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Our e.xperiences show that - in the long run -- to develop authoring functions is a more effective way than building a system where adaptation is accomplished by declarative knowledge in tables. One problem, however, is that the adaption process is not centrally guided. Instead, the ‘emancipated’ user is able to use the HIS in an unexpecl.ed way - for the developers. We feel that this kind of user could contribute to saving time and money in a hospital adapting computer supported functions to his individual requirements

in Biomedicine

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7. References [I]

G.C. van der Meer, R. Wijk and M.A..M. Felt. Metaphores and Metacommunication in the Development of Mental Models, in Cognitive Ergonomics, ed. P. Falzon, pp. 133-149 (Academic Press, London, 1993). [2] T. Winograd, Flares. Understanding cognition in man and machine (Addision Wesley, Reading, 1987). [3] J. Vavrina, A. Stettbacher. A. Wegmiiller and P. Stucki, Demonstration of computer assisted instructional media with Brainwork II Professional, in MEDINFO 92, eds. K.C. Lun et al., p. 1126 (North-Holland, Amsterdam. 1992). [4] M.R. Kidd, G.A. Hutchings, W. Hall and B. Cesnik, Hypermedia applications in medical education, in MEDINFO 92, eds. K.C. Lun et al., pp. 1095--l 100 (North-Holland, Amsterdam 1992).