Objective Most electronic health records display historical medication information only in a data table or clinician notes. We designed a medication timeline visualization intended to improve ease of use, speed, and accuracy in the ambulatory care of chronic disease. Materials and Methods We identified information needs for understanding a patient medication history, then applied human factors and interaction design principles to support that process. After research and analysis of existing medication lists and timelines to guide initial requirements, we hosted design workshops with multidisciplinary stakeholders to expand on our initial concepts. Subsequent core team meetings used an iterative user-centered design approach to refine our prototype. Finally, a small pilot evaluation of the design was conducted with practicing physicians. Results We propose an open-source online prototype that incorporates user feedback from initial design workshops, and broad multidisciplinary audience feedback. We describe the applicable design principles associated with each of the prototype’s key features. A pilot evaluation of the design showed improved physician performance in 5 common medication-related tasks, compared to tabular presentation of the same information. Discussion There is industry interest in developing medication timelines based on the example prototype concepts. An open, standards-based technology platform could enable developers to create a medication timeline that could be deployable across any compatible health IT application. Conclusion The design goal was to improve physician understanding of a patient’s complex medication history, using a medication timeline visualization. Such a design could reduce temporal and cognitive load on physicians for improved and safer care.
When reconfiguring the muscle biopsy service at our hospital, it became apparent that the referral form used was inadequate. The clinical information acquired was minimal. The form did not comply with National Coding practice.1The absence of good clinical information could negatively affect the neuropathological diagnosis and income generated by the muscle biopsy service. Therefore, in collaboration with Neuropathology and Clinical Coding, we developed a new form to capture relevant clinical and coding information. To determine the impact of the new referral form, we undertook a quality improvement project.Forty muscle biopsies (2012–2016) were selected at random from the Neuropathology archives. The notes were reviewed and used to complete the new referral form. Using this information, the coding and tariffs were reassessed and compared to those produced using the original referral form. Prospective data from muscle biopsy cases (01–06/2018) were also analysed.Results demonstrated a significant improvement in quality of documentation supplied to Clinical Coding and increased diagnostic usefulness for Neuropathology. Although the new form has significantly helped the Clinical Coding team, with a simpler and more efficient coding outline that has reached National Coding Standards1, it had little impact on the income generated.References‘National Clinical Coding Standards ICD-10 5th Edition 2017 -https://hscic.kahootz.com/gf2.ti/f/762498/27838213.1/PDF/-/NCCSICD102017.pdf
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