The Balance of Patient Charts and Medical History as a Needfinding Assessment
What area in the personal health data realm has needs which are not being filled right now?
That was the question posed to our Human-Computer Interaction class at Emory University last Wednesday. I thought it would be great to find a need in the root of personal health data: patient charts. They have been kept by your doctors since the day you were born. While other personal health data is great to keep track of yourself through various apps or other means, one will still go to their doctor at the end of the day as a trusted source of information about your body. I then developed a need-finding assessment to look into the two main facets: patient charts from a doctors perspective and from a patient’s perspective. My goal was to determine areas of satisfaction and dissatisfaction from both parties. The following article will walk you through the four interviews I conducted, the results of those interviews and my analysis.
The Interviews: 2 Doctors and 2 Patients
It only seems fair to interview both doctors and patients when discussing potential needs for patient charts, because charts need to be easily useable by doctors, and potentially easily readable by patients when they have questions about their health. I had the opportunity to interview a nephrologist (a kidney doctor), a dentist, and two college-aged patients who see a variety of different doctors. Each of these interviewees were chosen because of a mutual or direct connection to me. I wanted to gain a variety of perspectives, and so I thought it would be a good idea to talk to doctors who use separate systems to chart their patients’ data. I also wanted to talk to patients who have a variety of experiences, ranging from infrequent contact to frequent contact with their patient charts. I interviewed one doctor and one patient in person due to their proximity to my current location, and the other doctor and patient on the phone because they both reside in Connecticut and Pennsylvania, respectively.
The following is a list of the following questions that were planned for the interviews.
There were times when I chose to ask questions that were not on this list when I wanted to know more about the interviewee’s experiences, nor was every question asked due to time constraints and to not interrupt the flow of the interview.
Charting the Findings
Here are the summaries on each interview:
Doctor 1
Doctor 1 is a doctor of nephrology at Emory’s Midtown Hospital and was interviewed in person this past Thursday morning. He has been interacting with patient charts for 30 years but has been using electronic systems for the past 25. This past October he began using a new system for patient charts, which he has several concerns about. His main concern was with the layout of the program. The program tried to account for as many types of doctors inputting information as possible, and so he is suffering from both information overload and lack of on-screen real estate. He believes that he is savvy with computers, but because he had to start using the new system without any incremental training, he is finding it hard to interact with patient data.
Doctor 1: “Perfect is the enemy of good.”
There were several tensions, contradictions, and surprises throughout this interview. Moments of tension arose as he described the drawbacks of the new system to me, including how the screen split into three or more columns at times making the text cut itself off, how there were too many icons while navigating, and how there were too many colors on the graphs when selecting multiple test results. His voice became rapid and slightly irritated. A notable contradiction arose when he acknowledged the benefits of the new electronic charting system, including how it was faster and incorporated patient payments and billing more smoothly. I was surprised to learn the extremely quick turnover rate in which he had to learn the new patient chart system. This is not the last I would hear of an occurrence like this.
Doctor 2
Doctor 2 is a dentist in Connecticut and was interviewed over the phone this past Thursday evening. She has been interacting with patient charts for 39 years but has only been working with an electronic patient charting system for the past three, and still feels as though she is learning the system. She much more heavily prefers the paper patient charting system over the new system. She points out that it was much easier to see patient information in front of her on paper than it is to click around on the computer, such as medical history, family data, and X-ray charts.
She also was not happy about how she had to click through every individual year when trying to find old records of patients, and how it is hard to hide her own personal notes on the patient so that she can make them feel comfortable. The computer screens in the exam rooms face the patient, and so there is a chance that they will see when she pulls up notes from previous visits about family history and small talk, for example. She would really appreciate having an easier mode of access to the treatments that were done to the patient and an easier way to read her important information such as treatment history and personal notes without dealing with inefficient on-screen real estate.
Her biggest wish, though, is to have a pop-up module that would give her on the job training of the electronic patient chart system while she is using it if she ever needs assistance on certain features. She often likes to search for regular information online and uses Google over 10 times a day. She would really appreciate something like a search bar in the patient chart system, which currently does not exist.
Doctor 2: “[I want there to be] one click and everything opens up … Medical history has to pop up right away.”
There were many tensions, contradictions, and surprises during this interview. Tensions rose when Doctor 2 was discussing her familiarity with the new electronic patient charting system. She seemed upset at how fast they transitioned from paper to electronic, since it was for about three weeks while the office was closed during the height of the COVID pandemic. As a result, she was upset at some of the inefficiencies that still linger around the office when it comes to passing on messages from other doctors and keeping those messages for when the patient arrives up to six months later. The tone in her voice reflected her mood, and at times she would speed up her rate of speech.
She did bring up a contradiction between the paper and electronic patient charting system. She noted how the paper system favored accessibility while the electronic system favored cleanliness in the office. The biggest surprise of all came right at the end of the interview after I was done asking questions. Without being asked, Doctor 2 noted that if she was given the choice, she would not go back to paper charts because of the electronic systems advantage of being accessible from the home and having much more information in one place than a single patient folder could have done. This was very surprising to me because she had spent most of the interview sounding unhappy with the electronic patient chart system and pointing out her displeasures with it.
Patient 1
Patient 1 is a student at Temple University and was interviewed over the phone this past Thursday afternoon. Patient 1 rarely looks at her patient’s chart data unless there is a problem with her prescriptions. Her most recent experience looking at her patient chart involved looking at a digital copy on her doctor’s laptop. She found it to be interesting because they were discussing a specific topic where everything was clearly labeled. When she has questions about her patient charts, she prefers to be with her doctor so that she can ask in person and have a conversation.
Patient 1: “I don’t need to look at my charts … only if something is wrong with my prescriptions”
There were only a few tensions, contradictions, and surprises in this interview. A point of tension came up when Patient 1 said that they do not look at their patient charts very often. I had to find other ways of asking her questions about her experiences with her patient chart two still assess for needs than what I had originally planned. While I did not find any significant contradictions, I was surprised when she stated that during her most recent experience, she did not care to look at the unknown acronyms on her chart and that she does not usually ask questions unless she is sick or trying a new medication. This is surprising to me because I thought that patients usually want to be familiar with the ways in which they are being evaluated and the data that is tracked about them.
Patient 2
Patient 2 is a student at Emory University and was interviewed in person this past Saturday morning. Patient 2 looks at their charts at least twice a year. She sees a variety of doctors throughout the year and goes through many different test results with each one. Usually, she will look at her patient chart with her doctor to talk over the results and to ask any clarifying questions. She prefers to have the doctor with her in person so that her questions can be answered easily whether they are simple or complicated. She has experienced dissatisfaction results if they are labeled in an unspecified range, such as “low,” “medium,” or “high”. Sometimes those labels come next to their numerical counterparts but even then, she still must ask her doctor for clarification.
She would really appreciate it if her patient chart was formatted such that color-coded graphs and charts showing her history across a long period of time were in the middle of the page. Then interpretations from her doctor could be on the side. She would also feel more comfortable if she had access to her test results before her appointments so that she could prepare questions in advance. Her best experience has come when she has come when she has had written information at the bottom of her chart.
Throughout the interview, Patient 2 was very calm and collected. She kept her hands folded in her lap, except when she has gesturing to elaborate on her answers. Her eyes looked up at times while she paused, as if she were reading a copy of her patient chart in the air.
Patient 2: “I just receive the numbers and levels.”
There were also only a few tensions, contradictions, and surprises in this interview. It felt like there was some neutral tension in Patient 2’s answers because she paused very frequently before responding. It felt like she was trying to choose her words very carefully, and the conversation did not flow as smoothly at points. I also paused in-between questions while I was writing my notes and deciding on a course of action, which also interrupted the flow of the interview. I noticed an interesting contradiction when Patient 2 commented on her desire for a doctor’s written annotations and a face-to-face discussion on the data presented in her chart. I did not find any significant surprises from this interview.
Exercises: Empathy Map and “What? How? Why?” Map
The tensions, contradictions, and surprises were found from each interview via an exercise we were asked to do called an empathy map. An empathy map is when one breaks down the things that an interviewee says, does, thinks, and feels so that needs and insights can be drawn out when analyzing the interview. The following image captures an empathy map that was created for Doctor 1’s interview. Similar methods were used to learn the needs and insights from the other interviewees as well.
A second exercise asked of us was to create a “What? How? Why?” map. This exercise focuses on tuning into an interviewee’s movements and gestures during an interview and guides the interviewer to reach for a deeper level of observation. The following image captures a “What? How? Why?” that was created for Patient 2. Similar methods were also implemented for the other interviews where it was applicable.
The Doctor’s Screen Dilemmas and the Patient’s Patience: Assessment of Needs and Insights
From these interviews, I have concluded two overarching problems. Firstly, when patient charts are being viewed and updated by doctors there is a competition for on-screen real estate that strains their eyes and makes it difficult to update patient information. Secondly, a patient’s understanding of their charts is limited to what they can understand in the moment and what their focus is being directed towards.
Some questions remain though. For example, to what extent can containers be pushed together or pop out of the screen and still meet doctors’ satisfaction? What is the proper balance between showing patients what they care about in the moment and showing them too much information? What avenues are best for allowing patients to view their charts and results before or during appointments?
Additionally, I was able to identify a few needs and insights on the patient charting data realm from these interviews. I believe that doctors are in need of spatially efficient electronic patient charting programs, especially ones that are learnable and whose functions are easily discoverable. From the interviews with the doctors, I have gained insight on how little time they had to adjust to new electronic patient chart systems. They work hard every day with hardly any breathing room to gain their bearings on the programs, an essential function for them to track data efficiently.
I believe also that patients are in need of clearer methods of data interpretation both on the charts and from their doctors. I was able to gain the insight that the methods that work for doctor is to interpret patient data may not necessarily work for patients to interpret the same data. I wonder if there is a way to reduce the number of questions via a more quantitative or qualitative presentation of results and diagnoses.
Being very unfamiliar with personal health data research, I was unsure of what to expect going into the interviews. I felt more comfortable as each interview concluded, and after sifting through my findings am much more confident in continuing to address the needs to see if I can come up with the beginnings of a solution for one of the problems mentioned earlier. a lot of information was learned from each interview, not only from the responses of each interviewee, but from their body language and tone as well. Doctors are still going to need to look at a lot of information at once and patients will always have questions, but at least I am more aware of these situations now and I’m ready to help.
Thank you for reading this article! I hope you were able to gain some insights and can think about the kinds of questions you can ask your doctor the next time you have an appointment.
