Monday, July 02, 2007

Medical Informatics Developers and Medical Experience..

Back in Cairo Months ago , I tested and tried some EMRs , HMRs ...some are developed by Freelancers and the Others Developed by programmers from IT Universities , the first look at those software which supposed to handle the Medical Records and provide us as ( Doctors , Researchers and Medical Related ) with needed Medical Records , Data ... I find most of the software are missing a lot of urgent Needs which save us time, in search, and record .... Backup Feature sometimes was good, but otherwise was a mess ..... a lot of the software users didn't get training for all the software they were using, and how to handle the Data Flow, and Input/output options ...... but some of them already got some training , but the Training was for the common daily use features not for Hidden features as well as Software Configuration ...

Some of those software was Complete Mess in Interface design ( Lack of Features or Too Much Features added ) ...... sometimes the Users (Doctor , Nurse , Researcher ... ) feel Confused , Too Much options , Lack of Customization , heavy Interface full of Unnecessary/Unusable stuff ......

Of course , You might say that the cause is the lack of training they got, and the User could be familiar with Interface ( any interface ), but it seems to me it's about Customizations of the Interface for the Users and the needs ...I believe standards of software's Interfaces should be applicate in medical software as well ,

... after some discussion with Dr. Moaaz months ago I have to take 2 looks at those types of software, first look as a User Doctor , second look as a Developer, and trying to understand the Importance/Use of Medical Data and Data Flow as a Researcher .. That's why I wrote 2 articles about that : " Features of Successful EMR software " and " Standards for Evaluation of Medical Records software " ...i'll try to add them soon.


-Interface :
Developer's opinion and Doctor's Use : 2 types of interfaces I noticed and they were too radical in my developer's opinion , and too confusing in doctor's opinion (user) :
1-Too Much Features, Gathering in the same interface, with the daily needed and uncommonly needed features.
2-Small simple Interface with the Basic Need of the software ... the other features are listed in the program menu panel

Extensive Use of Forms/Frames : using of forms was extensive ( sometimes ), sometimes the need for small info or doing small action getting into 3 or 4 forms.
Work in it as it is : Interface Customization : never got that interest by most of the developers, that would be helpful for some users, to collect and arrange the daily needed features in the interface.
(Forbidden Features ) : I see but i can't get / I click but it doesn't work , sorry this feature is only for the admin : Sometimes I get the meaning that I am neglected as a normal user, I can't use 20 to 30% of features I see in the interface as I am just a User ... so why the need for these forbidden features in the user interface ?!! ( Q for the developers ).

When I was in self-study mode studying the Software Interface Design : I recognized the simple common Interface with commonly Traditional Menus ( Menu bar , Tabs , Buttons Menu , Features Menu ) was easy to get Familiar with and dealing with the software features as It's easy to find what you are looking for .... regarding the Freelances EMRs with the unique Interface designs, which definitely need training, help, tutorials to help the user to be familiar with the software ...

-Search ( for Patients , events ) :
Basic Search : This Search type aims at getting the Data of the Targeted Data by name ( No Spell Checking and correction ) .

Expanded Search and Advanced Search Features were really disappointing ... lack of Search Features might be caused by the developer focus on the Data Input and about more than finding these data or specific data ...

Search Parameters and Search Tags : from over 40 software : I get only 2 softwares which focus on the Usability of specific data and using it as Tags or anchors for search .... and using this "Tags" to classify and arrange the Data ...

The developer should Differentiate Between Statistical Search and normal User Daily Search .... and make special user Privilege for the Statistical Search , which I never notice even for the software which consider the Statistical Search .

-Statistics :

Statistical Data and Data Analysis : Huge amounts of Medical Data and Medical Related Data are so important in Medical Statistics, and that reminds me of one of my teacher's opinion about an EMR software " Why I should Extract ( Export ) the Data then Analyze it in other Program , to Get My Statistics ? "
and my Question is : the user of an EMRs software mostly doesn't need the Statistical Data and Data Analysis , but some people do , so Why the developers didn't use User privileges to get That Statistical and Data Analysis Operations working , under super user Permission ?!!

some other thinking : Exporting the Data in Spreadsheets files ( Comma Separated Value (.csv) , Microsoft Excel (.xls) files and OpenDocument Spreadsheet (.ods) )... then using it in another softwares.

Medical Statistics and Medical Data Analysis are very Important for Medical Researchers as well as Pharmaceutical Companies.

-Security :
Security for Patient Info is Necessary, to Protect the Patient Details and provide Privacy for Medical Data under the general law of medical Profession ...
Most of the software I've seen are completely lack of security , especially when it comes to my geeks side , sometimes under the basic Techniques I find it easy to extract the Non-Encrypted Data ... but that's was in some basic EMRs.
some more basic ones already got no access password and sometimes without any user system at all..

of course there are Great ones taking care of this Security matters ... and Data Encryption , but The Great Extra Feature I've ever seen is Encryption of the Backuped Data ...

-Users levels - Users privileges :
at Forbidden Features Interface Section : I recognized many of EMRs Systems never care about User levels and Privilege and deal with the system as one Block , sometimes for one level of users ( even there is Multiple users level ) , and single one Interface even there is users level and many privileges , ( Why there is unused - inactive features ( Forbidden features ) for the normal daily users ? as (Backup ,Configuration , Encryption , Security ..etc )

User supposed to work with this EMR ? who ? and what are their privileges?? The Daily User should not get an access to Statistical Data or Statistical Search ..

-Software Compatibilities , Operating System , and Other Software Compatibilities and Dependencies :
In Pre-Alpha (and/or Pre-Beta) Testing the Developer/s should get the first error and Compatibility debugging reports , letting the User get the first hits of errors never was good idea ...

-Backup (DB Backup and Configuration Backup) :
Using Backup aimed to save the Medical Records Data from being lost ( Human Error , Hardware error , Software error , Operating System Crash ) .

Two types of DB Backup system we got so far :
1- Same Species ( Same software ) special backup system dedicated to this special EMR Using special Encrypted Files , can be used only by this software.
2- International Backup , Using Spreadsheets files ( Comma Separated Value (.csv) , Microsoft Excel (.xls) files and OpenDocument Spreadsheet (.ods) )...International File Backup System : can be imported in Statistical Analysis systems .....

Saving The Backups :
1. Hard Copy : Burned to CD/DVD or Copied to Movable Drive ...
2. Uploaded and Saved to Web servers ...

-Communication :
Communication is a major Needed especially in Hospitals and Research Centers , definitely when this EMR is working on Network mode for Multiusers and for many related departments (as ex. Surgery , Radiology ) , Communication Between the Users should also consider the Data Transfer Mode ....

-Training :
Lack of Training among all these EMRs was the common disadvantage , I notice , Confused User has to deal with the Interface ( simple or Complex ) with amount of Features ( low , or Too Much ) as well as configuration / re-configuration of the system or Backup of his Data ....
Documents , Help files , FAQs , sometimes were great , but the developers could save time if they considered the Training could save the User Time .

-Development and Experience :
As result of lack in medical Experience most of the developers ,produce insufficient software with , sometimes with lack of features , or missing the points of our daily medical use ...
The aim of this topic is to provide the developers /project's Directors and sometimes at the hospital to know the medical need and experience the medical reality themselves to help us gaining time not loosing it ..

Dr.Hamza Emadeen Mousa


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