3 Figure 1 shows the basic geometry. CSS techniques provide highlighting of the left Menu entries on a mouse-hover event. CSS rules place border lines around system messages, such as the instruction box shown in the Content area. The user in this case, Mark, has Billing Rights and Administrative Rights as indicated by the B and the * at the top of the Menu. The Menu is dynamic; adding and subtracting options depending on both user role and context. For example, if the user is positioned on a Patient Visit, the Menu will provide Billers with an additional option to format and print an insurance claim form (the HCFA-1500 form). Design Goals of PedOne The IEEE MPTC E-Book (Jepsen et al., 2006) mentions functional and semantic interoperability as a key goal of the NHIN. They are also an important deliverable of PedOne. The functional piece is trivial for electronic systems; it simply means recording form fields and retrieving them without error. The semantic portion is more challenging. Simply put, there are numerous coding standards that confront the practice staff. Two of the major code families are the ICD9 (International Classification of Diseases, 9 th Revision) for diagnoses and Current Procedural Terminology (CPT) for procedures (exams, medications, supplies, treatments). These codes change over time, and are essential for patient record keeping, billing, and insurance claims submission. Semantic interoperability means the users have to successfully interpret the coded information in the system session. However, the American Medical Association (the keeper of the official CD-ROM ICD9 and CPT distributions) has extremely verbose code descriptions that are of little use to the practice staff. Only the code is necessary for billing and claims; but the description helps sense-making efforts during the data input. Thus it is important to give the users an easy way to edit code descriptors and have the new, simpler descriptors made immediately available in the online forms. Figure 2 shows an example of this (Menu, Header and Footer omitted to save space). Figure 2. Friendlier ICD9 Descriptors
5 the user and provides a link to clear them and start over. The goal here is to reduce the cost structure of information (Card, Mackinlay, and Shneiderman, 1999) by pre-populating fields as much as possible and hiding little-used fields. The net effect is faster data throughput to the internal accounting system, freeing the biller for other tasks. Graphing The open source graphics library GD is used to produce Portable Graphics format images (PNG) for Patient Height-Weight Plotting. Electronic plotting takes the place of the nurse having to manually plot on graph paper which is an error-prone process. Lowering the error rate improves the quality of the EMR and ultimately, patient care. As one might expect, this is a stated goal of the NHIN (Jepsen et al., 2006). Scheduling Patient Visits One of the most important modules is the Scheduler.In this screen, the doctors are organized by column in the Content section, and patient visit types are represented by various icons. For example, a well-visit is shown by a heart icon and a sick visit is a patient with an IV bottle. A sample day is shown in Figure 4. Figure 4. The Scheduler Day View.
7 Figure 6. The Patient Search Uses the AJAX Technique In Figure 6, I typed Test and the system automatically fetched all patients whose names start with Test. Two actual patient names and the primary care physician are blanked out for anonymity. The completions are placed in an inline XHTML element called an IFrame. This is a very useful interface technique, but one must be careful with long auto-complete lists. They may shift or obscure the standard Content and Footer components. The solution is to limit the maximum completions in the backend script that was invoked when the form field Last Name changed. The interface consideration here is to strive to avoid unexpected visual effects and thus avoid user consternation. Also shown in this Figure is a standard CSS-defined Instruction box. Color rules are used to simplify the user help display. Another interface consideration is to daisy-chain likely event sequences. Thus Schedule (to make an appointment) and Edit (to change patient or custodian information) are both hyperlinks in the auto-completion list. The Doctor Sick-Visit Interview The authors worked closely with the doctors to design a sick-visit interview form. It is highly tailored to pediatric practice, with domain specific prescription hints (for example, dosage per kilogram) and other granular input areas. An excerpt of the sick-visit form is shown in Figure 7.
9 ACKNOWLEDGMENTS (OPTIONAL) We thank the staff of Orange Grove Pediatrics for giving us unlimited access to the doctor, nurse, and front-office staff for system iteration. REFERENCES 1. Anonymous (2006). State of the Union: Affordable and Accessible Health Care, Office of the White House Secretary of the Press. Electronic Source, accessed 2/21/ Anonymous (2005). Interoperability for the National Health Information Network. IEEE-USA Board of Directors Position Statement, 11/15/05. Electronic Source, accessed 2/21/ Baker, M. L. (2004a). Is Lack of Coordination Hurting Health IT? eweek Enterprise News & Reviews, Ziff-Davis Internet, electronic source, accessed 2/21/ Baker, M. L. (2004b). Doctors Seek Guidance on Electronic Records. eweek Enterprise News & Reviews, Ziff-Davis Internet, electronic source, accessed 2/21/ Baker, M. L. (2005). Physicians Use of EHRs Doubles but Remains Small. eweek Enterprise News & Reviews, Ziff- Davis Internet, electronic source, accessed 2/21/ Broder, D. S. (2006). Hope for Health Care? HHS's Leavitt Sees an Opportunity in New Orleans. Washington Post, February 23, Page A Bell, T. E. (2005). Medical Records: From Clipboard To Point-and-Click. IEEE Institute. 12/1/05. Electronic Source, nline/legacy/inst2005/dec05/12w.fmedical_records.xml accessed 2/21/ Card, S. K., Mackinlay, J.D., and Shneiderman, B. (1999) Information Visualization in Readings in information visualization: using vision to think, pp. 1-34, Morgan Kauffman, San Francisco. 9. Garrett, J. J. (2005). Ajax: A New Approach to Web Applications. Electronic source, accessed 2/21/ Jepsen, T. et al. (2006). Interoperability for the National Health Information Network. IEEE-USA E-Book, developed by IEEE-USA s Medical Technology Policy Committee Interoperability Working Group. Available via accessed 2/21/ Lawrence, S. (2006). Intel s Barrett: Health IT is a Necessity. eweek Enterprise News & Reviews, Ziff-Davis Internet, electronic source, accessed 2/21/ Meyer, E. (2003). Eric Meyer on CSS: Mastering the Language of Web Design. New Riders, Berkeley, CA. 13. Mosquera, M. (2006). HHS lays out a plan to have e-health records on the table by next June. Government Computer News. Electronic Source, accessed 2/21/ Zeldman, J. (2003). Designing with Web Standards. New Riders, Berkeley, CA.
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