redesign of the columbia university infobutton manager james j. cimino, beth e. friedmann, kevin m....

Redesign of the Columbia University Infobutton Manager

James J. Cimino, Beth E. Friedmann, Kevin M. Jackson, Jianhua Li, Jenia Pevzner, Jesse Wrenn

Department of Biomedical InformaticsColumbia University

College of Physicians and Surgeons

Infobutton Manager Redesign

• What is an infobutton manager?

• Why does it need redesign (metrics)?

• What methods were used?

• What happened?

Overview

• Infobuttons – context specific links from one system (clinical) to another (resource)

Overview

• Infobutton Manager (IM) – provides a set of context-specific links

• Infobuttons – context-specific links from one system (clinical) to another (resource)

Overview

• Utilization statistics from log files– Usage – how often is it used– “Selection rate” – when used, how often is topic selected– “Perusal time” – how long does it take to select a topic

• Gold standard: Health Resources (HR) page

• Infobuttons – context-specific links from one system (clinical) to another (resource)

• Infobutton Manager (IM) – provides a set of context-specific links

Overview

• Utilization statistics from log files– Usage – how often is it used– “Selection rate” – when used, how often is topic selected– “Perusal time” – how long does it take to select a topic

• Gold standard: Health Resources (HR) page

• Infobuttons – context-specific links from one system (clinical) to another (resource)

• Infobutton Manager (IM) – provides a set of context-specific links

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Usage through October 2006

Selection Rate through October 2006

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Perusal Time through October 2006

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Methods

• Navigation study of IM version 1

• Redesign of IM architecture

• Redesign of user interface

• Navigation study of IM version 2

• Log file analysis of actual use

Navigation Study of IM Version 1

• Seven typical clinical questions from NLM– One diagnosis query– Two lab queries– Three in-patient medication queries– Three out-patient medication queries– “Does cranberry juice alter the action of warfarin?”

• Subjects shown sample clinical system• Evoke IM version 1• Attempt to answer the questions• Usability analysis software to record sessions (Morae)

Redesign of IM Architecture

• Version 1: CGI returned set of links (HTML)

• Version 2:

– Decouple user interface design from back end

– Support platform-specific user interfaces

Redesign of User Interface• Workflow (clicks): HR=many, IM=2• Aesthetics: similar font, color, graphics, layout• Efficiency:

– Scanability– Concise language– Keyword menus and buttons– Design consistency– Memorability (easy of reestablishing mastery)

• IM version 1:– Many concepts– Questions vary with concept and context– Questions are lengthy– Scrolling often required

Navigation Study of IM Version 2

• Repeated method used to study Version 1

Log File Analysis of Actual Use

• Logfile provides record of clicks on:– HR page– Links in HR page– Infobutton icons– Links in IM

• Also provides immediate prior action

• Time stamp, user, IP address

Results

• Navigation study of IM version 1– Convenience sample of six clinicians– Long persual times– Review of sessions confirmed wordiness and

layout inconsistency were factors

• Redesign of IM Architecture: AJAX

• Redesign of User Interface

Results

• Navigation study of IM version 1– Convenience sample of six clinicians– Long persual times– Review of sessions confirmed wordiness and

layout inconsistency were factors

• Redesign of IM Architecture: AJAX• Redesign of User Interface• Redesign of User Interface: scanability,

conciseness, keywords, consistency

• Navigation study of IM version 2

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IM-2 IM-1Time in Seconds

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Perusal Times in Navigation Studies

Results

• Navigation study of IM version 1– Convenience sample of six clinicians– Long persual times– Review of sessions confirmed wordiness and

layout inconsistency were factors

• Redesign of IM Architecture: AJAX• Redesign of User Interface: scanability,

conciseness, keywords, consistency

• Navigation study of IM version 2• Log file analysis of actual use

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Usage through October 2007

Selection Rate through October 2006

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Perusal Time through October 2006

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Perusal Time through October 2007

Average IM and HR Monthly Statistics

Time PeriodNumber of Uses (SD)

Selection Rate (SD)

Perusal Time (SD)

IM-1 1/06-10/06 1937 (250) 46.3 (2.5) 14.8 (1.4)

IM-2 11/06-2/07 1789 (154) 46.9 (2.9) 14.5 (1.5)

HR 1/06-10/06 5887 (268) 88.4 (0.9) 6.0 (0.5)

HR 11/06-2/07 6272 (535) 88.6 (0.5) 5.7 (0.4)

Usage in Lab Contexts

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Usage in Out-Patient Drug Contexts

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Usage in In-Patient Drug Contexts

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Usage in Diagnosis Context

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Usage in Lab Order Entry Context

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Usage in InPat Drug Order Entry

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What Happened?• IM version 1 had a lower success rate and

higher perusal time than the HR page• This was confirmed in the laboratory• Inspection of the user interface showed

several possible problems• IM version 2 appears, on inspection, to

address the observed problems• This was also confirmed in the laboratory• The field experience did not confirm the

laboratory experience

Why Did This Happen?

• Execution time adds a few seconds• The HR page is static, while the IM is, by

definition, dynamic• IM uses a different paradigm (pull-push)• Results varied by context, but not user type

or level of experience• Actual users are different, however

Users of HR vs. Users of IM

HR3: 1408 IM3: 715

HR<3, IM<3 1160

248

Total Users 1/07-10/07: 2933

Now What?

• Educational e-mails• New user interface may improve question-

answering time• Observational studies may be the only way to

identify the rate-limiting step• IM approach remains more efficient• Users prefer IM over HR in some situations• Version 3 (thanks, AJAX!)

Conclusions

• Good user interface design principles work

• Laboratory experience may not reflect reality

• Users do invest extra effort

• Selection rate and perusal time are not the only metrics of success

Acknowledgments

This work was supported in part by National Library of Medicine Grant R01LM07593.

The authors thank the test subjects for their time and effort.

The authors also thank Dr. Rick Gallagher for providing the log files.