The EHR TimeBar functions as a high-level overview of the patient record, as a query device, and as an intuitive navigation tool. Each EHR file (event) for the patient is represented by an icon. The set of icons and their labels are displayed in column format on the right side of the screen.
The icons are connected to the TimeBar by vertical lines. Because the vertical lines accurately position each event on the TimeBar, the date of each event is usually omitted in order to reduce clutter.
- I can open and view any file by clicking directly on its icon. While the file is open, its icon is highlighted, orienting me to how that file fits into the larger framework. Also, its exact date displays within the time bar.
- In addition to being able to open a file by clicking directly on its icon, I can also open files in sequence by using the back or forward buttons ( < , > ) in order to step backward or forward along the row of icons.
- Depending on the density of events, I can use the time interval buttons ( 3 yr, 1 yr . . ) below the TimeBar
to change the time scale. I can view earlier or later periods of time by using the arrow buttons ( ← , → )
on either side of the TimeBar. In addition, I can use the sliding tabs below the TimeBar to ‘zoom in’ on a particular time interval.
- The show and hide buttons allow me to display a subset of icons on the TimeBar. For instance, I could choose to display only office visits and consults by clicking the show button and then clicking those two icons from the right hand column.
- The search button permits queries such as: Search procedures and imaging for ‘coronary’. Any file that meets the search criteria would be flagged by a change in appearance of its icon on the time bar.
- The compare button permits selection of more than one file for simultaneous display. For instance, the 2 most recent ECGs could be selected to display on the same screen in order to facilitate comparison.
- If I want to quickly see a summary description without actually opening a file, a mouse-over hover query can be used:
Additional design options:
- Visual ‘bookmarks’ can be used to flag important files for future reference.
- Upcoming health maintenance events such as immunizations and yearly diabetic eye exams can be organized and displayed.
- When not being actively used, the TimeBar can be reduced to thumbnail size, minimizing its screen footprint while still orienting the user.
- Additional information can be conveyed visually by modification of the icons and/or use of initials. For instance, the 2 icons below designate abdominal MRI and head CT scan respectively.
- Color coding can be used to group icons by category. For instance, the same purple background color is used below to designate these icons as consults — generic, cardiology, pulmonary, and surgical respectively.
- While the TimeBar design presented here was created with office-based EHR programs in mind, the design works equally well for hospital-based EHRs, using time scales appropriate for acute care.
- If the EHR supports a patient portal, a patient and clinician can share information using the TimeBar. For example, a patient could enter a blood pressure reading from home as an event on the TimeBar.
Rick Weinhaus practices clinical ophthalmology outside Boston. He trained at Harvard Medical School, the Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute.
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to Mary Cain from Rick Weinhaus:
Mary, I’m glad you like this idea. For instance, in addition to having the three lines I suggested above for hypertension managment displayed as a multi-Y graph, there could be other lines for level of exercise, stress level, coded by the patient numerically and with the patient having the option of inserting pop-up comments when the mouse hovers over a particular data point. Patients could enter this information from home and the EHR could merge it with office and lab data so that both the patient and the clinician get a sense of how health behavior changes, not just medication changes, affect personal health.
Even without being linked to an EHR, a multi-Y view with the patient being to insert a comment for any data point would be extremely valuable. Let me know if you decide you might implement this view and I would be glad to contribute my ideas.
This is a stacked version of the timeline that patients maintain on Patients Like Me. We have been considering this as a view for health coaches as a quick way to see the health behavior changes that a patient is trying to make.
To David Kibbe from Rick Weinhaus:
David, you’ve hit on a major element of the TimeBar design. It can be configured to work with existing EHR applications because it doesn’t require any change to the underlying file structure.
In this regard, it could also be configured to be a part of a multi-Y graph, so that for instance, blood pressure measurements, changes in blood pressure medications, and TimeBar events could all be displayed graphically in a single view.
To the HL7 Guy from Rick Weinhaus:
You wrote: “The massive amount of data that clinicians have to feed into the systems using current input technologies is a major cause of non-acceptance of the EHRs found in the market.”
I would agree. I am strongly in favor of whatever solutions works best for inputting data. These solutions would include speech recognition and handwriting recognition software in addition to typing free text. You might also want to see a design a posted on EMRupdate.com as an alternative to template-based data entry. (http://www.emrupdate.com/forums/t/18878.aspx?PageIndex=1)
At first glance, I love this! What’s interesting to me is that this display/representation of the data is completely compatible with a more traditional rows-and-columns view, if the platform and middle ware are extensible and plug-and-play. Just the way that Google allows me to configure my iGoogle home page with different colors, menu bars, etc., the model for health data and information could become flexible and customize-able given appropriate standard APIs and such. It doesn’t have to be “my-way-or-the-byway,” and one size fits all.
Kind regards, and thanks for your post below, too, DCK
Hi,
This seems good to navigate through the information that has already been fed into the system.
An iPhone style application would also be good and it is a popular trend. Many physicians have adopted this device.
The big problem is creating solutions that are not disruptive to the clinician’s workflow and that do not fragment the clinician patient bond during an encounter.
The massive amount of data that clinicians have to feed into the systems using current input technologies is a major cause of non-acceptance of the EHRs found in the market. Most clinicians have to duplicate their work since they use paper throughout the process and then feed the systems from these forms.
We have to focus on ease of inputting data into the systems in real time, harmonious workflow, and non-obtrusive technologies. Artificial Intelligence can solve many issues but there are few practical applications using this paradigm.
The Input and not the output is the barrier to adoption. And money, of course.
My Two Cents.
Thanks