Thursday, August 13, 2020

Why Terminology Matters

 Hi fellow Clinical Informaticists, CMIOs, CNIOs, and other HealthIT friends,

A short post this time - Just sharing how terminology management can impact EMR usability

Managing an enterprise EMR is a lot like owning a closet. Information is stored in certain virtual 'drawers', where people (users) get used to storing and finding the information they need to do their jobs.

The problem is, just like closets - Exactly where and how people like to store this information is an intensely personal, cognitively-driven process. If you have ever had to share a closet, you probably know how challenging it can be to share a closet with another person. 

Now, imagine having to share a closet with 500 people. The first step would be getting all 500 people together for a meeting, and discussing/reviewing : 

  • Where should we keep the socks?
  • Where should we keep the pants?
  • Where should we keep the shirts?
Some people may have different opinions about where and how to keep things, but ultimately, you will need to make some final, group-based decisions

Still, some people may start working for your company after those group discussions/decisions are made, so it's helpful if you :
  • ... have an easily-identifable pattern associated with your information storage and retrieval, and...
  • ... if you label things correctly
Today's post is really about labeling things correctly. For teaching purposes, I sometimes simplify it as this : 
"Call it what it is."
It can sometimes be difficult to spot terminology issues, so I'll start with a simple hierarchy that helps explain the confusion that can create frustration for end-users :

Keep in mind that these are simple, real-world examples that we are using as proxies for more complicated, real-world clinical scenarios.

In any case - when labeling a button, folder, or other item in an EMR, it's important to have the appropriate level of granularity and accurate clinical terminology, or else you can lead to confusion for end-users : 

Suppose a user is looking for an apple. 

  • In scenario #1 above, if we just refer to apples and oranges as "fruit" - users will need to spend time clicking through both boxes, looking for the apple. It might be in the left box, or the right box - They are both labeled "Box of Fruit", and fruit is not a granular enough term to identify the exact tool the user is looking for (an apple).

  • In scenario #2 above, it's easy to find an apple. The first box is labeled, "Box of Apples".

So it's always very helpful to :

  • understand and anticipate what the user will be looking for, and...
  • understand the clinical terminology and associated hierarchies, and...
  • call it what it is.
Some people might argue "Well, if both apples and oranges are fruit, why not keep them in the same 'fruit' folder?" For sure, there are some scenarios where this may make sense, especially if there are not many items to look for under a folder. 

However, keeping too many items in a folder can also lead to unnecessary time spent looking for things. 

So ideally, especially when storing a large number of items - It's helpful to understand the clinical role, the clinical context, the clinical terminology, and the higher/lower level concepts, to help identify the right term to label buttons in your EMR, for maximum efficiency and less clicks.

Hope this helps shed some light on common terminology issues that every organization has to manage as they configure their EMRs. If you're not sure about a term, reach out to your local Clinical Informaticist for guidance, tips on how to reduce clicks, and other common clinical workflow design issues.

Remember, this blog is for educational/discussion purposes only, and your mileage may vary. If you have any terminology tips or suggestions, please leave them in the comments box below!


Sgermanmd said...

Dirk, I appreciate your analogies. How would you approach personalized filters in these scenarios? For example, there is a system-wide "box of fruit" that can be filtered based on the type of fruit, the color of the fruit, size of the fruit, etc. These parameters can be individually set based on the user's needs. This way, you do not need to have multiple boxes with lists or dropdowns that are inefficient and potentially risky to navigate.

Amar said...

Dr. Stanley - Your thoughts are very true. The need to identify and appropriately compartmentalize the terminology within our EHR hierarchy both granularly and in the specificity helps drive for better decision support through analytics