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Using&an&iconic&language&to improve&access&to&electronic medical&records&in&general medicine Chris&an)SIMON)a,,)Sylvain)HASSLER)b, Marie - Catherine)BEUSCARTZEPHIR)b,

  1. Using&an&iconic&language&to improve&access&to&electronic medical&records&in&general medicine Chris&an)SIMON)a,,)Sylvain)HASSLER)b, Marie - Catherine)BEUSCART—ZEPHIR)b, Madeleine)FAVRE)c,d,)Alain)VENOT)a,)Catherine DUCLOS)a,)Jean - Bap&ste)LAMY)a a !!LIMICS!(INSERM!UMRS!1142),!Université!Paris 13,!Sorbonne!Paris!Cité,!93017!Bobigny,!France, UPMC!Université!Paris!6,!Sorbonne!Universités, Paris

  2. Introduc)on • This/study/was/conducted/in/the/framework/of/L3IM/project/by a/consor)um/of/several/research/laboratories,/industrial/firms and/a/learned/society/in/general/prac)ce • The/research/laboratory/LIMICS/has/developed/an/iconDbased language/called/VCM/(Visualisa)on/of/Medical/Concepts) • Our/study/seeks/to/establish/whether/VCM/can/be/adapted/for use/in/an/electronic/medical/record – for/represen)ng/pa)ent/disorders – to/improve/the/overall/management/of/the/process – To/enhance/response/)mes/and/quality/in/the/selec)on/of/informa)on and/documenta)on/during/a/consulta)on/process / 01/09/2014 MIE*2014*+*Chris1an*SIMON 2

  3. Context • The*use*of*electronic*medical*records*in*general*prac7ce*has become*vital*for*pa7ent*follow;up • Doctors*need*quickly*find*all*the*relevant*informa7on*on*a pa7ent*from*the*electronic*medical*record • Physicians*have*difficul7es*to*access*and*analyse*informa7on in*a*medical*record • The*records*can*oCen*be*complex – The*plethora*of*condi7ons*that*can*affect*different*organs*or*func7ons – The*wealth*of*pa7ent*informa7on*(pa7ent*examina7on,*minutes, prescrip7on,*etc.) – Several*doctors*could*use*the*records * * * 01/09/2014 MIE$2014$)$Chris/an$SIMON 3

  4. Research(project(steps 1. To(iden3fy(the(func3onali3es(of(a(General(Medicine So;ware(that(would(benefit(from(icon@based(representa3on 2. To(implement(these(func3onali3es(in(an(electronic(medical record 3. To(assess(the(system(and(present(the(results(of(the evalua3on(in(terms(of(3me(for(reading(pa3ent(records,(the amount(of(relevant(informa3on(found(in(the(records(and perceived(user@sa3sfac3on 4. To(discuss(perspec3ves(for(icon@based(representa3ons(in health(records ( 01/09/2014 MIE*2014*+*Chris1an*SIMON 4

  5. Materials)*)VCM)language • Iconic)language)for)the)Visualiza7on)of)Concepts)in)Medicine • Icons)are)intended)to)tag)the)existent)medical)texts • Created)by)LIM&BIO)*) LIMICS • VCM)icon)combines)6)elements – Color • Red):)current)state • Orange):)risks)of)future)disorders • Green):)treatments)/)drugs • Blue):)follow*up)procedures • Brown):)antecedents – Main)shape – Central)pictogram – Exponent)pictogram)and)color – Op7onal)shadow 01/09/2014 MIE$2014$)$Chris/an$SIMON 5

  6. Mister'VCM 01/09/2014 MIE$2014$)$Chris/an$SIMON 6

  7. Mister'VCM'represents'the'diseases'of'a'pa1ent Ostei1s'deformans':'Paget'disease Pancrea1c'tumor bronchial'obstruc1on Nail'dystrophy Esophagi1s Moderated'renal'failure Pancrea1c'tumor Elderly'pa1ent 01/09/2014 MIE$2014$)$Chris/an$SIMON 7

  8. Materials)*)éO)Médecin • French)medical)So6ware)edited)by)SILK)Informa>que • Used)by)General)Prac>>oners,)Specialists • Management)of)the)Electronic)Health)Records • Standardised)informa>on)(Structured)and)coded) – ICD*10,)ICPC*2)classifica>ons – Problems)oriented,)SOAP – Pa>ent)medical)history – Medical)Time)Line ) ) ) ) • Used)in)several)research)projects)since)twenty)years ) 01/09/2014 MIE$2014$)$Chris/an$SIMON 8 ) )

  9. Methods()(Iden,fica,on(of(areas(of(informa,on • To(iden,fy(the(informa,on(that(may(benefit(from(VCM graphical(visualisa,on – Focus(group(involving(doctors(from(a(general(prac,ce(learned(society • Six(doctors(worked(on(two(clinical(cases(including(2(paper)based(pa,ent records((8(and(20(pages)(and(on(one(computerised(record(with(the(view to(solving(medical(problems • The(doctors(have(to – Discuss'about'the'difficul1es'to'search'informa1on'in'a'medical'record – Stuck'VCM'icons'on'parts'of'the'record – Drew'some'VCM'summaries – éO(soLware(was(analysed(and(stress)tested(over(several(sessions(with the(help(of(the(General(Prac,,oners – Analyzed(with(éO(Service(Center(the(change(requests(and(complaints for(improvement(from(their(customers ( ( 01/09/2014 MIE'2014'E'Chris1an'SIMON 9

  10. Methods()(User)centered(assessment • Representa3ve(sample(of(20(GPs(was(established – by(age(and(by(sex – with(users(using(the(éO(soEware((without(VCM(icons) • To(prepare(care(management,(Physicians(were(asked – to(read(the(records(in(éO,(either(with(or(without(VCM(func3onali3es – to(iden3fy(the(important(informa3on(items • Several(parameters(were(assessed(: 1. the(number(of(items(iden3fied(by(the(physician, 2. the(relevance(of(these(items(assessed, 3. The(3me(taken(by(the(GP(to(consult(and(analyse(the(record, 4. The(3me(per(item(ra3o. • GPs(completed(a(usability(scale(ques3onnaire(with(the(aim of(measuring(the(perceived(usability(of(the(system • GPs(discuss(freely(the(posi3ve(or(nega3ve(aspects(of(the(use of(VCM(and(its(incorpora3on(within(the(soEware 01/09/2014 MIE*2014*+*Chris1an*SIMON 10

  11. Results • The*focus*groups*highlighted*the*challenges*faced*by*the*GPs when*consul:ng*and*analysing*pa:ent*records • Iden:fica:on*of*the*key*func:onali:es*and*informa:on*in*a pa:ent*record*that*would*benefit*from*VCM – Pa:ent’s*iden:ty – Pa:ent's*current*disorders, – Pa:ent’s*health*History, – Reasons*for*encounters*and*diagnoses*from*consulta:ons, – Medical*special:es*associated*to*medical*reports, – Prescrip:on*drugs*and*treatments, – Dashboard*and*summaries – … 01/09/2014 MIE*2014*+*Chris1an*SIMON 11

  12. Current'disorder Hearth'rhythm'disorder 01/09/2014 MIE*2014*+*Chris1an*SIMON 12

  13. Problems)Oriented)Medical)Record)&)SOAP The)POMR)as)ini8ally)defined)by)Lawrence)Weed, a)system)of)record)keeping)in)which)a)list)of)the)pa8ent's)problems)is)created Cough ) Bronchi8s 01/09/2014 MIE$2014$)$Chris/an$SIMON 13

  14. Medical(special+es(associated(to(medical(reports • Chronological(list(of(medical(reports(and(received(documents • VCM(is(used(to(iden+fy(and(filter(informa+on Pediatrician Hematologic*document 01/09/2014 MIE*2014*+*Chris1an*SIMON 14

  15. Mister'VCM'and'the'pa/ent’s'medical'history Pa/ent’s'medical'Time'Line 01/09/2014 MIE*2014*+*Chris1an*SIMON 15

  16. Subjec've)evalua'on)results • The)subjec've)evalua'on)in)the)SUS)ques'onnaire)returned)a 65)out)of)100)sa'sfac'on)score,)thus)demonstra'ng)a)posi've assessment)of)this)implementa'on • To)improve)this)SUS)result,)a)majority)of)users – needed)more)'me)to)explore)and)prac'ce)all)the)VCMGbased)func'ons – believed)that)these)func'ons)have)not)been)complicated)by)VCM)and are)in)fact)easy)to)use. – believed)that)with)some)more)prac'ce)and)no)addi'onal)training,)they would)be)wellGplaced)to)take)over)the)system ) • I"s$ll"need"to"discover"and"prac$ce"VCM before"to"feel"easy"with"it Not$agree • I"felt"VCM"hard"to"use $ • VCM"was"not"harmonious $ • I"think"that"I"will"need"a"technical assistance"to"be"able"to"use"VCM Totally$agree • I""think"that"VCM"is"uselessly"complex 01/09/2014 MIE$2014$)$Chris/an$SIMON 16

  17. Subjec've)evalua'on)results • The)users – Are)comfortable)with)the)informa'on)displayed)by)the)VCM)graphical symbol – Have)expressed)the)desire)to)use)it • They)appreciate – The)filtering)of)informa'on) from)the)graphical)symbols – M.)VCM)pa'ent)profile)summaries which)provide)"a)quick)overview of)the)pa'ent)case")and) the)highligh'ng)of)key)informa'on ) 01/09/2014 MIE*2014*+*Chris1an*SIMON 17

  18. Quan2ta2ve%results • The%number%of%relevant%informa2on%items%retrieved%by%GPs%in both%test%records%is%a%li9le%higher%without%VCM%func2onali2es • The%Wilcoxon%test%does%not%demonstrate%sta2s2cally significant%differences%(P%=%0.54%and%0.73) • The%2me%taken%for%doctors%to%collect%informa2on%was%also recorded%: – For%the%first%record,%GPs%took%less%2me%using%VCM%but%this%difference%is not%significant. – For%the%second%record,%we%found%that%the%GPs%took%significantly%more 2me%when%using%VCM%(P=0.0312) * * Average*number*of*relevant Average*1me*to*collect Number*of*informa1on*on informa1on informa1on collect*1me Record*1 With*VCM ***8,0 ***612,8 ***20,46 Without*VCM ***7,0 ***457,3 ***8,12 Record*2 With*VCM ***8,0 ***439,9 ***12,44 01/09/2014 MIE*2014*+*Chris1an*SIMON 18 Without*VCM ***6,3 ***675,9 ***24,00

  19. Other&results&of&this&study • The&lack&of&structured&informa6on&and&common&language&is&a limita6ons&when&implemen6ng&a&support&system.&In&a previous&work,&ICD@10,&one&of&the&most&used&terminologies has&been&mapped&to&VCM • Furthermore,&we&used&mapping&between&ICPC@2&and&ICD@10 to&perform&transcoding&of&ICPC@2&and&VCM.&Programming&of an&algorithm&to&transcode&the&ICPC@2&code&in&ICD@10&code&to send&them&to&the&VCM&Server • In&addi6on,&we&have&extended&VCM&with&new&icons&to respond&to&GP&requirements 01/09/2014 MIE*2014*+*Chris1an*SIMON 19

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