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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,

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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)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

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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

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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

* * *

MIE$2014$)$Chris/an$SIMON 01/09/2014 3

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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

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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

MIE$2014$)$Chris/an$SIMON 01/09/2014 5

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Mister'VCM

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Mister'VCM'represents'the'diseases'of'a'pa1ent

Ostei1s'deformans':'Paget'disease Nail'dystrophy Pancrea1c'tumor Elderly'pa1ent Moderated'renal'failure bronchial'obstruc1on Esophagi1s Pancrea1c'tumor

MIE$2014$)$Chris/an$SIMON 01/09/2014 7

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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

)

)

)

MIE$2014$)$Chris/an$SIMON 01/09/2014 8

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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

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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
  • f(measuring(the(perceived(usability(of(the(system
  • GPs(discuss(freely(the(posi3ve(or(nega3ve(aspects(of(the(use
  • f(VCM(and(its(incorpora3on(within(the(soEware

01/09/2014 MIE*2014*+*Chris1an*SIMON 10

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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

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Current'disorder

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Hearth'rhythm'disorder

12

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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

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Cough ) Bronchi8s

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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

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Pediatrician Hematologic*document

14

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Mister'VCM'and'the'pa/ent’s'medical'history

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Pa/ent’s'medical'Time'Line

15

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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 )

MIE$2014$)$Chris/an$SIMON 01/09/2014

  • I"s$ll"need"to"discover"and"prac$ce"VCM

before"to"feel"easy"with"it

  • 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

  • I""think"that"VCM"is"uselessly"complex

Not$agree Totally$agree 16

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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

  • f)the)pa'ent)case")and)

the)highligh'ng)of)key)informa'on

)

01/09/2014 MIE*2014*+*Chris1an*SIMON 17

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  • 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)

Quan2ta2ve%results

01/09/2014 MIE*2014*+*Chris1an*SIMON * * Average*number*of*relevant informa1on Average*1me*to*collect informa1on Number*of*informa1on*on 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 Without*VCM ***6,3 ***675,9 ***24,00 18

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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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Discussion

  • This+study

– Shows+that+icons+represen6ng+disorders,+drug+treatments,+procedure, etc.,+can+be+used+to+enhance+medical+records – Highlight+the+system’s+benefits+to+users

  • The+results+do+not+provide+a+defini6ve+valida6on+of

hypotheses+(reversal+of+the+results+between+the+two+records)

– This+difference+may+be+due+to+the+complexity+of+the+second+record changing+the+behaviour+of+the+doctors – The+need+for+the+GPs+to+have+more+6me+to+discover+the+VCM+language – The+sample+size+of+GPLevaluators+was+reduced

MIE$2014$)$Chris/an$SIMON 01/09/2014 20

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Discussion

MIE$2014$)$Chris/an$SIMON 01/09/2014

  • To*go*further

– It*would*be*interes7ng*to*conduct*a*more*extensive*evalua7on – The*coding*of*medical*informa7on*is*necessary*to*enable*the*display*of the*informa7on*in*iconic*form – Improvement*of*the*interfaces*for*data*entry*and*to*propose*new methods*of*capturing*standardised*informa7on

  • So

– 2011*:*start*a*new*research*project,*SiFaDo*(Saisie&Facile&des&Données Médicales,*Easy*Entry*of*Medical*Data) – Last*quarter*of*2014*:*VCM*within*éO*Médecin*will*be*handed*over*to users*for*real*use*at*the*doctor’s*office

*

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Acknowledgement

  • This2study2is2the2result2of2a2collabora9ve2effort2from2several2specialist

areas2within2the2framework2of2the2L3IM2TecSan220082research2project (ANRI08ITECSI007)2funded2by2the2French2Research2Agency2(Agence Na9onal2de2la2Recherche)

  • The2complementary2and2current2study2is2SIFADO2TecSan220112(ANRI11I

TECSI0014)2funded2by2the2French2Research2Agency

2 2 Thank2you2for2your2aSen9on 2 2

Corresponding+Author.+Chris1an+Simon,+E7mail:+simonc@neuf.fr+ LIMICS,+UFR+SMBH,+Université+Paris+13,+74+rue+Marcel+Cachin,+93017+Bobigny+cedex,+France

2

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