Document Properties Document Title Patient List View

Prepared for NHS Connecting for Health Version 1.0.0.0 Baseline Prepared by Clinical Applications and Patient Safety Project NHS CUI Programme Team cuistakeholder.mailbox@hscic.gov.uk

PREFACE

PREFACE
1 INTRODUCTION
2 GUIDANCE OVERVIEW
- 2.1 Rationale Summary
- 2.2 Summary of Guidance
3 GUIDANCE DETAILS FOR PATIENT LIST LAYOUT
- 3.1 Introduction
- 3.2 Guidelines
4 GUIDANCE DETAILS FOR MANAGING THE INFORMATION DISPLAYED
- 4.1 Introduction
- 4.2 Guidelines
5 DOCUMENT INFORMATION
APPENDIX A USABILITY PRINCIPLES
APPENDIX B STUDY ID 77: EXECUTIVE SUMMARY
REVISION AND SIGNOFF SHEET

Source PDF: patlistview.pdf

Documents replaced by this document None Documents to be read in conjunction with this document Design Guide Entry – Patient Banner 4.0.0.0 Displaying Graphs and Tables – User Interface Design Guidance 2.0.0.0 Filtering, Sorting and Grouping – User Interface Design Guidance 1.0.0.0 This document was prepared for NHS Connecting for Health which ceased to exist on 31 March 2013. It may contain references to organisations, projects and other initiatives which also no longer exist. If you have any questions relating to any such references, or to any other aspect of the content, please contact cuistakeholder.mailbox@hscic.gov.uk Patient Safety Process The development lifecycle for this design guide includes an integrated patient / clinical safety risk assessment and management process. Known patient safety incidents relevant to this design guidance area have been researched and reviewed as part of ongoing development. The resulting guidance points aim to support mitigation of these known patient safety risks. In addition, the developers of this design guide have undertaken a patient safety risk assessment to identify new risks that could potentially be introduced by the guidance points in this document. Any potential risks identified have been assessed and managed to support the ongoing clinical safety case for this design guide. The Hazard Log records all the risks that have been identified during development and describes mitigatory actions that, in some cases, will need to be taken by users of this design guide. The Hazard Log is a live document that is updated as the design guide is developed and maintained. Until this design guide has received full Clinical Authority to Release (CATR) from the NHS Connecting for Health (CFH) Clinical Safety Group (CSG) – based on an approved Clinical Safety Case – there may be outstanding patient safety risks yet to be identified and mitigated. Additionally, users implementing applications that follow this design guide’s guidelines (for example, healthcare system suppliers) are expected to undertake further clinical safety risk assessments of their specific systems within their specific context of use. Refer to NHS Common User Interface for further information on the patient safety process and for the safety status and any relevant accompanying safety documentation for this design guide.

1 INTRODUCTION

This document provides guidance for the design of Patient Lists. It describes the area of focus, lists mandatory and recommended guidance points with usage examples and explains the rationale behind the guidance.

To indicate their relative importance, each guideline in this document is ranked by Conformance and by Evidence Rating . Table 1 defines those terms:

Conformance Indicates the extent to which you should follow the guideline when defining your User Interface (UI) implementation. There are two levels:

 Mandatory - An implementation should follow the guideline

 Recommended - An implementation is advised to follow the guideline

Evidence Rating Summarises the strength of the research defining the guideline and the extent to which it mitigates patient safety hazards. There are three ratings (with example factors used to determine the appropriate rating):

 Low :

 Does not mitigate specific patient safety hazards

 User research findings unclear and with few participants

 Unreferenced usability principles indicate the design is not significantly better than alternatives

 Medium :

 Mitigates specific patient safety hazards

 User research findings clear but with few participants

 References old authoritative guidance (for example, from National Patient Safety Agency (NPSA),

Institute for Safe Medication Practices (ISMP) or World Health Organization (WHO)) that is potentially soon to be superseded

 Referenced usability principles indicate the design is significantly better than alternatives

 High :

 Mitigates specific patient safety hazards

 User research findings clear and with a significant number of participants

 References recent authoritative guidance (for example, from NPSA, ISMP or WHO)

 Referenced usability principles indicate the design is significantly better than alternatives

Table 1: Conformance and Evidence Rating Definitions

Note

Refer to section 5.2 for definitions of the specific terminology used in this document.

1.1 Customer Need

Patient Lists are used in a wide range of clinical contexts within both primary and secondary care settings.

A Patient List comprises a structured list of patients specific to a service, a location or a care provider. For each patient, the list contains unique identification information and a subset of the patient’s health record appropriate to the use of the list.

Uses of Patient Lists include:

Reviewing information about a set of patients
Gaining an overview of their clinical situation
Managing tasks

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Figure 1 illustrates a Patient List that follows the guidance in this document:

Figure 1: Example Patient List Conformant to This Guidance, Populated with Fictitious Data

Important

The visual representations used within this document to display the guidance are illustrative only. They are simplified in order to support understanding of the guidance points. Stylistic choices, such as colours, fonts or icons are not part of the guidance and unless otherwise specified are not mandatory requirements for compliance with the guidance in this document.

Patient Lists may be used by an individual clinician (for example, consultant) or a team (for example, nursing team). The lists are typically used for a specific time period (for example, a shift) and are updated during this period if changes to the patient information occur.

During the research and collation of data for this document no guidance was found for a common presentation of Patient Lists as defined above.

During the development of this document, potential patient safety hazards around the display of patient data within a list were identified and recorded. The guidance within this document helps mitigate these recorded hazards and is determined by three key considerations:

Users must be able to easily access the Patient List information they need
Users must be able to quickly and easily familiarise themselves with the Patient List layout

on first use

Users must be able to quickly understand how to manage the display of Patient List

information

This guidance covers the safe display of information for multiple patients in a Patient List format.

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During research, the majority of identified potential patient safety hazards concerning Patient Lists applied to secondary care contexts, where teams of clinicians are caring for multiple patients in a single location (for example, a medical ward in a hospital). For this reason, the majority of examples provided throughout this document are based on a secondary care scenario, specifically a hospital respiratory ward. The medical information shown in these examples is fictitious but is based on the experiences of medical professionals who work or have recently worked on respiratory wards.

1.2 Scope

This section sets out the items that are in and out of scope for this design guidance.

1.2.1 In Scope

Datatype (format and layout)

Attribute (content and format)

 Structured text (for example, tasks) excluding

associated metadata (for example, task status changes)

 Patient identifiers (including layout and positioning)

 Location (static location)

 ‘Appointment’ times (including multiple times)

 Multiple data types per cell

 Style (for example, banding

 Size and resizing (both user and system initiated)

Cells  Cell padding

 Multiple entries per cell

List Header  Label and inclusion criteria of list

Row and Column  Headers (for example, style, labels)

 Gridlines

More Details  Opening items (for example, patient care records)  ‘Opened’ items in context with list

Navigation  Moving around a long or wide list (vertical and

horizontal scrolling)

No Data  Empty rows (beds or timeslots)  No results in list

Out of View  Indicating data out of view per cell and/or row (for

example, truncation)

 Indicating items out of list view

 Use of out of view (that is, do you always show some

datatypes and/or attributes)

 Fitting items on a page (for default views)

Provenance  Indication of refreshed list  Refreshing the list

Updates  Indication of update (at list or ‘cell’ level, including

‘new’ items)

 Viewing update history

 Viewing previous patients on the list

Datasets  Alter the visible dataset (for example, adding

columns, including role specific views, list level of detail, and so on)

Layout  Layout of data (for example, column order)

Manipulation  Indication of filtered list

 Filtering the list

 Indication of grouping

Similarity  Flagging similar names and similarity (indication of

determining differential)

Table 2: In Scope

 Provenance –- when was data last updated

 Snapshot history (viewing, navigating, indication of

past, et cetera)

 Indication of sort order

 Showing and hiding ‘columns’

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1.2.2 Out of Scope

This section defines areas that are not covered by this guidance. Although there may be specific hazards associated with these areas that are not addressed in this guidance, it is likely that the principles in this guidance will extend to Patient Lists in many of the areas listed in Table 3:

Alerts  Alerts of change in patient state (for example,

change of Medical Early Warning Score (MEWS))

Application  Location in window

 Context of list

 Window or port sizing

Attribute (content and format)

 Mark for discharge

 Resuscitation status

 Clinical summary (or equivalent) and its structure

Datasets  Specifying datasets for particular contexts

 Handling ‘exceptional data’ (that is, important data

but outside of the normal dataset)

Datatype (format and layout)

 Numerical data per cell

 Free-text

 Numerical series

 Scoring (for example, MEWS)

 Flagging potentially incorrect information

 Personal notes

 Highlighting information

Dual layout view  Ensuring equivalent patient information is presented

consistently between the two views

 Dealing with information that is only displayed in one

of the views (for example, ‘summary’ not shown on a schematic view)

 Consistent visual indication of selection

Form factor  Size and interaction modality

Graphical layout  Schematic, architectural, layout, and so on

 Minimum information

 Information constraints

Information Governance (IG)

 Showing and hiding data

 Screensaver or lockout

Input  Input of any data

Layout  Changing of layout (for example, column horizontal

order)

List actions The Patient List is not used to enter data into the system

Access to actions (for example, through header and incontext including selection)

 Differing actions based on list and/or selection

 Simultaneous user considerations (for example,

checkout, editing and so on)

 Search in progress

 Determining default row and column dimensions

 Association of goals with tasks, results and

outcomes

 Rationale for decisions

 Sealed information

 Multi-user view (for example, viewing in a

Multi-Disciplinary Team (MDT) meeting)

 Alter level of detail shown within a column

 Flagging and check of auto populated information

 Flagging missing data

 Graphing display

 Data structured in contextually relevant handover

information structures (for example, Mechanism Illness/Injury Signs/Symptoms Treatment (MIST))

 Abbreviations

 Misspellings

 Selection behaviour (for example, selecting a Patient

List row highlights location on a graphical schema)

 Ensuring equivalent patient information is in view in a

table when selected on a graphical schema

 Method of switching between views (if viewed

alternately)

 Access to further information

 Area showing ‘patient row’ for selection

 Area showing Patient Banner for selected location

 Restrictions on history viewing

 Find within a list

 Selection of rows, cells, data in cells, columns

(navigation, visual confirmation, states, navigation, and so on)

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List header  Ward level aggregated scores (for example, number

of infections)

List inclusion  Patient’s ‘outside’ the standard set (for example,

those pending admission)

 View non-patient data (for example, ward level

information)

 Data about patients not in the systems

Manipulation  Indication of grouping

 Change view setting

 Use of sort order

Miscellaneous  Handover status

 Colours

 Ambiguous information

 Lists with multiple instance of the same patient

 Specifying list criteria

 Multiple patients allocated to the same bed (next

patient awaiting admission)

 Sort on a key within multiple datatype cells

 Sorting items within a cell (for example, prioritising

patients)

 Remote view

 Patient List summary in the context of a single record

Navigation  Navigating to a Patient List  Navigating from Patient List

Printing  Printing all or part of a Patient List

Process  Process of handover (for example, transfer of responsibility)

Structured layout  Structured lines (for example, stack of Patient Banners)

Summary  Indicating fallibility of summaries  Usage of ‘how much’ data should be allowed ‘in’ a

Patient List

Tasks  Basic task display layout and format

 Task status indicator per task

 Task status indicator per patient

 Hierarchical view of tasks

 Filtering tasks

 Display of completed tasks

 Colour coding

 Role specific mark-up

 View task assignment

 Indicate overdue tasks

Table 3: Out of Scope

Note

 Task state transition model

 Viewing task priority

 Viewing tasks independence

 Viewing task time dependence

 Discharge with outstanding tasks

 Changing a task’s status

 Allocation of tasks

 Setting task priority

 View tasks in relation to care pathway

Listing an item as out of scope does not classify it as unimportant. Project time and resource constraints inevitably restrict what can be in scope for a particular release. It is possible that items out of scope for this release may be considered for a future release.

1.3 Assumptions

A1 The quality (that is, provenance, accuracy, and completeness) of the data displayed in the Patient List is of an acceptable level. Data quality is particularly important in scenarios where there are multiple data sources (as the quality of data may vary between sources).

A2 Where the system supports the live update of Patient List information, the system performance and connectivity is of such a level that there is minimum delay between the update being entered and the Patient List being updated.

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A3 The minimum screen resolution used by the clinician is 1024 x 768 pixels, although a higher resolution may be employed.

A4 The Patient List consists entirely of information that resides in and is accessible through other views, including views that represent the data as entered into the system.

Table 4: Assumptions

1.4 Dependencies

D1 Changes in the following documents may affect the guidance presented in this document:

 Design Guide Entry – Patient Banner

 Displaying Graphs and Tables – User Interface Design Guidance

 Filtering, Sorting and Grouping – User Interface Design Guidance

Table 5: Dependencies

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2 GUIDANCE OVERVIEW

2.1 Rationale Summary

The rationale for the current guidance draws on several pieces of evidence:

Research:

Primary Research:

 Interviews with healthcare professionals, including doctors (see APPENDIX B)

 Regular consultation with a panel of clinical experts

Secondary Research:

 Existing guidelines and standards

 UI best practice

Usability Principles (see APPENDIX A for details on these principles):

Nielsen’s usability heuristics
Shneiderman’s eight golden rules of interface design
International Organization for Standardization (ISO) 9241: Characteristics of presented

information (taken from BS EN ISO 9241-10: 1996 Ergonomic requirements for office work with visual display terminals (VDTs) — Part 10: Dialogues principles {R1} )

Existing Standards:

BS EN ISO 9241-10:1996 Ergonomic requirements for office work with visual display

terminals (VDTs): Part 10: Dialogues principles {R1}

BS 7581:1992 Guide to Presentation of tables and graphs {R2}

Evolving Standards:

Design Guide Entry – Patient Banner {R3}
Displaying Graphs and Tables – User Interface Design Guidance {R4}
Filtering, Sorting and Grouping – User Interface Design Guidance {R5}

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2.2 Summary of Guidance

Table 6 summarises the content of this document by outlining each area of guidance (along with a cross reference to the relevant section) and providing a visual example to illustrate how it might be implemented:

Section 3 provides guidance on the layout of Patient Lists

Section 3.2.1 provides guidance on the Patient List header, which communicates the context of the Patient List

Section 3.2.2 provides guidance on column headers, which provide the titles for each column

Section 3.2.3 provides guidance on columns, which contain the sets of information for the Patient List

Section 3.2.4 provides guidance on rows and cells. Rows contain the information for each patient in the Patient List. Cells contain specific information for each patient

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Section 3.2.5 provides guidance on sublists, which are located within cells and contain information that is structured in a list format

Section 3.2.6 provides guidance on the display of patient identification information

Section 3.2.7 provides guidance on row key identifiers, which uniquely identify each row from others in the Patient List

Section 4 provides guidance on managing the information displayed in a Patient List

Section 4.2.1 provides guidance on how to manage the columns displayed in the Patient List

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Section 4.2.2 provides guidance on notifying the user of updates to information displayed in the Patient List.

Section 4.2.3 provides guidance on displaying historical patient information as a complete Patient List ‘snapshot’.

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Section 4.2.4 provides guidance on how to display further information that a user has opened

Table 6: Summary of Guidance

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3 GUIDANCE DETAILS FOR PATIENT LIST LAYOUT

3.1 Introduction

This section includes guidance for the layout of Patient Lists, specifically:

Patient List headers
Column headers
Columns
Rows and cells
Sublists
Patient identification
Row key identifiers

3.2 Guidelines

3.2.1 Patient List Header

This section provides guidance on the Patient List header. This communicates the context of the list to the user. Figure 2 illustrates that feature:

Figure 2: Patient List Header

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3.2.2 Column Headers

This section provides guidance on column headers, which provide the titles for each column. Figure 3 illustrates that feature:

Figure 3: Column Headers

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3.2.3 Columns

This section provides guidance on columns, which contain the sets of information for the Patient List. Figure 4 illustrates that feature:

Figure 4: Columns

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In this incorrect example, the user has been permitted to resize the middle column narrower than the widest elements resulting in the words ‘Pancreatitis’ and ‘Cerebrovascular’ being truncated. (PAL-0210)

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In this incorrect example, when the user resizes the first column, the other columns are automatically resized to maintain the overall width of the combined columns. As a consequence information has been relocated (for example, ‘Wednesday – on Potassium’ and ‘Diarrhoea’ are no longer in view). (This example assumes the user has not set a preference for this behaviour). (PAL-0220)

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In this correct example, when the user resizes the third column (‘Presenting complaint’) the columns to the right remain the same width. The overall width has increased beyond the viewable area, so a horizontal scrollbar is displayed. The out-of-view symbols and warning message are displayed by default immediately above the viewable area. (PAL-0200, PAL-0220, PAL-0230, PAL-0240, PAL-0250, PAL-0260)

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3.2.4 Rows and Cells

This section provides guidance on rows and cells. Rows contain the information for each patient in the Patient List. Cells contain individual content (and sublists, where required). Figure 5 illustrates those features:

Figure 5: Rows and Cells

Col1	Evidence ID Guideline Conformance Rating
	PAL-0280 Orientate Patient List entries horizontally (that is, so the information for each patient is displayed across the viewing area.) Note This guidance overrides GTAB-191 in_Displaying Graphs and Tables –_ User Interface Design Guidance {R4} for Patient List contexts only Mandatory High
	PAL-0290 Separate rows using prominent horizontal divider lines Mandatory High

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3.2.5 Sublists

This section provides guidance on sublists, which are located within cells and contain information that is structured in a list format. Figure 6 illustrates that feature:

Figure 6: Sublists

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In this correct example, an update has added items to two of the sublists, which have increased in size accordingly. The rows containing the sublists have increased in height to avoid truncation. (PAL-0430, PAL-0440)

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3.2.6 Patient Identification

This section provides guidance on the display of patient identification information in a Patient List. Figure 7 illustrates that feature:

Figure 7: Patient Identification

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3.2.7 Row Key Identifiers

This section provides guidance on row key identifiers, which uniquely identify each row from others in the Patient List. Figure 8 illustrates that feature:

Figure 8: Row Key Identifiers

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 PLI029 What if the ‘main identifier’ (probably the patient name) is not the

most prominent attribute?

 PLI283 What if the list presents patients from mixed locations (for

example, more than one hospital ward in one view)?

 PLI030 What if preferred name is not displayed on the list and staff refer

to the patient by their given name?

 PAL-0600

 PAL-0640

 PAL-0590

 PLI033 What if the name prefix is shown in the list?  PAL-0590

 PLI044 What if the ‘NHS number’ is not displayed?  PAL-0590

 PLI016 What if empty beds are not shown in the list?  PAL-0660

 PLI017 What if empty beds are shown as completely blank lines (with no

bed number)?

 PAL-0660

 PLI015 What if empty beds are shown in the list?  PAL-0670

 PLI072 What if the visible view is horizontally long and you want to relate

information from opposite ends of the line?

 PAL-0620

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4 GUIDANCE DETAILS FOR MANAGING THE INFORMATION DISPLAYED

4.1 Introduction

This section includes guidance for managing the information displayed in Patient Lists, specifically:

Managing the columns displayed
Refresh options and update indication
Displaying historical Patient List information
Displaying further information

4.2 Guidelines

4.2.1 Managing the Columns Displayed

This section provides guidance on how users should be able to manage the columns displayed in the Patient List. Figure 9 illustrates that feature:

Figure 9: Managing the Columns Displayed

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 PLI108 What if it is unclear that the list is filtered?  PAL-0750, PAL-0760

 PLI082 What if a user cannot set up lists with different inclusion criteria (for example, all

patients, all deteriorating patients)?

 PAL-0750

 PLI116 What if there is no indication what the list is ordered on?  PAL-0770

 PLI134 What if it is unclear that the sort order is per group and the amount of groups

mean the sort order is less useful than it might be?

 PAL-0770, PAL-0780

 PLI259 What if the list is only ever able to be sorted by one criterion?  PAL-0770

 PLI274 What if there is only one sort order and the user is unable to change the view of

the list depending on preference and context of use?

 PLI022 What if in a list showing patients from multiple wards the patients are not

grouped by ward?

4.2.2 Refresh Options and Update Indication

 PAL-0770

 PAL-0780

This section provides guidance on notifying the user of updates to information displayed in the Patient List. Figure 10 illustrates those features:

Figure 10: Refresh Options and Update Notification

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Hazard Risk Analysis Summary:

Potential Hazards:

 PLI001 What if entries are made into the Patient List that result in two or

more versions of the same information in the record and in the Patient List?

 PLI097 What if the information underlying the view has changed (since it

was opened) even though the refresh alert has not yet appeared?

 PLI098 What if the view is updated while open without manual refresh or

indication of a change or what those changes are?

 PLI099 What if updates are not automatic (once the view is open) and

there is no option for manual refresh?

 PLI100 What if the changes since the clinician’s last view are not

indicated?

Mitigations:

 PAL-0800, PAL-0820, PAL-0830

 PAL-0870

 PAL-0840, PAL-0880

 PAL-0800, PAL-0870

 PAL-0800, PAL-0840, PAL-0880, PAL-0900

 PLI103 Risk of not knowing whether it was worth refreshing or not  PAL-0840, PAL-0860

 PLI104 Misinterpretation of time associated with refresh action  PAL-0840, PAL-0860

 PLI107 Updates: what if there is no marker to show what is new or what

has been updated and/or changed?

 PLI111 What if you do not realise that the status of the list has to be

manually updated?

 PLI125 What if you are not aware of the status of the list because no time

is shown?

 PLI129 What happens if you do not notice additional data which is

appearing on screen?

 PLI220 What if data in the view (either the list of patients or the data per

patient) is mistakenly interpreted to be current information when it is actually out of date?

 PLI279 What if the system allows you the ability to unmark all updates

even if all updates have not been viewed?

 PAL-0840, PAL-0880, PAL-0900

 PAL-0870

 PAL-0840, PAL-0860

 PAL-0840, PAL-0880, PAL-0900, PAL-0940

 PAL-0840, PAL-0860

 PAL-0850, PAL-0930, PAL-0980

 PLI152 What if you cannot see completed tasks?  PAL-0910, PAL-0920

 PLI066 What if completed jobs are removed too soon from the list?  PAL-0910, PAL-0920

 PLI270 What if results for unknown patient still show ‘unknown’ but live

system has now updated patient’s record with known demographics?

 PAL-0820

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4.2.3 Displaying Historical Patient List Information

This section provides guidance on displaying historical patient information as a complete Patient List ‘snapshot’. Figure 11 illustrates those features:

Figure 11: Historical Patient List Information

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4.2.4 Displaying Further Information

This section provides guidance on how to display further information that a user has opened from the Patient List. Figure 12 illustrates that feature:

Figure 12: Displaying Further Information

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5 DOCUMENT INFORMATION

5.1 Terms and Abbreviations

CATR Clinical Authority to Release

CSG Clinical Safety Group

CUI Common User Interface

IG Information Governance

ISMP Institute for Safe Medication Practices

ISO International Organization for Standardization

MDT Multi-Disciplinary Team

MEWS Medical Early Warning Score

MIST Mechanism Illness/Injury Signs/Symptoms Treatment

NHS National Health Service

NHS CFH NHS Connecting for Health

NPSA National Patient Safety Agency

UI User Interface

VDT Visual Display Terminal

WHO World Health Organization

Table 8: Terms and Abbreviations

5.2 Definitions

The Authority The organisation implementing the NHS National Programme for IT (currently NHS Connecting for Health).

Conformance In the guidance tables, indicates the extent to which you should follow the guideline when defining your UI implementation. There are two levels:

 Mandatory - An implementation should follow the guideline

 Recommended - An implementation is advised to follow the guideline

Current best practice Current best practice is used rather than best practice, as over time best practice guidance may change or be

revised due to changes to products, changes in technology, or simply the additional field deployment experience that comes over time.

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Evidence Rating In the guidance tables, summarises the strength of the research defining the guideline and the extent to which it mitigates patient safety hazards. There are three ratings (with example factors used to determine the appropriate rating):

 Low:

 Does not mitigate specific patient safety hazards

 User research findings unclear and with few participants

 Unreferenced usability principles indicate the design is not significantly better than alternatives

 Medium:

 Mitigates specific patient safety hazards

 User research findings clear but with few participants

 References old authoritative guidance (for example, from National Patient Safety Agency (NPSA),

Institute for Safe Medication Practices (ISMP) or World Health Organization (WHO)) that is potentially soon to be superseded

 Referenced usability principles indicate the design is significantly better than alternatives

 High:

 Mitigates specific patient safety hazards

 User research findings clear and with a significant number of participants

 References recent authoritative guidance (for example, from NPSA, ISMP or WHO)

 Referenced usability principles indicate the design is significantly better than alternatives

NHS Entity Within this document, defined as a single NHS organisation or group that is operated within a single technical infrastructure environment by a defined group of IT administrators.

Table 9: Definitions

5.3 Nomenclature

This section shows how to interpret the different styles used in this document to denote various types of information.

5.3.1 Body Text

Code Monospace

Script

Other markup languages

Interface dialog names Bold

Field names

Controls

Folder names Title Case

File names

Table 10: Body Text Styles

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5.3.2 Cross References

Current document – sections Section number only

Current document – figures/tables Caption number only

Other project documents Italics and possibly a footnote

Publicly available documents Italics with a footnote

External Web-based content Italics and a hyperlinked footnote

Table 11: Cross Reference Styles

5.4 References

R1. British Standards Institute – BS EN ISO 9241-10:1996 Ergonomic requirements for office work with visual display terminals (VDTs) – Part 10: Dialogues principles

1996

R2. British Standards Institute – BS 7581:1992 Guide to Presentation of tables and graphs 1992

R3. NHS CUI Programme – Design Guide Entry – Patient Banner 4.0.0.0

R4. NHS CUI Programme – Displaying Graphs and Tables – User Interface Design Guidance 2.0.0.0

R5. NHS CUI Programme – Filtering, Sorting and Grouping – User Interface Design Guidance 1.0.0.0

R6. NHS CUI Programme – Design Guide Entry – Time Display 4.0.0.0

R7. NHS CUI Programme – Design Guide Entry – Date Display 5.0.0.0

R8. World Health Organization Collaborating Centre for Patient Safety Solutions – Aide Memoire – Volume 1, solution 2, May 2007 – Patient Identification

R9. National Patient Safety Agency National Reporting and Learning Service – DSCN 04/2009 – Guidance on the standard for Patient Identifiers for Identity bands

May 2007

March 2009

R10. Nielsen, J – Usability Engineering 1993

R11. Shneiderman, B – Designing the User Interface: Strategies for Effective Human-Computer Interaction

Table 12: References

Third Edition

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APPENDIX A USABILITY PRINCIPLES

A.1 Nielsen’s Usability Heuristics

See Usability Engineering {R10} for more information on these principles:

Visibility of system status
Match between system and the real world
User control and freedom
Consistency and standards
Error prevention
Recognition rather than recall
Flexibility and efficiency of use
Aesthetic and minimalist design
Help users recognise, diagnose, and recover from errors
Help and documentation

A.2 Shneiderman’s Eight Golden Rules of Interface Design

See Designing the User Interface – Strategies for Effective Human-Computer Interaction {R11} for more information on these principles:

Strive for consistency
Enable frequent users to use shortcuts
Offer informative feedback
Design dialogs to yield closure
Offer error prevention and simple error handling
Permit easy reversal of actions
Support internal locus of control
Reduce short-term memory load

A.3 ISO 9241: Characteristics of Presented Information

See Ergonomic requirements for office work with visual display terminals (VDTs) — Part 10: Dialogues principles {R1} for more information on these principles:

Clarity (the information content is conveyed quickly and accurately)
Discriminability (the displayed information can be distinguished accurately)
Conciseness (users are given only the information necessary to accomplish the task)
Consistency (the same information is presented in the same way throughout the

application, according to the user’s expectation)

Detectability (the user’s attention is directed towards information required)

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Legibility (information is easy to read)
Comprehensibility (meaning is clearly understandable, unambiguous, interpretable and

recognisable)

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APPENDIX B STUDY ID 77: EXECUTIVE SUMMARY

B.1 Abstract

The UK National Health Service (NHS) Common User Interface (CUI) programme is a partnership between Microsoft [®] and NHS Connecting for Health (NHS CFH), which is part the NHS National Programme for Information Technology (NPfIT).

As part of CUI, the Clinical Applications and Patient Safety (CAPS) project has the goal of ensuring that software applications used by the NHS enhance patient safety. To achieve this, CAPS provides software developers with user interface design guidelines derived through a user-centric development process that includes explicit patient-safety evaluations.

This summary describes key findings from user research carried out in November 2009 by the CUI CAPS team on Patient List Views. These findings are a subset of those in a larger internal report prepared for the CUI CAPS Patient List Views team.

Purpose:

To gain clinical feedback on designs for Patient List Views.

Method:

Interviews: structured interviews with 11 Health Care Professionals (HCPs) eliciting HCP preferences and qualitative feedback on designs.

Key Results:

Based on clinician preference and rationale:

Truncating items in sublists is problematic and may hinder use of the view
The option for end-user clinicians to be able to customise the dataset visible should be

further explored

Marking of updates was a popular feature, though unmarking was initially unclear
A ‘snapshots’ feature was also liked, primarily in order to access patients no longer on the

current list

B.1 Research Objectives

To gather HCP preferences and qualitative feedback on, and to identify possible patient safety hazards with, CUI Patient List designs.

B.2 Research Design

11 clinicians were interviewed across 11 structured 1 hour interviews, carried out in person. Participants were shown static designs of the Patient List View, with design alternatives per design area. Designs and example data used a secondary care inpatient scenario.

Participants were asked for preferences based on patient safety criteria. Other qualitative feedback was elicited covering:

Rationale for preference
Design fit with current and best practice
Design understandability
Any potential hazards resulting from the designs

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Detailed notes from the interviews were qualitatively analysed using thematic coding.

B.3 Results

B.3.1 Participant Description

11 participants were interviewed in 11 sessions. Each had either volunteered through the NHS CFH Event Management System (EMS) signup or had been recruited by an HCP who had volunteered. 5 out of 11 participants had previously taken part in CUI clinical engagement for other work areas. Table 4 shows a summary of the participants’ profiles:

426 Doctor Obstetrics and Gynaecology

427 Doctor Obstetrics and Gynaecology

428 Doctor Obstetrics and Gynaecology

429 Doctor Obstetrics and Gynaecology

430 Doctor GP Rotation (Obstetrics and Gynaecology)

Senior SpR Labour board, handwritten list No

Junior SpR Labour board, printed document No

SpR Labour board, handwritten list No

SpR Labour board, printed document No

SHO Labour board, printed document (both personal and shared)

Yes

431 Nurse Renal (outpatients)? Consultant Printed document (both personal and shared)

432 Nurse Critical Care Senior Printed document (shared) Yes

433 Pharmacist ITU? Printed document (personal) No

434 Doctor GP Rotation / Military? F2 Electronic systems at two trusts, printed document (personal)

Yes

435 Doctor Surgery SHO Printed document (personal) Yes

436 Pharmacist Various? Electronic system, printed document (personal)

Table 13: Interview Participants

Yes

All participants were clinical staff who used patient lists as part of their role, generally for handover and supporting their work on the wards. The majority of the participants were junior doctors. Participants were from a number of different trusts around the UK.

The majority had had no experience of using electronic patient lists.

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B.3.2 Design Areas

Bullet text in italics represents researcher recommendations or comments in order to distinguish them from user feedback.

Current Practice

Inpatient lists are used by junior doctors as “an aide memoire so you know where they are,

who they are, what they are, and what you’ve done” (p435)

Several participants described using old versions of the patient list (usually from the

previous day) for:

 Backup – Due to still-relevant information not being transferred to the new version

 To see what had happened to patients no longer on the ward, in particular where they had been moved to

 To track the responsible staff on duty on a particular day

 To track infection risks

Too Much Data

Participants were shown three designs for dealing with large numbers of items in a cell

sublist (for example, tasks)

The most serious risks were with the design that forced the clinician to scroll the list within

the cell as this prevented them from comparing across patient’s tasks both within and between patients. They might forget to scroll, and they might mistakenly assume that the items were in order of importance (when it is likely they would not be as this is hard to reliably determine and varies depending on your clinical perspective)

Advantages of showing all items in a sublist without truncation were that all items across all

patients could (in theory) be seen in ‘one go’, though, as each patient row was likely to be much higher in this case, the clinician would have to do more scrolling and/or paging in order to see and compare items between patients

All current paper patient lists follow an untruncated model
Participants suggested that a short list of patients might be useful to get an overview of the

location or as a way to select a patient

Current Dataset Variation

As has been seen from analysis of current inpatient paper lists, participants described how

different wards can have very different datasets (for example, a general medical ward compared to a labour ward) and some modelled in different ways (for example, organising data by the body system in the Intensive Therapy Unit (ITU)):

 Implying that a patient list design cannot ignore the issue of varying datasets between wards and/or contexts

Changing Dataset

Participants were shown different designs for user-variation of the visible dataset. Issues

arising were:

 Disorientating ‘jumping’ if datasets were presented on different pages (in that the clinician has to re-find the patient they were interested in)

 Having to re-read information if datasets were presented on different pages

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 The desire to be able to compare attributes for a given patient (difficult if attributes were always displayed on separate pages)

 The belief among junior doctors that a dataset would be determined by senior staff (and possibly even non-clinical staff) and would likely be inappropriate for the juniors’ needs. Therefore, they would like the ability to vary the dataset themselves

 The desire for different roles to be able to access different datasets

 A desire to guide new staff to a recommended dataset for them in their context

 A desire to be able to vary the dataset visible dependant on patient or clinical situation

 All participants preferred a design where they could fully customise the visible dataset:

 However, this may have been influenced by a desire to account for varying datasets per ward (which does not necessarily imply that the end-user can vary the dataset)

Various risks were raised with the ability for the end-user to fully customise the visible

dataset

Updates

All participants liked the idea of marking the updates since you last saw the list:

 One participant pointed out this would be of most value in a larger team where many people were making updates to the same patients during a day (p437)

It was not seen as necessary to indicate times of updates in this view
Participants were unclear as to whether the update count included those updates on

columns out of view

The first five participants shown the design initially (mistakenly) assumed unmarking would

clear all the updates from the whole team’s view and didn’t like this, preferring the update unmarking to be personal

Other participants discussed the merits of using the updates as a kind of ‘micro-handover’

acknowledgement, in that the marking and unmarking could be shared between the team to indicate acceptance of information and tasks:

 Following internal CUI discussion, it was felt that this kind of functionality was both out of scope for this work and probably best left to a ‘proper’ communications feature

Snapshots

All six participants asked confirmed that they did want to know about patients who had

previously been on the ward (which is not possible from a continually updated patient list view)

This was mainly seen as a learning opportunity, an aid in finding the patient, for checking

tasks were done for patients now not on the ward and for quick access when writing the discharge summary

 A previous version of the patient list would mean that a clinician could find the patient’s details without having to remember unique identifiers and searching for them in the Patient Administration System (PAS), which may be unsuccessful or error prone as patients’ unique identifiers are hard to remember

History

Response was generally ambivalent, with no strong opinions for or against viewing a

per-patient history

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Opening More Details

The option to show more details for one patient at the same time as the patient list was only

discussed with four participants but there were more risks elicited for having the option than not having it

It was suggested that, given space constraints, there would in any case be a limit to how

much extra information would be able to be usefully seen at the same time

Multiple Wards

All six participants asked were initially confused by the ‘mixed’ list and all described the

benefits of seeing the patients grouped or ordered by ward

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REVISION AND SIGNOFF SHEET

Change Record

25-Nov-2009 Steve Loader 0.0.0.1 Initial draft for review/discussion

25-Nov-2009 Mick Harney 0.0.1.0 Made up Working Baseline version for copyedit/NHS CFH reviews

27-Nov-2009 Mick Harney 0.0.1.1 First pass copyedit

08-Dec-2009 Steve Loader 0.0.1.2 Update for copyedit and NHS CFH comments

10-Dec-2009 Mick Harney 0.0.1.3 Copyedit changes. Final points to agree.

10-Dec-2009 Mick Harney 0.1.0.0 Raised to Baseline Candidate

14-Dec-2009 Steve Loader 0.1.0.1 Updating with last changes

14-Dec-2009 Mick Harney 0.2.0.0 Bookmark and re-sequence IDs and raise to Baseline Candidate #2

17-Dec-2009 Mick Harney 1.0.0.0 Raised to Baseline

Document Status has the following meaning:

Drafts 0.0.0.X - Draft document reviewed by the Microsoft CUI Project team and the

Authority designate for the appropriate Project. The document is liable to change.

Working Baseline 0.0.X.0 - The document has reached the end of the review phase and

may only have minor changes. The document will be submitted to the Authority CUI Project team for wider review by stakeholders, ensuring buy-in and to assist in communication.

Baseline Candidate 0.X.0.0 - The document has reached the end of the review phase and

it is ready to be frozen on formal agreement between the Authority and the Company

Baseline X.0.0.0 - The document has been formally agreed between the Authority and the

Company

Note that minor updates or corrections to a document may lead to multiple versions at a particular status.

Open Issues Summary

None

Audience

The audience for this document includes:

Authority CUI Manager / Project Sponsor . Overall project manager and sponsor for the

NHS CUI project within the Authority

Authority Clinical Applications and Patient Safety Project Project Manager.

Responsible for ongoing management and administration of the Project

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The Authority Project Team . Responsible for jointly agreeing with the Company NHS CUI

Project Team the approach defined in this document and any necessary redefinition of the Clinical Applications and Patient Safety Project strategy that results from the document or approach agreed

Company NHS CUI Team . Responsible for agreeing with the Authority Project Team the

approach defined in this document, including any necessary redefinition of the Clinical Applications and Patient Safety Project strategy that results from the document or approach agreed

Reviewers

Mike Carey NHS CFH Project Manager 0.2.0.0 15-Dec-2009

Tim Chearman NHS CFH Project Lead 0.2.0.0 15-Dec-2009

Frank Cross Clinical Advisor 0.2.0.0 15-Dec-2009

Lindsey Butler Clinical Safety Advisor 0.2.0.0 15-Dec-2009

Peter Johnson Clinical Architect 0.2.0.0 15-Dec-2009

Greg Scott Clinical Advisor 0.2.0.0 15-Dec-2009

Priya Shah Clinical Advisor 0.2.0.0 15-Dec-2009

Distribution

As above

Document Properties

Document Title Patient List View User Interface Design Guidance

Author Clinical Applications and Patient Safety Project

Restrictions RESTRICTED – COMMERCIAL; MICROSOFT COMMERCIAL; Access restricted to: NHS CUI Project Team, Microsoft NHS Account Team

Creation Date 2 November 2009

Last Updated 23 June 2015

Copyright:

You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence or email psi@nationalarchives.gsi.gov.uk.

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