I have really been diving into MEDITECH’s 6.0 Clinical Panels.  This is, after all, the latest MEDITECH has to offer for patient chart review and support for clinical decision making.   I find it very frustrating though, because it’s difficult to get a good flow of data evaluation.  In MEDITECH’s demonstrations, the data is all perfectly placed in these narrow columns so that the user gets a wonderful vibe of an easy, relaxed chart review.  However, as soon as reality strikes, users realize that all responses are not less than 15 characters.  A user is notified of a longer response with an ellipsis after a truncated entry.  In order to see the  longer response, he must click once to open an additional screen, move the mouse to the bottom right of the screen, click close and then continue the chart review.  In the assessment below, which certainly represents a very limited assessment, the user cannot easily glean the patient’s status.  There are so many entries with the ellipsis after them that the user is forced to click on each to see the response.

This results in a very clunky workflow.  If you count the keystrokes required to view the first (and shortest) entry in this example, the user would have to use 10 keystrokes.  This may irritate users and in some cases, the user may think the beginning of the entry is intuitive and assume the remainder of the response in order to save time. However, this represents bad practice and could result in compromised patient safety.  For instance, the “Gastrointestinal” entry has two responses, which are both truncated with an ellipsis.  They are “Bowel Soun…” and “Abdomen D…”  Upon clicking on the row, the user sees that the entry is “Bowel Sounds Hypoactive” and “Abdomen Distended.”  The user can then sweep the mouse to the bottom right of the screen, click close and return to the assessment.  To see all of the entries on this screen, the user will have to click 40 times.  That is not a typo.  FORTY clicks!  Wow.  There is no apparent method to widen the columns and no apparent method to use that blue space to the right of my last column.  It’s just sitting there, teasing me.  Sure would be a good place for the rest of my results.  Hmmmmm.

How do you think your clinicians will react to this method of chart review?  Can this, will this meet their needs?

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When you consider the impact that a 6.x migration would have on your end-users, bear in mind that a significant amount of time will need to be arranged for the re-education of the clinicians who will be using the PCS (NUR) module. The documentation routines in 6.x will feel somewhat familiar to current Client/Server (C/S) users, but very different to those currently in the MAGIC community.

First off, there is a change in the lingo. For MAGIC users who are unaware, the NUR Module is called Patient Care System (PCS) in C/S and 6.x.

In C/S and 6.x, MEDITECH’s Status Board is required to access a nurse’s patient list. This functionality has been available for some time in MAGIC but is not required.

The 6.x Status Board has a different look and feel than its MAGIC and C/S predecessors. The new Status Board has two main sections. The top section displays a list of an individual clinician’s patients with a spreadsheet array. The patient assignment editing routines are available on buttons at the bottom of this screen. Access to alternate lists is set up in the PCS Access/User Preference dictionary.

The patient list may be set up with pinned columns and a horizontal scroll for data that does not fit within the initial display. The functionality is somewhat improved over earlier versions as users may use click functionality within this section to view more information such as interventions or medications that are due, or new orders or lab results.

Click to enlarge

The second section of the Status Board displays below the first and is the source for further patient detail. This is a curious design because it requires the user to look in two different places on the same screen to view patient data. If the highlighted patient happens to be at the top of a lengthy patient list that requires a vertical scroll, then the user may not be able to visualize both sources of patient data on the screen at the same time!

Click to enlarge.

This two tier Status Tier design could contribute to the user not having access to complete patient data at one glance – with ramifications in terms of clinical decision making.

More 6.x Status Board scrutiny with the next post …

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