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What happens when you have a great radiology information system but want to make it even better for your customers?

By Stuart G. Hall

What happens when you have a great radiology information system but want to make it even better for your customers? In the case of Empiric Systems based out in Morrisville, North Carolina, the answer was to hire the services of an interface design company called RedWhale to work on their Encompass.NET product. With results which have impressed many in the imaging community we thought it was worth finding out why and how this happened.

Empric's Mark Janas sets the scene: "Since its inception, Empiric Systems has been driven by radiology business, clinical, and workflow expertise. We have decades of collective experience in managing both hospital and outpatient-based imaging center operations. And over the last seven years, we have continued to add modules and functionality that enabled us to provide a true, single source, single database, web-based radiology information system, PACS, and billing system.

"However, with all of our business, clinical, and technical expertise, we recognized that we weren’t ergonomic design experts, and we believe that our customers deserved and would benefit from enlisting a firm that specialized in just that. Our goals were simple: more intuitive system flow, better screen management, better use of colors and fonts, and fewer clicks… in short, anything we could do with a graphical user interface to make the lives of our customers easier. After an intense search, we found RedWhale to be the company that could help us."

RedWhale's CEO, Dr Angel Puerta, himself an internationally recognized scientific leader in the area of human-computer interaction, says in essence the challenge was moving a system from an engineering-oriented design to a user-friendly one: “Our design process is based not on the functions and how are they organised as we assume the system can kind of do those things; what we are interested in are who are the users, what are the characteristics of the users, the different roles they play in an organisation, and we want to understand what they do in their daily routine…And what we try to do is to create a task flow for each of the users from their own perspective how they go about going about a particular task. [And what needs to be displayed for each task]. We call that user-centred task analysis. That’s what we use to convert something engineering-centred to something user-centred.”

RedWhale's CEO Angel Puerta

Often the problem with many traditional information system designs is that often the system has developed over time to reflect the growing number of functions for the medical imaging professional. This happens because there has been a push from the user, who understandably want as much information as possible on one screen to be able to do everything from one place. And this is typical of many medical informatics systems because time is of the essence and you want to manipulate things as little as possible because you are busy with other things.

Dr Puerta explains: “But when you have lots of functions and it’s not organised in a coherent manner, it actually takes you longer just to locate what you want to do, compared to the benefit of having everything on just one screen. “There are two problems, one is with trying to put all functions on one screen, and secondly, it involves cognitive overload. And actions and information are grouped together so you cannot easily distinguish what is a piece of data and what is an item from which you can act.”

Two things in particular were very important in the redesign of Empiric’s product, one was ensuring there is a definite task flow for the professional, that is supported by the interface itself. Secondly, organizing the data within the flow so that relevant data items appear on the screen in the right place and at the right time..In other words, presenting the busy imaging professional with overall much less information than before, especially irrelevant information within the context. “With the new design we wanted to give you sense of workflow, that is how far you are along with the present exam, and of present status. So if you want information on a particular exam you’ll click on a particular exam. By contextually showing the user where they are you can also show them what can be done, so you don’t have to worry about 17 options that happen to be there but you don’t need them anyway,” explains Dr Puerta.

RedWhale's passion for turning the jargon of human-centred design into reality is reflected in a subtle change, with potentially impressive effects. Instead of representing a patient in the interface with a unique number, the first instinct of any computer ‘geek’, they have simply replaced that with the patient’s name. Dr Puerta takes up the story: "What we wanted to achieve is the idea that if a patient comes into your radiology office they do not become an exam, they are a patient first and foremost. By that simple means we bridge the gap between the patient and the system, and we humanize the interaction. From an engineering point of view I will never use a name as a database index. Names are not unique to a person – I really need a unique identifier, which is typically a number.

"But if I use a number as the identifier in the interface, then the interaction moves much closer to the system than to the patient..which creates an unwanted separation between the machine and the human process.”