Posts Tagged ‘Oncology’

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EMR virtualization… possibly

June 7, 2010

Throughout this whole project we’ve been operating under the assumption that we would have a typical (maybe not) intranet web setup: a dedicated application server, a database server and scale from there.

But recently, we’ve begun to examine the possibility of virtualizing the entire operation. COS are currently using VMWare (HIT Link) for some of their applications and it would make a lot of sense to simply load up another vitual app on their servers. Maybe some hardware would need updating, but that’s easy with virtualization.

I still have a lot to research and learn about the specifics of the different virtualization platforms, but it seems like a no-brainer.  Virtualization could also allow us to easily disseminate Ankhos at a later date with the use of virtual ‘apps’. There are many EMR systems currently available as virtualized apps, but none addresses the specific needs of the oncology internist… yet.

What have your experiences been with EMR virtualization?  I know there are many commercial initiatives (Dell, McKesson) starting up and this is probably very fertile ground for the future of EMR rollouts.

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Chemo administration screenshot

May 19, 2010

This is a promised screenshot of our current iteration of the page our nurses will be using to administer chemo.  There is a LOT going on in this picture, but some of the important procedural bookkeeping that is required of the nurses is streamlined on this page.  IV notes, allergies, even plain old warnings about a patient are present here.  Also present are things like dual-signature chemo dose verification and minute-by-minute tracking of what has happened to this patient.

Keep in mind, this is a beta, and there are some debugging/feedback features here for the time being.

The orders these nurses are carrying out come from the specialized physician order interface (not pictured here).

I would love to get more into the rest of the application, but that is premature at this juncture.

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Winning the hearts and minds of the people

May 18, 2010

We spent the last few weeks  going through the initial process of using Ankhos in the office, as well as developing a specific rollout schedule.  We have been very sensitive about how receptive the employees are to our new software, as their acceptance can make or break the software.

To this end, I spent most of my time this week working one-on-one with the future users of the software, coaching them through their roles with the software.  Physician’s assistants would be working with the software in different ways than the nurses or lab techs, and I made sure everyone understood their proposed roles.  (I say proposed because software is organic, and these roles and use cases will likely change)

Working one-on-one with the user, asking questions and prompting criticizm is the best way to win the hearts and minds of the users and to make the software their own.  I am excited to abdicate this  ”developer’s throne”  and give the power to the users. Ankhos 1.0 is coming soon…

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Seeing the forest without the trees

May 13, 2010

A while back, I posted a video of how regimen creation is done in Ankhos. In my recent visits, we have decided to almost completely gut that portion of the  UI.

We were using tree widgets, the kind you find when you navigate  file systems on some operating systems. Instead, we are going with the automatically-populated textbox that displays not only drug and procedure names but regimen names, as well.

I think some of the reason we went with the tree paradigm in the beginning was my own ignorance of how chemo regimens are prescribed. The PAs and MDs know what they are looking for when they search for a regimen. They are not ‘exploring’ all of the breast cancer regimens searching for the right one.

I, on the other hand, did not. I assumed that because I had to explore to find a relevant regimen, that the user would too. I think this is an important lesson and a very productive UI improvement that will save them time.

Another lesson here is that I was only able to learn this by performing usability inverviews on-site with the future users of the system. Scrutinizing every click and mouse movement they made, how long they hovered over certain things and trying to ascertain what aspects of the UI seemed to confuse them. Not scientific by any means, but productive.

I find it hard to imagine a large software/EMR company being able to have the close interaction and trust that one can engender with a small engineering team

We are near the end of our annealing user sessions and the home stretch is ahead for completion of phase 1 of Ankhos.  I am very excited as are all of the users at COS. They even have their fancy new long-battery-life Acer laptops!

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Video: Regimen creation

February 26, 2010

Last night, I compiled a quick video showing how regimen creation works in Ankhos. This blog is about openness and collaboration and I hope that some ideas may be useful for those starting their own oncology EMR. Please leave feedback if you love or hate the way Ankhos handles regimen creation. And let us know if this information was helpful for you! Please keep in mind that the look is not yet polished.

Below are the general steps that occur in the video

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Regimen creation success

February 23, 2010

Today was the first day in three of on-site user tests for Ankhos. I sat with Joy, the lead nurse at COS and went through the creation of a few oncology regimens. Granted, the previous experiences she has had with regimen entry in other EMR products has been a nightmare but, in her words, Ankhos is “Awesome!”

Oncology regimens can be as simple as prescribing one dose of one drug on one day. They can also morph into tentacled behemoths capable of devouring days of productivity and chomping away at the morale of those charged with their creation. Today we concluded that the simple interface Ankhos uses is able to tame these horriffic beasts and make their creation… dare I say… fun.

To make regimen entry simple, we tried to break it down into fundamentals. We took a step back and noticed a few fundamental principles

1. Regimens are cyclical — There should be some notion of periodicity built in to how we specify them.

2. Regimens are cohesive — They are not simply a collection of drugs, but are notions of intent for how to treat a patient.

3. Regimens are subject to real life events — They have to be flexible enough to accommodate a patient missing a treatment, or not having a ride home, or having bad reactions during treatment.

4. Regimens are temporally dependent — Modification of an ordered regimen must be allowed to ‘cascade’ to future doses and schedules.

5. Regimens can be hierarchical — Some are derived from others, and if we can design our interface around that, we can make modification and addition of regimens easier.

By taking these principles into account, we were able to design an interface that is both easy to use and powerful enough to express the most complex regimens.  More testing tomorrow…

If there is enough interest, I would be willing to create a video demonstration of our regimen creation process.

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User feedback is important

February 17, 2010

Things are going really well in the development of Ankhos and we are planning a live alpha test on Monday. Live alpha means we are going to be working with real data, real drug regimens and real patients in the office while using Ankhos. I  am going to be very busy and won’t possibly be able to be with all users as they use the system.

So, I have put in a rudimentary feedback option.

I hope that this simple, anonymous feedback channel can allow me to get meaningful input from users I am not necessarily working with at the moment. Also, I hope that users will be able to be more critical of the application without having to speak their criticism in public.  I am looking for another paradigm shift, in the constant search to make this application even better.

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Screenshot: Daily notes, treatment status

February 9, 2010

I’ve been busy at work and not posting as much, but I thought I would post a screenshot of how we are handling the status of treatments.  There are many more features in this screenshot than I can talk about in one post, so those will be for later. I do want to point out a few features, though.

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Screenshot: calendar context menu

January 29, 2010

One of the neat things about the dojo toolkit is the support for cool widgets like the right-click context menu. We have a screenshot of how we are using it in our application past the break.

We are using Dojo for our javascript framework. It works very well in most browsers without too much special-case programming. The biggest disadvantage that Dojo has is it’s horrendous documentation. Nearly every official page is marked ‘out of date’ and the automatically-generated API documentation contains virtually no information other than method names.

That said, two books that have been indispensible (especially when the internet is out) are O’Reilly’s Definitive Guide to Dojo and Mastering Dojo. Both provide detailed discussions of design philosophies and go into how dojo leverages the idiosyncrasies of javascript to create easily-maintainable code (not a trivial task in javascript).

I really like Dojo, but most of the other competing frameworks have better documentation. Anyway, on to the screenshot…

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Oncology EMR: The human element

January 25, 2010

I’ve said it before and I’ll say it again. Enthusiastic clients are  a huge part in creating quality software.  I read the Daily WTF often (as most programmers should). This blog reminds me of all the things that can  easily go wrong with a software project if you don’t keep your head on straight and learn to side-step people eager to get in the way. It also makes me constantly appreciate the doctors and nurses with whom I am writing this software. Without their expert and creative input, this project would be a lost cause.

It is this human element; the creativity, expertise and enthusiasm of people that makes Ankhos great.

If you have an EMR vendor who is not excited to work with you, don’t just walk to the nearest exit. Run. If you have an EMR vendor who works very closely and listens to your needs, cherish them and count yourself lucky. If you are looking for an oncology EMR product developed by and for oncologists, stay tuned. Drop us a line, or provide feedback. Ankhos  will deliver.

More screenshots coming soon…

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Posted in EMR, meaningful use, Oncology, Software | Leave a Comment »

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