PubMed on Tap: Access PubMed
on Handheld, Wireless Devices
Dina Demner-Fushman
University of Maryland, College Park
and
CEB/LHNCBC/NLM/NIH/HHS
PubMed on Tap
• a pilot R&D project of the Communications Engineering Branch,
Lister Hill National Center for Biomedical Communications,
National Library of Medicine, National Institutes of Health,
Health and Human Services
• Goal
– Develop a stable system to study design principles for delivery
of medical information to handheld devices at the point-of-care
• Designers/Developers
– Susan Hauser, project leader
– Glenn Ford
– Dina Demner-Fushman
Outline
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Motivation
PubMed at a glance
Design questions
Usability study
Next steps
Why patients need just-in-time
information for clinicians:
Patient Fact Sheet
20 Tips to Help Prevent Medical Errors
….Medical errors are one of the Nation's leading causes of death and
injury. A recent report by the Institute of Medicine estimates that as
many as 44,000 to 98,000 people die in U.S. hospitals each year as the
result of medical errors. This means that more people die from medical
errors than from motor vehicle accidents, breast cancer, or AIDS…..
Ask your doctor if your treatment is based on the
latest evidence
AHRQ Publication No. 00-PO38, February 2000. Agency for Healthcare Research and Quality
http://www.ahrq.gov/consumer/20tips.htm
motivationPubMeddesignusabilityfuture
Doctors are encouraged to search for evidence based answers to
their questions about patient care but most go unanswered
Fifty nine obstacles were found while attempting to
answer clinical questions with evidence
3. Obstacles related to seeking information
3.1.3. Lack of time to initiate search
3.2.1. Uncertainty about where to look for information
3.3.1. Resource physically distant
3.3.9. Resource not current
3.3.10. …. Most general resources do not allow real time
interaction with the searcher
(Ely et al., British Medical Journal. 2002)
motivationPubMeddesignusabilityfuture
Where to look for information
motivationPubMeddesignusabilityfuture
Current interactive resource at hand
• Speed up search
– Navigation
– Presentation
• Provide expected PubMed functionality
motivationPubMeddesignusabilityfuture
PubMed Search
motivationPubMeddesignusabilityfuture
Advanced Search
("variola virus"[MeSH Terms]
OR "smallpox"[MeSH Terms])
AND hasabstract[text] AND
Clinical Trial[ptyp] AND
jsubsetaim[text] AND
"adult"[MeSH Terms] AND
("hominidae"[MeSH Terms] OR
"Human"[MeSH Terms]) AND
("2000"[PDAT] :"2004"[PDAT])
motivationPubMeddesignusabilityfuture
Clinical Queries
motivationPubMeddesignusabilityfuture
Search Results
motivationPubMeddesignusabilityfuture
Working with Search Results
Navigating results pages
motivationPubMeddesignusabilityfuture
Working with Search Results
Viewing selected citations and links
motivationPubMeddesignusabilityfuture
Working with Search Results
Saving selected citations
motivationPubMeddesignusabilityfuture
Saving Search Strategy
Use the Cubby to store search strategies and
LinkOut preferences. Access Cubby on the
PubMed sidebar. You need to register for the
Cubby and then login whenever you want to
use it. Your web browser must be set to accept
cookies.
motivationPubMeddesignusabilityfuture
Interface Design Challenges
• Maximize utilization of 160x160 pixels, but don’t
lose readability
• Decide what information is essential for an
overview and how to organize ‘detail on demand’
• Organize content in an easy to navigate manner,
avoid scrolling
• Find clear graphical metaphors for task objects
and actions
• Maximally approximate users’ model of the
existing desktop application
motivationPubMeddesignusabilityfuture
Our Approach
• Identify most likely target user’s tasks
• Develop a working prototype, and present
to potential users for feedback
• Develop a stable system with a usable
interface and sufficient features to be useful
• Conduct usability study
• Release the improved system to health care
professionals, listen to users’ feedback, and
study aggregate user statistics
motivationPubMeddesignusabilityfuture
Organizing Content
prototype presentation
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s
a
b
i
l
i
t
y
s
t
u
d
y
motivationPubMeddesignusabilityfuture
Organizing Content continued
motivationPubMeddesignusabilityfuture
Finding Metaphors is Hard
motivationPubMeddesignusabilityfuture
Maintaining common feel and look for different
platforms and operating systems is hard
motivationPubMeddesignusabilityfuture
Usability Study
• Conducted at the National Cancer Institute (NCI)
usability laboratory, facilitator Gregory Alexander, RN
• 9 subjects (informatics students, nurses, physicians,
and medical librarians)
• 3 test tasks embedded in clinical scenarios
• 6 observers taking “stream of consciousness” notes,
while viewing participant’s face and the PDA projected
on a large screen
• Post-test questionnaire
motivationPubMeddesignusabilityfuture
Usability Study Results
All participants were able to find Medline citations containing answers to
questions described in all test scenarios
Time to complete three scenarios
50
minutes
40
30
20
10
0
There is strong correlation between time to completion and problems
in locating functions and navigation
motivationPubMeddesignusabilityfuture
Usability Study Observations
234 unique observations
Most frequent observations. Participants:
• Found brief mode (more titles per screen) useful
• Were confused by the related articles icon
• Did not know how to get back to the search tab from the
profiles
• Did not know how to drill down to a citation
• Expected more information messages, e.g. on saving
profiles
• Hesitated tapping the search globe
motivationPubMeddesignusabilityfuture
Next Steps
• Organize content
using key points of
clinical scenario
• Conduct usability
testing of all
alternative layouts
• Include other NLM
resources, e.g.
practical guidelines
motivationPubMeddesignusabilityfuture
PMOT home
http://archive.nlm.nih.gov/proj/pmot/pmot.php
Contact:
demner@cs.umd.edu
ddemner@mail.nih.gov