Trump Order of Pages

... if a patient has a large past history, dormant significant diseases, operations and other events, as well as several current problems, and a large (but dead of interesting diseases) family... which area shall we squeeze and which display in full ...

Modern monitors present more information per screen, and more per square centimetre than those around at the beginning of GP Clinical Record System design.

Modern users are more used to the medium, more demanding, and expect to see and use more information on a single screen than previously.

Combining Screens

The response to this must be to combine some of the categories of information which had previously been presented as individual screens. Apart from the need to save space, there is considerable logic to presenting for instance the Past Medical History and the Problem List together, since they can both claim to be elements in the summary.

It is arguable whether the most appropriate use of any remaining screen space is for reminders[1], or for Family History[2]. Reminders are presented in some systems as modal stop messageboxes, which is irritating, and leads users to learn to click anything that appears, so presenting them as an unobtrusive list which neither goes away nor gets in the way has considerable merit but devoting a significant area of an important screen to reminders when most patients will have none may be wasteful. Family history is an important part of the summary, but so is occupation, which is not commonly presented with as much immediacy as the designer of the Lloyd George envelope achieved.

Where there is so much choice it is reasonable for a system designer to choose according to the most immediate voice, or his own taste, or to take an easy way out and make it user configurable and allow users who read the instructions to choose which cards are concatenated onto their summary screen.

If an individual has only a few lines in each of the lists, then no problem occurs, still less likely if the user has a large screen. However if an individual patient has a large amount of past history, dormant significant diseases, operations and other events, as well as several current problems, and a large (but dead of interesting diseases) family... which area shall we squeeze and which display in full, or shall we simply set the screen to show say 7 lines of each?

Insufficient Ambition

The last solution seems insufficiently ambitious. Some work on the human computer interface suggests that the position of information on the screen is more important than most other cues to meaning, however it seems unlikely that altering the position of the lines betwwen lists is going to throw us off.

So, the divisions in the summary should intelligently shift with the aim of displaying all the lines, but if the total number of lines of summary is greater than the screen available, we need an order of preference for showing versus hiding.

Accept a minimum display of two lines for each box, assuming that entires to the category can be made by highlighting and activating it's display, and then set rules on how to restrict the displays.

I chose[2] to place Family History lowest in the order, with Past Medical History above the Problem List. Some GPs would prefer the latter pair reversed, no doubt, so this really should be user or practice configurable.

[1] Torex Premiere demonstrates this choice. Up

[2] The candidate system I wrote in 1997-98 chooses this. Up