Sorry, this is an overdue update! I left for a six-week trip to the Philippines to help deploy Moca in the Batanes province on a teleradiology project. It was the MOST amazing experience of my life. I learned so much by speaking to doctors, nurses, midwives, healthcare workers, and other locals on the ground. I was shocked and frustrated by the obstacles in the healthcare system that left millions without health insurance coverage and many more without proper access to quality care.
I will blog more about the trip in the coming posts, but I wanted to write about the extremely valuable input I received on the OpenMRS image viewer from the doctors and health professionals who I worked with. Below is a summary of the feedback I received when doing usability tests on them. I tried to gather research on the specific workflow that the media viewer would be used in so that I could tailor the system to integrate well with that workflow.
Radiologist
Usability test done on radiology oncologist (for radiation therapy for cancer patients) at Philippine General Hospital (PGH). He is a consultant with the radiology department at PGH and teaches residents. He voluntarily answers all teleradiology referrals for the National Telehealth Center by email.
Existing Workflow
• Uses Mac image viewer called “Preview”
• Uses Preview to modify darkness/brightness, white balance
• “Eventually we want it like this (the OpenMRS image viewer). What we do now is difficult because I open the email, read it, etc..”
• Receive only a few films by email, 10 per week
• Willing to read up to 100 plates per day
• Problems w/ x-rays (patient is breathing), radiology technician not properly trained
• Send notification to cell phone to check the web
• Will check email when get home, 1x per day, sometimes 2x
• Each takes on average 1 minute to diagnose, chest x-ray 2 mins, max 5 mins
• Slow internet at hospital
• Doing telehealth referrals for pro bono now
• 1 patient per email so don’t mix up names with images
• Takes 1 min to download the image, 2-3 minutes to diagnose
Take proper chest x-ray image (to retrain radiology technician)
• Angulated by 15 degrees
• See apex
• Top part of chest should take up 50% of the x-ray
• Female patient should remove bra
Features Needed
• Zoom magnification
• Vary contrast and brightness
• Just save original image (not modified version)
• Panel of information: symptoms, clinical diagnosis, clinical history
• View past x-rays (2 side by side, previous and latest)
• Access to older films (zoom and brightness capabilities on those images too)
• Radiologists need box for “findings/interpretation” and for “notes”
• Clinicians should be able to write diagnosis, treatment, notes (some fields can be blank)
• No drop down box for diagnosis, no fixed reading (except for “normal chest”)
• No cancel button needed, will read it then
• If not sure of diagnosis, will leave it blank or refer to someone else put case on “hold”, assign it to another doctor, allow both doctors to be on the case
• Output an official report, type report next to image, then go directly to an editable version of the official report (auto populate the official report and then make it editable, preview + edit report)
• Don’t need to annotate image, maybe a circle/arrow/pointer if clinician wants to see lesion (dermatology cases may require annotations)
• List of on-call doctors, typically on-call all day from 7am-11pm, diff person per day, a doctor is on-call 2-3 times per week
• Could charge 30-50 pesos per x-ray plate reading
• If bad image, disappear from queue until need it again, don’t need the bad pics
• Personal digital signature
Nurse
Difficulties
• Double click to annotate
Workflow
• Clinician needs to incorporate the radiologist reading with other data from patient (ECGs, other labs)
• Once sure about interpretation, don’t need to go back and save, only compare, won’t return to edit it
• Clinician rad tech radiologist clinician
• Time diagnosis 48 hrs
• Use Windows default image viewer
Features Needed
• Make the image DICOM compliant (Open binary file, first part is text (key value pairs in header), parse into fields, latter part is image
• Embed in file the doctor who interpreted the data
• Click on annotation to edit again
• Zoom (enlarge it so one lung is screen width, 3-5 MP)
• Don’t need to rotate it
• Label it as “user” or “patient”
• Add doctor’s name as the one interpreting the data
• Annotation box can be fixed to a corner of the screen
• Don’t need other info from medical record of patient besides the summary
• Compare with previous x-ray films, click to see previous plates, side by side comparison
• If not sure, need to refer to another doctor (residents may be unsure about diagnosis)
• Clinician needs diagnosis, treatment, other notes box
• Clinician may not need to annotate image
• Can have another system for clinician, pull out radiology image for same visit of patient
• Change brightness, contrast, sometimes can see shadows
• Date is fine, don’t need timestamp
• Bad image quality -> comment why bad image, want another view
• Retake shot (i.e. top of chest)
• Save original ones with new images
• Drag image around, zoom to click, scroll image like google maps
Doctors in Batanes
• Need annotations for clinicians and radiologists
• Blank spot for clinical diagnosis
• Blank spot for radiologist (i.e. there were no densities, diaphragm is intact, heart is not enlarged)
Doctor in Manila
• Spell checking for the boxes
• Findings, diagnosis boxes
• Make sure it’s embedded in the workflow (see surgery system by National Telehealth Center)
• Separate screen for diagnosis of patient, not in the image viewer
Tags: GSOC Media Viewer, OpenMRS