Healthcare CIOs seeking to unlock productivity gains and improve outcomes with new technology may be overlooking one answer that’s been hiding in plain sight ― clinical review displays.
Informed by human-computer interaction studies, as well as by feedback from physicians, vendors are introducing a new generation of healthcare-specific displays. These larger displays offer higher resolution and greater contrast than regular commercial displays that are prevalent in hospitals, are DICOM Part 14 compliant, integrate accessories for videoconferencing and enterprise authentication, and include special coatings to withstand repeated sanitizing. And they’re helping clinicians take fuller advantage of new digital imaging tools and EHR features.
At Palmetto Health-USC Medical Group, an organization that comprises 87 practices in nearly 100 locations throughout South Carolina, Nick Patel, MD, Executive Medical Director of Clinical Informatics, believes the new DICOM-compliant displays can close a small but significant gap in care by improving image viewing after official reads from radiologists are made ― especially useful for provider collaboration or patient education.
“Visualization is a key aspect of communicating. The problem that we had in the past was that the displays were not up to par,” said Patel. “The grayscale, and contrast were not good, so sometimes you might not be able to see those little hairline fractures and other subtleties.”
But last year, Patel’s group had the opportunity to pilot the new clinical review displays and found them to be very useful when it came to the fidelity of the image and the accuracy of the interpretation.”
Patel also sees opportunities for the new displays in the emergency room.
“If emergency physicians waited for the radiologist to interpret every study, then you would see the wait times quadruple,” Patel said. “There are only a couple of radiologists working during a shift, and you've got to give them ― unless it’s a stat read ― at least an hour to read it. They’re getting reads not only from ER but also from the main hospital, and ambulatory clinics. It's imperative for the physician who are taking care of the patient to make a preliminary wet read” so that they can render care right away.”
Bigger and better
Beyond digital imaging, a larger and sharper display can improve productivity across a variety of clinical settings. Physicians and nurses continue to do most of their clinical work using lower resolution commercial displays that are suboptimal for looking at patient records and other contextual information. Clinical review displays that are at least 24 inches with higher resolution (WUXGA or QHD) can deliver more complete, at-a-glance views of patient records and streamline workflows.
Human-computer interaction studies suggest that this increased real estate makes the human side of the equation more productive. Frequently cited research from the University of Utah found “very high performance increases” (of up to 52 percent for some tasks) when moving from an 18-inch monitor to a wider 24-inch monitor1. Another study from the Fraunhofer Institute for Industrial Engineering pegged the performance increase from dual monitors at about 36 percent over a single monitor.
There are several explanations for the effect: More information can be consumed “at a glance” so that users perceive and process more; less time is consumed on window management and clicks; and there is less reliance on faulty, short-term human memory.
This is especially true for large-format monitors that provide “picture within a picture” views from two different connected devices. Absent that feature, Patel said, cardiologists, in particular, request dual monitors in order to visualize EHR data and studies side by side. “We definitely have a lot of our subspecialists ― neurologists, cardiologists and orthopedists who interact with images more often than a primary care doctor might ― requesting this,” he said.
Some of the dominant EHR vendors are anticipating a broader industry move to larger, healthcare-specific display. In a recent update, for instance, Cerner added a feature that provides more information on the horizontal plane when it detects a larger display. A spokesman for the company said that the goal is to make the best use of the display being used “from the largest desktop down. We are working to make the navigation as intuitive as possible.” And while Epic doesn’t require that clinicians use larger or wider monitors, the company does recommend them to clients.
When Patel tried a new healthcare-specific display at a nursing station, several other unanticipated advantages emerged.
“These nurses are not doing diagnostic interpretations, but they are looking at charts, they're doing phone messages, nursing intakes, all day,” he said. “One piece of feedback we received from the nurses was 'at the end of the day, my eyes are not as strained. I’m not as tired.’ From a work fatigue standpoint, there was a clear improvement.”
1. Productivity, Screens, and Aspect Ratios, Anderson, James A. et al, University of Utah, 2007. ()