Medical data formatting to improve physician interpretation speed in the military healthcare system

Objective: The purpose of this project was to improve the ease and speed
of physician comprehension when interpreting daily laboratory data for
patients admitted within the Military Healthcare System (MHS). Materials
and Methods: A JavaScript program was created to convert the laboratory
data obtained via the outpatient electronic medical record (EMR) into a
“fishbone diagram” format that is familiar to most physicians. Using a
balanced crossover design, 35 internal medicine trainees and staff were
asked to complete timed comprehension tests for laboratory data sets
formatted in the outpatient EMR’s format and in fishbone diagram format.
The number of responses per second and error rate per response were
measured for each format. Participants were asked to rate relative ease of
use for each format and indicate which format they preferred. Results:
Comprehension speed increased 37% (6.28 seconds per interpretation) with
the fishbone diagram format with no observed increase in errors. Using a
Likert scale of 1 to 5 (1 being hard, 5 easy), participants indicated the
new format was easier to use (4.14 for fishbone vs 2.14 for table) with
89% expressing a preference for the new format.  Discussion: The
publically available web application that converts tabular lab data to
fishbone diagram format is currently used 10,000-12,000 times per month
across the MHS, delivering significant benefit to the enterprise in terms
of time saved and improved physician experience. Conclusions: This study
supports the use of fishbone diagram formatting for laboratory data for
inpatients within the MHS.