Medical data formatting to improve physician interpretation speed in the Military Healthcare System

Objective: The purpose of this project was to improve 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 at Naval Medical Center Portsmouth 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 1-5 (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 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.