To illustrate how the medical records should work, using the iotaPad design, we'll go through a couple of scenarios.
Suspected Diabetes type 2
In this scenario, the patient is suspected of having diabetes 2. After selecting the patient (not shown), we hit the "Issues" button and get a selection of issues. One issue has sub-issues, which would be typical of main issues being rather broad symptoms, leading to the workup of several candidate diagnoses.
Tapping the second line in the popup list, Diabetes type 2, closes the list and opens the clinical guideline for establishing a diagnosis of diabetes type 2:
As you can see, the text shown is a clinical guideline, but equipped with interactive features. Through these elements, we can see actual lab values, we can order lab tests, enter comments using the keyboard or the microphone, look up other clinical guidelines, add diagnoses, and eliminate diagnoses. In the example, we can see two diagnoses that have been eliminated, pancreas carcinoma and MIDD. We can see that there are seven text or voice entries in the first diagnosis section and next to it we also see the last two glycemia values. Next to the remark about DISS, we have a link that allows us to immediatly send that report to DISS simply by hitting the rightmost button. The plus-signs allow the adding of the suggested differential diagnoses as top level issues in their own right.
In the example, we can see that there are seven comments on the first line. Hitting that button gives you a popup with the comment texts:
When you enter comments, you can either tap once to use the built-in keyboard, or tap and hold to talk into the microphone. The last three comments you can see on screen here have been dictated into the machine and not yet converted to text by a secretary, so hitting the play button will play back the voice recording for this one field.
Please note that the clinical guideline is equipped with links and tools to allow you to quickly check off the things that need to be done, but the clinical guideline does not enforce a certain order of working and does not even enforce conclusions. It does not automatically confirm or eliminate diagnoses according to values; you have to do that yourself. Just as a pilot's checklist, it is not taking over the decisionmaking, it is simply presenting the alternatives and prodding your memory. For more on this, see Evidence vs Experience'.'
Follow-up diabetes type 2
Scrolling down in the issue "Diabetes type 2", we get to the "Follow up" section. This is the section we use when examining the patient. The following image contains just a few of the elements we need (this is just an example, after all), but there are instances of different types to illustrate how to work with it.
The top part shows the relevant lab values from the last three lab reports. Only the values that are of relevance to diabetes type 2, according to clinical guidelines, are shown. There's a separate screen to see the lab report in full, without seeing it in relation to an issue, of course.
The line "Antihypertensive meds", which is part of what the national registry wants, indicates there are antihypertensive meds in the medication list. This is automatically extracted, but the user may manually change the indication. Also, there's the usual icon for entering a comment, either as text or dictated through the microphone.
The lines Macroalbuminuria and Microalbuminuria show icons for comments and for indicating if it is present or not. This indication can be automatic if the local system supports it, or manual.
The last line, "Latest ophthalmo", indicates with a date when the last referral has been done. It also has a comment icon. And, very usefully, it has a referral button, which creates a referral and fills it in fully, since the system has all the information it needs to do that. It would also be useful to include a recommendation in the guideline right here, so the line could read "Latest ophthalmo (3 years max)", which would be very helpful. Since the text of the guideline is under the control of the healthcare organisation, recommendations such as these can be rolled out to the users instantly.