Design Challenges in Converting a Paper Checklist to Digital Format for Dynamic Medical Settings

Abstract

We describe a mobile digital checklist that we designed and developed for trauma resuscitation-a dynamic, fast-paced medical process of treating severely injured patients. The checklist design was informed by our analysis of user interactions with a paper checklist that was introduced to improve team performance during resuscitations. The design process followed an iterative approach and involved several medical experts. We discuss design challenges in converting a paper checklist to its digital counterpart, as well as our approaches for addressing those challenges. While we show that using a digital checklist during a fast-paced medical event is feasible, we also recognize several design constraints, including limited display size, difficulties in entering notes about the medical process and patient, and difficulties in replicating user experience with paper checklists.

Keywords: Medical checklist; electronic health record (EHR); emergency medicine; paper forms; trauma resuscitation; user-centered design.

Figure 1

Paper-based checklist with handwritten notes from an actual trauma resuscitation

Figure 2

Primary Survey and Pre-arrival Plan screens from the digital checklist: (a) tab-based design highlighting the current tab and showing the number of remaining items on each tab; (b) drawing area for taking “margin” notes; (c) expanded “If intubating” checklist section; (d) white rectangle fields for showing recorded notes; (e) drawing area for taking item-associated notes.

Figure 3

Vital signs tab.