06 Jan The Medical Icons of Vernon Smith, M.D.
A hospital emergency room is just about the last place one would expect to find a very particular, highly sophisticated, ancient form of art hanging on the walls – much less hanging every 15 feet or so, much less being watched constantly by everyone.
But look closer: affixed just a few inches above eye-level throughout the St. Marys emergency rooms are 21-inch, black-framed computer screens. Each screen is filled with parallel rows of rectangular boxes glowing red, green, yellow, white and blue.
The screens are an electronic patient tracking system created by Dr. Vernon Smith, a St. Marys emergency physician with a passion for combining computers and medicine.
Designed with financial help from the CoDE awards program of Mayo Clinic’s Center for Innovation, the “YES Patient Locator Boards” offer a real-time, at-a-glance overview of emergency department patients including what rooms they are in, their vital signs, whether they are trending towards dangerous status, and a great deal more.
Now look closer still: each of the several dozen brightly-colored rectangles on a YES screen represents a patient’s room, and each box contains a vertical row of tiny works of art, each one only about ¼ inch high. These tiny images connect the walls of St. Marys to prehistoric cave walls displaying hand-drawn artistic images of human hands, fish, spears and bison, and the great halls, too, of the Louvre, the Prado and the Metropolitan museums -- all great catalogs of images of human and natural life.
So what are these miniature objets d’art?
Computer icons -- modern, digital kin to all works of art that throughout history have merged aesthetics with information, sensory delight with practical guidance, artistic form with actionable function.
On today’s ubiquitous computer screens – such as the one you are doubtless reading this article on -- we are talking about icons of tumbling hour glasses, ticking clocks, speech bubbles, calendar pages, camera lenses, butterflies, clipboards, compasses, diskettes, notepads, checklists, paperclips, bowties, wine glasses, umbrellas, globes spinning around and crumpled wads of paper flying into the trash.
On the wall-mounted computer canvases at St. Marys, Dr. Smith paints his world using icons such as valentine-style hearts, sets of lungs, C-clamps, ZZZZ’s, “Closed for Cleaning” sandwich boards, discussion bubbles, spinning biohazard symbols, mortars and pestles, nurses’ caps, pulsing airborne droplets and flashing geometric shapes.
“My goal is to make the symbols obvious to the untrained eye,” Dr. Smith says. “I want the information imparted by the icons to change what you were going to do. I try to limit the use of words as it requires a separate subprocessor from your mind to make the interpretation, whereas a picture requires only recognition.”
Initially designed for the Emergency Department, the YES patient tracking system is now used as well in St. Marys units. Dr. David Klocke, a Mayo hospital medicine specialist, is collaborating with Dr. Smith to install the system in many more.
A half-dozen or fewer icons per patient gives practically all the at-a-glance information an emergency caregiver needs to know about that patient’s medical status.
An icon depicting a tiny set of lungs indicates a patient on a ventilator. A rotating biohazard symbol indicates a patient susceptible to whole-body inflammation, or “sepsis.” A heart placed inside a C-clamp indicates a patient being treated with a “pressor,” i.e. a drug to keep blood pressure from crashing. Meanwhile, a flashing heart indicates a patient with critically abnormal vital signs and thus in need of quick attention; and a series of ZZZZ’s floating skyward says that patient is on sedation.
To make his YES Board icons, Dr. Smith uses a combination of pen and paper, digital camera and graphic design software. Sometimes he borrows clip art form public domain collections on the web. Other times, starting with a photograph, he’ll use Photoshop to create a more stylized, simplified shape.
To indicate a hospital room that is closed for cleaning, the YES icon shows the bright yellow sandwich board placed in rooms that are getting swept and mopped. To make the icon, Dr. Smith took a photograph of an actual sandwich board, stylized it, typed in the “Closed for Cleaning” text and – as a final artistic flourish – drew a teeny-tiny mop.
His most complex creation is the icon that indicates “patient is on a ventilator” -- a pair of tiny lungs with a set of tiny mechanical gears superimposed. He used two photos, one of lungs and one of gears, then used photoshop to stylize and superimpose them.
Like any artist, Dr. Smith struggles to find just the right image. Sometimes, a solution eludes him for months or longer. Showing in icon form which specific doctors, nurses and other staffers are on duty at any given moment is proving to be such a challenge.
“I would like to show staffing as a picture, but I can’t find a way to do it,” Dr. Smith says. “I also want to show the waiting room as a meter, but the gauge would change too rapidly, so I have to resort to using a number. And I’m still looking for the right model for an icon to show how many ambulances are on their way to the ED.”
Whether the YES Boards offer “too much information,” overloading instead of simplifying life for its users, is something Dr. Smith keeps his eye on.
But he’s seen no evidence for it yet. “I get two or three requests a week to add more information,” he says, with no complaints of TMI so far. “Think about air traffic control displays, or stock market tickers, or the cockpit of a 747. We are nowhere near that yet.”
The biggest challenge created by the icon-based YES system is patient privacy, a sacrosanct value at Mayo Clinic. Some privacy protections are built in, such as restricting access to personal data on more publicly-accessible screens. But at some point it is recognized that most people would decide to trade off some degree of privacy, for example, to avert a permanently debilitating condition or to save a life.
“It’s a tough balancing act,” Dr. Smith says. “On the one hand, you want to make the data as easy as possible to get for those who need it. But on the other hand, make it impossible for those who don’t. The trick lies in determining who needs to know what.”
It seems a trick well worth mastering since, when it comes to Dr. Smith’s gallery of medical icons, art doesn’t only imitate life. It can also save it.
By Doug McGill