MailMinder: Taming DHCP's Mailman Interface Edward K. Shultz, Roger Brown, George Kotta Program in Medical Information Science Dartmouth-Hitchcock Medical Center Lebanon, NH ABSTRACT While the Department of Veteran's Affairs Decentralized Hospital Computer Program (DHCP) is one of the most widely disseminated and successful hospital information systems in existence, it currently is accessed through a user interface which is not as mature as the rest of the system. This interface is a VT-100 compatible, character oriented interface using menus accessed by typed commands forfeature access. This project demonstrated that a mature graphical user interface (MailMinder) can be successfully used as a ':front-end" to DHCP. MailMinder is completely compatible with the existing unmodified DHCP electronic mail program, Mailman. MailMinder allows the user to be more efficient than the current interface and offers additionalfeatures over the current mail system. The program has undergone evaluation and limited deployment at five separate sites. The feature set of this program and its operation will be shown at this demonstration. The demonstration has implications for all current hospital information systems.
An Apple Hypercard based front-end was successfully completed satisfying five functional requirements. Goal one, transparency to the host system, was achieved by emulation of a VT-100 terminal and a "dialogue manager" [1]. The manager effectively shields the user from having to learn any of the conventions of the various host systems. All requests from the front end are translated into the appropriate set of sequential, interactive commands to the host system to achieve the task. Since all of our host systems employ a hierarchical tree structure (sequential list of menus) to perform tasks, a list of "paths" through the possible branching command trees were created. It was found that paths both down (towards a more specific command) and up (returning to a more general command level) were necessary. This was achieved by use of tables, and hence were easily modifiable if new communication protocols were necessitated by changes in the host systems. The system is initialized by downloading all messages into a local copy on the Macintosh. This provides immediate response time for viewing messages, as well as the ability to search for anything contained in the text of a message, a function which does not currently exist on Mailman. During the download a copy of all senders is put into a local "address book", which allows the user to address a future message with a double mouse click. When viewing individual messages they are brought up in individual windows, allowing copying and pasting of different messages into a new message. The system supports the Mailman functions of forwarding, replying to, deleting and the viewing the recipients of a specific message. The user can also save the message to a categorical "basket". For more rare functions not supported by MailMinder the user can use a terminal window to interact in the native DHCP mode, satisfying requirement two. All transactions are accomplished using point-and-click technology or pull down menus, satisfying requirement three. A new function was implemented to allow the user to put messages in an "Out" basket or "Delete" baskeL The user could then have all messages in the baskets sent or deleted by a single click of the mouse. This allows the
The sophistication and consistency of the human/computer interface of Mailman, the electronic mail system of DHCP, has lagged behind the easy to use technology found in many microcomputers. This has resulted in decreased utilization of the electronic mail subsystem by clinicians. This is not due to a lack of advanced features of the system, which are comparable or superior to most commercial electronic mail systems. It appears to be more a lack of the basic user interface functionality which most clinicians have grown to expect from exposure to microcomputers systems. For example, while one can easily forward a message across the country, it is frustrating to change a simple misspelling. While one can archive a message to a subject specific file (called "baskets"), one can't "cut and paste" a line as is possible on most common word processors. This communication describes an effort to create a workstation "front end" employing a mature graphical user interface interfaced to the DHCP. The resultant program will be demonstrated.
0195-4210/92/$5.00 X)1993 AMIA, Inc.
812
impossible due to the complexity of the interface. Other interfaces [2,3] which have emulated terminals to host systems have not had the complexity or the random access capability to the multiple functions which exist in this system. We are not aware of any other user graphical user interfaces to the DHCP system in current use.
user to have rapid response time provided by the microcomputer, and to avoid the time required to singly delete or send individual messages on the host system, which can slow down during high user activity periods of the day. Testing the system was problematical due to many undocumented conventions which had gone into the makeup of the host e-mail system ("Mailman"), which had evolved over the years. There were also slight variations existing at different sites in the implementation of the Mailman system. In addition, the host system has the convention of changing the level in the hierarchical menu tree after a variable period of time. This meant that MailMinder had to keep track of a "moving target." Four test hospitals were employed for three months for development. Evaluation consisted of 15 users at 5 hospitals using the package over a 1 month period. No errors were reported in transactions over the month, even though weekly phone contact with major users was maintained. Figure one shows a typical screen after the system has initialized. The menu pulled down shows how one selects different functions. Figure two shows the screen when it is being used to composed new messages.
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While emulation of a serially connected VT-100 will remain a functional requirement, inclusion of the capability to perform comparable tasks across a local area network is under development. Use of more advanced communications between the microcomputer and host (process to process communications) is under consideration to increase efficiency of data transfer. Impressions from this experience are that a modem day interface is mandatory to increase clinician use of the DHCP and hypothetically to increase clinician entry of data. Therefore the implications go beyond facilitating electronic mail delivery and extend to making general purpose interfaces to existing hospital information systems [1]. The many benefits of direct caretaker data entry includes the potential for outcomes research on the resultant database, more effective decision support, decreased errors and more economic operation. If this hypothesis is true, the mechanism demonstrated here may help to provide for far reaching, much needed changes in automated medical records.
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Figure 1. This is a typical screen when the user is reviewing the contents of a mail basket. The black dots indicate messages which have not been read. When the user double dicks on a message line the message appears in a separate window which is copyable. Other functions are accessed from the buttons at the bottom or using the pull down menus. Help is available through the help menu.
We conclude that modernizing the interface of the mail system of DHCP is feasible. Emulating a simple terminal has the disadvantage of being less efficient than process to process communication, and possibly requires modification if the host system modifies its interface. Data exchange standards such as HL-7 and SMTIP (Simple Mail Transfer Protocol) offer a preferable approach in some respects. Yet these standards do not currently encompass the rich feature set of DHCP Mailman, and MailMinder would thus have had less functionality if standards had been employed. Use of Macros (automated sets of preselected commands) would have been
References
1. Shultz E., Brown R. "GraphMaker: A Step in the Design of a Universal Interface for Hospital Information Systems." Proc Symp Comp App Med Care, 1989, 675. 2. Swaine M. Bullish on the stack market. MacUser 5:211-212, May, 1989. 3. Wood L. Data entry goes high-tech. Bte 1:231-233, September, 1988.
813
An Apple Hypercard based front-end was successfully completed satisfying five functional requirements. Goal one, transparency to the host system, was achieved by emulation of a VT-100 terminal and a "dialogue manager" [1]. The manager effectively shields the user from having to learn any of the conventions of the various host systems. All requests from the front end are translated into the appropriate set of sequential, interactive commands to the host system to achieve the task. Since all of our host systems employ a hierarchical tree structure (sequential list of menus) to perform tasks, a list of "paths" through the possible branching command trees were created. It was found that paths both down (towards a more specific command) and up (returning to a more general command level) were necessary. This was achieved by use of tables, and hence were easily modifiable if new communication protocols were necessitated by changes in the host systems. The system is initialized by downloading all messages into a local copy on the Macintosh. This provides immediate response time for viewing messages, as well as the ability to search for anything contained in the text of a message, a function which does not currently exist on Mailman. During the download a copy of all senders is put into a local "address book", which allows the user to address a future message with a double mouse click. When viewing individual messages they are brought up in individual windows, allowing copying and pasting of different messages into a new message. The system supports the Mailman functions of forwarding, replying to, deleting and the viewing the recipients of a specific message. The user can also save the message to a categorical "basket". For more rare functions not supported by MailMinder the user can use a terminal window to interact in the native DHCP mode, satisfying requirement two. All transactions are accomplished using point-and-click technology or pull down menus, satisfying requirement three. A new function was implemented to allow the user to put messages in an "Out" basket or "Delete" baskeL The user could then have all messages in the baskets sent or deleted by a single click of the mouse. This allows the
The sophistication and consistency of the human/computer interface of Mailman, the electronic mail system of DHCP, has lagged behind the easy to use technology found in many microcomputers. This has resulted in decreased utilization of the electronic mail subsystem by clinicians. This is not due to a lack of advanced features of the system, which are comparable or superior to most commercial electronic mail systems. It appears to be more a lack of the basic user interface functionality which most clinicians have grown to expect from exposure to microcomputers systems. For example, while one can easily forward a message across the country, it is frustrating to change a simple misspelling. While one can archive a message to a subject specific file (called "baskets"), one can't "cut and paste" a line as is possible on most common word processors. This communication describes an effort to create a workstation "front end" employing a mature graphical user interface interfaced to the DHCP. The resultant program will be demonstrated.
0195-4210/92/$5.00 X)1993 AMIA, Inc.
812
impossible due to the complexity of the interface. Other interfaces [2,3] which have emulated terminals to host systems have not had the complexity or the random access capability to the multiple functions which exist in this system. We are not aware of any other user graphical user interfaces to the DHCP system in current use.
user to have rapid response time provided by the microcomputer, and to avoid the time required to singly delete or send individual messages on the host system, which can slow down during high user activity periods of the day. Testing the system was problematical due to many undocumented conventions which had gone into the makeup of the host e-mail system ("Mailman"), which had evolved over the years. There were also slight variations existing at different sites in the implementation of the Mailman system. In addition, the host system has the convention of changing the level in the hierarchical menu tree after a variable period of time. This meant that MailMinder had to keep track of a "moving target." Four test hospitals were employed for three months for development. Evaluation consisted of 15 users at 5 hospitals using the package over a 1 month period. No errors were reported in transactions over the month, even though weekly phone contact with major users was maintained. Figure one shows a typical screen after the system has initialized. The menu pulled down shows how one selects different functions. Figure two shows the screen when it is being used to composed new messages.
_ file
ffoFro-
Mail Baskets bosket Page Besket:
_
IN
on
Computer ApP
i cat i
g_l1l be held in ialtimore Howeeber S-11. 1992.
Sender Saner
The tA ought to maintoain a high profile at that meeting useful to identify possible topics, papers. deos ete
u. RRIRA2AELIZABETH EIETRlICES. JIfVISC-f1BA ITF ne Phil, hwe been talking *i the folks ninutes about their Focus product shid' now I ink SMfITN,JOSEPH C4 KOLOOIER,ROBERT POSTnRSTER POSTMASTIER
fARRIRR.lELIZABETH
ROSOm,nILI f4tleit
SeetsFrvn
ta t Houston i s trying the product .Hai I 'd Routing long enogh to see shot it's like 1992 flat out. IN.
Aot s
lIA
CONFERENCE
10 Jon 92
16:17
AN=shSfrmm
nee
massage Fiel
Put in Out Basket
MlolMln system
Sn Now
While emulation of a serially connected VT-100 will remain a functional requirement, inclusion of the capability to perform comparable tasks across a local area network is under development. Use of more advanced communications between the microcomputer and host (process to process communications) is under consideration to increase efficiency of data transfer. Impressions from this experience are that a modem day interface is mandatory to increase clinician use of the DHCP and hypothetically to increase clinician entry of data. Therefore the implications go beyond facilitating electronic mail delivery and extend to making general purpose interfaces to existing hospital information systems [1]. The many benefits of direct caretaker data entry includes the potential for outcomes research on the resultant database, more effective decision support, decreased errors and more economic operation. If this hypothesis is true, the mechanism demonstrated here may help to provide for far reaching, much needed changes in automated medical records.
ons in Madz Thos yeaor
SHRIOIAOOER SC4LELERHCJSERCM SC8LEIUDER,CfSE
_ CURTlS,CLAvTOM4
Tp:O-g
so Hoes, Addresses Preferences Nev Ma^il Baloeskets Foward Figure 2. Comnposition of a message takes place in a Hypercard field which allows cutting. pasting copying and mouse driven editing.
be
massages
Uip
jbject
Clear
3 of 3 Res
S,port*ng Collaboration, but presentatioos outside t o~acepntable DOeadline for the reciapt of submissions is flarch 5, 1997
46
*
The 1tih Arwtuol Sippos6u
Da llas)
Look
£xa-pIe Jim this was iritter using the lloiIninder front-end to Use lVA I can use a mture m T "I otinVownam as~~~ _to p ~~to
1844630141 22 Jon 92 12 5 II Lners
(Psuch.atrr,yUfRlC
DEMETRIADES.JIMl
O50conFrmttmStatus: S
SCRME 1992 1992
0 KOLOEI1,RODERT
____
Compose a Message To
file Edit Go Termeinal Message Help
iubj SCAWIC
EdiI Go Terminal Help lR MailHinder l.0b9
27
s.
Figure 1. This is a typical screen when the user is reviewing the contents of a mail basket. The black dots indicate messages which have not been read. When the user double dicks on a message line the message appears in a separate window which is copyable. Other functions are accessed from the buttons at the bottom or using the pull down menus. Help is available through the help menu.
We conclude that modernizing the interface of the mail system of DHCP is feasible. Emulating a simple terminal has the disadvantage of being less efficient than process to process communication, and possibly requires modification if the host system modifies its interface. Data exchange standards such as HL-7 and SMTIP (Simple Mail Transfer Protocol) offer a preferable approach in some respects. Yet these standards do not currently encompass the rich feature set of DHCP Mailman, and MailMinder would thus have had less functionality if standards had been employed. Use of Macros (automated sets of preselected commands) would have been
References
1. Shultz E., Brown R. "GraphMaker: A Step in the Design of a Universal Interface for Hospital Information Systems." Proc Symp Comp App Med Care, 1989, 675. 2. Swaine M. Bullish on the stack market. MacUser 5:211-212, May, 1989. 3. Wood L. Data entry goes high-tech. Bte 1:231-233, September, 1988.
813
