A Clinical Dashboard summarizes information from an associated electronic health record (EHR) relating the real-time condition of a patient cohort in a visually concise and usable interface. Dashboards provide feedback to clinicians and managers at the point of care for clinical decision support.
Quality Dashboards or Health System Dashboards provide feedback on entire departments or enterprises. They can display individual patient, provider, or aggregate metrics (such as performance or quality indicators) for the purposes of improving healthcare quality, efficiency, safety, or revenues. These operational dashboards provide an at-a-glance view to help managers quickly uncover problems and make immediate decisions.
- 1 History and Terminology
- 2 End-Users of Dashboards
- 3 Potential Use Cases and Examples
- 4 Effects on Workflows
- 5 Design Considerations
- 6 References
History and Terminology
Dashboards were developed in the business sector as a way to "summarize and integrate key performance information across an organization into a visual display as a way of informing operational decision making". 
The terms "registry" and "dashboard" are often used interchangeably in the literature. However, the term "clinical data registry" is usually in reference to a retrospective patient cohort comprising a database for the purposes of research or quality improvement. The data collected by a registry can have multiple sources, providing information about a patient's longitudinal care. The information is not necessarily displayed with an interface intending on real-time decision making.
Clinical dashboards, on the other hand, provide operational/point-of-care feedback to physicians, nurses, pharmacists, administrators, and other ancillary staff.
End-Users of Dashboards
- Healthcare organizations (ie hospitals, clinics, and government bodies) to monitor performance and quality indicators.
- Hospital administrators for patient placement and flow.
- Physicians for monitoring their patient panels, whether in a hospital unit or outpatient clinic.
- Nursing to monitor their patient panels and nursing-specific workflows.
- Pharmacists to assess medication use.
- Care managers for coordinating discharge and follow up.
- Ancillary staff for scheduling, transport, and more.
Potential Use Cases and Examples
- Primary care physicians can identify patients from their panel that are high-risk, that have a recent ED visit, or that have recent admission.
- Specialty clinicians can view the HbA1c and medication refill status of his diabetic patients from a single screen.
- Medical assistants & Clinic Managers can manage the check-in, rooming, and throughput status of clinic visits.
- Acute care physicians can track quality measures and identify patients at high risk for AKI or line infections.
- Intensivists can monitor their unit’s compliance with safety bundles, such as for ventilators and lines.
- Emergency Departments can display a patient-level table of triage information, bed status, provider assignments, resulting labs, and more. An aggregate dashboard can also display throughput metrics and overcrowding information.
- Surgical staff can similarly use dashboards to display scheduling and throughput information
- Nursing can see a unit-wide visual representation of bed status, provider contacts, and equipment availability.
- Hospital command centers can monitor throughput and incorporate predictive modeling to optimize census levels while preventing overcrowding.
- Pharmacists can monitor for potential adverse drug events, high-risk medication scenarios, supply issues, and to safeguard against over-use as with antibiotic stewardship programs.
- Coordinated Care Organizations (CCOs) can compare provider performance. Risk stratification with predictive modeling can help to identify high-cost patients that may benefit from care coordination. The multi-disciplinary care team can use the interface to coordinate their actions and communicate in one place.
In-depth: Emergency Department throughput dashboard at The University of Texas Health Science Center at Houston
Franklin et al. describe the design, implementation, and evaluation of a real-time throughput dashboard for improving efficiency within their emergency departments. In pre-planning, they considered supporting situational awareness and optimal time visualization as top priorities. They sought to “improve throughput in-the-moment by focusing on breaking down bottlenecks within stages of care and improving the turnaround for the individual patient.” Throughput was measured as the “duration of time within an interval or stage of care”. Temporal events (timestamps) in the EHR were mapped to meaningful stages of care. Each stage was given its own throughput time goal.
In considering the dashboard visualizations, they wanted to highlight actionable information, including identification of bottlenecks and individuals who are approaching or are over time thresholds for a stage of care. To integrate the dashboard into workflows, providers were shadowed/observed to develop a work domain ontology (WDO). The dashboards themselves were developed in Tableau. Patients and their throughput status are represented by colored symbols. In addition to throughput time data, the displays also support providers with census info, laboratory and imaging order status, and individual physician workloads.
The prototype dashboard was refined during presentations and focus groups at multiple EDs. During implementation, multiple surveys and sample observations were conducted.
Effects on Workflows
Benefits of clinical dashboard utilization
- Reduced information overload.
- Improved ability to find information effectively.
- Provides clinical decision support, guiding clinicians on the priority of care and on the priorities of the organization.
- Facilitates communication among multiple providers and multidisciplinary team members caring for common patients.
Unintended consequences of clinical dashboard utilization
- Tunnel vision: Focusing on the metrics that are displayed, while ignoring other unmeasured indicators.
- Measurement fixation: Focusing on improving the quantitative representation of performance and quality (meeting the target number), rather than on the overarching purpose of care.
The presentation of information affects the decisions of end-users.
Additional information about the urgency of data can be imparted using color coding, or with symbols such as warning signs or traffic lights. Recent trends can be simplified on a dashboard display using spark-lines.
An emergency department may have a large physical screen permanently displaying the ED census and important metrics, such as triage info and bed assignments. A dashboard can be a screensaver or the first page when logging into an EHR. Studies of dashboard implementation have shown that difficult or inconvenient accessing is a major impediment to their usage. 
The dashboard should allow for convenient linking to more detailed information, by allowing the user to hover for expanded data, clicking to drill-down, or clicking to access an element in the patient's chart.
Risk scoring algorithms or risk stratification can make use of multiple patient metrics to provide a visual or numerical representation of a patient’s risk for poor outcomes, including mortality, care utilization, or re-admission.
- Dowding D, Randell R, Gardner P, et al. Dashboards for improving patient care: review of the literature. Int J Med Inf. 2015;84(2):87-100.
- Sharp J. Registries in Accountable Care. Agency for Healthcare Research and Quality (AHRQ); 2018.
- Franklin A, Gantela S, Shifarraw S, et al. Dashboard visualizations: Supporting real-time throughput decision-making. J Biomed Inform. 2017;71:211-221.
- Martinez DA, Kane EM, Jalalpour M, et al. An Electronic Dashboard to Monitor Patient Flow at the Johns Hopkins Hospital: Communication of Key Performance Indicators Using the Donabedian Model. J Med Syst. 2018;42(8):133.
Submitted by Jonathan Sachs