Open Access Research article

Improving access to clinical practice guidelines with an interactive graphical interface using an iconic language

Suzanne Pereira1, Sylvain Hassler23, Saliha Hamek23, César Boog23, Nicolas Leroy23, Marie-Catherine Beuscart-Zéphir23, Madeleine Favre45, Alain Venot6, Catherine Duclos6 and Jean-Baptiste Lamy6*

Author Affiliations

1 VIDAL, 21 rue Camille Desmoulins, 92789 Issy les Moulineaux, France

2 INSERM CIC-IT/Evalab, Université Lille Nord, Lille, France

3 UDSL EA 2694, CHU Lille, 59000 Lille, France

4 Université Paris Descartes, Faculté de Médecine, Département de Médecine Générale, Paris, France

5 , Société de Formation Thérapeutique du Généraliste (SFTG), Paris, France

6 , Laboratoire d’informatique médicale et d’ingénierie des connaissances en e-santé (LIMICS), Université Paris 13, Sorbonne Paris Cité, INSERM UMRS 1142, Université Paris 6, 74 rue Marcel Cachin, 93017 Bobigny, France

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BMC Medical Informatics and Decision Making 2014, 14:77  doi:10.1186/1472-6947-14-77

Published: 26 August 2014



Clinical practice guidelines are useful for physicians, and guidelines are available on the Internet from various websites such as Vidal Recos. However, these guidelines are long and difficult to read, especially during consultation. Similar difficulties have been encountered with drug summaries of product characteristics. In a previous work, we have proposed an iconic language (called VCM, for Visualization of Concepts in Medicine) for representing patient conditions, treatments and laboratory tests, and we have used these icons to design a user interface that graphically indexes summaries of product characteristics. In the current study, our objective was to design and evaluate an iconic user interface for the consultation of clinical practice guidelines by physicians.


Focus groups of physicians were set up to identify the difficulties encountered when reading guidelines. Icons were integrated into Vidal Recos, taking human factors into account. The resulting interface includes a graphical summary and an iconic indexation of the guideline. The new interface was evaluated. We compared the response times and the number of errors recorded when physicians answered questions about two clinical scenarios using the interactive iconic interface or a textual interface. Users’ perceived usability was evaluated with the System Usability Scale.


The main difficulties encountered by physicians when reading guidelines were obtaining an overview and finding recommendations for patients corresponding to “particular cases”. We designed a graphical interface for guideline consultation, using icons to identify particular cases and providing a graphical summary of the icons organized by anatomy and etiology. The evaluation showed that physicians gave clinical responses more rapidly with the iconic interface than the textual interface (25.2 seconds versus 45.6, p < 0.05). The physicians appreciated the new interface, and the System Usability Scale score value was 75 (between good and excellent).


An interactive iconic interface can provide physicians with an overview of clinical practice guidelines, and can decrease the time required to access the content of such guidelines.

Practice guidelines as topic; User-computer interface; Computer graphics; Iconic language