1. Perry, William MA, RN

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The Internet has brought the spirit of global communication and collaboration to nurses and other healthcare professionals in ways never before thought possible. These resources are offered to expand your opportunities for discussion, reference, education, and research.


I recently saw in a news posting that Microsoft had acquired an electronic medical record system called "Azyxxi," which was developed by in-house programmers at the Washington Hospital in Washington, DC. The name intrigued me, so I went looking for its meaning. I did not find out what it means, but there were some fascinating stories about its development and deployment.


"The Azyxxi system is so easy to use that, by design, it doesn't have online Help. The team doesn't make documentation available and offers no training. Instead of forming committees, scheduling training, and announcing the arrival of the new system, Dr. Feied simply put a computer out in the clinical area with a sign taped to the monitor that said, 'Beta Test. Do Not Use.' He figured that human curiosity would do the rest.


'I came back a week later and I found seven people standing in line to use the system,' Dr. Feied says. 'Each one was flipping up the paper that said 'Do Not Use,' using the system, and then flipping the paper back down for the next person. In one week, the word had gotten out all over the entire hospital that it was faster to go down six floors to the emergency department and stand in line with seven other people than it was to try to get the data out of paper charts or the mainframes'." (


No documentation and reliance on human curiosity is certainly a different approach to system implementation! I cannot imagine following that path as we implement documentation and CPOE at my facility. Azyxxi appears to be a results retrieval-oriented system, and I could not find any mention of electronic order entry or progress notes. It will be interesting to follow the commercial development of this product.


While meandering about the Internet, looking for more information on Azyxxi, I came across The National Institute for Medical Informatics ( It is a fascinating site composed of "[horizontal ellipsis]six associated research centers: The ER One Institute, The National Biosurveillance Testbed, The Medical Media Lab, The Center for Biologic Counterterrorism and Emerging Disease (CBCED), The National Center for Emergency Medicine Informatics (, and the Simulation Training and Education Lab (SiTEL)."


With six centers, there is a lot going on at this site. This is an information-rich Web site with many video clips describing various aspects of research being conducted by the different centers. There are videos on facial recognition, voice interaction, robotics, and Azyxxi (to name just a few) at


In the Simulation Training and Environment Lab (, each section is introduced by an animated character. There are sections on gaming, learning, human computer interface, and much more. Games are demonstrated as a tool for teaching HIPAA orientation, and there is an introduction to a three-dimensional disaster simulation program, as well as online lectures.


The National Institute for Medical Informatics is a wonderful site to explore cutting-edge projects in informatics. The Simulation Lab's use of animated characters engages the viewer in what Kathy Sierra describes in her "Crash Course in Learning Theory" as an ongoing conversation with the application. "The brain pays more attention when it thinks it's in a conversation and must 'hold up its end.' And there's evidence that suggests your brain behaves this way even if the 'conversation' is between a human (you) and a book or computer screen (or lecture)." (


This Net Nomad journey started out with an unusual name for an electronic clinical data repository fielded without user training or documentation, wandered into research projects at the National Institute for Medical Informatics, and ended with multimedia interaction and a link to leaning theory. I still do not know the meaning of the term "Azyxxi," but all these links are worth a visit.


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William A. Perry, MA, RN