Computers, Medicine, Usability, viewed from the ED
If you're new here, you might like to look through this introduction to the site first.
Are you interested in how computers can reduce medical error?
Did you know that many early medical computer systems increased medical error? (Some current ones, too.)
From your own experience with your own computer at home, do you think that some computers and programs crash on a regular basis? Do you think that most software is hard to use, rude, and frustrating to work with? Based on experience, what you’ve heard, or simple extrapolation, do you suspect that medical computer systems are even worse?
Did you know that the best place to test medical computer systems is the ED, because people working in the ED don’t have the time to deal with bad computer systems, and are intolerant of BS? (If it works in the ED, you can make it work anywhere else in the hospital.)
Do you want to learn more about how to make medical computer systems usable, so as to prevent medical error?
If the answer to any of these questions is “yes,” then read through the Medical Computing series. Although looked at from my viewpoint in the ED, it all applies to medical computer systems wherever they are used, in a hospital, in a clinic or in an office.
If you need a backgrounder on Healthcare IT concepts and terminology, see Healthcare IT in a Nutshell.
There’s also a series of “word” essays that focus on particular and generally more advanced medical computer issues.
To keep up with new postings, you might want to subscribe to my RSS feed.
One final note: Once explained, most of the suggestions on this site seem simple and obvious. But as one is creating a program, or even as one is using a program with a high level of frustration, they are still not obvious until pointed out.
I hope you find the site informative and, perhaps, a bit mind-expandingly entertaining.
Keith Conover, M.D., FACEP
In high school English class, many of my generation were forced to study a book about writing known as “Strunk and White.” Compared to many other books we were forced to read, it had many advantages. It was short. It was to-the-point. It was full of pithy sayings, the most pithy: omit needless words.
Dr. Vivek Reddy, a neurologist at the University of Pittsburgh Medical Center, also works on its digital records effort.
In a February 19 article in the New York Times, Julie Creswell calls the healthcare IT portion of the 2009 stimulus bill (American Recovery and Reinvestment Act of 2009) ‘a $19 billion government “giveaway”’ resulting from the lobbying of the big HIS vendors. One of the quotes in her article points out the usability limitations of these big HIS systems: ‘“On a really good day, you might be able to call the system mediocre, but most of the time, it’s lousy,” said Michael Callaham, the chairman of the department of emergency medicine at the University of California, San Francisco Medical Center.’
I have to admit, I wouldn’t mind giving a lot of our tax dollars to these big companies, if they would only invest it in usability improvements that would save both lives and money.
Architects including Frank Lloyd Wrighthave eschewed it. Alan Cooper, known as one of the founding fathers of user interaction design for computer systems, decried it in the first edition of his classic text, About Face: Essentials of User Interaction Design. And more recently (~October 2012), people have compared Apple products with the new anti-skeuomorphic Modern UI (in-speak for User Interface) of Windows 8, previously known as Metro, and accused Apple of poor design because of rampant excess skeuomorphism.
One of the supposed means to the great gains of electronic health records is that of the Personal Health Record (PHR). Big guns like Microsoft and Google dived into the PHR pool a few years ago (Microsoft HealthVault and Google Health), only to find that the water was quite shallow. Getting information into a Personal Health Record turns out to be so hard, that the effort wasn’t worth the results. Google gave up, at least for now, yet Microsoft persists. (There may be a lesson in there somewhere… ) But, as pointed out in an article on Slashdot, the Department of Health and Human Services has released newly revised rules for the Health Information Privacy and Accountability Act (HIPAA). These are effective on March 26, 2013. This is designed to, among other things, make PHRs more functional. As the press release says: “Patients can ask for a copy of their electronic medical record in an electronic form.”
In the January 2013 HealthAffairs, Arthur L. Kellermann and Spencer S. Jones of the RAND Corporation look back at the projections of a 2005 RAND study of healthcare IT. Why, in defiance of that study’s projections, are our medical computer systems not saving us $81 billion a year? They list reasons: slow adoption, lack of interoperability, and – you guessed it – poor usability. So, just maybe, if you get vendor CEOs and hospital CIOs to spend a few hours browsing the essays on this website, you can save the country billions of dollars. (Not to mention saving hospitals’ money and making more money for vendors.) Who’d have figured?