- “Niche” Computer Systems
- Meaningful Use
- “Wrong Patient”
- Cognitive Friction
- Dialog-Box Rooms
- What’s in a word?
- Cost Disease
- Model T
- Signal-to-Noise Ratio
- Anti-Data Pixels
- Fitts’s Law
- Bad Apple
Trying to find my way from the entrance of my 12 year old daughter’s bedroom to the bed to kiss her goodnight, especially if barefoot, is considerably more dangerous than most of the search and rescue and disaster operations I’ve been on.
Navigating the screens of medical software often seems like walking in my daughter’s room with the lights out, blindfolded, backwards. I’m sure you can find examples in many medical software applications, and there are many causes for such problems.
But one of the most important is consistency, or rather lack of it.
I know of one EMR application, DocuTAP, where clicking on things is inconsistent. Sometimes you have to click on something that looks like a button. Sometimes you have to click on a word (and, inconsistent with the standard for web pages, it is neither blue nor underlined, even when you hover the mouse over it). Sometimes you have to click on a checkbox.
Sometimes, clicking on a word does nothing, because you have to click the checkbox next to it.
Sometimes, in a configuration screen, you can click on a checkbox, and a checkmark appears, but this has absolutely no effect on anything.
Sometimes, you have to click on a line of text in a listbox and then click on a button below the listbox.
Sometimes, clicking on a word initiates some action.
Sometimes, clicking on a word selects it.
Sometimes, left-clicking on a word results in a popup box, with the word “remove” which when clicked removes the word from a list.
Sometimes, you have to right-click to get a context menu to pop up.
Sometimes, you have to click on a word or sentence to select it, then look around and click on the red X at the upper right corner to remove the item. The red X is not a button. It is not blue. It is not underlined. There is nothing that tells you it’s clickable. It has no affordance. Once you’ve figured out to click the red X, it’s easy to remember, so it’s memorable, but it’s certainly not easily learnable.
Once, I was totally stymied on how to sign the PA’s electronic charts; I had clicked on the chart’s listings in a listbox and reviewed each. But how to “sign?” Looking around the list of charts, I saw nothing. Someone finally pointed out to me that, at the very bottom of the screen, far, far away from the couple of charts at the top of the listbox, was a button that said “Sign.” Duh.
But I’m not the only one who had this self-same problem. Many others did. Placing a button far away from the foveal vision range of the items on which it is to operate is not, apparently, a good idea. This seems like a good candidate for being detected during discount usability testing, which makes me think that no usability testing, discount or retail, was aimed at this particular screen.
Let me also pick on another medical product that I use: Cerner FirstNet. When doing discharge instructions, and you want to remove something you’ve added, sometimes you right-click and from the context menu select “remove”, other times you have to highlight the entry and then click a big red X (which, again, doesn’t have any clickability or “affordance” to indicate it’s clickable). Seems as though (1) big red Xs are trendy, and (2) most medical software designers don’t know from “affordance”.
*** Update, December 4, 2012 ***
Here is another example from Cerner FirstNet.
As mentioned in the essay on Efficiency, “HIS vendors tend to deliver a box of parts rather than an assembled system.” And that means that much of an HIS is assembled by local personnel who have no training nor understanding of user interaction design, leading to violations of even the most basic usability principles. (Note: this does not imply that the HIS vendor is expert at usability.)
The implementation of Cerner FirstNet that I use now has a new discharge process (“Depart Process”). The screens are built locally, and there are five of them, linked by a clickable list:
- Discharge Details
- Discharge Instructions/Education
- Follow-up Information
- EasyScript [prescription printing]
But of the five screens, there are four different ways to finish and go on to the next screen.
- Diagnosis: in the right lower corner is a button that says Close.
- Discharge Details: there is a button bar at the top, each of the 10 buttons having icons on it (with no ToolTips if you have the mouse over them, so you have to guess what they mean) and the top left button, with a blue checkmark on it is what you have to click.
- Discharge Instructions/Education: In the right lower corner is a button with Cancel/Exit, and to the left of it is a button that says Sign.
- Follow-up Information: In the right lower corner is a button with Cancel/Exit, and to the left of it is a button that says Sign.
- EasyScript [prescription printing]: in the right lower corner, a button that says Sign Orders.
And finally, the screen with the links for all five separate pages has a different way to continue: in the right lower corner, a button that says Sign_Close.
Emerson said A foolish consistency is the hobgoblin of little minds but this is an example of foolish inconsistency. The impact on usability is left as an exercise for the reader.
*** End Update ***
In Mental Models, Input Modes and Cognitive Friction, I wrote about how distracting and slowing it is when you have to change input modes, for instance, changing from using the mouse to using the keyboard and back to the mouse. The same applies for “mental input modes”: left-clicking, right-clicking, clicking on a button, clicking on a big red X, or clicking on a checkbox. Changing from one mental input mode to another distracts us from the mental task at hand, slows us down, and makes us more likely to make an error.
If you coded a program, leaving the interface like a messy room might be OK for you: you know where everything is. If you know every little corner of the code and where everything is, that’s fine, but it doesn’t mean that users of your code should have to know each idiosyncratic corner where you’ve hidden things.
Want usability? Clean up your room.