Mouse CursorsUser experience (“UX” to the cognoscenti) is a burgeoning field. Used to be we called this computer usability, user interface design or user interaction design. It was focused mostly on software such as word processors, spreadsheets, industrial control software, airplane cockpits, and medical applications. But, given how much money can be made on the web, UX focus is now quite tightly on web usability, particularly e-commerce websites.

Early efforts at assessing usability were crude. For the most part, they are still crude. Early on, usabilitists (I just made that up) would count the clicks needed to perform a task. Cutting down the number of clicks was a simple way to make at least this particular task faster.

But these days, the Web UX community sees “counting clicks” as unbearably primitive and déclassée. As UX grew out of usability and user interaction design, and focused tightly on web-page design, dogma evolved, including “All pages should be accessible in 3 clicks.” But this dogma was later debunked: “Three clicks is a myth.” When people are browsing the web, more than 3 clicks are fine, as long as you continuously have “the scent of information” – that is, your clicks each result in more, and perhaps more specifically useful, information.

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I-am-not-worthyThere is an electronic medical record program (EMR) called DocuTAP that I use at one of my jobs. It’s not bad overall, and it’s the top-rated Urgent Care Center EMR. But, as with every EMR, it can be improved. In many ways.

I just ran across another new way in which it can be improved. This is a small issue, almost trivial. But as we discussed in Kludge, little issues, when they occur frequently, can have major impacts on usability, efficiency, and user satisfaction.

What’s the issue? In a particular circumstance, the computer doesn’t pay attention. It ignores me when. If this happened once or twice, I wouldn’t think too much about it. But since the computer keeps ignoring what I say on a regular basis, I start to think it’s deaf, incompetent, or maybe it’s just being mean. Read the rest of this entry »



On occasion, an academic paper is published, but one of the following Letters to the Editor or editorial is much more important, with a longer-lasting influence than the original article. An example is an editorial about sore throats/tonsillitis by Dr. Centor, of Centor Criteria fame. Well, now we have similar situation in the field of medical software usability.Kludge with duct tape

An article in the Annals of Emergency Medicine discusses a method to help prevent wrong-patient order entry: introducing a popup with name, age, and sex, chief complaint, bed location, length of stay, and recent medication orders, but also a mandatory 2.5 second pause. If you’re interested in informatics, I don’t recommend the article, as it discusses an inelegant, klunky, duct-tape-type workaround that should never be emulated.

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Ebola VirionLet’s suppose it is 1980. Suppose someone shows up in your ED with a fever, and a history of travel to an area with a new plague characterized by fever. The nurse has heard about this on the news, asks the patient about travel to the area, and gets a “yes.” The nurse not only writes this on the paper chart, but tells one of the ED doctors about it. The patient is correctly identified as a possible plague carrier, and admitted into an isolation room.

1950s Emergency Room

Mid-20th-Century Emergency Room

Let’s now suppose it is 2014. There is a shortage of primary care physicians. Primary care physicians no longer see emergencies, even minor emergencies, in their offices. EDs are much, much busier, and overcrowded. As a way to make things better (and, let’s be honest, to make money), vendors have developed electronic medical record systems (EMRs). Physicians, nurses and other ED staff give these hospital-wide EMRs low grades for usability, but the Federal government has been dangling big bags of money in front of hospital administrators as an incentive to buy an EMR. The government succeeded in persuading hospitals to go ahead full-bore with hospital-wide EMRs irrespective of their poor usability.

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Fitts’s Law

Fitts’s Law has been known since Paul Fitts first proposed it in 1954. Wikipedia has a detailed exposition of Fitts’s Law. In essence, it says that “the time required to rapidly move to a target area is a function of the distance to the target and the size of the target.” “Targets that are smaller and/or farther away require more time to acquire.” While this has many applications in industry, we are particularly interested in computer applications, and, specifically, usability of medical software.

Fitt's Law Diagra

Fitts’ Law

We can expand this definition a bit, by being engineers and designers and critics rather than scientists. It is reasonable to assume that the harder something is to do, the more fatigue – mental, physical or both – it will entail.

We know from the Pen-Ivory experiments that paging is better than scrolling. Many vendors are tied to the idea of resizable windows, both due to laziness, and due to user demands to use the maximum space on their monitors. But as with lines of text, increasing the window size may decrease readability and usability.

Many medical applications present us with pages filled with a massive number of small targets. We know that a larger the number of choices on a screen means a more cognitively-tiring process in selecting among them. But there is another dimension to such cluttered pages; when clickable items are widely separated on the page, Fitts’s Law tells us that using the page could be made easier, in both physical and cognitive terms, by decreasing the number of clickable items on the page and increasing their clickable target size. As Strunk and White says: “omit needless clickable items.” (I paraphrase slightly.)

Fitts’s Law is interesting. But for medical applications, where a wrong click may have consequences far beyond navigating to the wrong page, it’s something all developers should keep in the front of their minds. Wrong clicks can kill.

//commented out L sidebar 7/26/11 //