This is another installment of my rant regarding the condition of healthcare system user experience. My earlier blog entry is at http://belveal.net/?p=1249 In short, I am again expounding upon my case that the days of bad UI in medicine are numbered, though its tenure is still far too long for my satisfaction.

During my twenty plus years in UX design, in aerospace, travel , financial services, and banking, I have seen and been a part of the transformation of many business environments through multiple generations of technology. I have also watched with interest as my RN wife has encountered technology in a variety of medical environments and followed the trends in medical IT.

One particular evening recently I was shaking my head while watching this highly skilled and experienced RN struggle to do what should have been some fairly straightforward charting using an atrocious system that appears to have been cryogenically preserved from 1994. I stepped in to the next room to see my college student son in a user experience on X-Box that is mind blowing with utter user control, feedback and all of the Nielsen nine or ten factors (or heuristics, aka, principles) that we know comprise a great user experience.

My first thought was what a travesty it is that the best user experience exists for something as inconsequential as a video game while the systems used in the treatment and management of our very well being is utter garbage. There is something dreadfully wrong with this picture.

My next thought however, was to remind myself that my son is studying for a career in medicine, possibly as an MD, or possibly a PA. His younger sister is following in her mother’s footsteps and studying nursing. Both have grown up with technology and unlike the victims of today’s nightmarish healthcare user experiences, will not accept a sales rep’s line that “this is what technology in healthcare has to be”. They simply know better. They won’t buy it and someday, not all that long form now, they and their peers will literally be making the buying or not buying decisions.

In addition to the bar rising on the demand side of the equation, the technology opportunities to deliver a high quality user experience cheaply and efficiently are exploding. The toolsets are so far beyond even a few years ago. We are coming out of the dark ages of the dumb thin client UI. The rich interaction of the desktop is being built once again, only better. And this time, its going into the cloud, meaning that migration to it is easy compared with what such a changeover would mean to an enterprise of the past.

A new generation of startups is thriving and competing. Many are cutting their teeth on mobile design which is fast, cheap, low risk, with huge potential for striking it rich. This is the new gold rush. And as some of us close to mobile have expected to happen, the tail is beginning to wag to the dog. The “mobile first” philosophy is taking root in a lot of serious fixture organizations. The straightforward minimalist, get it done style of user interaction characteristic of mobile is a tsunami sized wave. It is headed for the desktop and every conceivable device or control. Can you say Windows 8? The global adoption of html5, CSS and related architecture means that the ability to change and change again and again virtually overnight is being built into systems like never before.

As this new and “agile” wave undercuts and overtakes the stagnant fixtures in the domain, the dynamics of change will have their way. Islands of legacy user experience will go the way of the mainframes of the past, some getting a special grandfathering for a while if they offer some unique value, but most simply disappearing. And I don’t think the lobbyists finger in the dike to be of all that much help when the wave arrives on shore. Cost will dictate winners and losers. And in case you didn’t get the memo, usability = efficiency = low cost.

Besides the cost driver, a UX-savvy public that is emerging, will simply demand the change. Consider the strong hold on the market enjoyed by the Palm Treo and other smart phones when the iPhone arrived. That is the kind of magnitude of gap that exists between many established healthcare systems today and a quality contemporary UX in other fields. The wave is on the horizon.

Again, this won’t happen tomorrow or next week. But if you depend on a paycheck from a healthcare IT company that ignores user experience, I would make sure your 401k is elsewhere.

- roger