Tag Archives: healthcare

Failure to communicate ebola

Texas Health systems report that a factor in missing the Ebola patient had recently traveled from Liberia was that the nurse patient records which contained that fact are separate from the info the doctors access.

Many people are surprised and appalled that this could happen.

Reality is that healthcare systems are an aggregate of disparate systems evolved of different origins serving various niches in the vast healthcare arena. just getting them to share the most common frequently used information efficiently has been the focus of healthcare IT for years. Asking for bigData intelligence that is usable and flexible to new needs such as this is a big expectation. So much work to be done.

Some naively think that having doctors and nurses on the IT design team is the answer to all the troubles facing healthcare IT.

Having domain experts, including people who are from that target user base, in this case actual medical professionals, on board is important. However, it is not a substitute for having process analysts and user experience designers who are experts in teasing out the important task and information elements and translating it into a usable high performing system. Other fields such as banking, transportation, and aerospace have learned this through a lot of trial and error over the past twenty years, Doctors are not designers any more than airline pilots, travel agents, or loan underwriters.
Healthcare UX is an area of huge need.  Of course, I have been saying this for along while.  See my previous blogs




“When I Look here, I Leave Them”

Another installment in my discussion of user experience design in health care.

The child’s drawing in this article (see link to “The Cost of Technology” ) is a fantastic visual commentary, not just on health care UX, but on many many types of system user experience challenges. http://jama.jamanetwork.com/data/Journals/JAMA/24244/jpo120008_2497_2498.pdf

Fifteen years ago I was working on a computer system to be used by a major airplane manufacturer in the course of meeting with airlines purchasing commercial airplanes.  The dynamics were quite interesting and challenging.

A commercial airplane is the most complex machine ever built by mankind. A customer paying over a hundred million dollars for a product expects to get it the way they want it. Working through its configuration with all of the options and interdependencies is a very complicated process.     The social dynamics of a room full of customers and sales engineers all working through screens filled with searches, search results, data entry, compatibility messages, feature descriptions, and recommendations is a very challenging scenario to support.

The comment that sticks in my mind as we usability tested many variations of designs is from one of the sales engineers.  He said, “When I look here”, pointing at the screen, “I leave them” referring to his customers.   Maintaining focus on the customer while using a computer was the most challenging aspect of this application.

I spent the next several years after that designing systems for customer call centers, then for ecommerce.  The goal of maintaining focus on the customer remains the make or break factor in all of them.  Succeeding in this is the mark of a great design.  A lot has been learned over the past decade or two about how to do this.  Why has so little of this knowledge seeped into health care system user interface design?   How can we help this important field to catch up?

– roger

Bad Healthcare UX on Life Support

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

Healthcare UX on the Critical List

Nice article on the dismal state of UX in healthcare. http://mikecuesta.com/post/24974526585/healthcare-its-the-user-stupid?goback=%2Egde_1996303_member_123868048

It could go a lot further in explaining what is lacking, why, and how the gap can be filled, but this much is already edgy enough to the healthcare IT field.   It is amazing to me how the systems utilized in healthcare can be so far behind other fields in terms of usability / user experience.  It’s particularly ironic given that human factors have been involved in healthcare about as long as anywhere.  So why is the condition so awful?  It’s not a matter of technology, but of culture.

The terrible condition of healthcare UX means that there is opportunity for great design to do a sweep.  Lazy cow IT companies getting paid bundles to deliver farce user experiences are easy prey for a savvy and capable upstart firm.  And the generation of healthcare IT decision-makers that have been swindled into accepting laughably bad design will eventually be replaced by youngsters that know how well things can and should work.  There will be no more excuses. It’s not a question of if, but when.

– roger