Re:

bcrounse — Tue, 17 Jul 2007 01:48:19 GMT

Thanks for sharing your insights. I couldn't have said it better. If only all developers were as enlightened, maybe the electronic medical record would truly be mainstream by now.

Bill Crounse, MD

Re: Age and culture as impediments to the adoption of healthcare IT

DHunscher — Fri, 29 Jun 2007 20:58:52 GMT

I think the cultural issues are very real, but the sad truth is that many IT systems created for use by health professionals are designed by IT staff who have no understanding of the basics of user experience design. This leads to systems that get in the way of healthcare delivery. The problems include but are not limited to:

- rigid system workflows that do not match the wide variation of real-world workflows, eg. in an ER setting; HIPAA security based on timeouts, requiring nurses to log in many times during a shift.

- poor hardware choices, such as low-quality displays that distort colors used as part of the UI semantics; tablet PCs that break, or require a special pen that gets lost, or spread infections, or have too short a battery life; or wireless LANs with dead zones in locations where the need for connectivity is critical.

- color choices that make the color-blind truly blind, or that obfuscate rather than highlighting crucial information.

If every health IT application was as usable as Word or Excel, I'd have less sympathy for the health professionals on the front line who get handed an application they didn't ask for. At this point in the evolution of health IT, what they get will likely have been written by engineers who are fundamentally clueless about the basics of cognitive psychology, organizational culture, and ergonomics. In terms of usability, commercial applications often do better than those written by in-house teams, but not always by much.

Jonathan Grudin of Microsoft Research wrote a great paper on the kinds of challenges one faces in creating and introducing complex applications: Groupware and Social Dynamics: Eight Challenges for Groupware Developers (http://research.microsoft.com/research/coet/Grudin/papers/CACM1994.pdf). If every software designer read and understood the implications of Grudin's paper, we'd have a better chance of overcoming the objections of those passive-aggressive end users.

I've met a lot of them over the years, and they really are a pain to deal with, there's no denying that. Even after you finally deliver a system that they like and are actually willing to use, the adaptive response sets in by week 2 and suddenly they realize you didn't add a feature they never told you about, that you could never have imagined if they didn't tell you about it, but that they must have by Tuesday. Oh, how I wish this were an exaggeration.

Still, to the degree that their recalcitrance is actually justified, we can't afford to ignore or belittle their concerns. The best we who design their systems can do is to make software so good that all their complaints are irrational and/or unrealistic. At the end of the day, what they do in caring directly for patients is valuable, maybe more so than what we engineers do, and we should keep that in mind as we listen to their ranting.

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Re: Age and culture as impediments to the adoption of healthcare IT