Sunday, May 20, 2012

EHR & Good User Interface Design

I think I have mentioned before that I read the Kevin MD blog. Today, I read an interesting article. I did not agree with the writer’s ideas, but it made me think and that is a bloggers whole purpose. So while, my opinion is widely different from the author’s, I think the ideas are well worth consideration… then after reading my opinion, you can form your own.

The article was called The UserInterface for EHR Should be Uniform by Roheet Kakday.  In a nutshell the article discusses the challenges physicians face in learning to use multiple EHR systems such as their office EHR and the EHR for the hospital. The author believes that this is one of the problems slowing adoption. With that in mind, the author proposes that EHR user interfaces be uniform and even recommends a mandatory adoption of a single EHR vendor by region.

Again, I do not completely agree with this idea. Over time reading my blog the reader may begin to learn a little about my personality… but for the sake of this article, I will tell you flat out – I am very pro-capitalism – even when it comes to healthcare. In the article, Roheet Kakday says that capitalism leads to product diversification and stratification. I cannot deny that to be a fact. The difference between our opinion is the value of diversity and competition. I thoroughly believe that competition is the single most powerful driver of innovation. If healthcare providers, HIT vendors, etc. are constantly struggling to gain market share – they are bound to be striving toward better products and thereby better healthcare.

I believe that it is competition and the resulting innovation that makes the American Healthcare system the best in the world.  Think about it… people come to America from all over the world for healthcare. If you or a loved one were diagnosed with a terrible disease, perhaps a life threatening cancer, where would you go? I doubt Zimbabwe or New Guinea were the first places to came to mind.  Why is our healthcare better? Simply, we have the best resources – designed, built, and marketed because of competition.

Still there is a problem. If diversity is in fact preventing adoption, providers are therefore not sharing the benefits of capitalism (referring to superior technology created because of competition). Therefore the benefit is lost and capitalism is of no value in healthcare, right? NO, the value is still there but HIT vendors need to shape up and get it right. The problem is NOT related to diverse user interface, the problem is stupid user interface.

Before I go on, I want to back and explain user interface. I know that some of my readers are not overly technical and I hate when people speak jargon without considering clarity. So, allow me to explain in English. Everything computerized is made from a combination of hardware and software. Hardware is comprised of the tangible, mechanical parts. Software, however, is a little less tangible.

Software is an ‘instruction manual’ that tells the computer what to do. Software (as an instruction manual for the computer) is written in code that the computer can understand. Computer programmers are experts in code and ‘speak’ it as a another language. Most other people, however, cannot understand code. So, to make software so that non-programmers can use it – programmers and designers arrange pictures or simple (common language) words on top of the code.

These pictures are the buttons, links, and things you see and click on in any software program. For example, when you click on a button in a software program (like the save button or icon) – you are actually clicking on a picture that lays on top of an individual instruction that tells the computer what to do in response to your click. Since what you see on a software or website are all pictures on top of code these pictures, including all of the button, icons, etc. are called the graphical user interface or just user interface (sometimes also referred to as GUI or UI). 

Now that all readers are on the same page, we can go back to the point at hand – whether UI should be completely uniform. Personally, I do not think such a measure is fair to competition and I don’t think it is necessary. What I do think is necessary is that EHR vendors follow basic and generally accepted  in user interface design. Allow me to explain using an example.

Like most people, I do some shopping online from a variety of websites. Each website looks different or has a different user interface. When I started using these websites, no one came to my house to do a formal implementation or training. I just figured out how to use the websites myself. Also, like most people, I access several bank websites, for my mortgage, car, personal banking, and credit cards. Yet, again, no one taught me how to use these sites. So why is it that most of us can use so many websites without training, but EHR software are too hard to use?

The answer is simple. Shopping sites, banks, news sites all have common elements and a common arrangement. They are not uniform – but they share similarities that help us navigate easily. These commonalities are simply good user interface design. As an example of this, think about a shopping website – any one – what do you look for when you are ready to pay for your purchases? The shopping cart icon, right? Now think about how you search for something that is not immediately visible. Where is the search? Isn’t the search usually toward the top of the web page? Menus are often in a bar along the top of the page or to the right side.

With good UI design there is no inconvenient left to right scrolling and the most often used or most important things are visible toward the top of the page. Colors and shapes are also sometimes used as indicators or to draw the user’s eyes to a particular location. For example, red and bold attract the eye and hyperlinks are often blue until the user clicks on them and then they are purple to indicate that they were previously viewed. Further, think about a shopping web site… when was the last time you chose shipping options before selecting merchandise? Never. Why? Because websites are supposed to be designed to move in a rational order.

The problem with EHR is that vendors often ignore the virtues of good user interface design and user experience. We don’t need total uniformity. We don’t need to have our choices and competition limited. What we do need is for EHR vendors to adhere to good user interface design principles.  Here’s a clue to the EHR vendors… you are wasting time, effort, and profit on training and support. A little effort and time spent during the design process will benefit all parties far more and improve adoption. 


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