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.
