Explaining Healthcare IT application UI complexity

February 9, 2009

A friend of mine sent me this drawing a little while ago.


Striving for Simplicity

I have performed many usability analyses on healthcare IT software and I usually end up writing many pages of a “summary report” which should probably include the diagram shown above. It crystallizes the reason why HISs, EMRs, and other healthcare IT software gets a bad rap – they are often more complex to use and significantly more difficult train than many other commercial applications.

Yes, healthcare applications aren’t exactly the same as MP3 players and search engines but we can certainly learn from “minimalist” user interfaces and ease the burden on our users.

I’ve invited a couple of usability experts to come talk about why healthcare IT app UI’s need to be complex or how they can be simplified. If you’re an expert in usability and want to talk about it here as a guest author, drop me a note below.

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  • http://zorgbeheer.blogspot.com/ Bart

    Well, minimalist software design is guaranteed by flexible FOSS, which gives you the freedom of eliminating bloath and the freedom of custimization. This freedom results in reducing the amount of buttons by 50% (at least).
    Reducing the amount of buttons should be priority N°1 in webdesign.

  • http://changehealthcare.com/ Chris McIntyre

    LOL, I have always loved this one. The last two companies I worked for we printed this out and had it hanging prominently in the office. It is hard for some people to believe that their users do NOT want to see everything at one time and that they do NOT know everything they know, which would be required to navigate the REALLY complex website they’ve built (especially in healthcare). We are working through this same issue where I am working now, but is worth every minute and dollar put into simplifying the interface.

  • http://shahid.shah.org Shahid N. Shah

    Thanks, Chris. If you’re learning some lessons on your current project that you could share with the community I’d love to give you the podium through a guest article or something.

    Bart — if you have some thoughts to share about how FOSS can simplify UIs that would be a great guest posting, too.

  • Mathias

    Great post! It is so true! It has always been my opinion that most of the FOSS software (not only in healthcare) mainly doesn’t succeed not because of the architecture (often really good) but the very terrible GUIs they come with. Though I found this non-industry-specific, the same goes for OSS software in healthcare, it’s simply terrible and often text-based GUI like it’s been used 15 years ago – except now it’s browser based ;)

    Of course there are also terrible GUIs in proprietary software systems, but usually more effort is spent on it than in an OSS ‘geek’ project.

  • Kevin Puscas

    Outstanding, I’m going to have to steal that cartoon. I’ve been a “rescue” architect/dev mgr on a number of software projects and the problem I’ve seen time and time again is a real lack of understanding of how user-centered design/information architecture fits into the SDLC by the group doing the development. At best it is thrown in at UAT which by then is too late.

    In most projects the focus is on collecting/displaying data not on how the data is collected by the user as part of their work or figuring out who needs to see what when. Just show everything to everyone. Healthcare apps in particular seem to suffer from this, both COTS and OSS ones I’ve seen. I think part of this is most of these apps are mimicking paper forms. I’ve even seem some cases where it seemed the UI form was meant to capture data for a specific HL7 message (ughh). It reminds me of some ERP-type systems you had back in the 90′s. It took a while for those systems to get more usable. Hopefully IT in healthcare matures in the same way.

  • Erika

    I hadn’t seen this graphic before, but I think it is great. It definitely sums up many of the information overload issues I have dealt with for a number of companies. I am currently working in Healthcare IT and would be happy to do a guest post on usability.

  • http://www.grahamazon.com/ Graham

    I’ve worked with at least 6 different EMRs, and the interface is clearly always an afterthought, designed and spec’d by some engineer with absolutely no healthcare background or knowledge. Case in point: just look at how [insert EMR here] displays a chemistry panel. It’s usually in some non-sensical order, when it should be displayed in the order physicians write it in during their notes.

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  • http://www.thedigitalgroup.com Mustafa Balsara

    This post certainly gives food for good thought! The eccentricities and absurdities in most of the Business Application’s UI is well depicted by the picture. Someone made a mature point in the above posts that the UI has to be designed looking to the user who is going to use it and what information he would like to “USE” rather than ‘SEE’.
    I personally follow the following Guideline for UI design:
    1. Strive for consistency
    2. Cater to universal usability
    3. Offer informative feedback
    4. Design task-flows to yield closure
    5. Prevent errors
    6. Permit easy reversal of actions
    7. Make users feel they are in control
    8. Minimize short-term memory load

  • http://trialx.org Kamal

    Shahid, thanks for bringing this very important point up. Most EHR and related systems have incredibly complex and “heavy” interfaces.
    While designing TrialX, we spend a lot of time and effort to keep the interface simple and minimalistic .
    One thing that has helped in this process is looking at our usage data (e.g., logfiles) to identify problems where users seem to face issues. Also we have implemented a widget (through get satisfaction.com) to allow users to send us quick feedbacks and tips. And we rapidly iterate based on feedback and continue to do so as there are still many avenues for improvement.

  • http://www.streamlinemd.com Sandy Rosenbluth

    Definitely lol, yet raises a tricky design point.

    EMR use must be exceedingly efficient to properly support the fast-paced medical office. Less on the screen is good for training new or non-experienced users but extra clicks and screens usually slow clinical people down and may require greater practice for them to learn where all the functions are located.

    More on the screen can greatly increase productivity for experienced users, though at the price of a typically steeper beginner learning curve.

    Some may recall this same trade-off in word processors with the old WordPerfect 5.1 (bluescreen version) vs MS Office (windows version). WP 5.1 was tougher to learn with all its key-combinations, but was the clear choice of professionals due to the speed with which a trained user could create and edit documents.

    New users (to word processing) found the windows graphics helpful for initial learning.

    All good UI designers should be aware of the tradeoffs and attempt to balance these factors.

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    Very interesting post, i thought it was pretty funny yet extremely true.

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  • http://www.medicineandtechnology.com/ Joseph Kim, MD, MPH

    This is a great illustration!

  • Abayomi Olufemi

    the complexity of an interface usually prevents users from adopting ICT solutions. This is particularly evident in the developing countries where ICT is still in its infancy.

  • http://www.middleblog.com Middle Blog

    nice… great info guys

  • http://www.rapid-servers.com Josh

    Pretty Funny illustration,
    I think part of this is most of these apps are mimicking paper forms.

  • http://www.bobfessler.com/ BOB HEALTH

    hi…. nice posting, keep writing thanks for sharing… thanks

  • http://www.rapidindex.net Sean

    Hopefully IT in healthcare matures in the same way.
    It will be good for better world

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