On the Need to Improve User-Centered Design (i.e. Design Thinking) for Healthcare IT Usability

The usability (or lack thereof) of Healthcare IT has been in the news a lot again.

Bennett LauberThe lack of usability of electronic health records (EHRs) and healthcare IT applications, in general, has been in the news a lot again. This time it is a research report published in the Journal of the American Medical Association (JAMA) on March 27. The study analyzed voluntary error reports associated with EHR systems and found that problems with EHR usability may have directly resulted in patient harm  (Howe JL ; Adams KT ; Hettinger AZ; et al. Electronic health record usability issues and potential contribution to patient harm. JAMA. 2018; 319: 1276-1278).

Unfortunately, this situation is all too common in the healthcare industry. Numerous health care systems are designed and created ad hoc, or with a very engineering-centric approach. End users are dissatisfied and often systems or workflows are abandoned and/or dangerous work-a-rounds created (see Workarounds to Intended Use of Health Information Technology: A Narrative Review of the Human Factors Engineering Literature) A lot of people are saying Healthcare IT needs a disruption. What HealthIT needs is to begin to learn about and understand the needs, goals, and methods of the actual end-users, like doctors, nurses, medical assistants, etc.

Luckily there is a well-established paradigm. It is called "User-Centered-Design" (UCD) and it is essential for Healthcare IT vendors to understand, and apply it to all of their development efforts.

UCD has had a number of names over the years, from Human Factors, to Usability, to "Design Thinking."

The concept is simple, take a look at your site/application from the perspective of your end-users and design the information architecture, nomenclature and workflow to match THEIR mental model. The Electronic Health Records Association (EHRA) has created some great personas to help organizations learn about and empathize with actual users - see EHRA publishes free personas to help developers consider EHR usability design from a variety of end-user perspectives Working with consulting firm that focuses on health IT and EHR can help one get started (of course I'd recommend my own company, The Usability People!).

The Return on Investment (ROI) of using the usability paradigm in healthcare is about 10 times to 100 times per dollar spent, but also can save lives. A lot of lives.

Usability professionals, old and new, know about the long-term ROI of doing user research, design thinking and/or user-centered design. Designing to match the mental models of your users, for their needs and workflows can save a LOT of money. Development costs are reduced, training and documentation cost are also reduced.

It is way easier to support a program or system that makes sense to it's users, so associated costs go WAY down.

Developers are not thinking about the issues that they will likely have to deal with "down the road" when they produce software systems using an Engineering-centric Design paradigm. We recommend that Usability campaigns focus on the more short-term immediate positives associated with Usability, Human Factors, Design Thinking, User Experience or whatever they are calling it this year.

The money spent on marketing bad designs, building bad designs, supporting bad designs dwarfs the money people are willing to spend to ensure that the design of their products support user needs, and are effective, efficient and satisfying to use. (Dominira Saul of Akendi.com)

Let's fix this!