Can Usability Be a Life or Death Matter?
For years, patient safety advocates have lobbied for better medical technology: the kind that automates the dispensing of medication, and prevents error by popping up alerts about duplicate medications or allergies.
I count myself among people who believe in the opportunities of technology. I’ve known enough people harmed by inadequate paper medical records to want to see the system change and modernize.
But modern systems don’t intrinsically mean error-free ones. As I read this morning about the root causes of one major patient-safety error at the University of California San Francisco Medical Center (UCSF), I was reminded of the importance of usability — of REAL human-centered design, applicable to the needs of a specific audience.
If you have an hour or so, I do highly recommend that you read through all five parts of the important Harm in a Hospital series, excerpted from The Digital Doctor by Robert Wachter.
In this series, Wachter thoroughly lays out the challenges of interacting with medical technology through the lens of one serious patient safety error. Although this error (fortunately) did not end in loss of life, it could have — and the problems are instructive in terms of showing how safety systems at all levels (technological, environmental, and personal) can improve.
System Usability Concerns in Medical Technology
Designing an e-commerce website with great usability is tricky enough on its own. You have to get inside your customers’ heads and anticipate where they will struggle to achieve necessary tasks on the site. You need to determine what you most want them to be able to do, and predict what will be the most straightforward way for them to do it.
Full-scale medical technology systems are a whole other ball game.
There are all kinds of different levels at which these systems have to operate. They must manage records, dispense medications, monitor vital signs, and much much more. And they must do it all within a system encompassing the highest possible level of security and privacy.
Epic Health Systems, which designed the system at UCSF, is one of the industry leaders. But no system operating at this scale can be perfect, even when it is customized for the hospital’s specifications.
Usability and Environmental Concerns
From a usability perspective, the challenges outlined by Wachter reflect one simple truth for us to consider:
Perhaps the single greatest challenge in medical systems design is the way your system interacts with users in the unique pressures of the hospital environment.
Most modern website designers assume a very short attention span span for users — which means, from a marketing perspective, we’re designing with the assumption that users aren’t paying attention to what we want them to do.
And these are users who may well be browsing the Internet from the comfort of their couches or office computers in cubicles.
In hospitals, doctors and nurses are interacting with these systems constantly as they move from patient to patient. They provide treatments, make sure the patients are comfortable and stable, handle questions, and manage overall care. All while in a high-pressure environment with life and death consequences to many of their actions.
Uncovering bugs and other systemic issues is inevitable in that kind of environment. And that’s what happened in the case at UCSF. The usability challenges in the system at the time combined with human error and the selected symptom requirements of the hospital to cause patient harm.
- A crowded form design and data shortcuts allowed the doctor to input data in a standardized format. Even though she believed the data to be correct, she forgot to change the unit of measurement for the medication dosage.
- Hospital-specific environmental challenges, multiple system alerts (on top of the usual beeping devices) and a lack of visual differences between warning types cause doctors and pharmacists to dismiss even important overdose alerts.
- The robotic distribution system was not programmed with maximum dosage limits (primarily because UCSF is a research hospital and hard stops would make it harder for doctors to do their jobs).
- Users (nurses) have been trained to have confidence in the system and have not been sufficiently encouraged to report problems or instinctive concerns.
None of these problems can be wholly blamed on the hospital, or the technology, or the individuals involved. But all of them can be improved upon, both within hospital culture and within the systems themselves.
How can we improve our medical systems for better usability and patient safety?
Systems can be designed with greater care for the attention spans and environmental demands of physicians and other medical personnel. Small visual choices matter in terms of facilitating better interactions.
System notifications and alerts can be created with care to make sure that even weary users are aware of the things which really matter. Design aesthetic matters in creating a sense of intuitive priority.
Hospitals are complex places by their very nature; as such, all systems created for them seem to be inherently complex. And usability is rarely a one-step process; designs change to be more usable over time.
However, patient safety issues call into sharp relief the importance of listening to the needs and environmental concerns of medical professionals, and of factoring those concerns into new designs. In environments like that, usability choices can mean the difference between healing and harm.