Performance vs Clinical Risk

The complexity of creating usable solutions in healthcare 

The productivity that a user can get with a tool depends, among other things, on the usability of the interface used to work. In the context of healthcare applications, the interface design solutions can supose in certain situations a number of hazards that result in clinical risk. A productive solution is incompatible with clinical risk free solution? In an effort to provide a broad view of the problems, in this article we offer solutions addressing the most common design patterns used to increase productivity in user interfaces.

For the analysis, we propose two specific usage modes: data entry (interaction with the system) and data output (representation of information and data management interactions) in a health system.

Data Entry (garbage-in)

Help to complete the information

  • Problem: Help may be decontextualized
  • Solution: The help that is offered to the user should not contextualize only normal activity but the content and the information required.

Autocomplete

  • Problem:The autocomplete action may end up in the selection of an unwanted value
  • Solution: Actions should allow the end user to overwrite the value and warn you that you are entering a value outside the catalog.

Validation and error feedback

  • Problem: The errors reported are partial
  • Solution: Inform the user about the possible existence of more errors and the need for revision

Defaults

  • Problem: Default values ​​may be based on faulty assumptions
  • Solution: Report existing defaults and even offer the possibility of removing.

Shortcuts

  • Problem: Loss of visual feedback on what you are doing.
  • Solution: Inform the user with a message of the action to be executed.

Commands (actions, undo, massive actions)

  • Problem: The command may cause a failure in the integrity of the data.
  • Solution: Run command to complete mock confirmation by the user and inform the local view of the result.

Data Output (garbage-out)

Indexes and data summaries

  • Problem: The data are not updated
  • Solution: Inform the user of the last update of the data and provide the ability to update it in context.

Search

  • Problem: The search is hidding results.
  • Solution: Reporting results of existence visible and hidden results either paging issues as matching with the search.

Notifications

  • Problem: Notifications are not prioritized.
  • Solution: Offer a prioritization system and allow customization of alert priority one by one or by type.

Alerts

  • Problem: It was considered an alert something that is not.
  • Solution: Associate clinical alerts to static domains consistently identifiable
  • Problem: An unintuituve icon has been associated to an alert
  • Solution: Tagged alerts with short terms  and / or group them under predefined domains

The healthcare scenario

We should note that in the health context, the tasks that a user must perform that require a computer system can account for up to 30% of their time and therefore there is a clear need to improve the efficiency and productivity in their daily use.

At the same time it is important to consider that during the working day there are many and frequent changes of tasks, activities and contexts, for instance, a doctor in the emergency room in a 10’ frame has been triaging two patients, be consulted by the nursing team 3 times on matters of different nature, it has been lifted from his seat 6 times for different tests of material, information, etc.

Therefore, although the task itself requires a high concentration effort, attention span is reduced by the high number of interruptions. In this context, the user controls what he does but is subjected to a high load of stress and distractions in almost any of its activities. A medical error could pose a risk to the health of their patients.

From the most simplified view of a computer system as a mere representation of the information model, the most basic interface is build up with forms to fill available data and views for display them. Even with this formula, the application would not be free of clinical risks. Any solution applicable for the simplest interface is not incompatible with richer and more usable interfaces. For this we consider that not only is not incompatible to have solutions which can enhance productivity and usability, but it is also necessary.

References

Clinical Risks and Design Decisions – How usability can save lifes

Information technology has made possible to improve healthcare services by increasing productivity, getting more accessible services, and automating daily care activities – among others. However, the software itself allows getting a better patient care at the same time that it opens a door to clinical risks. It is a responsability for designers to avoid hazards as well as design rich-interactive solutions.

As you know, it is part of the process of making design decisions: user centred design to ensure usable products. UCD, UX and Usability have a lot of meanings and aspects that influence in reducing the errros that clinical staff could make by only interacting with the software.

I’ll give some examples of how the main topics of usability could avoid clinical risks:

Visibility of system status

Working with the right patient in the right time. Keep always visible the patient information that will help users to identify it without any doubt.

Match between system and the real world

Use clinical language as much as you can to help to understand the purpose, the scope, and to support the clinical process. Clinical procedures has specific names which require clarity unambigously.

User control and freedom

Provide multiple visualization modes to ease the data understanding. Allow performing activities in different orders to get adapted both users and business process. The more natural the process is for the user the more confident s/he will feel.

Consistency and standards

Respect familiarities with the real world activities and with previous software solutions. Clinical staff is very hard-working with protocols and routines, consistency could be boring but effective.

Error prevention

Provide clear points of interaction and valuable data for decision-making. A correct labeling and control aesthetic will help to easily understand how the data can be managed, as well as a correct data presentation will avoid performing wrong actions.

Recognition rather than recall

Reduce the workload by creating recognisable solutions. Do not stress the user with a lot of information to be remembered.

Flexibility and efficiency of use

Provide shortcuts and give a chance to experts, the more efficient they’ll use the solution the more time they’ll spend providing care. Allow users workarounds.

Aesthetic and minimalist design

Minimal design will simplify the data presentation and a good aesthetic will increase the content meaning to facilitate the interpretation and the decision-making. Use aesthetic to provide meaning and avoid decorators that mix up the patient information.

Help users recognize, diagnose, and recover from errors

Allow undo actions for the most critical actions: prescribing medications, deleting patient data, managing patient history, etc. A mistake should be able to be recovered by a an undo action or a rollback process.

Help and documentation

Describe how every care activity can be achieved by your solution. Show main conflicts and risks if there are any dependency between them.

These are only some clues about how putting attention in usability can help to reduce the amount of clinical risks. Lately, every data that is presented in a screen and every allowed interaction between users and clinical software it’s a potential risk to provide a wrong care to patients. Undoubtlely, there are many other hazards non-UI-related that can end up in a catastrophic situation.

Nothing is free of hazards, but good design decisions can save time, costs, and even lifes.

[Book] Emotional Design: Why we love (or hate) everyday things

The Norman’s book Emotional Design: why we love (or hate) everyday things is certainly praised by designers and non-designers.

Truly, it has made me a better person (I would never say that I’m now a better designer since I’ve just read a book). But yes, that’s the positive feeling you can get after reading it. You will feel like an alive and creative animal which understand the emotions through design and technology.

The book is full of examples, (figurative) pictures, experiences, and situations to illustrate why without emotions, your decision-making ability would be impaired.

There’s a kind of anachronistic tone in his view of design. He splits it in three different levels:

  1. Visceral: visceral design is about the initial impact of a product, about appearance, touch, and feel.
  2. Behavioural: is about use, about experience with a product: function, performance, and usability.
  3. Reflecive: is about long-term relations, about feelings of satisfaction produced by owning, displaying, and using a product.

explaining why attractive things really work better: beauty and usefulness are inside everyone’s mind when we look at objects. Even if we would dislike something there’s always a strong emotion behind which affects to the interaction and the perception.

So interesting, so recommended… and ready for the next one.