Sunday, March 01, 2009

Information Technology Makes Healthcare Easier? Is This Industry Trying to Harm Patients? Part 7 of a Series

This post is part 7 of a series on the stunningly poor human engineering of production healthcare IT from major vendors, in use today at major medical centers. These devices provide a decidedly mission hostile user experience, yet with an almost religious fervor are being touted as cybernetic miracles to cure healthcare's ills.

(Note: Part 1 of this series is here, part 2 is here, part 3 is here, part 4 is here, part 5 is here, part 6 is here, part 7 is here, and part 8 is here. 2011 addendums: a post that can be considered part 9 is here, part 10 is here.)

Want to make a doctor or nurse miserable?

Want to up the odds for error?

Simply force them to review lab results on a screen as sloppily designed and cluttered as this one:

(click to enlarge)

What technical genius programmed this monstrosity? The clutter is enough to impair the best clinicians who have to use such screens day in and day out on their often substantial patient loads.

How is such a screen better than paper?

Does the clinician really need to see subcomponents of panels such as General Chemistry split up all over the place, into sections of columns? Perhaps monolithic columns and horizontal scrolling would be less cognitively taxing? More columns, of course, could be placed in the available screen width if space were not wasted by ... units and Abn's!

Does the clinician really need to see "Abn" as opposed to, say, "A" for abnormals? (At least the abnormals are actually marked in this application, unlike here in "Warning! No warnings!)

Does the clinician need to see units such as mg/dL (milligrams pre deciliter) and mEq/L (milliequivalents per liter) on each and every lab value? Correction - on ANY lab value?

Could not that information be placed - once - in the column or row headers?

(Oh, wait ... as shown here, those headers in some products have a tendency to scroll away, forcing the "track the value with your finger" method of medical error prevention!)

(click to enlarge)

Then there's this, just in from Down Under on clinical decision support, touted as one of the most important benefits of HIT:

Sweidan et al., Medical Journal of Australia 2009; 190 (5): 251-254

Objective: To investigate the quality of drug interaction decision support in selected prescribing and dispensing software systems, and to compare this information with that found in a range of reference sources.

Design and setting
: A comparative study, conducted between June 2006 and February 2007, of the support provided for making decisions about 20 major and 20 minor drug interactions in six prescribing and three dispensing software systems used in primary care in Australia. Five electronic reference sources were evaluated for comparison

Six of the nine software systems had a sensitivity rate ≥ 90%, detecting most of the major interactions. Only 3/9 systems had a specificity rate of ≥ 80%, with other systems providing inappropriate or unhelpful alerts for many minor interactions. Only 2/9 systems provided adequate information about clinical effects for more than half the major drug interactions, and 1/9 provided useful management advice for more than half of these. The reference sources had high sensitivity and in general provided more comprehensive clinical information than the software systems.

Drug interaction decision support in commonly used prescribing and dispensing software has significant shortcomings.

More in part 8.

-- SS


NRK said...

I agree with much of what you say about design and the lack of what seems common sense to those of us who actually use, rather than design, EMRs. But, in all fairness, the lab grid you posted is not only useless, but never used by me or my colleagues who are on this same EMR platform. A simple click of the "Table" radio button brings you to a logical and easy to navigate presentation.

InformaticsMD said...


I think what you meant to say is that you never use this view because it is useless.

That raises another question:

How much of the $XX millions of dollars organization pay for these systems goes into making "useless" displays? Or was this put in for free, simply to be ignored?

-- SS

InformaticsMD said...

and by the way, more is coming regarding the "more clear" table views in these applications.

I can't wait to count the ways basic concepts in presentation of information are violated for want of some grad student level code and clinician involvement.

Anonymous said...

This post, there are some problem, unfortunately many docs actually ask for this kind of display - granted the example is a particularly bad one.

As for drug interactions - there are multiple problems here - the biggest one is that the drug interaction engine is actually controlled by one company - a Hearst media subsiduary! So most EMRs are held hostage to pay for only the parts they can afford.

We opted for a German company - better cost structure and actually a more complete engine.