Blame design, not user error, for much of what ails health IT

The recent article “EHR safety goes to court” (June 27/July 4, p. 30) included this quote: “It looks like it’s a round of litigation that’s about to happen as the inevitable human errors in dispensing healthcare are now being traced back to negligent use of the computer technology,” said Robert Fuller, a partner at Nelson Hardiman and former chief operating officer at Downey (Calif.) Regional Medical Center.

This statement blames users, ignoring the reality of bad design. Based on reports now proliferating from some of the most reputable medical organizations, e.g., ECRI, the Joint Commission, the Institute of Medicine, National Institute of Standards and Technology and others, it’s negligent design and negligent implementation that are far more a cause of a phenomenon called “use error,” as opposed to the “user error” described. This is not simply a play on words. “Use error” is a term used specifically to refer to user interface designs that will engender users to make errors of commission or omission. It is true that users do make errors, but many mistakes are due not to user error per se but due to designs that are flawed, such as poorly written messaging (or lack of messaging—no warnings of potentially dangerous actions), misuse of color-coding conventions, omission of information, etc.

Blaming the user is part of the problem that perpetuates bad health IT.

Dr. Scot Silverstein Adjunct professor of healthcare informatics Drexel University Philadelphia