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

Modern Healthcare - - COMMENT -

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

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