The following appeared in the New York Times a little while ago.
July 16, 2011
Seeing Promise and Peril in Digital Records
By STEVE LOHR
TECHNICAL standards may seem arcane, but they are often powerful tools of economic development and social welfare. They can be essential building blocks for innovation and new industries. The basic software standards for the Web are striking proof.
Safety is also a potent argument for standards. History abounds with telling examples, like the Baltimore fire of 1904. That inferno blazed for 30 hours, destroying more than 1,500 buildings across 70 city blocks. Fire engines from other cities came to help, but could not. Their hose couplings — each a different size — did not fit the Baltimore fire hydrants. Until then, cities saw little reason to adopt a standard size coupling, and local equipment manufacturers did not want competition. So competing interests undermined the usefulness of, and investment in, the technology of the day.
Today, the matter of standards for electronic health records is raising similar concerns, prompting heated debate in recent meetings of representatives from medicine, industry, academia and government. The stakes, they say, could scarcely be higher. They agree that, when well designed and wisely used, digital records can deliver the power of better information to medicine, improving care and curbing costs. But computer forms, they add, can also be difficult to use, cluttered and distracting, causing more harm than good in health care.
“This is an issue that potentially affects the health and safety of every American,” says Ben Shneiderman, a computer scientist at the University of Maryland.
The controversy points to the delicate balancing of interests involved when creating technical standards that inherently limit some design choices yet try to keep the door open to innovation. It also raises the question of the appropriate role for government in devising such technology requirements.
At issue is the Obama administration’s plan to develop standards to measure how effective and easy digital patient records are to use — applying a research discipline known as human-computer interaction or human factors. (The International Organization for Standardization, which is based in Geneva, defines the usability of a product by three attributes: “effectiveness, efficiency and satisfaction.”)
The need to improve the usability of computerized records is clearly evident — and has been for some time. A 2009 study by the National Research Council, an arm of the National Academy of Sciences, found that electronic health record systems were often poorly designed, and so could “increase the chance of error, add to rather than reduce work flow, and compound the frustrations doing the required tasks.”
At a government-sponsored gathering last month, Dr. David Brick, a pediatric cardiologist in New York, demonstrated how it took eight mouse clicks on a digital record to find the patient information presented comfortably on the single sheet of a paper chart. Hearing such complaints, countless times, from doctors and nurses is what prompted the administration to put usability on its policy agenda.
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What is also beyond doubt is that the promise of digital records will be unfulfilled if doctors refuse to adopt them, because they regard the technology as cumbersome, time-consuming and possibly dangerous.
“Usability is going to be the single greatest impediment to physician acceptance,” says Dr. Edward H. Shortliffe, a professor at the University of Texas Health Science Center in Houston and the president of the American Medical Informatics Association.
Lots More here:
This article raises a really important issue. How do you make software work well, be suitable to the needs and at the same time be safe and not get in the way of clinicians trying to get the job done,
My view is that there is a difficult line to draw. We need practitioner systems that work well, are easy to use and foster safe practice but at the same time over regulation might ensure the incentive to create such systems is blunted.
Well worth a read. I would love views from software developers etc.
David.
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