This article hits home for me. I work on an EHR, a system very similar to Epic. We talk about this stuff all the time. There are a lot of breakdowns that can result in a situation like the one described in the article.
Simply redesigning the UI can be a fool's errand when you don't know the system architecture and business goals. A lot of these systems (including the one I work on) are legacy systems with layers and layers of different code stacks, APIs, databases, etc. that results in a house of cards. Or you have a tech stack that's so old, all the people who worked on it are gone and newer engineers don't even want to touch it in fear of breaking everything.
For enterprise healthcare systems, like Epic, the UI can become an amalgam of shit because competing functional teams at the hospital vie for competing needs. And then the people who actually use it (i.e., nurses and doctors) are stuck trying to use a broken UI.
For ambulatory systems, like the one I work on, the perception from customers and companies is that the product must bundle with 100+ functions and features that no one will use. The more features, the better. This makes sense intuitively but it usually results in common usability problems with navigation and discoverability.
Health systems are starting to wake up though. I'm inspired by ListRunner which helps doctors track their patients. It's a focused, single-purpose mobile app that doctors actually like using. I'm hoping we start to see more of these unbundled style healthcare apps. There's clarity and power in a focused experience that's separate from the main EMR system.
I was hoping someone with real experience would share about what its like. I thought it might be a lot of red tape and business issues.
So do you think theres any hope of fixing the current systems, or is it going to take a brand new company to step in?
What do you suggest can be done?
There's a lot to be done. Sometimes, I think maybe the best thing to do is just blow up the entire ecosystem and start over.
Aside from just solid UI design, I think there needs to be innovations in business models for healthcare systems. We're starting to see these emerge. One model that I'm inspired by is direct primary care which removes a lot of the administrative costs to healthcare and changes incentives from volume-based care to patient-based care. With this model, it doesn't matter how many patients you see in a day (which leads to 10min appointments and poor care). What matters is how well are your patients doing.
Sometimes, the best thing to do for a patient is to do nothing. But that won't get a doctor paid, even if they know it's in the patient's best interest. So they order unnecessary tests and procedures they can bill for. Direct care removes this kind of incentive.
Iora Health is a company attempting to get direct care models in place.
One Medical is also disrupting the traditional care model.
From a UX perspective, I think unbundled, single-purpose product experiences that are so common in consumer apps today will start to permeate in the healthcare space. As I mentioned before, ListRunner is doing this.
In general, healthcare is getting a lot of VC recently so I wouldn't be surprised if we start seeing these things sooner than later.
Hale Health has a really cool telemedicine product that I'm excited to try out.
Thank you for your excellent and thoughtful reply. Im going to keep an on those companies.
In addition to working in Operations here at LayerVault, I spend a lot of time on an ambulance, delivering patients to an Emergency Department that runs on Epic, and it's quite ... horrific. Absolutely horrible UI, and there would be very little surprise that information could easily get lost, possibly critical. The UI is amateur, ugly, and complex.
I should submit some screenshots from Tiburon (who supplies our Fire Deparments with mobile data terminal software). We're talking an embedded IE7 engine in an ugly app with quite possibly the world's worst map UI (picture working on a ToughBook in a moving fire engine with a map that works in only a single context at once - pan, zoom, scroll, select), for one.
Thank you so much for sharing. I'd love to see those screenshots.
As someone who uses these types of software, what do you think can/needs to be done?
I must start by saying that the title feels a bit sensationalist. I know you probably didn't mean it that way, so I'd rather focus on the topic you're talking about, which is of prime importance.
I find it very frustrating that the most critical systems are usually the ones with the poorest design: health, air & space, online banks and ATMs, cars are all areas where the UX seems to be traditionally in hands of engineers. I'm not going to blame engineers for situations like the one you describe, but I've had some experience trying to be the UX guy in teams and big organizations that are led by engineers and could say that in most cases the main concern for them is to make the things work.
Things like CapitalOne acquiring Adaptive Path seems to be a good first step to change this paradigm, but of course, that's only one case.
Hey Juan, I feel you on the title. I went back and forth a lot last night with it. I didn't want it to come off that way but considering my emotions and the story, I felt it was direct. I felt that it honored what happened to her. The UX of that system failed the nurses, it failed Jenny, and there is really no excuse for it.
I really hope you're right, I hope a shift can happen and more companies bring in Design as a core value of everything they do and back it up with a VP role and actions.
Couldn't agree more. Those screens you shared gave me anxiety. Thinking of someone in my family in hands of systems like that worries me a lot
Very timely read as I just began a project in the medical field.
Anyone know of other good web / app designs for this industry? Please share.
Theres a lot UX problems need to be solve in healthcare industry. I'm currrently working for a startup that builds app for doctors to use.
Jonathan, thanks for sharing. Agreed with how heartbreaking the UI is for mission-critical systems.
I admit I have a hard time with your conclusions, though: as far as unsolicited redesigns go, we need fewer of those in the world, not more. I can't condone spec work and as bad as those UIs are, without an intimate understanding or appreciation of both the user needs and business objectives, we can't possibly claim to know which insights should inform our design decisions.
Stated differently: without data, we're talking decoration, not design, no matter how pretty it looks.
Bad UX permeates even the most basic functions that nurses perform every day. Here's a piece of anecdotal evidence:
Just last week I was talking to two RN's, from two different large and busy hospitals, who both shared very similar experiences of nearly losing a patient in the same way.
The problem was, when a patient was sitting up, and suddenly they needed CPR (for two different reasons), neither of them could find the button to flatten the bed out quickly, both had to resort to the slow and steady motorized lowering of the bed whilst their patients were suffocating. This button is rarely needed, but in those moments, seconds spent missing the right button and waiting for the wrong button can mean the difference between life and death.
It's a very simple example of potentially dangerous UX, but the idea is the same. When lives are on the line, somebody should be caring more about the end user (doctors, nurses, pilots, refinery operators) and making their job easier.
Wow thanks for sharing. You're right, it really does permeate everything, and is especially bad in life threatening situations. It also can deny justice. If someone wants to access help from the government and can't, then that service is useless. If good citizens can't figure out how to pay fines or go through the giant hassle of rebutting them, then is there really justice provided?
It makes me so sad. I wish I could do something directly. What else can we do?
I think articles like yours here are a good start. As far as the next steps go? I'm not entirely sure. But I think the solution isn't a simple one, and will involve a lot of people with a lot of valuable insight that needs to be shared.
Money, power, politics, and competing goals often prevent the individuals creating these systems from having the input or feedback to get it right. (See Mitch Malone's comment, for example)
If empathy and compassion were as important as profits and margins, these kinds of problems would be much fewer and farther between.
But empathy doesn't come easily. It can't be taught in one semester of a college class for a few units of credit. Compassion costs more than a few thousand dollars of college tuition. It costs emotion, sometimes heartbreak, sometimes joy. It takes up your thoughts and feelings for more than just 8 hours a day, 5 days a week.
People genuinely caring about each other is the solution at it's very heart, but that is no easy task.
I somewhat agree. I think empathy can align with profits. I think once startup systems come into the market with better UX, patients will flock to them. There will be no stopping them.
the thing is patients don't have a choice, and they especially are not in a situation to flock to those systems when they are in need of medical care. I think the solution is to enter into markets overseas, to prove the quality, then into the teaching systems and schools, and then into new hospitals and training hospitals. It has to be designed to be slow so that you don't over burden the already overburdened health workers, and it has to be similar to systems they already know, but still better. It will take thousands of layers of iterations to slowly pare the system down to the needs of the medical staff, but it can work.
I guess online guides or templates/examples on how to best present information specifically for government websites could be created? Like a best practices or even an open source site people can use to repurpose into their own.
The Creative Commons license has taken off, and I’ve seen it used by the Australian government online, so possibly a standard website user experience that people in government come to know about could take off too.