Usability and confusability in Health IT: doctor-computer interaction vs. doctor-human interaction

A segment on the Marketplace Tech Report, Health care providers having trouble with new technology, caught my ear yesterday. The story included health and safety concerns raised by one of the authors of a 197-page report, Health IT and Patient Safety: Building Safer Systems for Better Care, published by the Institute of Medicine this week:

Dr. Ashish Jha, a professor at Harvard's School of Public Health and an author of this report as well says, "One of things that happened in Pittsburgh, in the pediatric ICU was that when the electronic system was put in, it really changed the way doctors and nurses interacted and the way they worked together. Physicians started spending a lot less time at the bedside and they were spending a lot more time staring at the computer screen, and interacting less with nurses and interacting less with patients. And there's a lot of information you pick up when you speak directly with people that when you go to purely electronic communication, you miss."

Two diametrically opposed possible explanations for the increased inattention of doctors to their human colleagues and customers (aka patients) came to mind:

• the health information technology (HealthIT) systems are so well designed that doctors are becoming engrossed in the wealth of information newly available to them
• the new HealthIT systems are so poorly designed that doctors are being needlessly distracted by confusing and unintuitive interfaces that require significant attention to navigate effectively.

After downloading and skimming the report [a pre-publication version of which is available as a free PDF], it appears that the latter explanation is most on point. Chapter 4 of the report, Opportunities to Build a Safer System for Health IT, includes observations, analysis and recommendations for usability, workflow and other human-computer interaction (HCI) issues involved in the design of effective Health IT systems. The report includes chapters on other topics involving information and technology (many of which incorporate elements of HCI), but it is encouraging to see such a strong human-centered focus on what is, by definition, a very human-centered domain.

Among the observations shared by the committee who authored the report is a strident call for usability as a mission-critical factor:

The committee expressed concerns that poor [Health IT] usability ... is one of the single greatest threats to patient safety. On the other hand, once improved, it can be an effective promoter of patient safety. [emphasis added]

Among the relevant references they recommend for improving usability:

• NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records (29 November 2010)
• Customized Common Industry Format Template for Electronic Health Record Usability Testing (16 November 2010)
• National Center for Cognitive Informatics and Decision Making in Healthcare (NCCD) Rapid Usability Assessment
• NCCD's unified framework incorporating task, user, representation & function (TURF) for defining, designing and assessing usability for Electronic Healthcare Records (EHR)

Unfortunately, I don't currently have the time to dig more deeply into the report or the wealth of references it cites (I have 75 midterm Operating Systems exams to grade in the next 36 hours). However, in my [re]new[ed] role as educator, I will be teaching a class on HCI next quarter and am pondering how I might indulge my increasing interest in computer supported cooperative healthcare and find ways of focusing on healthcare issues as a stimulating and worthwhile problem domain for undergraduate students learning about HCI.

Having recently read a compelling NYTimes article on Why Science Majors Change Their Minds (It's Just So Darn Hard) - which emphasized the increasing importance of design, projects, problem solving and social service to motivate students studying Science, Technology, Engineering and Math (STEM) - I'm eager to put some of these ideas into practice.

[Update: The New York Times has a related article on doctor-computer interaction, which focuses on the distraction caused by highly engaging IT devices and services that are not designed specifically for healthcare: As Doctors Use More Devices, Potential for Distraction Grows (found via a post on Distraction at Josephine Ensign's "Medical Margins" Blog).]