by Jim Bradford, MediCHI Consulting
Posted: November 15, 2008
The goal of human factors is to make complex computer systems easy to understand and simple to use. Unfortunately, computer systems are usually created by engineers and computer programmers. Throughout the development cycle, those who create computer systems tend to use themselves as a model for the user population. The result is often a system that is frustratingly difficult to use.
Computer systems fall into two broad categories. Many systems are developed for the general population (for example: word processors and spreadsheets). Other systems are developed to support particular industries (for example: banking, the airline industry or the medical profession). Each industry has its own special requirements and the medical profession is no exception. The following lists five major reasons why the human factors associated with medical information systems are a special case.
#1. Do No Harm: If someone makes a mistake while using a word processor it can be annoying but a mistake using a medical information system could cost someone their life. The design of a user interface can either increase or decrease the likelihood of error. The human factors expert must use what is known about human performance to minimize the risk of medical mistakes.
#2. Doctors are Always Busy: Programmers create medical information systems in the quiet of their cubicles, but physicians use these systems in environments that are anything but quiet. From the assembly line environment of a busy medical practice to the controlled chaos of an emergency room, physicians must retrieve information, make decisions, and update records with an absolute minimum of time and attention available for system interaction. A skilled human factors practitioner uses workflow analysis to create or select a user interface that meets the demands of a busy doctor or nurse.
#3. Adapt the Interface, Not the Physician: Organizations and professions frequently have a set way of doing things. This is often called “business process” or “professional protocol.” Software designers usually have little knowledge of the business processes their software serves. The skillfully designed user interface must ask the right question at the right time and must provide the correct information just when it is needed. The human factors expert is responsible for analyzing the business processes of a user population to make sure that the software serves the processes and not the other way around.
#4. When in Rome, Speak as the Romans Do: Few professions have such a distinct professional vocabulary as does medicine. Medical information systems must use the language of medicine and not require medical staff to learn a new set of terms specific to the software. It is the responsibility of the human factors expert to devise and conduct field studies with an actual user population to ensure that the medical information system uses the correct terms in the correct way.
#5. A House Divided Cannot Function: the issue of “cognitive load” is frequently important in the design of information systems. Can a person drive a car down a busy freeway while simultaneously talking on a mobile phone? Not everybody can. When a person’s attention is divided between several tasks, the possibility of catastrophic error can arise. There are few application areas where this is more critical than in the case of medical information systems. The concepts of “simple and intuitive” are most important when a medical practitioner should be devoting most of his or her attention to medical issues. The human factors expert must identify these critical areas of high cognitive load during the “requirements specification” phase of a system’s development and confirm that the designers succeeded in addressing these issues during the post-development field testing phase.
At a time when many medical practices are replacing paper-based record keeping with electronic medical records systems, the art and science of medical human factors has never been more important.
We are entering an era when hospitals, clinics, laboratories, insurers, and individual medical practices will need to communicate seamlessly with one another through computerized medical information systems. If the human factors is done right, we can expect to see physician productivity go up and the frequency of medical error go down. If the human factors are not done right, we will see productivity go down and the frequency of medical errors go up.
The key to realizing the potential of medical systems is to include human factors in the development cycle and to make extensive use of human factors when medical information systems are selected. Indeed the latter guarantees the former.
Tags: eHealth, Medical Human Factors, medical information technology
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