[gforge]

I am an orthopedic surgeon during the day and at night I write code. I just don't believe that spending a few hours watching surgery actually helps. You need to really work with the software, a solve daily problems and be aware of what problems are trivial software fixes.

For instance, when I sign lab results I get to see the references for twenty year old subjects. It would be much more helpful to see the patients last lab result (in 60+% of the cases this is available).

Another example is in the ER where we have a list of all the patients. There is a column for my name so that I know which cases I am handling, unfortunately that column is too the far right and only visible after resizing the other columns. This setting is also not saved so each time I open the list I have to resize over and over again. If you could move that column to the left would be great, or even just bold font my patients' name.

The major problem that I see is that we have:

- huge monolithic software that make any change a living nightmare

- all changes are treated as we were doing open heart surgery. Most stuff we do is trivial but having a standard that high makes it almost impossible to deploy updates - especially the minor changes that really would change things.

- 80% of users complain about the software but very few understand the underlying problem.

- much of our software is spec driven - I can sign my lab results and I can see the patients in the ER, no one bothered to add the last tweaks to actually make it easy.

[ivan_gammel]

All that you mention points to lack of proper UX design process as part of SDLC. Observation is part this process, it is important and better not to be skipped, because it can provide very useful insights, but it’s just a single stage of research - there are more techniques and methods to solve problems that you mention.

[gforge]

Yes, there have been numerous people pointing out this in this thread. I think that UX design is viewed as frosting on the cake instead of the thing that actually makes it work. Unfortunately I think one of the issues is that the SDLC is broken.

For some reason we keep getting features that few of us actually requested but that often make sense in that they are life saving, that is if people actually used them. I have a ton of indicators flashing all-over the place and after a while your brain simply adapts and ignores them. I doubt that anyone has actually done any analysis to see if these tools actually save lives.

I've been involved in some projects when I've spent 30 minutes with UX people and then never heard back from them. When the final product arrives it is full of annoying flaws, e.g. the latest software I was involved in the work flow is: 1. click on "open software" from the patient chart 2. a new window opens where I manually have to click on "log in" (note, I'm not adding a password) 3. the UI goes into authentication 4. the UI goes back to the login screen 5. the UI asks me a question that I _always_ answer the same thing to 6. I actually get to the data I was interested in

The most annoying part is number 4 - if I accidentally click on "log in" everything breaks and I have to close the window and redo everything from start.

Most of these UX issues fall under the category - murder by a thousand cuts. It is mentally tiring to be faced with all these issues but none of them is like open heart surgery where one mistake can be fatal. What happens is that doctors/nurses become tired and don't put the effort into the patient interaction where the actual value in healthcare is created. I'm pretty sure that bad UX in the end kills many more patients through this than malfunctioning critical hardware.

I truly wish that people in this forum that create health-care software think of UX and actually use their software more than just "I clicked through and everything works". Your bosses will probably never ask for UX features because they have a deadline, but you are in charge of designing and during that process it is easy to fix many of these annoyances (e.g. just disable the log in button).

[Novashi]

Epic and Cerner have been around since before UX and SDLC were common parlance, so their software and processes are likely locked into what we consider bad practices today.

Healthcare software exists in a weird trap where it can't move too quickly because hospitals are resistant to change, but it's software, and the software world normally moves quickly (including things around software like UX and SDLC concepts and ideas).

Simultaneously, hospitals can be slow getting off of deprecated platforms because of dysfunctional IT leadership, bad budgeting, and staff that can't or don't want to learn new software.