User-Centered Design (aka. Design Thinking) for Healthcare IT Usability Improvement

The usability (or lack thereof) of Healthcare IT has been in the news a lot again.

This time a research report published in JAMA (Howe JL ; Adams KT ; Hettinger AZ; et al. Electronic health record usability issues and potential contribution to patient harm. JAMA. 2018; 319: 1276-1278) researchers analyzed voluntary error reports associated with Electronic Health Record (EHR) systems and found that problems with EHR usability may have directly resulted in patient harm.

Numerous health care systems are designed and created ad hoc, or with a very engineering-centric approach. End users are dissatisfied and often systems or workflows are abandoned and/or dangerous work-a-rounds created. (see Workarounds to Intended Use of Health Information Technology: A Narrative Review of the Human Factors Engineering Literature) A lot of people are saying Healthcare IT needs a disruption. What HealthIT needs is to begin to learn about and understand the needs, goals, and methods of the actual end-users, like doctors, nurses, medical assistants, etc.

Luckily there is a well-established paradigm. It is called "User-Centered-Design" (UCD) and it is essential for Healthcare IT vendors to understand, and apply it to all of their development efforts.

UCD has had a number of names over the years, from Human Factors, to Usability, to "Design Thinking."

The concept is simple, take a look at your site/application from the perspective of your end-users and design the information architecture, nomenclature and workflow to match THEIR mental model. The Electronic Health Records Association (EHRA) has created some great personas to help organizations learn about and empathize with actual users - see EHRA publishes free personas to help developers consider EHR usability design from a variety of end-user perspectives Working with a Usability consultancy that focuses on Healthcare IT can help you get started (of course I'd recommend )

The ROI of using this paradigm in healthcare is about 10 to 100x per dollar spent, but also can save lives. A lot of lives.

Usability professionals, old and new, know about the long-term ROI of doing user research, design thinking and/or user centered design. Designing to match the mental models of your users, for their needs and workflows can save a LOT of money. Development costs are reduced, training and documentation cost are also reduced.

It is way easier to support a program or system that makes sense to it's users, so associated costs go WAY down.

Developers are not thinking about the issues that they will likely have to deal with "down the road" when they produce software systems using an Engineering-centric Design paradigm. We recommend that Usability campaigns focus on the more short-term immediate positives associated with Usability, Human Factors, Design Thinking, User Experience or whatever they are calling it this year.

The money spent on marketing bad designs, building bad designs, supporting bad designs dwarfs the money people are willing to spend to ensure that the design of their products support user needs, and are effective, efficient and satisfying to use. (Dominira Saul of

Let's fix this!