Why health IT usability matters to patients

It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.)

According to the rumor, the exec said, “Over my dead body.” As if he ran the agency.

Whether or not the rumor’s true it’s not funny. So when I was asked to represent the patient perspective in a keynote recently in Washington, I used that phrase as my title.

Here are my slides, with a few changes to make it work better standalone. The “dead body” part starts at #48.

“Over My Dead Body”: Why Reliable Systems Matter to Patients

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I don’t think “over my dead body” is an appropriate business argument when the business is healthcare. Systems in any industry that are hard to use are more likely to lead to human error, and in some industries errors cause deaths. Aviation is one, and healthcare is another.

A big difference is that aviation deaths are spectacular and unexpected so they get investigated, while hospital deaths can be blamed on sickness. That’s no excuse for weasels to resist quality regulations: a death is a death.

Accidental deaths and harm are hard on staff as well as patients.

I know vendors want their systems to qualify for Federal stimulus incentives under the Meaningful Use regulations. Those incentives are a powerful carrot (higher payments) and stick (penalties, a few years from now), leaning on physicians and hospitals to buy health IT. The big question being defined in the regs is, how good must a system be to qualify the buyer for those incentives?  Can any piece of crap system qualify?

As much as I want health providers to get modern with IT, I assert that it’s just plain wrong to force people to buy crappy, hard to use systems. So I think usability is an issue.

Some people have said “Well, but how do you measure usability?” There are experts who do that in other fields – again I’m amazed that healthcare denies knowledge from other industries. But here’s the method we had to live by when I was in consumer software: ask users if the system sucks. I said that in the January post:

Here’s one radical idea:

What if a system could only get certified (and thus get the stimulus money) if the people who use it say it basically works?

Can a system be meaningful if the users say it doesn’t work?

Guiding principle: ask the workers who are directly impacted if the system screws up.

Some things about healthcare are rocket science. This one isn’t.

Dave deBronkart, also known as e-Patient Dave, blogs at e-Patients.net and is the author of Laugh, Sing, and Eat Like a Pig: How an Empowered Patient Beat Stage IV Cancer and Let Patients Help!

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