Epic Fail

Atul Gawande describes the Epic software system being rolled out in America’s hospitals.

It reads like a  potpourri of everything bad about enterprise IT. Standardize on endpoints instead of interoperability, Big Bang changes instead of incremental improvements, and failure to adhere to the simplest principles of usability.

The sad thing is that the litany of horrors in this article are all solved problems. Unfortunately, it seems that in the process of “professionalizing” usability, the discipline has lost its way.

Reading through the article, you can just tally up the violations of my proposed Usability Heuristics, and there’s very few issues described in the article that would not be eliminated by applying one of them.

The others would fall to simple principles like using battle-tested standards (ISO timestamps anyone?) and picking the right level of database normalization (it should be difficult or impossible to enter different variations of the same problem in “problem lists”, and easier to elaborate on existing problems).

There was a column of thirteen tabs on the left side of my screen, crowded with nearly identical terms: “chart review,” “results review,” “review flowsheet.”

I’m sure the tabs LOOKED nice, though. (Hint: maximize generality, minimize steps, progressive disclosure, viability.)

“Ordering a mammogram used to be one click,” she said. “Now I spend three extra clicks to put in a diagnosis. When I do a Pap smear, I have eleven clicks. It’s ‘Oh, who did it?’ Why not, by default, think that I did it?” She was almost shouting now. “I’m the one putting the order in. Why is it asking me what date, if the patient is in the office today? When do you think this actually happened? It is incredible!”

Sensible defaults can be helpful?! Who knew? (Hint: sensible defaults, minimize steps.)

This is probably my favorite (even though it’s not usability-related):

Last fall, the night before daylight-saving time ended, an all-user e-mail alert went out. The system did not have a way to record information when the hour from 1 a.m. to 1:59 a.m. repeated in the night. This was, for the system, a surprise event.

Face meet palm.

Date-and-time is a fundamental issue with all software and the layers of stupidity that must have signed off on a system that couldn’t cope with Daylight Savings boggles my mind.

A former colleague of mine linked to US Web Design System as if this were some kind of intrinsically Good Thing. Hilariously, the site itself does not appear to have been designed for accessibility or even decent semantic web, and blocks robots.

Even if the site itself were perfect, the bigger problems are that (a) there are plenty of similar open source projects, they could have just blessed one; (b) it’s a cosmetic standard, and (c) there’s pretty much no emphasis on the conceptual side of usability. So, at best it helps make government websites look nice and consistent.

(To be continued…)