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…)

How to fix the United States

The problems of the United States are entirely self-inflicted. Fixing them is a huge political problem, even though solutions are easy to see. Here are ten ideas (that are probably politically untenable) that would address major problems in the US.

  1. End the War on Drugs. Triage recreational drugs based on whether they’re harmless, mostly harmless, or harmful and regulate them accordingly (available over-the-counter, like aspirin; available with restrictions, like booze and cigarettes; available with some kind of precaution (e.g. sign a risk waiver)). This will have a huge positive impact on inner city decay, deny organized crime, our enemies in Afghanistan, and various insane guerilla groups in South America their funding, reduce prison overcrowding, and free up the police, FBI, and judiciary to deal with stuff that actually matters. By all means allocate some of the wasted money to rehab, public education, and so forth. But let’s stop pretending that (a) this war is worth fighting, (b) it’s winnable, or (c) illegal drugs are categorically worse than legal ones.
  2. End the War on Terror. Let’s rename and rethink it. Terrorism can’t be beaten by fighting wars (indeed, wars tend to create terrorism).
  3. Pull out of Iraq and Afghanistan. Get out with indecent haste. Call it defeat. Call it victory. Call it “peace with honor”. It doesn’t matter. In the long run we will lose in both.
  4. Nationalize Health Care. Probably the best way to do this is go 100% public, then rebuild private insurance so that it doesn’t suck. Public health care can unsnarl the bizarre and evil relationships between insurance companies, hospitals, and other parts of the healthcare clusterfrack that costs the United States more per person than anywhere else on Earth and delivers third world results.
  5. Make Preventative Health Care a Priority. E.g. if you don’t get an annual checkup, all your co-pays go up by $25.
  6. Reduce US Military Spending to Sane Levels. No less a publication than the Scientific American once said the US could reduce military spending to 1/3 of current levels and still be more powerful than the next two most powerful countries put together.
  7. Tax Gasoline More. It only took a month of cheap gas to restore pickup sales to former levels.
  8. Slowly Ramp Up Energy Prices (via Taxation). The best alternative energy is energy conservation. Get people to cut power consumption or use alternatives by increasing the cost of energy, especially fossil fuel energy.
  9. Tax Speculative Money Market Transactions. George Soros recommended this after the Asian market meltdowns of the 90s. It’s still a good idea.
  10. Break the ISP Monopolies. I don’t care how you do it, but eliminate local ISP monopolies. In my neighborhood I have two choices — DSL or Cable, each with one possible provider. This isn’t competition (as evinced by the fact that the prices are indistinguishable). Nationalize it or break it up. Or do a bit of both.
  11. Break the TV Monopolies. Why do I have to buy channels bundled? TV as we know it is dying. Kick it in the head so that it evolves into something less retarded.
  12. Eliminate Local School Boards. Teach biology in science classes. Teach religion in religion classes. Having a national or even just state standardized syllabus would allow economies of scale in education that simply can’t exist in the current mess.
  13. Use the Internet to Fix Assessment. Use national testing schemes or have educational institutions assess students from other educational institutions. Professors should be graded on how well they are able to impart knowledge to students, not on how easy their courses are. Students should get grades based on what they know and can do. Eliminating the assessment feedback loops (where students grade professors and professors grade students) will help fix the US college system. If your professor isn’t grading you, then suddenly you want the professor to teach you.
  14. Use the Internet to Fix Teaching. This is already happening. You can download lectures from Harvard and UC Berkeley from iTunes. Why listen to your professor if another professor covers the same material better? What century is this?
  15. Force Retailers to Display Actual Prices. Pretty much everything in Economic theory involves actors having good information. In the US you generally need to perform mental gymnastics to figure out how much the simplest things cost. Fix it. The benefits will be incredibly huge.