Short Link: http://j.mp/cbQP2c
I can’t leave the iPad alone, literally or figuratively (how many EMR users can say *that* about their EMR?). Last week I explored the relationship between EMR/EHR/clinical groupware contextual usability and process awareness. This week I consider the following apparent contradiction:
Most reviewers agree that the iPad is optimized for content consumption, not content creation.
“The iPad is not a laptop. It’s not nearly as good for creating stuff. On the other hand, it’s infinitely more convenient for consuming it — books, music, video, photos, Web, e-mail and so on. For most people, manipulating these digital materials directly by touching them is a completely new experience — and a deeply satisfying one.” (Looking at the iPad From Two Angles, David Pogue)
However another article reports that of all industries healthcare is most agog at the iPad’s form factor and usability.
“So while the rest of the world texts, tweets, and generally fawns over the thing, that’s muted compared with the reception the iPad is getting in the health care universe…This isn’t just hot-new-toy fever sweeping the mediverse, though: If the iPad becomes as ubiquitous in medical facilities as the iPod is everywhere else, it could usher in literally billions in savings.” (An Apple a Day: Will the iPad revolutionize health care?, Martha White)
The apparent contradiction? Physicians need to create content at the point of care, not just consume it. They will resist hauling around multiple devices. While the iPad has a virtual keyboard and an optional keyboard accessory, and there’s Dragon Dictation, clicking (or in this case, tapping) to perform routine data entry is not likely to go away.
But consider the following blogosphere comment:
“I have read reports from ‘excellent’ EHR systems…which contain disastrous errors created by a 0.5 mm slip of the mouse pointer and a click. This is what happens when two opposite diagnoses differ by one consonant and are adjacent in the pull-down list. We are trying to treat the patient but we are really doctoring the EHR.”
And (in reaction to the iPad):
“Even most template driven EMR software would not be fun on an iPad. Checking a check box with touch can be painful if the check box is too small, no?”
Absolutely right and exactly my point. The Cognitive Psychology of Pediatric EMR Usability and Workflow starts with a question and graphic example of the issue.
Figure 1: See Post Script.
The answer is obvious. There’s even a psychological law.
Fitts’s Law: “The time required to rapidly move to a target area is a function of the distance to and the size of the target.” (Wiki article on Fitts’s Law)
For user interface design, Hick’s Law complements Fitts’s Law:
Hick’s Law: “The more choices you have to choose from, the longer it takes for you to make a decision.” (Wiki article on Hick’s Law–you’ll have to copy and paste “http://en.wikipedia.org/wiki/Hick’s_law” into your browser, WordPress doesn’t handle apostrophe’s in links well)
“Acquiring” (human factors speak for click or tap) one small “target” amidst many “competing” targets is slower, more effortful, and error prone than a large target among just a few alternatives.
How, might you ask, can EMRs, EHRs, or clinical groupware present *enough* buttons to their physician users so they can enter all the data and orders that they need? Instead of just a few big screens containing many small buttons and checkboxes and so on, spread larger buttons (and no checkboxes, not a one) across many screens.
How, might you ask, are you expected to navigate to the right screen at the right time to click on the right button? For each specific context (well child visit, sick child visit, vaccination, etc.) present the right screens in the right sequence to the user in a way that mirrors the natural order of the tasks the user needs to accomplish. That was my major point in last week’s post Contextual Usability, My Apple iPad, and Process-Aware Clinical Groupware for Pediatric Practice.
The iPad and similar devices may indeed transform digital medicine. If they do, one important reason will likely be that it forces EMR, EHR, and clinical groupware developers to get rid of those cramped rows of itty-bitty little checkboxes and endlessly scrolling lists of skinny pick list items. To do so requires clinical groupware to ask and answer the right question at the right time and act appropriately, to hand to the user the right data or order entry screen with all, but only, the right data or options. I don’t see any other way for clinical groupware to do this than to rely on some form of user-programmable executable process model.
P.S. Read about post-WIMP (Windows, Icons, Menus, Pointer) user interfaces.
P.S.S. Follow me on Twitter at @chuckwebster.