Bad software destroyed my doctor's memory
- Reference: 1692167225
- News link: https://www.theregister.co.uk/2023/08/16/bad_software_destroyed_doctors_memory/
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"It’s not working?" I asked.
"Oh, it's working," he replied. "We spent six months digitizing every bit of paperwork that I've ever created in the last twenty years I've had my practice. It's all" – he gestured toward the screen – "in there."
[1]
I asked, tentatively, if that was a good thing.
[2]
[3]
From his sigh, I knew it wasn't.
IT professionals try to radically alter the workflow of medical professionals, without their input
"I've always had a nice big patient file to work with. Yours has everything from the first time I saw you, through to the very last time I saw you."
I remembered that file. It got bigger and thicker as the years passed, crowded with handwritten notes, his copies of prescriptions issued, reports from other medicos – all of the various details collected by modern medicine.
That file was nowhere to be seen on my specialist's completely clean desk, which sported just a telephone and that convertible laptop-slash-tablet.
[4]
"I saw you six months ago," he said. "That's in the file. I could just open it up, flip back a page or two, and see everything that I wrote, everything I prescribed, all of it. I don't have any of that now."
I asked what he meant and was told I'd been reduced to a "patient record."
"Yes, all of the information is in there, and sure, I can find it. But it's completely disconnected from when and how and why it happened. In a paper file, I could know things were related because they were close together. Here, everything is … well, I don't even know where it is," he lamented.
[5]
"So you've lost your memory?" I asked.
Another sigh. "Well, it is good for one thing," my specialist said. "It's completely portable. I can bring this along, take it out, and wherever I am, I've got my patients' records. I couldn't do that before."
He paused, trying to articulate something he didn't really have words for. "I just wish that I could swipe backward and forward through a patient record and have that move backward and forward in time through that record. So that I could swipe back twice and look at what was going on a year ago, or a week ago. But that's not how this works. And it feels like I never quite know where I am."
I understood: digitizing data is only the first step. How you access that data once it's digitized is the important part.
Had he been consulted, my specialist likely would have opted for a [6]highly skeuomorphic design that faithfully replicated the look and feel of his paper record keeping. That simulation of a connection between himself, his files and his patients would have given him a sense of place, of knowledge, and capability. Without it, he felt like someone adrift on a sea of information, lacking a craft to navigate it.
[7]Social media is too much for most of us to handle
[8]Open the pod bay doors, GPT, and see if you're smart enough for the real world
[9]Open source AI makes modern PCs relevant, and subscriptions seem shabby
[10]It's time to reveal all recommendation algorithms – by law if necessary
This sort of "design blindness" happens whenever system designers prioritize the needs of the IT system, rather than its users. My specialist is therefore forced to deal with a client interface barely pasted over some sort of database. The data is shaped to fit the design of that database, rather than the other way around.
The database – and however many translation layers on top that it takes to do the job – should present its content in a form that is so easily apprehensible my specialist need never give it a second thought. It should just work.
Instead, twenty years of his experience lie trapped inside an information schema that provides benefits no one except the cloud provider that powers his new application.
Those benefits may be that it makes it easier to share data between doctors. Perhaps it's easier to keep track of billings. But the cost is in the quality of patient care.
That reminded me of a recent visit to my regular doctor – who had somehow forgotten that he'd just sent me for an expensive, invasive test. At the time, I wondered if my doctor's powers had waned.
Suddenly, I saw this forgetfulness in an entirely new light. The practice's patient management system probably hid that information a few pages down. When I popped into his office, he hadn't seen it, hadn't had his memory refreshed, and naturally had forgotten all about it.
As I am one of many hundreds of patients my doctor sees on a recurring basis, it's not surprising that details are forgotten. Yet this is exactly the sort of lapse that a good tool should help to prevent. If we can't trust our computing machinery to maintain clinical memory for patients and practitioners, why use computers in medicine at all?
The whole history of IT and medicine has been [11]littered with failed digitization projects . Almost always that boils down to IT professionals trying to radically alter the workflow of medical professionals, without their input. IT seems to be gaining the upper hand, forcing digitization through the medical system.
Can we make that a human transition? If IT works hard to make good tools for doctors, nurses and other specialists, they make it better – and safer – for the rest of us. ®
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[6] https://www.theregister.com/2013/06/10/apple_wwdc_announcements/
[7] https://www.theregister.com/2023/07/20/social_overload/
[8] https://www.theregister.com/2023/06/15/gpts_in_the_real_world/
[9] https://www.theregister.com/2023/05/11/open_source_ai_makes_subscriptions_irrelevant/
[10] https://www.theregister.com/2023/04/13/reveal_all_recommendation_algorithms/
[11] https://www.theregister.com/2017/09/25/ai_in_medicine/
[12] https://whitepapers.theregister.com/
Have a hundred upvotes
Abso-bloody-lutely.
I daily use a digital medical record which mimics the layout of the old paper record, segregated into alerts / outpatient episodes / inpatient episodes / diagnostics / correspondence sections then partitioned according to patient contact episode, and internal sorting of those according to admission / progress / specialist inpatient (ICU/theatre/diagnostic procedure) / discharge by the hospital paper form MR type. Precisely what the paper record had evolved into after centuries of human experience showed us how to minimise the use of any sentence beginning with the words ”Where in this thing am I supposed to find...".
This is a perfect exemplar of you don't know what you've got till it's gone. No-one gives this problem a second thought until some bright spark comes along and, presented with a problem that is already solved, says "no, we should do it this way..." and tries to implement some system that was abandoned the last time it was tried because it didn't work as well.
Re: Have a hundred upvotes
Computers could certainly enhance a paper file, assuming the contents are filed properly. I would hope that system has a chronological summary of the patient history but also allows
- Searching for any term in the file, e.g. "hip". Easy in a digitized file, not so easy in a paper file..
- Linking an Episode, e.g. a broken hip treated in a hospital plus outpatient physiotherapy sessions plus disability assessment.
- Selecting an item, then paging backwards/forwards through related OR unrelated pages. (e.g. You had a fall, but also have low blood sugar. Hmm, could they be related? The human brain is great at making correlations, computers not so good)
- Side-by-side comparison of two pages, e.g. blood test results, to see what has changed. Maybe even highlight changes or anything out of the norm.
That's just off the top of my head, and with little knowledge of current practices. Hopefully those involved are way ahead of me!
(It occurs to me that any CRM system should have those features, so the wheel doesn't have to be reinvented for each use case)
The whole history of IT and medicine has been littered with failed digitization projects. Almost always that boils down to IT professionals trying to radically alter the workflow of medical professionals, without their input.
Not just the medical world. Every field is bedevilled with IT geeks who think they know better than actual practitioners how those practitioners should do their jobs. Or who claim to know better as a cover for not taking the time or trouble to produce a usable system.
The GNOME projects bizarre "usability" guidelines are just one small example of this; the problem is pervasive. Ever tried using SAP Concur?
When I started, I was in Marketing Automation or Agency Automation (in the airline/travel industry). The idea was the existing paper processes were good and existed for a reason, and the IT challenge was to automate them. That was it. Not to reinvent them, not to put a one-size-fits-all solution in.
"radically alter the workflow of medical professionals, without their input"
And there is the problem. You do not design an interface without spending some time with the people who are supposed to use it and learning about how they work.
Designing a product without ever talking to its users is a high sign of arrogance, these days. That only works when you are creating something that never existed before.
The word processor is a perfect example. When the first word processors came out, nobody had ever even dreamt of it. There was no one to talk to, because it was an entirely new product.
Today, if you embark on making a new word processor, you hardly need to talk to anybody because if it doesn't work like Word, you're up the proverbial creek without a paddle.
So you're designing a product to "help" doctors ? Go talk to a doctor. Find out what they need and how they work, and then go back to the office and wrack your brain to find out how you can replicate that in your UI.
Not doing that just makes your product useless, and at the mercy of anybody who understands the issue and gives two hoots about it.
Re: "radically alter the workflow of medical professionals, without their input"
I first made a comment about this 8 years ago.
https://forums.theregister.com/forum/all/2015/09/02/nhs_to_go_paperless_by_2020_says_info_director/#c_2620739
System designers absolutely must talk talk to the users. And not just talk, watch them do their job, try and spot the things they do so instinctively that they would think to tell you about them.
Sometimes the inverse works
I work in NHS IT looking after a system that is written by a Clinician (from a different trust) . It seems to have hit a sweet spot, works really well for the users, adaptions that are needed are quickly understood and implemented as all of us have worked in type of department it serves. From an IT point of view it runs on Ruby/Postgresql and is open source, the tables are well organised to serve the UI so report writing is easy.
Sometimes things can be done well
Re: Sometimes the inverse works
Quiet, you might put a stop to hundreds of millions going to 'digitise the NHS' pork projects that get cancelled and restarted every five years or so.
One of my best software development projects was also one of my earliest. Despite the fact that I was still green, I had the massive advantage that I was developing this tool while sitting with the team who would be (and latterly was) using it. It was originally designed to solve a couple of problems they had with their workflow, and any issues or complaints they had they could tell me directly. I could also observe them using it passively, over the course of the working day. I could see what worked, what didn't, what made sense to me but wasn't intuitive for them, and what else might be added to further streamline things.
That project taught me an awful lot about UI.