"Death by a Thousand Clicks" and Physician Burnout: Poor UX is an Inhumane Public Health Issue

Here is a great feature article from Fortune, entitled Death by a Thousand Clicks:

It’s about the visible and less-visible costs of poorly designed electronic health record (EHR) software, and the incentives that brought the current mess about. The article is a reminder that poor UX, bad information hierarchies/organization, and a lack of vision for how a tool should work is medically unethical and inhumane (on several levels). Given that the quality of software more or less reflects the quality of the communication in the group that builds it, the implication is that poorly managing a EHR company is also inhumane.

Some points that I find interesting:

  • Poor UX and poor information design is implicated as a leading contributor to physician burnout (!!)
  • The enterprise software world is an entirely different beast from startups.
  • QA (on the part of the software companies) and due diligence (on the part of the hospitals) seems to be lacking, especially because the consequences of software-induced medical errors are high. (For comparison, here is an article about how the code that launches the space shuttle is made nearly bug free.)
  • Apparently, voice-recognition interfaces are still being developed to transcribe medical data.
  • It seems that neither public-health foundations nor sets of wealthy philanthropists have offered to donate money to hospitals that agree to participate (or pressure their vendors to participate) in a data-interoperability / medical-record-standards consortium.

I’d love to hear your thoughts on the article (or the points I’ve raised here), I think the discussion could prove fruitful.

Edit: I had forgotten that Atul Gawande wrote up another perspective: https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers


These issues go so deep where do I start. I’ll say they aren’t as bad as they sound now- many glitches have been solved. It depends on if the hospital buys the IT service service plan from the EHR company- or they try to figure it out cHT themselves.

In any event, the wrgonomic implications are disastrous though. Technology impacts nurses on the front lines with user interface issues- nurses and smdoxtues should have been consulted fir these issues- but these companies think they can survive without front line expert advice. Guess who suffers- the health care provider is lucky to find a good acupuncturist and they will make it to the end of their expected career life with the ergonomic implications. Patients also suffer with the decreased eye contact so needed in a crisis situation.

But like all things there are good and bad. I just wish technology companies consulted with front line people and did research before implimdbting these tools- they just didn’t think at all- sounds rude to say this but that’s what health care oruvrdwrs eill their eyes about Every. single. Day.


This is too big a topic for a brief reply. A few key points include:

  • A completely unacknowledged and major part of the Affordable Care Act (aka Obamacare) was that it did a pretty decent job of trying to drag a national dinosaur industry on paper into the digital 21st century.

  • Move fast and break things is a cute slogan… until somebody dies. Welcome to health care, where regulatory frameworks don’t take kindly to breaking rules when lives, and lawsuits, are at stake.

  • EHRs are an improvement, but the schemas and systems are a complete mess of public and mostly private and a complete lack of singular standards. There’s a reason why you don’t want different cities to have different WiFi standards around the world, and this is the proof. Talk about a situation where government should have been more brute-forced and private industry only served to screw things up without that.

  • If you think digital transformation is hard in a corporation, imagine in a health care system. Back in the 1990s, there were many hospital systems that were still using token ring networks and relying on pocket IT mini-departments isolated between different health care departments. Byzantine as anything. This is an industry that is going to be among the last to digitally modernize, so things like QA, looking at the inbetweens of successful product design, etc., were major gaps.

  • Doctors rightfully hate their jobs now because everything is oriented as a nag for compliance from an overlording compliance system. It is not designed to enable physicians. It is designed with bureaucrats and insurers as the end customers.