Biograph for CT scans

Medical Device Usability

The prevalence of medical errors and the difficulty of using medical devices are such common complaints among health care providers and patients that I won’t bore you with the usual statistics. I think we all know these are grand challenges for the HF/E profession. But a look back at a 2012 article in User Experience magazine by Shannon Clark and Ed Israelski reminded me of how little progress we seem to be making. They share a few famous health care human factors stories that we see in the mass media whenever there is a major incident, but then fade into the background when the general public’s limited attention span runs its course. I was reminded of this when reviewing the program of the 2015 Human Factors in Health Care conference.

Perhaps you have heard stories of a doctor operating on or amputating the wrong limb. Even though this is an age-old problem, some medical devices cause the user to confuse the sides of the body, consequently leading to recalls of the devices. Just last year, the U.S. Food and Drug Administration (FDA) recalled a software system because the interface led doctors to confuse the left and right sides of the brain when evaluating patients. Imagine the consequences of this design flaw during brain surgery!

The most famous one is when patients or nurses write in marker on their bodies to remind surgeons of where to cut. These errors are not inattention by the surgeon; it is that many of the electronic devices they use make it hard to resolve which side is being displayed. We have symmetrical bodies and our right sides look an awful lot like our left sides. A big splotch of marker ink might be the only salient difference.

Another famous failure that they review is the alarm fatigue commonly experienced by teams in the operating room or the emergency room. The medical team either needs to filter their attention through an incessant barrage of auditory and visual warnings or turn them off and risk missing something important.

Now that we are developing health care solutions as smartphone apps, another famous problem is going to get even worse. Medical device displays are notorious for visibility issues. Either the user can’t see the units, the decimal point, the mode, or any number of important pieces of information. Now that we are migrating these apps to smart watches or other wearable devices with even smaller displays, this challenge will only get worse. Moreover, app designers are often teams of just a few developers, none of whom have human factors expertise.

Your Turn

OK, so I know I have not told you anything you don’t already know and have not heard about dozens of times. But that should make you stop and think. If we have known about these problems for decades now, why are they still so prevalent?

Image Credit: Thirteen Of Clubs

2 thoughts on “Medical Device Usability”

  1. In answer to your question, I think that there are just too few trained human factors professionals out there to make a difference. Many people doing human factors work on medical devices are not trained human factors professionals; many don’t have the grounding in psychology and human performance to really do a good job of recognizing and dealing with these issues either during the design process or during implementation, and hospitals themselves don’t typically don’t hire human factors people, unless they are very big hospitals.
    And of course, another sad fact is that human factors is not the squeaky wheel that gets the grease. The health IT folks, in particular, have been very slow to realize just how much poorly designed information technology creates risk – to wit, the FDASIA report that basically looked at EHRs as low-moderate risk. Health IT folks have pumped millions if not billions into attempting to solve interoperability and security problems, the former of which, to me, is definitely a lost cause, and the second, maybe, as well. Even if one could achieve interoperability, it would be meaningless (as far as the patient is concerned), as long as we have hospital systems that wouldn’t share their data even if they could. The accurate electronic medical record, therefore, is an impossibility as long people get treated in more than one place and facilities don’t share data. It is a fundamental problem that can’t be fixed as long as health care in this country remains a for-profit, competitive enterprise.
    I could go on, but what REALLY amazes me is how oblivious the public seems to what is going on. I suspect it’s a classic case of “learned helplessness” – they don’t understand the health care system (or even their bills), they do what they are told to get by, and try not to think about it. They have given up. If something bad happens, they think it’s their fault, or just “bad luck.” Similar to the Edward Snowden business – we’ve just sort of accepted that the government can find out anything about us, and that’s the way it is. Or as John Oliver has so “pithily” stated, if you put a picture of your “junk” out there in the ether, you have to assume the NSA (and others) know about it. The only alternative to NOT involuntarily sharing, is to stay completely unconnected. And good luck with that….

  2. All very true, unfortunately. We need as much marketing and recruiting as we need to practice our profession!!

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