Saturday, September 28, 2013

Vocabulary Standards make poor User Interfaces

There are many articles written on the poor user interface experience that clinicians have with Electronic Health Records. One out yesterday from the Washington Post did a good job of explaining the problem. The user interface simply overwhelms the clinician.

Too often I hear this attributed to poor interoperability standards. This leap of logic is simply not correct. The problem is that too often, interoperability standards overly influence the user interface. Note the opposite is also true, too often user interface incorrectly influences interoperability standards. This happens when we forget that the purpose of an interoperability standard is to achieve interoperability between systems, not to enable interoperability with humans. This is especially true when applications are designed around RESTful interfaces, but is not a fundamental problem with RESTful, just poor design.

The problem identified is one of medical knowledge structure. This is a hugely rich space, that is we have a huge amount of medical knowledge. Medical knowledge is not the same as Health Information. Medical knowledge is the organization of biomedical, clinical, epidemiological, and social-behavioral sciences as well as the application of this knowledge to patients. Medical knowledge is all that stuff that clinicians learn in school. Medical knowledge is what vocabularies aid with defining.

The medical knowledge space is scientifically organized, that is it is organized in a way that makes good scientific sense. This organization is good for managing a comprehensive vocabulary. Such ontology view of vocabulary helps make sure the vocabulary is complete and not overlapping. It works good for technical interoperability. It is good for computer processing.

This ontology is not the best organization for the user interface, for workflows like the exam room. A different view of the knowledge space should guide user interface. This perspective must come from the 'use' of the knowledge perspective. The medical professional societies need to come up with one or more ways to 'use' the knowledge space.

These ‘use’ perspectives do come from some medical professional societies. We need to include them in the Meaningful Use discussion. For example, I have worked with the guidance given by the American Congress of Obstetricians and Gynecologists (ACOG) when we worked on an IHE Antepartum Profiles (includes the following profiles) - Antepartum Education (APE), Antepartum Laboratory (APL), Antepartum History and Physical (APHP), and Antepartum Summary (APS). These IHE profiles work on the technical Interoperability level, but more to the point ACOG works hard to define the user experience and expected outcomes.

We should make sure we include “Medical Professional Society”, and their “Standards of Practice” when we talk about standards. Technical standards alone are sure to be a poor user experience. I am usually the one reminding people that Security and Privacy are not just technical issues, but require far more in Policy, Physical, and Procedure space. All these spaces are far more than just technical.