Improving Clinical Usability and Safety – the role of Clinical Informatics

Dr Chris Paton is a Fellow of the Faculty of Clinical Informatics. Following his medical training, he worked on a range of health informatics projects in New Zealand before returning to the UK where he is now the head of the Global Health Informatics research group in the Centre for Tropical Medicine and Global Health at the University of Oxford. He is the Founder and Editor of the Health Informatics Forum, an open access e-learning platform for health informatics professionals around the world.

Improving the design of digital health systems to improve clinical usability and patient safety is an urgent issue. Most hospitals in high-income countries now use Electronic Health Record (EHR) systems and low-income and middle-income countries are quickly catching up. The speed of this change during a period of worldwide cost-cutting and austerity has meant that clinical user interfaces may have received less priority than perhaps they should have, as hospitals have prioritised administrative systems that focused on controlling costs and improving hospital management.

Decades of research from the fields of human-computer interaction (HCI) and human factors and ergonomics (HF/E) have shown that efficient and effective use of IT systems in safety-critical industries requires careful attention to user interface design. This is now becoming evident in the healthcare domain, with a number of recent academic studies reporting potentially serious patient safety issues and clinicians regularly expressing frustration at having to use clunky and inefficient user interfaces. In the US, the American Medical Association (AMA) and the MedStar National Center for Human Factors in Healthcare have recently created a new website that highlights usability and patient safety issues with EHR systems (https://ehrseewhatwemean.org) and has written an open letter to Congress that is garnering widespread support.

Clinical informaticians are well placed to drive the improvement needed in the usability and safety of digital health systems. By drawing on our own clinical experiences, we naturally empathise with clinical end-users and their day-to-day frustrations. Our clinical training also emphasises the importance of evidence-based approaches to new interventions. Clinicians wouldn’t dream of giving a new drug to a patient without being sure it had been extensively tested for effectiveness and monitored by a regulator who can remove it from use if problems develop. A clinical approach to informatics means that we should expect critical IT systems to be subject to the same kind of validation as other potentially harmful medical interventions.

Looking at the broader picture, clinician informaticians often have experience of the deep complexity and unpredictability of healthcare and therefore know that digital health projects need to be treated as complex interventions and not “magic bullets” that can transform clinical practice on their own. With the best will in the world, perfectly engineered systems can fail if they are not designed to take into consideration the complexity of the healthcare environment.