Firstly, a note of thanks to colleague Hal Reed for introducing me (and now you?) to the term deprovement. Hal defines deprovement as “a change that is intended to improve something, but in actual practice makes it worse, e.g., harder to adopt, harder to use, or less reliable.”

In the world of software or Web applications, deprovement is all too often what occurs when a company enthusiastically announces their next release. Today, I was inspired to learn that Mozilla added an honest to goodness improvement in their 3.0 release of the fast growing (and excellent) browser Firefox. Their secret: Version 3.0 is reported to run “more than twice as fast as the previous version while using less memory!”

How many times have you opened the newest release of a software application only to find that the latest improvements and new features have substantially deproved your system performance? This is even more serious for a large scale Web site or Web application. As an industry, let’s try to remember that speed is one of the most important elements of software and Web site usability!

Clinical user experience (UX) is a term we use to indicate the design and usability of software used in clinical health care settings. Makes sense, no? A few clarifications, though:

1. It isn’t limited to using software; we’re talking about the entire range of the software experience, from initial impressions to training to daily (and hopefully second-nature) use.
2. The “clinical” portion of this term is very important—it clarifies that we are only talking about software user experiences that relate specifically and directly to patient care.

Of course, along with internationalization, content management solutions, and Web 2.0, clinical UX is a big offering of ours, having worked with IDX / GE Healthcare, Partners, and others. So we have this experience, but we’ve been doing clinical design work for several years now; why are we making a push for clinical UX now?

Progression of Software Engineering Focus

Simply put, the timing is right for clinical UX because I believe the clinical software market is about to hit a key point in the progression of software engineering focus. This progression is actually something I’ve been thinking about for a while, but I originally thought of it in terms of Microsoft Office. I will tie the concept back to clinical UX in a bit.

At first, existing is enough. Microsoft created a suite of tools that allowed people to do things that they were unable to do in the past. It didn’t matter what the user interaction was like because the power of integrated office applications singularly made Office worth it. So long as people were empowered in ways they were not before, they were satisfied enough, even if it took a while to master and was unintuitive. There was little to no competition on the market. The fact that Office existed at all was enough for it to be successful.

Then, you must compete on features. As competitors see that there is a market for this product or technology, existing is no longer enough, especially if your market is getting crowded. So it went with Microsoft Office for over a decade. They consistently added more and more features to the suite until there were no more logical features to add. If everything up to Office 97 was the cake, Office 2000, XP, and 2003 were all just little dabs of icing here and there.

Finally, it’s all about the experience. So Microsoft had stuffed every conceivable feature into word processing, spreadsheets, presentations, and PIMs. That probably would have been fine. They had crushed all their commercial competitors, Office was a gigantic cash cow for them; what could go wrong? Try free, open source software like OpenOffice.org. Microsoft had actually made it easy for free office software to flourish because they, through all their releases, had basically written functional specifications anyone could use to roll their own software. Once free and paid software reach feature parity, what reason is there to pay? I believe Microsoft realized this and decided that their next release had to be all about the user experience. Whether or not they were successful remains to be seen, but if you read about why they came up with the UI, it sure seems like UX was the priority for Office 2007.

And this is related to clinical UX because…?

The timing is right for us to concentrate on clinical UX because I believe the major players in the EMR, PACS, HIS, and other health care IT markets are close to reaching that point of feature parity. Unlike Microsoft, we can’t let doctors, nurses, managers and support staff languish in a sea of lackluster software user experiences. It’s simply a matter of the work: every day thousands of health care staff have to deal with difficult and unclear UIs when they’re prescribing drugs, analyzing flowsheets, scheduling operations, and reading x-rays. Usability issues in those UIs have a much larger impact than issues in Office.

The fact of the matter is clinical software developers need to recognize the need for improved user experiences before their software becomes overcrowded with unusable features, and we’d like to help them get to that point. The opportunity is there for everyone. That’s why we’re making the push for clinical UX.

I was recently listening to NPR about Vitruvius, a 1st century BC architect and writer. He is most famously known as the inspiration for Vitruvian Man, Leonardo da Vinci famous pen and ink drawing (see http://en.wikipedia.org/wiki/Vitruvian_Man). Vitruvius is best known for his De architectura, “The Ten Books on Architecture” in which he famously says that great buildings have the following 3 characteristics:

1. Strength
2. Utility
3. Delight

By strength, Vitrivius meant that a building should last for a long time and be well constructed. By utility, he meant a building should be well organized with the necessary space and layout to serve the people who inhabit the building, and by delight he meant that a building should give aesthetically pleasure to those who look upon it or walk within its walls.

It struck me as I listened, that this is really a lesson 2000 years later for great Web site design. We should build Web sites to be (1) long lasting, e.g. with application logic, data or services layers that last a long time, (2) with effective information architecture and user experience design so that the people who use the site can find what they need intuitively and effectively, and (3) with a design aesthetic that is creative and pleasing.

Isn’t it fascinating that good design principals from Roman architecture are entirely relevant today?