We are looking at the fundamentals of making good healthcare software. Tools that empower the people who are working on the front lines of medicine. This is part 2 of the building better healthcare software series. In this post, we are taking a look at an important component of well-made software: the User Interface (UI). The UI is the part of the software that a person interacts with directly. It could be visual, audio, physical, or a combination. Good UI practices increase the software's "usability". A recent Mayo study found that EHR systems received an F grade from physicians compared to an A grade for Google's search engine. This is no surprise to EHR users. So what makes good UI and what can be done to improve EHRs?

EHRs were developed a long time ago. Although widespread adoption happened in the last decade, the biggest players have been around for 40 years. You would think that this would allow time to develop a well-refined system, but the interface still looks like it is from the days of MS-DOS and floppy disks. Of course, those UIs were created with the tools and techniques that were available at that time. Since then, our understanding of usability and the types of tools available have expanded. Even with increased knowledge, some of the metaphors from the old original systems have propagated into updates and new systems, because people like to use what is familiar, even if it is not the best. Changing the way a major system looks and works is not a simple thing. Any organization is reluctant to make a big change that will affect many or all people who use the system. There are also technical challenges to making changes to a UI.

To make UI changes easier, developers use a technique called "decoupling", which allows different components in software to be worked on and improved independently. Software can be conceptually divided into a frontend and a backend. The backend is the complex hidden inner workings of code that store and move data as well as execute commands from the user. The frontend is what the user interacts with. In an online search, you would type what you are looking for into the frontend. The backend performs the complex operations to find what you are looking for and returns the results to the frontend to report back to you. Decoupling loosens the relationship in between the frontend and backend, so when you want to update and improve the frontend UI, it doesn't require a massive overhaul of the whole system. On a massive EHR system used by thousands of institutions, a major UI update would be extremely costly if the components were dependent. Decoupling allows for versatile software that can have an up-to-date UI.

So what are good UI practices? They are tools and approaches that result in software that is immediately understandable and require little to no training to use. When you look at an interface you know where to find things, because it is laid out intuitively. Vital information isn't hard to find, and it's not a burden on your cognitive load scanning a page for what you need. UI designers talk about death by a thousand clicks. Software shouldn't hinder a clinician when time is a valuable commodity. The visual design should support good workflows that guide the user to the right place. All of the user’s thinking should be focused on the work they are doing, with not a thought spent on how to get the system to support them in that task

In the future, we will create a guide to evaluating good UI design to help address this problem of bad interfaces in healthcare. Have you interacted with software that gets in your way? Maybe it feels tiring to use? Please share your thoughts with us.