Why did that happen? Exploring the proliferation of barely usable software in healthcare systems

Clinicians and support staff are faced with increasingly complex computer applications. This complexity stems partly from the integration of heterogeneous systems ranging from computerized patient records to theatre management and dosage planning applications, and also from the increased functionality offered by the new generation of IT systems. Many members of clinical staff are bewildered by the vast array of configuration options and operating modes supported by computer based systems, while manufacturers often feel compelled to offer more and more software features to retain market position. These factors combine to create "usability" problems that have had a direct impact on patient outcomes as well as a number of indirect effects-for example, the costs of replacing and upgrading inadequate computer systems carry significant opportunity costs in terms of services that might otherwise have been funded. In the future we need to educate staff to reject substandard computer interfaces early in the acquisition process; encourage the use of human computer interaction techniques in health care; and train staff to recognize the dangers of "working around" poor interface design.