It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.)

According to the rumor, the exec said “Over my dead body.” As if s/he ran the agency.

Whether or not the rumor’s true it’s not funny. So when I was asked to represent the patient perspective in a keynote June 3 in Washington (details below), I used that phrase as my title.

Here are my slides, with a few changes to make it work better standalone. (If you’ve seen my talks before, skip through the familiar slides.) The “dead body” part starts at #48.

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I don’t think “over my dead body” is an appropriate business argument when the business is healthcare. Systems in any industry that are hard to use are more likely to lead to human error, and in some industries errors cause deaths. Aviation is one, and healthcare is another.

A big difference is that aviation deaths are spectacular and unexpected so they get investigated, while hospital deaths can be blamed on sickness. That’s no excuse for weasels to resist quality regulations: a death is a death.

(Accidental deaths and harm are hard on staff as well as patients, as we’ve covered here.)

I know vendors want their systems to qualify for Federal stimulus incentives under the Meaningful Use regulations. Those incentives are a powerful carrot (higher payments) and stick (penalties, a few years from now), leaning on physicians and hospitals to buy health IT. The big question being defined in the regs is, how good must a system be to qualify the buyer for those incentives?  Can any piece-of-crap system qualify? (See our January post Cream of the Crap – a term used by a hospital, not me, about the system they chose despite  its being crappy!)

As much as I want health providers to get modern with IT, I assert that it’s just plain wrong to force people to buy crappy, hard to use systems. So I think usability is an issue.

Some people have said “Welllllll, but how do you measure usability?” There are experts who do that in other fields – again I’m amazed that healthcare denies knowledge from other industries. But here’s the method we-all had to live by when I was in consumer software: ask users if the system sucks. I said that in the January post:

Here’s one radical idea:

What if a system could only get certified (and thus get the stimulus money) if the people who use it say it basically works??

(Can a system be meaningful if the users say it doesn’t work?)

Guiding principle: ask the workers who are directly impacted if the system screws up.

Some things about healthcare are rocket science. This one isn’t.


About the conference:

AHRQ (“ark”), the Agency for Healthcare Research and Quality, is a division of HHS that sponsors important contracts and grants. On June 3 I gave a keynote at the annual meeting of their health IT grantees and contractors. I’m thrilled that I was invited to represent the patient point of view. And I chose to use the words of that rumor as my title.  I don’t know if the rumor’s true, but my sentiment is true regardless: this is not just a business parameter to be kicked around like a football. I want the people caring for me in the hospital to be supported by good systems!

I have to say that I was impressed by the brains in the room at that conference. These struck me as competent, thoughtful people – top tier among all the events I’ve attended. AND, for whatever reason, they’ve been thinking too much inside-the-box and inside-the-hospital, and not thinking enough about what I’ve called “the ultimate stakeholder” – the person who dies if the system fails.  This is one of those areas where we can do better, and I think it starts with refusing to accept (or fund) crappy hard-to-use systems.