Archive for February, 2008|Monthly archive page
Towards user Design? On the shift from object to user as the subject of design
Leave a CommentWe should not design the use. Unfortunately, this was an unintended outcome of usability research. The Author argues that we should go back and focus on the designed object itself. We should aim at designing objects that people will probably use. People who become users of this object should be able to use it whatever way they please. These users will then have a user experience. This is opposite to the designs that start by designing the user experience and ending up with the design.
This is the 2006 Design research society design studies award. This study is by Johan Redström and is published in Design Studies Vol. 27, No. 2, pp 123-139.
Based on this, a suggestion to design the perfect clinician interface system is to first list all types of data that is needed as labs, imaging, problem list. Then, develop a way to view and access these. The opposite, that is if we focus on the user first, is to develop use-case scenarios. Then design the clinician interface based on these scenario.
Do we really need health informatics?
Lately I been having a thought: do we need health informatics? Could Information Technology (IT) professionals do the job? Some may say that heath informatitions are IT professionals. But, health informatics is different. You can realize this if you look into informatitions career paths. I have no statistics, but a lot have a medical background. This is clear if you focus on the presence of Nursing Informatics as a recognized specialty at some colleges.
I started raising this question as I am studying system analysis (for my health informatics degree). System analyst’s duty is to analyze and design new information systems. So, a system analyst could go on a journey to explore healthcare institutions and, then, design the perfect healthcare system. Systems are designed by teams. These teams will have users. In our situation users will be healthcare professionals. These teams will also have programmers. Do we really need health informatitions with expertise in computer and healthcare?
Information systems are improving. In the past Information technology professionals were more involved in the day to day operation. Now, users expect a “perfect system” that seamlessly provides them with the information they need (with no IT person bugging them). They expect an internet like experience. What I am trying to say here is my understanding of what was put nicely the authors of System Analysis and Design seventh edition (Sally, G., Cashman, T. and Rosenblatt, H. 2008): the IT group became a supplier of information technology, rather than a supplier of information.
If your answer to my question (do wee need health informatics?) is yes we do need it, then we need a different and demanding form of heath informatics. Health informatitions will be needed during the development of systems. Health informatitions will need to have more computer science expertise. I believe that only someone expert enough in healthcare (knowledge domain) and computer science can know what is possible and what is not possible in healthcare. Those developers who don’t understand how medicine is practiced go overboard with technology designs. And, healthcare professionals who don’t know what is possible don’t know what to ask for.
Note: in my post health informatics is medical or clinical informatics and not biomedical informatics.
Evidence based medicine critisim: Eating Soup with a Fork
Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement On Demand: Eating Soup with a Fork
Today I watched/listened to an outstanding presentation by Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement titled: Eating Soup with a Fork.
He answers one of my skepticism about the usefulness of evidence based medicine (EBM). He points out that using Randomized Control Trials to find the usefulness of complex processes is misleading. For example the RCT done to find the usefulness of cardiac events rapid response teams that these teams make no difference in outcome. These are multidisplinary teams that are mobilized once a cardiac event (mainly a myocardial infarction) is realized. RCTs are good for finding the usefulness of a drug or a surgical procedure. RCTs are misleading if used incorrectly to find the usefulness of complex process as rapid response team, anticoagulation clinic and complex stroke rehab programs. He points out that to perform RCT we blind ourselves of what is happening and just focus on one point or problem. In complex systems we need to know the details of what is happening to seen what things when available we get the desired outcome. This is common in business. The authors of the business book Good to Great when on looking to see what made good companies good.He points out that we need new ways to learn. We need to way to produce new knowledge. I am left with one criticism against EBM need for RCTs. RCTs take too, too, long and will never answer all our questions. So, Should we just stop thinking till we have RCTs?I totally agree that we should never go to the pre EBM era. But we truly need new ways to discover new knowledge in medicine. Methods that would give us the confidence that RCTs give.
