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Another big mistake is the concept of an application. Applications are programs that prevent you from using most of the power of your computer. They are walled cities. When I am using my CAD package, I am prevented from using the spelling checker in my word processor. When I am using my word processor, I am prevented from adjusting the gray scale of the lettering as I can in my image processor. When I am using my image processing program, I am prevented from solving equations, and so on. Make up your own list. Some operating systems build tunnels between applications that we can crawl through (Microsoft’s OLE, Apple’s Publish and Subscribe features, HP’s New Wave, for example), but we want to run aboveground.

This is quote from an article by the diseased guru of of interface design Jef Raskin. This article was published by WIRED magazine in Dec 1993. This is a link.

This quoute deserves no further explanation. Within health care the design of workstation should be reconsidred using Jef Raskin’s recommnedations. If you have not read his book “The Humane interface” then it is time for it.

I will leave you with another quote form the same article:

Designers forget that humans can only do what we are wired to do. Human adaptability has limits and today’s GUIs have many features that lie outside those limits, so we never fully adapt but just muddle along at one or another level of expertise. It can’t be helped: Some of the deepest GUI features conflict with our wiring. So they can’t be fixed. Like bad governments, they are evil, well entrenched, and must be overthrown.

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We all agree that formatted text and text within forms cannot convey the subtleties conveyed by freely written natural language. Yet, informaticians push for standardized text entries. Using today’s technology, codifiable and formatted text allow for easy extraction of data. The extracted data can be flexibly used in foreseen and unforeseen uses. Two foreseen uses are conducting studies and designing smart decision support systems.

On the other hand, extracting data from naturally written text (non-codifiable and non-formatted) is hard, and with today’s technology unreliable.

Is there a compromised? That is having data within EMR that can convey the subtleties of language and at the same time be flexible enough for utilizing this data for things as research, QI and designing smarter decisions support systems.

I do believe that writing naturally and conveying the full meaning of text comes first. We should wait for technology to change and improve instead of forcing people to change their writing style to a less effective style. Yet, if I am to compromise I would present the following rule:

use codifiable and formatted text entry only when the writer and reader have similar background knowledge

Follows is the rational for this rule:

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