Left and right and wrong Political and process disconnects show up everywhere, including health IT.

Sometimes I find a picture or a blog post that leaps off the screen at me and says “your readers must see this as it applies to health IT.”

Normal Modes, a solid UX company based in Houston, sends me fairly good UX tips on a regular business. The last one featured this photo (used with permission):

Parking log picture from Normal Modes

Normal Modes points out, very clearly, that points of confusion like this are bad for users. They regard their job, as UX experts, to eliminate this kind of experience for users. Theiranalysis about how to do this is right on.

I have seen this kind of error in EHR systems and PHR systems on countless occasions.
From an engineering perspective, it is really useful to take a moment and consider how something like this happens. First, you have two different “levels” of operation here. One is concerned with how traffic flows in the parking lot. The other is concerned with directions in the parking lot. For whatever reasons, these two “parking lot features” were implemented separately by people who had access to two different sets of resources. It stands to reason that the people who had access to white paint and stencils to make the sign on the right were the same people using stencils to mark the parking spots. It stands to reason that the people who had access to the professional sign-making system were somewhat removed from the people actually designing the parking lot.

In short, what you are seeing here is the artifact of a political and process disconnect. In health IT, there are constant political disconnects that cause similar issues. The EHR vendor is one political group, the insurance companies another, and the government is so large that it actually has multiple groups with different agendas. (HHS alone has so many sub groups that it’s very difficult to completely follow what is happening.)

As enthusiastic as I am about the potential for meaningful use incentives, I think there will be lots of artifacts like this in EHRs that do not make much sense because the EHR vendor was pulled in a new direction by these incentives.

I have said in almost every talk about health IT I have ever given that the problems in health IT are political and not technical. I think it is my most tweeted quote. But sometimes a picture is worth a thousand words.

Fred Trotter

Fred shapes our software development and data gathering strategies, which doesn't stop him from getting elbow-deep in the code on a regular basis. He is co-author of the first Health IT O’Reilly book Hacking Healthcare, and co-creator of the DIRECT protocol mandated in Meaningful Use. Fred’s technical commentary and data journalism work has been featured in several online and print journals including Wired, Forbes, U.S. News, NPR, Government Health IT, and Modern Healthcare.