Microsoft Healthcare and England's National Health Service are creating guidance for clinical user interfaces in clinical applications. This may be a good idea, if the guidance is carefully justified.
On 10 September 2007, Microsoft and the National Health Service (NHS) announced that they have jointly developed 16 items of design guidance for common user interfaces (CUIs; see www.mscui.net ) . The guidance applies to features such as displays of time and date, timelines and medications. The NHS intends to treat these items and many more as standards for NHS suppliers, and may require conformance by its existing contracts and in future tenders.
Looking at the broader international healthcare IT community, Microsoft treats the guidance as recommendations, rather than standards.
Microsoft also offers code to implement the guidance in .NET, and expresses the hope that implementations will also occur in Java environments. Microsoft covers the recommendations and software with its permissive license, which allows derivate use.
The premise behind this work is that clinicians must move between applications frequently, and variations in the user interface (UI) increase training costs and are potentially dangerous. Gartner agrees that the healthcare industry would benefit if UIs were not arbitrarily different. At the same time, we are concerned that the differences that most impact training and safety have deep roots in workflow, clinical decision support models and other semantic issues that cannot be retrofitted without fundamental re-engineering.
We are not aware of any studies that quantify the relationship between heterogeneous UI artifacts and patient safety. Quantifying the problem is important if the standards are to be enforced rigorously. Unnecessary changes to acquired software, even when desirable, create substantial added costs and extended timeframes, and increase the risk of project failure.
The Microsoft approach is appropriate. It recommends that system developers use the standards when creating new UI elements. Developers should find it easier to incorporate the standard features using available design and code than to use arbitrarily different UIs. Over time, applications should have fewer arbitrary differences. Gartner concurs with Microsoft's community-based approach. We have not seen data to justify mandatory retrofits.
System developers that are creating or substantially revising UIs should consider the recommendations where there is not a compelling reason to use a different approach. This is true whether or not developers are suppliers to the NHS. Open-source developers for non-Microsoft technologies should provide comparable widgets.
Purchasers of clinical systems should review the UIs of products. They may find the guidance to be useful input. However, they should not place such a high value on point-for-point compliance that they exclude otherwise-capable products.
"Microsoft Plays for High Stakes With English Healthcare Project” — In 2005, when Microsoft renewed its licensing deal with England's NHS to jointly develop a CUI for the Connecting for Health Program, the project was seen as critical for its success in the healthcare market. By Jonathan Edwards and Jonathan Mein
"2007 CPR Generation Criteria Update: Clinical Display" — Gartner has updated its criteria for evaluating the clinical display core capability of computer-based patient record systems. By Thomas Handler, M.D. and Barry Hieb, M.D.
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