Clinicians as artisanal data designers
Clinicians have always designed their own paper records. EHR interfaces should be no different
Dave Pao
3 min read
In her book, Design as an Attitude, Rawsthorn (2018) asserts that design has always had ‘one elemental role’ as an agent of change that interprets shifts of any type (social, political, economic, scientific etc.) such that anything new 'will affect us positively, rather than negatively.' She echoes Heskett (2017), who observes that design is less about the status quo and more about envisioning change. The advent of the EHR represents—without any question of doubt—such a shift.
Rawsthorn also focuses on a belief that 'artists, designers and scientists [note the designers in the middle] should work in collaboration with industry to build a better, fairer society.' She also echoes Moholy-Nagy (1947), who describes a broad approach to design when he asks for projects to be seen not in isolation but in relationship with the needs of the individual and their community.
The inclusion of members of the community, regardless of their background, is a theme that often runs through descriptions of design. Herbert Simon (1969) affirms Moholy-Nagy's viewpoint when he asks to embrace people who did not train to be designers yet are eager to engage with design.
Florence Nightingale (1858) is an example of community contribution to design within healthcare. A nurse in the Crimean War, she 'designed' information in such a way as to understand why fatalities amongst soldiers were so high. Her visualisations revealed a grim reality where many more soldiers were dying from post-battle infections than on the battlefield (see image). Through her modified pie charts, we came to understand infection control.
Before design was even conceived as a discipline, human beings practised design by fabricating tools in a way that was intuitive and often unconscious. Traditionally, artisans make all or part of their tools—in contrast to designers, who devise specifications as to how they should be made. Paper medical records benefit from such an artisanal approach.
But commercial EHR interfaces today are not artisanal. Their design process has transitioned from artisanal practice to a form of technical science, focused on how to do things to accomplish goals. Without sufficient collaboration we lose what Deming (1992) terms profound knowledge, comprising four related facets: appreciation for a system, knowledge about variation, theory of knowledge and psychology.
In his New Yorker article, ‘Why Doctors Hate Their Computers’, the surgeon, writer and public health researcher Atul Gawande (2018) speaks of the dependency on the computer programmer whereas before there was pen and paper: 'Make no mistake, clinicians are a marginalised group... Artisanship has been throttled, and so has our professional capacity to identify and solve problems through ground-level experimentation.’
That being said, clinicians are pushing back. A breathtakingly comprehensive, useful and accessible resource has been created by Gregory Schmidt, a Canadian clinician. In one seminal post, he lays out the past, present and future role of design in EHRs. Perhaps the most efficient EHR primer you will ever read, and one that authentically represents the clinician voice.
Deming, W. (1992). A system of profound knowledge. Knoxville, TN, USA: SPC.
Gawande, A. (2018). Why doctors hate their computers. New Yorker, 12. Available at: https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers
Heskett, J. (2017). Design and the creation of value. Dilnot, C. and Boztepe, S. (Eds). London, UK: Bloomsbury.
Moholy-Nagy, L. (1947). Vision in motion. Chicago, IL, USA: P. Theobald.
Nightingale, F. (1858). Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army. Harrison and Sons.
Rawsthorn, A. (2018). Design as an attitude. Geneva, Switzerland: JRP Ringier.
Schmidt, G (2018). The Role of Design in Electronic Health Records: Past, Present, & Future. Available at: https://www.gregoryschmidt.ca/writing/the-role-of-design-in-ehrs
Simon, H. A. (1969). The sciences of the artificial. Cambridge, MA, USA: M.I.T. Press.
November 2023
