Design for System Success - A Review of Donald Norman's The Design of Everyday Things

A recent Linkedin Poll discovered 32% of respondents ranking Teamwork as the weakest link in their practice. Since patient's perception of teamwork is one of the two key factors for referral generation (the other factor is your expertise), teamwork is important not only to get the job done but also to grow your practice. So, teamwork must be one of the key design criteria for medical practice management systems. For instance, electronic medical record (EMR) software is designed for compliance and for teamwork between physicians.

Similarly, billing software must be designed for teamwork between physicians, insurance companies, and billing staff. What are design principles for successful medical practice management systems?
In the absence of comprehensive books focused on user interface design for medical office management systems, I recently read three design books that have to do with general design, user interface design, and social network design. Below is my summary of lessons learned.

Donald Norman - "The Design of Everyday Things"
Technology - especially computer technology - advances quickly. But humans do not change quickly, and the processes we use to perceive, learn, and think change slowly. Donald Norman, a cognitive scientist and author of "The Design of Everyday Things," noted this fact 30 years ago, in 1983. According to Donald Norman, the real culprit for "user judgement error" is always the design. His book, which has been adopted in leading colleges as a standard textbook, pays tremendous attention to the psychology of the mind, to how our mind works, resulting in a pragmatic set of four basic design principles:

Conceptual Models that explain how things work, so that we can use different behaviours to accomplish our goals. Different classes of actions must have different command sequences or menu items to avoid capture or description problems.
Feedback so we know immediately the result of our action. The state of the system needs to be clearly communicated to the user, helping to avoid mode errors.
Constraints, making it impossible to use the device the wrong way. Also allow reversible actions.
Affordances, making the appropriate actions perceptible and inappropriate - invisible.

So, if you want to design something hard to use, you can follow these rules (what NOT to do):

Hide things. Widen the "Gulf of Execution:" give no hints to the expected operation. Widen the "Gulf of Evaluation:" give no feedback, no visible results of the action.
Be arbitrary. Use non-obvious commands and names. Use arbitrary mapping between intended action and result. Use idiosyncratic language and abbreviations. Use uninformative error messages.
Be inconsistent. Change rules. Do the same thing in different ways when operating in different modes.
Be impolite. Treat erroneous user actions as breaches of contract. Snarl. Insult. Mumble unintelligible verbiage.
Make operations dangerous. Allow a single action to destroy invaluable data or work. Prevent recoverability. But add warnings in the manual. When users complain, ask "Did you read the manual?"

One of the key observations of Norman's book is that easy looking is not necessarily easy to use. A surfboard and ice skates look simple but require years of practice to use them well. They look simple because there are few controls and no moving parts. In such cases, the user accomplishes rich complexity of action through rich execution. If there was a single control for each possible action, then execution would reduce to simply finding and applying the proper control.

So the more controls, the easier is the operation but the more complex is the appearance and the more difficult is the task of finding the right control. Conversely, the fewer controls, the simpler and easier is the appearance of the device but the more difficult is the operation.

Reading Norman's book helps develop your power of observation. Norman's book teaches how to observe and understand design of things around us, how to see what conflicting constraints they must satisfy and apply his principles to create useful designs.

Know any health care providers who complain about shrinking insurance payments and increasing audit risk? Help them learn winning Internet strategies for the modern payer-provider conflict by steering them to Vericle - Medical Billing Network and Practice Management Software ( http://www.vericle.com ), which powers such leading-edge billing services as Affinity Billing ( http://www.affinitybilling.com ), Billing Dynamix, and Billing Precision, and is home for "Medical Billing Networks and Processes" book by Yuval Lirov, PhD and inventor of patents in artificial intelligence and computer security.

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