5 ms·

Bad software destroyed my doctor's memory

59 points by jjgreen 3y ago

qprofyeh 3y ago
I might work in a “Hacker News bubble” but this type of story in 2023 actually surprises me. Software development has become product-driven, some may say even a little too much, and data-driven, both progress around user and stakeholder feedback. Who are these charlatans that still make applications that function so horribly?
- hulitu 3y ago
  > Who are these charlatans that still make applications that function so horribly? Ever used any Microsoft product recently ? Or the new xsnow which has a config screen when it starts ? Or Google with warning messages occupying half the screen ? This is the trend since about 15 years.
  - hospitalJail 3y ago
    Its incredible that Microsoft has gotten worse since Windows 7. Literally more windows 7 would be an upgrade over windows 11. Whatever stuff they have going on in the background is not worth the anti-user crap.
- hgomersall 3y ago
  The world of medical software is, from everything I've seen and heard (from clinicians and prospective new entrants) a deep dark pit of dispair. The barriers to entry are so high that almost nobody can improve on the mess that has bled everywhere, and those supplying the mess crank the money machine at will.
  - blueflow 3y ago
    My mom once managed to get into the hospital in a weird enough way that she got a bed assigned by the management software, but no food. "Software issue, can't do anything about it". I ended up bringing groceries to her room each second day.
- smeej 3y ago
  Having worked almost exclusively in customer-facing roles for software companies for the last six years, it doesn't surprise me at all that a developer would be surprised by this story. As far as I can tell, the number one rule of being a UX or UI specialist is that one must never, under any circumstances, actually talk with a U, nor consult the team whose job it is to assist U's with the X the designers and developers swear up and down is so intuitive it should never require explanation. Most applications are still horrible and unintuitive to the people expected to use them, especially when they're built for niche users. This is the normal experience of using software as a non-developer. Almost every company has customer support people who are beating their heads against their desks trying desperately to surface this feedback in a way that anyone in the company will care about, but support agents "aren't technical," so the developers don't think they could possibly have anything useful to say about their work. It's a vicious circle. It doesn't have to be this way. But I'm all put of ideas about how to change it.
  - oezi 3y ago
    > But I'm all out of ideas about how to change it. Instead of stand-ups let developers spend 15 minutes each day in a call with a customer who has a problem or feature request.
    - loa_in_ 3y ago
      I would absolutely very much appreciate it as a developer, because nowadays,the motivational structures put in place rarely do anything for me but this would be a great: problem -> effort -> feedback -> closure -> motivation; loop element
    - hgomersall 3y ago
      Isn't this sort of the theory behind scrum - having rapid feedback loops with the product owner that is (supposedly) the one that has the deep necessary insight into the problem?
      - oezi 3y ago
        Product owners are not real customers. Extreme Programming got that part covered much better.
- qzio 3y ago
  These type of software is regulated, and hospitals and clinics can't easily move to a competitor if they are not happy with their current system. Journal systems "is a thing" with lots of hairy issues such as integrations between different hospitals and primary care givers, privacy issues etc. These are not really solved yet, (even on a regional basis) and on top of this comes the probably most important thing, UX for the actual users such as doctors and nurses.
- gambiting 3y ago
  >>Who are these charlatans that still make applications that function so horribly? The people selling this software and buying this software are ultimately not the people that use it. In developers minds and according to their spec sheets, the sofware might actually be amazing and flawless.
- deleted 3y ago
  [deleted]
- seized 3y ago
  Healthcare is it's own thing, what happens outside it software wise isn't always applicable to healthcare. The system in question is electronic health records (EHR). These are vast systems, really the comparison is "SAP for medical records" as they typically handle scheduling, billing, coding, store reports, notes, results (blood tests, as the tip of the ice berg). The tie ins to other systems are complex. And all of it is critical, as in patient injury or death if sole things go wrong. And much of it can fall under various federal laws, HIPAA is just the start. These are long lived systems, upgraded over time. Replacing one can be a multi year effort for even a small organization. So replacing one isn't done because a new shiny one exists. New entries face a long battle into the industry, and the needs of a family physician are very different from a hospital or large group of hospitals. If you want an idea of the scale and scope, the NYC Health and Hospitals project for their Epic EHR ran $1 billion over budget. Might have been more that that.
hospitalJail 3y ago
Its telling how corrupt the medical field is when the government is more advanced technologically than the medical industry. No its not just Big Pharma/Insurance, its every member of the medical cartel. From Physicians to Hospitals, to everyone in pharma, to BCBS. The whole system is designed to stay exactly the same, with 5% Medicare raises every year(despite CPI being 2%/yr). We own a practice and the billing practices make me sick. We blame insurance companies, but its really us, we could bill less, instead we bill the moon and let them 'adjust'. The licensure system is so bad, terrible students get through because every school wants a 99.9% graduation rate. Do not let anyone pretend that doctors in the US are better than elsewhere, we have terrible terrible doctors who did unethical things with full blown licenses. Everything in pharma is amazing to watch, there are so many unnecessary layers. Everyone makes crazy money in medical, anyone who complains about debt is just pretending they are wealthy to be more in-touch with the common person.
- Pigalowda 3y ago
  [flagged]
eimrine 3y ago
ASCII or even UTF-8/16/whatever is not even close to have as much metadata as a written letter. Every people writing have its different "font-set", while computer text is uniformed. Sometimes you see somebody's prescription in the medical card and understand the mood of the doctor while writing this. Mathematics have developed TeX/LaTeX but this notation system is not for doctors by any stretch of imagination. And also there is no a single software thing except of maybe Common Lisp which scripts can overcome tens of years with keeping backward compatibility as a primary goal, I mean try to run any scripts from '10s '00s '90s in any other language except of CL. Software industry produces too shortliving things being promoted with bold and click-bait statements and when it breaks, typically because of becoming a legacy, they say you that you just need more software because your one is too old!
fuzzy2 3y ago
I’m torn on this article. I understand where the doctor is coming from. However, I also disagree entirely with the “should’ve been super skeuomorphic” conclusion. From my experience, that just does not work. It could’ve been a temporary thing to facilitate the transition at best. In fact, I do not see a single argument that supports the “bad software” claim. Instead, I see something else: part of the information was not in the files that were digitized, but instead in the doctors head. This information is no longer applicable. When you decide to go digital, the workflow changes, period. There’s no easy solution, it may take quite some time to let go of the old ways and embrace the new system.
- eimrine 3y ago
  > I do not see a single argument that supports the “bad software” claim. What is bad in this article is not the software. It is a software.
- gambiting 3y ago
  >>There’s no easy solution No? The doctor's frustration seems pretty simple - just let them go left/right for newer/older notes on the patient's health. Seems simple enough to me.
  - fuzzy2 3y ago
    I would be tremendously surprised if this were not possible. I have seen many programs at various doctors’ offices and all of them could do this. I suspect that instead the doctor was not properly taught how to operate the software. Of course this could also mean the UX is bad, yes. I’m not convinced yet however.
    - hgomersall 3y ago
      The fact the doctor struggles is literally the definition of a bad UX. I don't understand how you can suggest anything else. It might be the doctor can learn a new workflow which is as good as or better than previously, but you can't just impose that on someone.
    - 3y ago
squeegee_scream 3y ago
> IT professionals try to radically alter the workflow of medical professionals, without their input That’s because, as I understand it, EHRs are made primarily for insurance companies, not medical staff. This is a huge problem. IT staff should not be blamed.
- moribvndvs 3y ago
  My company does EMR and practice management. Yeah, insurance companies definitely are insinuating themselves further and further into the encounter and it’s very gross on top of distracting. We’re also spending a lot of time on Meaningful Use/CURES (regulatory) and interoperability and not as much time innovating and addressing core issues (usability, performance, stability). But sometimes we just plain miss by modeling solutions that sound fine from the engineering side but are impractical in the practice. On the other hand, it’s incredibly frustrating to try to build solutions when each doctor can have a radically different idea of an essential workflow (and often are inconsistent or obstinate about it). I think there’s a plenty of blame to spread around, but I think vendors (i.e. me) have a hell of a lot of room for improvement.
rchaud 3y ago
> This sort of "design blindness" happens whenever system designers prioritize the needs of the IT system, rather than its users. My specialist is therefore forced to deal with a client interface barely pasted over some sort of database. The data is shaped to fit the design of that database, rather than the other way around. I wrote my graduate thesis on digital medical record systems in family practice over a decade ago, user experience was a huge issue then as well. Having training sessions alone isn't enough. The problem isn't going to be solved because doctors are not the primary customer for these systems, the procurement department is. They will care more about HIPAA compliance than whether the end-user can effectively replace their workflow with this new tool.
- owenmarshall 3y ago
  > The problem isn't going to be solved because doctors are not the primary customer for these systems Agreed! > the procurement department is. But I disagree here. From what I’ve seen in ambulatory EHRs, they are finely tuned for billing workflows. The key outcome is that a patient encounter is tied cleanly to an ICD. Actually tracking patient information in a useful way seems to be an afterthought.
  - NoraCodes 3y ago
    This seems like this might lead to some interesting second-order benefits of single-payer healthcare schemes; is the state of EHRs as bad in the UK? If so, is it because they're buying American EHRs?
- nunez 3y ago
  Afaik, this is further exacerbated by the extraordinary pace at which private practices are getting swallowed up by major hospital networks, like HCA (nationally) and large regionals like Baylor Scott and White in DFW. [0]. [0] https://www.statnews.com/2020/02/27/physician-practice-consolidation-its-only-just-begun/ https://www.statnews.com/2020/02/27/physician-practice-conso...
- nunez 3y ago
  The craziest thing about EMR systems like this is that you would _think_ that their adoption would help bolster universal patient records that transfer from doctor to doctor (useful now in the world of services like ZocDoc where booking care is ubiquitous). But that's not the case at all!
moribvndvs 3y ago
I’ve been working in healthcare, specifically EMR and practice management for over 20 years. I think the sector is a mess, honestly. It’s too big of a topic for me to get into here. However, there is large amount of variance in how users access and work with medical records, from person to person, role to role, specialty to specialty, hospital type to hospital type, org to org and it gets even worse when users are transitioning from paper. Skeuomorphism might be attractive to non-technical users in transition, but in my experience (this approach isn’t novel) it falls apart very quickly because a) as I previously suggested, there isn’t one model to replicate and skeuomorphic approaches tend to be rigid, and b) users usually very quickly grow out of analog processes as they adapt to software. It’s important to allow practices to customize views for roles and allow users to override so they can put the most important information at their fingertips, and make it quick and easy to jump into the rest of the full details of their record. It’s an information dense problem area, so your fluffy, padded, pretty commerce-focused user patterns are often an anti-pattern. Automation, driven by rules specified by practice and doctors, to help error check their records or point out patient issues (“patient has disease x but we don’t have record that they’ve done y and z preventative measures”, etc.) can help reduce cognitive load and simple mistakes. Dynamic, annotated notation systems driven by templates selected based on the appointment reason and patient history where they do more simply tapping/clicking checkboxes and less typing let doctors focus on interacting with the patient during encounters. Automatically pull in data collected by sensors (weight, blood pressure, whatever) speeds things up, especially for overworked supporting staff. Speed, stability, and consistency over everything. Skeuomorphism really doesn’t help any of that. It was mostly a sales tool like 10-15 years ago.
dctoedt 3y ago
Highly recommended reading about designing human-focused online systems to replace hard-copy workflows: Recoding America, by Jennifer Pahlka. [0] [0] https://www.amazon.com/Recoding-America-Government-Failing-D https://www.amazon.com/Recoding-America-Government-Failing-D... — it was recommended on another HN thread.
captainbland 3y ago
Not sure about the skeuomorphism angle. I'm no UX specialist or anything but I would have thought the best practice would be to use 'standard' (well understood, probably familiar for potential users already) UI elements which are an appropriate analogy for the use case. If you're flicking through paper, it might be easier to e.g. scroll through records for a specific patient and to have some kind of contextual search. But I think the obvious issue is really that they haven't validated and iterated on the design with actual users or even had somebody on the team responsible for caring about this stuff.
friend_and_foe 3y ago
You see this everywhere nowadays, in everything. Bad UX. All over the place. Even things that once had fantastic UX are breaking it. I want to know what they're teaching these designers in design school because theyre fucking everything up. Or is it management making design decisions for them and they just go along with it for the paycheck? Are people in these companies deliberately sabotaging products? I don't know what it is but I'm sick of it. I'll give you an example. When Android came out, one of the first, most important sets of requirements was that it do everything a normal cell phone could do the way a normal cell phone would do it. If you turn the volume all the way down, it must stay all the way down, period. And it worked like that, perfectly, for years. But recently, every so often, you want to play a video silently, and a chirp happens at the very beginning. Someone at some point changed the code where the volume control doesnt control the volume, it saves a variable that's read by the audio decoding software asynchronously and sometimes you get a race condition where audio starts before it is read. Why was this changed? Why is ensuring this functionality no longer a top priority? That's just a tiny little example. With android, side scrolling menus, pages in the recent apps that take up the whole screen, little race conditions here and there. And that's just android, probably the least offensive software UX wise that there is. Hamburger menus, border less flat elements, nests upon nests, you see UX crumbling everywhere you look. I don't know what to make of it.
- nunez 3y ago
  Biggest example of late for me was Audible. Want to buy some audiobooks for a long drive? You'll need to sign up for their subscription service! Want to buy individual books? Well, for that, you'll OBVIOUSLY need to open Amazon.com _in desktop mode_ and click through a submenu to purchase them individually!
nunez 3y ago
> This sort of "design blindness" happens whenever system designers prioritize the needs of the IT system, rather than its users. My specialist is therefore forced to deal with a client interface barely pasted over some sort of database. The data is shaped to fit the design of that database, rather than the other way around. I just finished listening to The Pragmatic Programmer (EXCELLENT as an audiobook), and the authors talk about this pretty explicitly: > As soon as you have an executable user interface or prototype, you need to answer an all-important question: the users told you what they wanted, but is it what they need? > Does it meet the functional requirements of the system? This, too, needs to be tested. A bug-free system that answers the wrong ques tion isn't very useful. So it looks like some programmers need to read this book for homework!

59 points by jjgreen 3y ago

I might work in a “Hacker News bubble” but this type of story in 2023 actually surprises me. Software development has become product-driven, some may say even a little too much, and data-driven, both progress around user and stakeholder feedback. Who are these charlatans that still make applications that function so horribly?

hulitu 3y ago
> Who are these charlatans that still make applications that function so horribly? Ever used any Microsoft product recently ? Or the new xsnow which has a config screen when it starts ? Or Google with warning messages occupying half the screen ? This is the trend since about 15 years.
- hospitalJail 3y ago
  Its incredible that Microsoft has gotten worse since Windows 7. Literally more windows 7 would be an upgrade over windows 11. Whatever stuff they have going on in the background is not worth the anti-user crap.
hgomersall 3y ago
The world of medical software is, from everything I've seen and heard (from clinicians and prospective new entrants) a deep dark pit of dispair. The barriers to entry are so high that almost nobody can improve on the mess that has bled everywhere, and those supplying the mess crank the money machine at will.
- blueflow 3y ago
  My mom once managed to get into the hospital in a weird enough way that she got a bed assigned by the management software, but no food. "Software issue, can't do anything about it". I ended up bringing groceries to her room each second day.
smeej 3y ago
Having worked almost exclusively in customer-facing roles for software companies for the last six years, it doesn't surprise me at all that a developer would be surprised by this story. As far as I can tell, the number one rule of being a UX or UI specialist is that one must never, under any circumstances, actually talk with a U, nor consult the team whose job it is to assist U's with the X the designers and developers swear up and down is so intuitive it should never require explanation. Most applications are still horrible and unintuitive to the people expected to use them, especially when they're built for niche users. This is the normal experience of using software as a non-developer. Almost every company has customer support people who are beating their heads against their desks trying desperately to surface this feedback in a way that anyone in the company will care about, but support agents "aren't technical," so the developers don't think they could possibly have anything useful to say about their work. It's a vicious circle. It doesn't have to be this way. But I'm all put of ideas about how to change it.
- oezi 3y ago
  > But I'm all out of ideas about how to change it. Instead of stand-ups let developers spend 15 minutes each day in a call with a customer who has a problem or feature request.
  - loa_in_ 3y ago
    I would absolutely very much appreciate it as a developer, because nowadays,the motivational structures put in place rarely do anything for me but this would be a great: problem -> effort -> feedback -> closure -> motivation; loop element
  - hgomersall 3y ago
    Isn't this sort of the theory behind scrum - having rapid feedback loops with the product owner that is (supposedly) the one that has the deep necessary insight into the problem?
    - oezi 3y ago
      Product owners are not real customers. Extreme Programming got that part covered much better.
qzio 3y ago
These type of software is regulated, and hospitals and clinics can't easily move to a competitor if they are not happy with their current system. Journal systems "is a thing" with lots of hairy issues such as integrations between different hospitals and primary care givers, privacy issues etc. These are not really solved yet, (even on a regional basis) and on top of this comes the probably most important thing, UX for the actual users such as doctors and nurses.
gambiting 3y ago
>>Who are these charlatans that still make applications that function so horribly? The people selling this software and buying this software are ultimately not the people that use it. In developers minds and according to their spec sheets, the sofware might actually be amazing and flawless.
deleted 3y ago
[deleted]
seized 3y ago
Healthcare is it's own thing, what happens outside it software wise isn't always applicable to healthcare. The system in question is electronic health records (EHR). These are vast systems, really the comparison is "SAP for medical records" as they typically handle scheduling, billing, coding, store reports, notes, results (blood tests, as the tip of the ice berg). The tie ins to other systems are complex. And all of it is critical, as in patient injury or death if sole things go wrong. And much of it can fall under various federal laws, HIPAA is just the start. These are long lived systems, upgraded over time. Replacing one can be a multi year effort for even a small organization. So replacing one isn't done because a new shiny one exists. New entries face a long battle into the industry, and the needs of a family physician are very different from a hospital or large group of hospitals. If you want an idea of the scale and scope, the NYC Health and Hospitals project for their Epic EHR ran $1 billion over budget. Might have been more that that.

hospitalJail 3y ago

Its telling how corrupt the medical field is when the government is more advanced technologically than the medical industry. No its not just Big Pharma/Insurance, its every member of the medical cartel. From Physicians to Hospitals, to everyone in pharma, to BCBS. The whole system is designed to stay exactly the same, with 5% Medicare raises every year(despite CPI being 2%/yr). We own a practice and the billing practices make me sick. We blame insurance companies, but its really us, we could bill less, instead we bill the moon and let them 'adjust'. The licensure system is so bad, terrible students get through because every school wants a 99.9% graduation rate. Do not let anyone pretend that doctors in the US are better than elsewhere, we have terrible terrible doctors who did unethical things with full blown licenses. Everything in pharma is amazing to watch, there are so many unnecessary layers. Everyone makes crazy money in medical, anyone who complains about debt is just pretending they are wealthy to be more in-touch with the common person.

Pigalowda 3y ago
[flagged]

eimrine 3y ago

ASCII or even UTF-8/16/whatever is not even close to have as much metadata as a written letter. Every people writing have its different "font-set", while computer text is uniformed. Sometimes you see somebody's prescription in the medical card and understand the mood of the doctor while writing this. Mathematics have developed TeX/LaTeX but this notation system is not for doctors by any stretch of imagination. And also there is no a single software thing except of maybe Common Lisp which scripts can overcome tens of years with keeping backward compatibility as a primary goal, I mean try to run any scripts from '10s '00s '90s in any other language except of CL. Software industry produces too shortliving things being promoted with bold and click-bait statements and when it breaks, typically because of becoming a legacy, they say you that you just need more software because your one is too old!

fuzzy2 3y ago

I’m torn on this article. I understand where the doctor is coming from. However, I also disagree entirely with the “should’ve been super skeuomorphic” conclusion. From my experience, that just does not work. It could’ve been a temporary thing to facilitate the transition at best. In fact, I do not see a single argument that supports the “bad software” claim. Instead, I see something else: part of the information was not in the files that were digitized, but instead in the doctors head. This information is no longer applicable. When you decide to go digital, the workflow changes, period. There’s no easy solution, it may take quite some time to let go of the old ways and embrace the new system.

eimrine 3y ago
> I do not see a single argument that supports the “bad software” claim. What is bad in this article is not the software. It is a software.
gambiting 3y ago
>>There’s no easy solution No? The doctor's frustration seems pretty simple - just let them go left/right for newer/older notes on the patient's health. Seems simple enough to me.
- fuzzy2 3y ago
  I would be tremendously surprised if this were not possible. I have seen many programs at various doctors’ offices and all of them could do this. I suspect that instead the doctor was not properly taught how to operate the software. Of course this could also mean the UX is bad, yes. I’m not convinced yet however.
  - hgomersall 3y ago
    The fact the doctor struggles is literally the definition of a bad UX. I don't understand how you can suggest anything else. It might be the doctor can learn a new workflow which is as good as or better than previously, but you can't just impose that on someone.
  - 3y ago

squeegee_scream 3y ago

> IT professionals try to radically alter the workflow of medical professionals, without their input That’s because, as I understand it, EHRs are made primarily for insurance companies, not medical staff. This is a huge problem. IT staff should not be blamed.

moribvndvs 3y ago
My company does EMR and practice management. Yeah, insurance companies definitely are insinuating themselves further and further into the encounter and it’s very gross on top of distracting. We’re also spending a lot of time on Meaningful Use/CURES (regulatory) and interoperability and not as much time innovating and addressing core issues (usability, performance, stability). But sometimes we just plain miss by modeling solutions that sound fine from the engineering side but are impractical in the practice. On the other hand, it’s incredibly frustrating to try to build solutions when each doctor can have a radically different idea of an essential workflow (and often are inconsistent or obstinate about it). I think there’s a plenty of blame to spread around, but I think vendors (i.e. me) have a hell of a lot of room for improvement.

rchaud 3y ago

> This sort of "design blindness" happens whenever system designers prioritize the needs of the IT system, rather than its users. My specialist is therefore forced to deal with a client interface barely pasted over some sort of database. The data is shaped to fit the design of that database, rather than the other way around. I wrote my graduate thesis on digital medical record systems in family practice over a decade ago, user experience was a huge issue then as well. Having training sessions alone isn't enough. The problem isn't going to be solved because doctors are not the primary customer for these systems, the procurement department is. They will care more about HIPAA compliance than whether the end-user can effectively replace their workflow with this new tool.

owenmarshall 3y ago
> The problem isn't going to be solved because doctors are not the primary customer for these systems Agreed! > the procurement department is. But I disagree here. From what I’ve seen in ambulatory EHRs, they are finely tuned for billing workflows. The key outcome is that a patient encounter is tied cleanly to an ICD. Actually tracking patient information in a useful way seems to be an afterthought.
- NoraCodes 3y ago
  This seems like this might lead to some interesting second-order benefits of single-payer healthcare schemes; is the state of EHRs as bad in the UK? If so, is it because they're buying American EHRs?
nunez 3y ago
Afaik, this is further exacerbated by the extraordinary pace at which private practices are getting swallowed up by major hospital networks, like HCA (nationally) and large regionals like Baylor Scott and White in DFW. [0]. [0] https://www.statnews.com/2020/02/27/physician-practice-consolidation-its-only-just-begun/ https://www.statnews.com/2020/02/27/physician-practice-conso...
nunez 3y ago
The craziest thing about EMR systems like this is that you would _think_ that their adoption would help bolster universal patient records that transfer from doctor to doctor (useful now in the world of services like ZocDoc where booking care is ubiquitous). But that's not the case at all!

moribvndvs 3y ago

I’ve been working in healthcare, specifically EMR and practice management for over 20 years. I think the sector is a mess, honestly. It’s too big of a topic for me to get into here. However, there is large amount of variance in how users access and work with medical records, from person to person, role to role, specialty to specialty, hospital type to hospital type, org to org and it gets even worse when users are transitioning from paper. Skeuomorphism might be attractive to non-technical users in transition, but in my experience (this approach isn’t novel) it falls apart very quickly because a) as I previously suggested, there isn’t one model to replicate and skeuomorphic approaches tend to be rigid, and b) users usually very quickly grow out of analog processes as they adapt to software. It’s important to allow practices to customize views for roles and allow users to override so they can put the most important information at their fingertips, and make it quick and easy to jump into the rest of the full details of their record. It’s an information dense problem area, so your fluffy, padded, pretty commerce-focused user patterns are often an anti-pattern. Automation, driven by rules specified by practice and doctors, to help error check their records or point out patient issues (“patient has disease x but we don’t have record that they’ve done y and z preventative measures”, etc.) can help reduce cognitive load and simple mistakes. Dynamic, annotated notation systems driven by templates selected based on the appointment reason and patient history where they do more simply tapping/clicking checkboxes and less typing let doctors focus on interacting with the patient during encounters. Automatically pull in data collected by sensors (weight, blood pressure, whatever) speeds things up, especially for overworked supporting staff. Speed, stability, and consistency over everything. Skeuomorphism really doesn’t help any of that. It was mostly a sales tool like 10-15 years ago.

dctoedt 3y ago

Highly recommended reading about designing human-focused online systems to replace hard-copy workflows: Recoding America, by Jennifer Pahlka. [0] [0] https://www.amazon.com/Recoding-America-Government-Failing-D https://www.amazon.com/Recoding-America-Government-Failing-D... — it was recommended on another HN thread.

captainbland 3y ago

Not sure about the skeuomorphism angle. I'm no UX specialist or anything but I would have thought the best practice would be to use 'standard' (well understood, probably familiar for potential users already) UI elements which are an appropriate analogy for the use case. If you're flicking through paper, it might be easier to e.g. scroll through records for a specific patient and to have some kind of contextual search. But I think the obvious issue is really that they haven't validated and iterated on the design with actual users or even had somebody on the team responsible for caring about this stuff.

friend_and_foe 3y ago

You see this everywhere nowadays, in everything. Bad UX. All over the place. Even things that once had fantastic UX are breaking it. I want to know what they're teaching these designers in design school because theyre fucking everything up. Or is it management making design decisions for them and they just go along with it for the paycheck? Are people in these companies deliberately sabotaging products? I don't know what it is but I'm sick of it. I'll give you an example. When Android came out, one of the first, most important sets of requirements was that it do everything a normal cell phone could do the way a normal cell phone would do it. If you turn the volume all the way down, it must stay all the way down, period. And it worked like that, perfectly, for years. But recently, every so often, you want to play a video silently, and a chirp happens at the very beginning. Someone at some point changed the code where the volume control doesnt control the volume, it saves a variable that's read by the audio decoding software asynchronously and sometimes you get a race condition where audio starts before it is read. Why was this changed? Why is ensuring this functionality no longer a top priority? That's just a tiny little example. With android, side scrolling menus, pages in the recent apps that take up the whole screen, little race conditions here and there. And that's just android, probably the least offensive software UX wise that there is. Hamburger menus, border less flat elements, nests upon nests, you see UX crumbling everywhere you look. I don't know what to make of it.

nunez 3y ago
Biggest example of late for me was Audible. Want to buy some audiobooks for a long drive? You'll need to sign up for their subscription service! Want to buy individual books? Well, for that, you'll OBVIOUSLY need to open Amazon.com _in desktop mode_ and click through a submenu to purchase them individually!

nunez 3y ago

> This sort of "design blindness" happens whenever system designers prioritize the needs of the IT system, rather than its users. My specialist is therefore forced to deal with a client interface barely pasted over some sort of database. The data is shaped to fit the design of that database, rather than the other way around. I just finished listening to The Pragmatic Programmer (EXCELLENT as an audiobook), and the authors talk about this pretty explicitly: > As soon as you have an executable user interface or prototype, you need to answer an all-important question: the users told you what they wanted, but is it what they need? > Does it meet the functional requirements of the system? This, too, needs to be tested. A bug-free system that answers the wrong ques tion isn't very useful. So it looks like some programmers need to read this book for homework!