10 ms·
> An automated alert popped up warning that the doctors should consider Sepsis. That alert essentially then blocked progress, and the doctors ended up (essentia
by ryandrake 1y ago
> An automated alert popped up warning that the doctors should consider Sepsis. That alert essentially then blocked progress, and the doctors ended up (essentially) ticking the 'not sepsis' box so that they could get on with their (reasonable) next step which was either ordering an x-ray or starting antibiotics.
Man, I feel like I've been trying in vain to fight pop-ups for my whole software development career. Now we have an example where, at worst a pop-up got someone killed, and at best it was part of the chain of events that got someone killed. I don't know what it is that draws product designers to keep reaching for that horrible UX pattern, but it's got to be stopped. Nobody reads these things so a popup is the worst place to put important information that the user needs to read!
I think a lot of pop-up usage comes from company lawyers trying to cover butts: "Well, regulation says that users need to be informed of XYZ, so just stick a pop-up there. Then we can tell the regulator 'Hey at least we did our part to inform the user.'"
- bcrl 1y agoThis is why I think that we're getting to the point where software developers need to be trained in ethics and licensed in the same way as professional engineers are around the world. The people building the tools need to be held accountable when design choices kill people.
- WalterBright 1y agoDoesn't the FDA already regulate medical software?
- nradov 1y agoTo an extent, but only if the software meets the criteria for being legally classified as a "medical device". And at the lower classification levels the regulations are very light. You don't necessarily have to prove any level of reliability or usability. https://www.fda.gov/medical-devices/classify-your-medical-device/how-determine-if-your-product-medical-device https://www.fda.gov/medical-devices/classify-your-medical-de...
- Neywiny 1y agoEx employee of the division of imagine devices and software reliability here. I have nothing to add, and I'm not qualified to confirm or deny your comment. Just interesting to see a mention of my past life
- codeulike 1y agoBut thats part of the problem, as well as part of the solution. The FDA regulations say the software must do this and must do that, and you end up with thousands of pop up alerts. I think the regulations are well meaning but they way they translate into software is not realistic. In the article an FDA-regulated pop-up is part of the story.
- nradov 1y agoThere are no FDA regulations that require EHR software to display pop-up alerts for possible sepsis.
- deleted 1y ago[deleted]
- Zak 1y agoMost software development is not much like engineering. That's probably the right choice for low-stakes consumer products, but wouldn't be accepted in avionics and shouldn't be accepted in medical software that impacts life safety.
- bcrl 1y agoEthics is applicable to many situations outside of life critical systems. Engineers take ethics very seriously because it is important, and I think it is important for software developers as well. The first time I worked closely with a Professional Engineer on a project, it was eye opening as to how the concern of doing things the ethical way shaped the interaction... Everything from identifying potential business conflicts to ensuring data collection for inputs to the design process was done correctly and traceable. Corporations already push enough random HR requirements on tech employees. I can't see how having a semester or 2 of ethics courses is particularly onerous.
- Zak 1y agoI think including ethics in the curriculum at both the high school and university level is a great idea. I do not think requiring software developers to be licensed is a good idea at all. Safety-critical software projects should have a licensed engineer in a supervisory role.
- bcrl 1y agoLicensing takes many forms. Some are onerous, some are not. Working At Heights training takes 0.5-1 day of training every 3 years where I live, and it's mandated because it saves lives. Yes, it's a form of licensing, but it's an easy box to check because it's accessible. For example: running experiments on humans without their prior consent is considered unethical. However, large tech firms routinely run A / B tests on their users without providing Informed Consent. If software developers were trained like engineers, they would be ethically obligated to obtain Informed Consent prior to engaging in this kind of conduct. More importantly, when software developers realize they were being experimented upon (as happened in the Linux kernel community a while back), they were justifiably outraged. I know this isn't going to be a popular position to hold here, but there's a lot of harm being done by unethical practices that are currently widespread in big tech. Ephemeral ads that prey on the elderly would be considered Not Good by anyone that has seen a parent fall prey to them, yet there doesn't seem to be any concern whatsoever amongst the industry giants themselves to prevent this practice. So long as an ad brings in money, it's good to run seems to be the bar for advertisers at present, and I don't think that's good for society. When there are no ethical considerations given to the consequences of an action, unethical outcomes are inevitable. Fixing that starts with learning, which is something every great developer already does.
- terminalshort 1y agoBureaucracy won't help anything. You can't train people to be more ethical.
- ozgrakkurt 1y agoIt is doctor’s responsibility to know the patient might have such a condition, software system is just for helping
- GenerWork 1y agoAs a product designer, I can think of 2 reasons why the person that came up with this flow might've made it a popup: 1) That's the default design system pattern for alerts, so whoever was the designer just went with it. 2) There's other alert patterns (alert bar, toast, etc), but sepsis was deemed to be so dangerous to the patient that it deserved to have its own special friction inducing UI element to alert doctors to take action. >I don't know what it is that draws product designers to keep reaching for that horrible UX pattern There are legitimate cases for alert modals like this one, but this definitely is an example as to when it shouldn't be used.
- lazide 1y agoSepsis is indeed an immediate life threatening condition, and I bet the alert was added as some kind of legal/medical ‘oh shit’ type of condition - without thinking through the consequences from a UX perspective.
- jahsome 1y agoWhat could possibly be a better use case for a progress halting pop up than a potential/likely "immediate life threatening condition"??? The issue is not the UX, it's the provider's arrogance thinking they know better. This thread is literally unbelievable.
- kube-system 1y agoUX is sort of the issue in the sense that people have been trained to ignore pop-ups because they are used for so much irrelevant garbage that it is a "boy who cried wolf" situation. The questions of: "How do you force a computer user to take something seriously?" is fundamentally a UX question. When people encounter a jarring interaction with a computer, most people's default response is to blame the computer for not doing what they expected it to... even when the computer is telling them that they need to do something differently. This makes it very difficult to guide users into changing their behavior. And if the user has experienced this message erroneously in the past, they have been conditioned to presume it is erroneous. Anyone who has ever worked helpdesk can tell you that people call in with "computer errors" all of the time that are simply messages telling the user to do something... but it doesn't occur to them to actually follow the instructions. This is a fundamental HCI issue that is tough to solve, and usually isn't solved by someone who is just building a form to check off a compliance item.
- pwg 1y ago> that draws product designers to keep reaching for that horrible UX pattern Because in almost every GUI library, they are the default built-in "alert" setup that can be used. Almost any other alert system other than a "popup" has to be coded, and the designers and coders take the easy way out and just use the "built in popup widget" already in the library.
- account42 1y agoIt's more that modal alerts are easier to reason about. With some other kind of notification you'd need to think about what the user should or should not be able to do until the alert condition is dealt with and what the consequences of dong it without dealing with the alert should be. It's generally easier to make the user deal with the special condition now so that the rest of the code can assume it either doesn't apply or has been dealt with.
- cogman10 1y agoI've reached for a pop-up and stopped using them exactly because of the "nobody reads this" problem. What's the alternative when you have a potentially dangerous action that you need to give the user fair warning about?
- lazide 1y ago<blink/> tag? (/s)
- kragen 1y agoYou make it possible to undo the action! In rare cases that's not possible; four that I know of: - the action is controlling something in the physical world such as a CNC milling machine, or - the action involves acting on somebody else's computer, for example sending an email, or - the action involves securely deleting information so that future adversaries who obtain your data storage medium can't recover it, or - data storage space is so limited that you don't have room to log an undo record. Obviously none of those were the case here, but when there are, there are well-known techniques for reducing the risk. For example, you can include by default a "cooling off" period to cancel the email send in or restore from nightly backups, or figure out how to do a "dry run" without a cutting tool in the chuck to see if it looks like your CNC program is going to smash the mill. You can put a molly-guard over inevitably destructive actions; that's why the IBM PC's reset keystroke is a three-key chord, and Emacs asks for you to type "yes" or "no" rather than "y" or "n" in certain cases. (Although in many of Emacs's cases, being able to undo would have been better. Freeing up the memory of a closed buffer with unsaved changes, for example, could almost always wait a few minutes!) It's also important in such cases for the user to be able to clearly see all the relevant information.
- kragen 1y agoThis should read "but when there is such a case" and "in which to cancel the email send".
- scotty79 1y agoYou could simulate the destructive actions instead of asking beforehand and make user confirm all destructive action before proceeding to actually executing them.
- Nifty3929 1y agoI think the main problem with pop-ups that makes them a bad place to put important (any?) information is that they interrupt the user's workflow - which is, indeed, kinda the point of the pop-up. But what is a normal human's reaction to this. They are in the middle of trying to do the thing they want to do. To continue with this, they need to get the pop-up out of the way, so they just click the button. I run into this ALL THE TIME during the normal course of using software. I am trying to do something, then I get a pop-up about something-or-another that the developer clearly thought was important for me to see, but I click past it so I can get back to what I was doing. A lot of times is these "look at this cool new feature" kind of things - ARGH! And the worst part is, I might actually WANT to come back and learn about the new feature, but often I only get that one chance, and I'm too busy on my important task to focus on it right now. Actually - a specific example of this just case to mind: I want to take a screenshot with Snagit - so I press PrtSn. But now Snagit pops up and asks me if I want to update. Sure, maybe I do - but not now! Now I just want to take my damn screenshot! So I click 'no.' And then I don't see it again until the next time I want to take a screenshot, and also do not want to be interrupted in my 5sec tasks with a 5min update. Much better is to provide the information in a conspicuous, hard-to-miss area of the UI, but which DOESN'T block my workflow. Like, literally just put the text right on the form/interface in bold, red font. Like for Snagit - don't make it a popup update notification. Just put a bold/red link on the capture window and editor UI that says "Update"
- dredmorbius 1y agoLogs, or a message queue, where messages can be filtered / sorted for priority.
- whatevertrevor 1y agoI remember a time when I thought we were past the Windows 98/XP popup malware era. Now every single website and application loves to shove popups in my face whenever I'm trying to accomplish a quick task. I don't think I have ever read anything other than the buttons to figure out which ones not to press. Engagement metrics will be the death of us.
- 1y ago
- deleted 1y ago[deleted]
- devilbunny 1y agoIt's even worse, in a way. Mt Sinai uses Epic, as do many (most?) other larger hospitals in the US. The stops - which in my experience (anesthesiologist, not ER doc, so I don't get sepsis warnings but I do get some of my own) are not popups, per se, but warnings that prevent you from leaving the screen until you have dealt with them. In this case, he could not place an order for at least some of the sepsis bundle of orders without placing all of them or making the sepsis warning go away - permanently. And the inexperienced trainee was told by the experienced supervising physician not to order the antibiotics and x-ray until at least preliminary labs had come back. At least for the antibiotics, this is good stewardship - we don't want to be giving people antibiotics for viral illnesses. I have fought against incomprehensible ordering systems so much that when I order a chest X-ray (usually to confirm the placement of a large central IV), I have found it best to call the radiology technician and tell them what I want and let them order it under my name, because if I don't, I'll inevitably screw up some minor detail and they will have to re-order it anyway. "Chest x-ray to confirm internal jugular central venous catheter placement" (well, "CXR to check IJ CVC") is what I would have written in a paper chart; now it wants to know vast amounts of detail that I often don't know.
- nradov 1y agoEpic has 41% market share for inpatient EHRs so it's in many but not most hospitals. https://www.definitivehc.com/blog/most-common-inpatient-ehr-systems https://www.definitivehc.com/blog/most-common-inpatient-ehr-...
- wombatpm 1y agoBut that is 41% for a single vendor out of 10. So market leader. And it looks like the data is based on hospital installations but not normalized based on quantity of patient served or patient case complexity. Edward’s Hospital in Plainfield, Il and Mt Sinai are two different use cases and should not count equally.
- devilbunny 1y agoThat is something to keep an eye on. The system that owns the hospital where 95% of my work happens uses Epic and they subsidize it for hospitals that aren’t formally part of our system but could be a good referral base. Catholic hospital, so it has its own internal issues, but it’s definitely not PE-controlled.
- FireBeyond 1y ago> don't know what it is that draws product designers to keep reaching for that horrible UX pattern, but it's got to be stopped. Nobody reads these things so a popup is the worst place to put important information that the user needs to read! Hi, Product Manager and paramedic here. The type of popup you are talking about is not what is happening here. It's a modal dialog requiring the provider to answer multiple questions to evaluate their patient (see my other comment in this thread). And then it will warn you that the patient meets SIRS or sepsis criteria. It's not quite as simple as "regulation says user needs to get warned of blah".
- deleted 1y ago[deleted]
- anon291 1y agoSometimes I accidentally dismiss a popup and then don't even know what it said. Terrible pattern.
- ratelimitsteve 1y agois it the popup that got someone killed or the fact that they're so pervasive and misused that we're all trained to ignore and dismiss them?