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As 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 patter

As 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 ago
Sepsis 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 ago
  What 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 ago
    UX 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.
  - cfu28 1y ago
    Have you been on the other side of this? I get dozens of sepsis alerts a day, usually on the same patient, and the criteria that triggers them is so broad and non specific they are functionally useless. Each alert locks down the entire system ironically preventing you from reviewing what triggered it in the first place. You cannot do anything until it is addressed and you are forced to commit to an action without all the data because of it like administer a medication or order fluids, which may not be appropriate. Lots of things mimic sepsis criteria including but not limited to decompensated cirrhosis, HF, cancers, leukemias. The worst is that they don’t even pop up at the right time, they usually pop up usually way after the sepsis has been treated. In the past year, I’ve only had about a half dozen appropriate sepsis pop ups among the hundreds I’ve received.
    - mystraline 1y ago
      Wait what?! It blocks the system with a demanded action, but doesn't even show you what triggered the alert condition? I would completely expect a "List of conditions that suspect sepsis" and get those details up front and center. I'd be putting in medical records "Due to software popping up an un-dismissable sepsis screen that does not show details, I dismissed it due to needing the data it was flagged on". Lemee guess? Epic?
      - cfu28 1y ago
        Yes, really. I’ve had to restart my Citrix session to make it go away or dismiss it like the writer did. You’ll get something like “sepsis criteria triggered by wbc 13, cr 1.5, hr 101, rr 22.” And that’s it - usually in the middle of a night on a new patient I just got a page for. Can’t open documentation to see the patients med history. It’s ridiculous. I’m not using Epic but I am using a major EMR. To be fair I’ve written almost exactly what you mentioned out of sheer frustration once or twice but it’s not ideal
      - pwg 1y ago
        > It blocks the system with a demanded action Yes, in almost every case, the default "popup" GUI library call is also a modal dialog. You cannot access anything else, anywhere else, in the entire program (even if the program had multiple separate windows open). All you can do is read the dialog's text, and hit the "ok" button to dismiss it (or pick from one of a set of "buttons" that are shown on the popup to dismiss it). The worst ones also do a global grab, with the result that you can't even switch away to another unrelated application on the system without first "interacting" with and dismissing the popup. To see the version that is built into Javascript in the browser, put the following into the URL field of a new bookmark, and save the new bookmark. javascript:(function(){alert("hello");})(); Then, while here on HN (or anywhere else), click that new bookmark you just made, which will pop up the default built in Javascript alert box, and try to interact with the rest of the page it pops up in front of.
  - tracker1 1y ago
    Kind of my thinking here... the fact that popups are abused for BS doesn't mean that they don't serve a purpose and this is one of those times. The fact that it was confusing and a second Doctor went ahead and bypassed it altogether that hadn't seen the patient is a bit problematic to me. Beyond this, as much as I empathize with the family here, people still die... I had two similar ER visits in my life and it's only chance I wasn't sent home both times... when I came down with Guilliam-Barre and when I had ketoacidosis. The former, was about to be sent home when one of the residents recognized my symptoms (sudden onset weakness all over). In the latter, urgent care said it was just a cold/virus etc.. but I couldn't even keep water down, after 4 days I couldn't stand up and called for an ambulance I dropped over 50# of weight in under a week. I remember thinking to myself "if I go back to sleep I won't wake up."
    - anon291 1y ago
      > The fact that it was confusing and a second Doctor went ahead and bypassed it altogether that hadn't seen the patient is a bit problematic to me. Doctors are humans, and humans have cultures. In this culture, it was normal for people to dismiss popups that seemed to be distracting, and one human shared with another human this useful tidbit of information. People need to get real about who doctors are. They are not super-people. The system was set up in such a way that the popup became a distraction, and humans naturally want to get rid of distraction.
  - mscrnt 1y ago
    10000000 Mind boggling
  - lazide 1y ago
    If you are actually trying to do something to resolve the situation, why would you want a progress stopping pop-up forcing you out of actually doing the thing you need to do? Especially if it forces you to pick out of two options when the thing you are trying to do is figure out which option is appropriate? Using EMR systems are nightmares for anyone actually doing things, but great for figuring out what was documented later. The two are rarely related. If someone is trying to land a plane, would a pop-up about an engine fire that takes over all control input also be a good idea?
  - BeFlatXIII 1y ago
    >implying people read pop-ups instead of just closing them
  - amluto 1y ago
    Have you read any of the details? The provider was unable to take appropriate action because the progress halting popup was preventing taking that action.
    - deleted 1y ago
      [deleted]
    - jahsome 1y ago
      Of course I did. You're wrong. The provider CHOSE not to take the appropriate action. The appropriate action was ordering the medication because the automated diagnoses was in fact correct. PS - I would suggest avoiding rhetoric like "did you even read" as per the guidelines. It's just a waste of everyone's time.
      - amluto 1y ago
        Quoting the article: > Agyare had instructed Banerjee to hydrate Sam right away but to wait for the results of Sam’s lab work before ordering a chest X-ray or the strong antibiotics used to treat sepsis. > But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help. > At 8:50 p.m., Welsh showed Banerjee how. From his own computer, he clicked into a field on Sam’s chart to assert that sepsis was not likely: “Based on my evaluation,” the automated note said, “this patient does not meet clinical criteria for bacterial sepsis.” The provider was instructed (possibly wisely) to take some of the automated sepsis actions and to defer others. The computer did not allow this without generating an automated note saying “ this patient does not meet clinical criteria for bacterial sepsis.” Imagine if your email UI auto-classified one particular email as so high priority that it would allow you to do nothing else, including reading other emails, until you archived the priority email and, to for good measure, would auto-reply “no action needed” when you hit archive. You get a priority email, and you determine that the correct action is to wait up to 20 minutes for another email that you expect and, while waiting 20 minutes, to read other emails from the same sender. But you can’t because your UI won’t allow it. So you archive it, send the “no action needed” reply (which is outrageously inappropriate but you don’t actually have any control here), and hope you remember in 20 minutes while you are horribly overworked. ISTM the patient’s family should consider suing the software vendor.
  - scotty79 1y ago
    The issue with popups is that it's all or nothing and you are forced to choose one before you do anything else. Mandatory "snooze" button for a popup would go a long way. Also easily accessible history of recently dismissed popups would be great.
throwaway173738 1y ago
I’m really shocked that nobody stopped and thought “doctors have special training and should be expected to diagnose and treat Sepsis if reminded about the possibility.” I don’t think it was appropriate to block the entire flow, and I’m surprised nobody thought it was possible to want some but not all of the actions for sepsis. If the developers are really making popups that make life or death decisions then maybe EMR customizations should have a tighter safety class. If it were me, I would have also named the developer or administrator who implemented the popup. It sounds like a key stumbling block in a medical device.

lazide 1y ago

Sepsis 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 ago
What 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 ago
  UX 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.
- cfu28 1y ago
  Have you been on the other side of this? I get dozens of sepsis alerts a day, usually on the same patient, and the criteria that triggers them is so broad and non specific they are functionally useless. Each alert locks down the entire system ironically preventing you from reviewing what triggered it in the first place. You cannot do anything until it is addressed and you are forced to commit to an action without all the data because of it like administer a medication or order fluids, which may not be appropriate. Lots of things mimic sepsis criteria including but not limited to decompensated cirrhosis, HF, cancers, leukemias. The worst is that they don’t even pop up at the right time, they usually pop up usually way after the sepsis has been treated. In the past year, I’ve only had about a half dozen appropriate sepsis pop ups among the hundreds I’ve received.
  - mystraline 1y ago
    Wait what?! It blocks the system with a demanded action, but doesn't even show you what triggered the alert condition? I would completely expect a "List of conditions that suspect sepsis" and get those details up front and center. I'd be putting in medical records "Due to software popping up an un-dismissable sepsis screen that does not show details, I dismissed it due to needing the data it was flagged on". Lemee guess? Epic?
    - cfu28 1y ago
      Yes, really. I’ve had to restart my Citrix session to make it go away or dismiss it like the writer did. You’ll get something like “sepsis criteria triggered by wbc 13, cr 1.5, hr 101, rr 22.” And that’s it - usually in the middle of a night on a new patient I just got a page for. Can’t open documentation to see the patients med history. It’s ridiculous. I’m not using Epic but I am using a major EMR. To be fair I’ve written almost exactly what you mentioned out of sheer frustration once or twice but it’s not ideal
    - pwg 1y ago
      > It blocks the system with a demanded action Yes, in almost every case, the default "popup" GUI library call is also a modal dialog. You cannot access anything else, anywhere else, in the entire program (even if the program had multiple separate windows open). All you can do is read the dialog's text, and hit the "ok" button to dismiss it (or pick from one of a set of "buttons" that are shown on the popup to dismiss it). The worst ones also do a global grab, with the result that you can't even switch away to another unrelated application on the system without first "interacting" with and dismissing the popup. To see the version that is built into Javascript in the browser, put the following into the URL field of a new bookmark, and save the new bookmark. javascript:(function(){alert("hello");})(); Then, while here on HN (or anywhere else), click that new bookmark you just made, which will pop up the default built in Javascript alert box, and try to interact with the rest of the page it pops up in front of.
- tracker1 1y ago
  Kind of my thinking here... the fact that popups are abused for BS doesn't mean that they don't serve a purpose and this is one of those times. The fact that it was confusing and a second Doctor went ahead and bypassed it altogether that hadn't seen the patient is a bit problematic to me. Beyond this, as much as I empathize with the family here, people still die... I had two similar ER visits in my life and it's only chance I wasn't sent home both times... when I came down with Guilliam-Barre and when I had ketoacidosis. The former, was about to be sent home when one of the residents recognized my symptoms (sudden onset weakness all over). In the latter, urgent care said it was just a cold/virus etc.. but I couldn't even keep water down, after 4 days I couldn't stand up and called for an ambulance I dropped over 50# of weight in under a week. I remember thinking to myself "if I go back to sleep I won't wake up."
  - anon291 1y ago
    > The fact that it was confusing and a second Doctor went ahead and bypassed it altogether that hadn't seen the patient is a bit problematic to me. Doctors are humans, and humans have cultures. In this culture, it was normal for people to dismiss popups that seemed to be distracting, and one human shared with another human this useful tidbit of information. People need to get real about who doctors are. They are not super-people. The system was set up in such a way that the popup became a distraction, and humans naturally want to get rid of distraction.
- mscrnt 1y ago
  10000000 Mind boggling
- lazide 1y ago
  If you are actually trying to do something to resolve the situation, why would you want a progress stopping pop-up forcing you out of actually doing the thing you need to do? Especially if it forces you to pick out of two options when the thing you are trying to do is figure out which option is appropriate? Using EMR systems are nightmares for anyone actually doing things, but great for figuring out what was documented later. The two are rarely related. If someone is trying to land a plane, would a pop-up about an engine fire that takes over all control input also be a good idea?
- BeFlatXIII 1y ago
  >implying people read pop-ups instead of just closing them
- amluto 1y ago
  Have you read any of the details? The provider was unable to take appropriate action because the progress halting popup was preventing taking that action.
  - deleted 1y ago
    [deleted]
  - jahsome 1y ago
    Of course I did. You're wrong. The provider CHOSE not to take the appropriate action. The appropriate action was ordering the medication because the automated diagnoses was in fact correct. PS - I would suggest avoiding rhetoric like "did you even read" as per the guidelines. It's just a waste of everyone's time.
    - amluto 1y ago
      Quoting the article: > Agyare had instructed Banerjee to hydrate Sam right away but to wait for the results of Sam’s lab work before ordering a chest X-ray or the strong antibiotics used to treat sepsis. > But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help. > At 8:50 p.m., Welsh showed Banerjee how. From his own computer, he clicked into a field on Sam’s chart to assert that sepsis was not likely: “Based on my evaluation,” the automated note said, “this patient does not meet clinical criteria for bacterial sepsis.” The provider was instructed (possibly wisely) to take some of the automated sepsis actions and to defer others. The computer did not allow this without generating an automated note saying “ this patient does not meet clinical criteria for bacterial sepsis.” Imagine if your email UI auto-classified one particular email as so high priority that it would allow you to do nothing else, including reading other emails, until you archived the priority email and, to for good measure, would auto-reply “no action needed” when you hit archive. You get a priority email, and you determine that the correct action is to wait up to 20 minutes for another email that you expect and, while waiting 20 minutes, to read other emails from the same sender. But you can’t because your UI won’t allow it. So you archive it, send the “no action needed” reply (which is outrageously inappropriate but you don’t actually have any control here), and hope you remember in 20 minutes while you are horribly overworked. ISTM the patient’s family should consider suing the software vendor.
- scotty79 1y ago
  The issue with popups is that it's all or nothing and you are forced to choose one before you do anything else. Mandatory "snooze" button for a popup would go a long way. Also easily accessible history of recently dismissed popups would be great.

throwaway173738 1y ago

I’m really shocked that nobody stopped and thought “doctors have special training and should be expected to diagnose and treat Sepsis if reminded about the possibility.” I don’t think it was appropriate to block the entire flow, and I’m surprised nobody thought it was possible to want some but not all of the actions for sepsis. If the developers are really making popups that make life or death decisions then maybe EMR customizations should have a tighter safety class. If it were me, I would have also named the developer or administrator who implemented the popup. It sounds like a key stumbling block in a medical device.