Anticlue responded to my post from yesterday and missed my arguement entirely, while stepping back and lecturing me on what to do.
Here's my response. For the readers who don't know ... Elyse and I are colleagues, and I have a great deal of respect for her ... which is why I'll let loose a bit here ... all in the interests of continuing a good debate between friends .. ;-)
Elyse, you make some good points .. but by working so hard to figure out what was wrong with what I was saying .. you miss the forest for the trees, and don't seem to acknowledge the importance of the concept that that I was discussing - that usability is important.
1) Asking if usability was in the RFP is insulting .. and misses the point that I was talking about most point-of-care products .. not one in particular. The argument that I have consistently made is that usability is the "bullet point" most often ignored on functional matrices ... and due to its subjectivity ... most vendors can wave their hands about how easy a product is to use .. but it's not. Measuring how long it takes to do a lookup (patient, dx code, medication, procedure code, allergy) is one way to measure usability, since these lookups occur many times during a given provider/computer interaction. How many keystrokes or mouse-clicks does it take to accomplish a given task? Do you argue that it is better to accomplish something with more rather than fewer actions? I don't see how this would make something safer - as you imply.
2) Replicating the functionality that google demonstrates (BTW - they are using XMLHttpRequest) can be done in many ways .. and of course no one is going to load a full MPI for a large healthcare organization into the browser. This would be dumb, as you suggest .. and would likely be a security risk if any application were to be used through a browser remotely. (BTW - Dave points out that it's only one part of our app that loads it all .. the others re-poll the database with evey keystroke, like XMLHttpRequest). But you CAN check in with the database and maintain a responsive user interface with every keystroke. This is what Google demonstrates. If they're doing it with a HUGE database (the Internet) .. and many more users than the typical healthcare organization would have at any given moment .. you can be certain that such functionality could be replicated on a smaller scale for a healthcare application.
Hundreds or even thousands of users is a tiny load compared to the load that Google's servers endure .. and recall that I was not only talking about patient lists. When I use epocrates on my PDA to look up a medication, I can type the 1st few letters of a medication to find it. This is good design. Are you arguing that it would be better to have a 1980's style screen where I type in the medication name .. click "search" and then get back what I was searching for? (or not). Your point about misspellings also misses the mark. Indeed, it's the instant feedback that will REDUCE the likelihood of finding the wrong diagnosis, CPT code or patient name ... not enhance it. Let's take the example of your last name. Let's say I don't recall whether it's IE or EI or EE or I or EA. So I type N (space) Ely. Done. I found you. Now with a "old method" search: Type Neelsen, Elyse .. hit return .. find nothing. Back to the search screen. Nealsen .. nope .. back to search .. etc etc. Giving the user feedback about what's in the black hole of the database is better.. not worse. Vendors are beginning to take advantage of this .. with windows tools .. and XMLHttpRequest .. which is good. I applaud the use of such techniques, and I hope to see more of it in healthcare applications, as I would predict we will - so that we can focus more of our time on patient care .. and less of our time on typing and clicking and (in the age of The Tablet PC) .. pen-tapping. I don't think I need to put this in an RFP .. or even build consensus for this concept. It's a given.
3) Your suggestions about my making a list of issues for my practice organization, and your comment about working WITH the vendor (do you imply that I would work AGAINST them?) are again puzzling ... and I fear that you are making statements on your weblog about what you know (or think that you know) about what I am doing for that organization ... which is well beyond the scope of my post. While it is true that I have been vocal about my concerns about the usability of a product in the past ... I remain a passionate advocate for the user AND the vendor. If we can't work together, there is no way for the product to meet the needs of the user.
On a lighter note ...
I'll finish with a quiz about usability - posed by one of my heroes (who has a three-letter name that rhymes with DOG) .. and challenge my readers to go find the answer.
Which takes less time?
a) Heating water in a microwave for one minute and ten seconds.
b) Heating water in a microwave for one minute and eleven seconds.
I'll post the answer tomorrow if no one figures this out.