Why we are withdrawing the NHS Common User Interface
I can&#x27;t tell you how bad UI design is in existing EMRs.<p>Last night I spent 15 minutes trying to get FirstNet (a Cerner system) to accept a medication order so I could discharge a patient.<p>The problem? Inconsistent UI.<p><pre><code>  - Firstly, the patient had incorrectly had a medication allergy to codeine recorded; and I was trying to prescribe a medication containing codeine. The patient had had nausea and vomiting in response to previous morphine administration, which is a drug side effect (Mild), not a drug allergy. So this was the information I was trying to encode.
  - So, I removed the codeine drug allergy.
  - But then, because there were no allergies recorded, it wouldn&#x27;t let me prescribe a drug unless the drug allegies had been reviewed.
  - So I entered the allergy recording section; which has a UI which is not only totally inconsistent with the hodge-podge of the rest of the application, but *inconsistent within itself*
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This is the screen for adding a drug allergy. <a href="https:&#x2F;&#x2F;ibb.co&#x2F;Y7gs85h" rel="nofollow">https:&#x2F;&#x2F;ibb.co&#x2F;Y7gs85h</a> Guess what bit I have to fill out first?<p>Hint: It is not what you think.<p>I must fill out the right side of the screen first, because as soon as I either <i></i>double-click on Morphine<i></i> on the left hand side, or Hit the &#x27;select&#x27; button left-of-middle, it considers that I have completed the details I need to enter, and closes out of this screen. So the <i>1.</i> at the top is a lie!<p>So, now I am trying to start by completing the right side of the screen, from 2 down. <a href="https:&#x2F;&#x2F;ibb.co&#x2F;kcgYJw2" rel="nofollow">https:&#x2F;&#x2F;ibb.co&#x2F;kcgYJw2</a><p><pre><code>  - Note that I have changed the reaction type in 2. from &#x27;Allergy&#x27; to &#x27;Side effect&#x27;.
  - Now I have to select the side effect; in the search pane on the left.
  - It&#x27;s vomiting, so I select it once. I can now double click on Vomiting! Horray!
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So, now to fill out the remaining details. Be careful not to click ahead, or it will close out; forcing you to have to restart the process all over again.<p>Now, I have 2 more steps to complete.
I need to confirm that this is the correct set of allergies and I have reviewed it. <a href="https:&#x2F;&#x2F;ibb.co&#x2F;nM1fXtB" rel="nofollow">https:&#x2F;&#x2F;ibb.co&#x2F;nM1fXtB</a><p><pre><code>  - In a UI change, I now need to click the green tick in the top left to proceed.
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I can&#x27;t even bear the pain of going through the last step because once I had navigated all of the above, a final UX change on the page where I need to over-rule the Clinical Decision Support Dialogue that is trying to warn me that because there is a side-effect to Morphine and I am prescribing Codeine, would I like to proceed. A somewhat useful notice, as they are the same class; but really frustrating and since I had just coded it as a mild side-effect, not a severe allergy, I would hope that an intelligent CDSS would recognise this and stop giving me alert fatigue.<p>In my state of fatigue (14 hour shift after a 10 hour shift the day before), I inadvertently clicked the wrong UI elements and had to repeat the process so many times that I actually started documenting it because it was so fucking ridiculous.
I was trying to use the system as it was intended; To actually record accurate information that would be of benefit in future patient encounters. The system <i>actively worked against me achieving this aim</i>.<p>EMR Designers should be first against the wall when the revolution comes.<p>To bring this a bit more back on topic, it would be lovely if there were consistent UI standards. 
But the horse has bolted so far. I can&#x27;t see how we are going to get human centred design on more than a fraction of deployed EMRs at any point within the next 15 years; the infrastructure and licensing deals that have been done are too established and the inertia too slow.<p>The NHS actually does have an eMR that it has built itself - Leeds - <a href="https:&#x2F;&#x2F;www.digitalhealth.net&#x2F;2018&#x2F;01&#x2F;leeds-teaching-hospitals-trust-electronic-health-record&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.digitalhealth.net&#x2F;2018&#x2F;01&#x2F;leeds-teaching-hospita...</a> Apparently it is pretty good (relatively speaking!)