Healthcare Software

Patients have veto power

Creating software for the healthcare domain is a balancing act. Often clients will request that applications employ strict rules for form validation thinking that this will help to improve past problems with data quality. However, in a clinical application, constraints on the data will likely end up causing more problems than they prevent. The basis for these problems is twofold. First, it is usually a technician or a physician (not the patient himself) entering the data and second, the patient is a human being with the last say in all matters. He has the privilege to raise a red card at any moment in time and interrupt an examination or procedure.

Consider the following example:

An application provides for the manual recording of blood pressure measurements. Data fields prompt the user to receive a measurement with systolic and diastolic component values. The patient is asked to lie down and relax. The physician places the cuff of the blood pressure meter around the patient’s arm. He inflates the cuff and watches the dial go down. Just as he records the systolic blood pressure, the patient gets uncomfortable and moves. The diastolic measurement was missed and now the patient does not want to repeat the test.

If the physician now has to enter the data into an application that requires both values, he is unable to get past the form validation stage and will ultimately have to find a way around it. He would typically enter a value that satisfies the field constraints (such as 0 or 1), but also lets other physicians know the value could not be right and therefore it must be a missed reading.

In my opinion, this is a poor substitute for a more elegant solution. Clinical applications should be prepared to handle the fact that at every step in the workflow a patient-driven interrupt is possible. When interrupted, the user must have the option of skipping the field and to record the nature of the problem encountered.

In either case, the method implemented must be future proof and keep in mind that somewhere down the road someone will want to use the stored data for analysis. To this person, it is important to know that this particular value was not entered and needs to be handled in a special manner. He may also want to know the reason why the measurement was not performed.

In healthcare, software can impose little (if any) hard constraints on the environment in which it operates. Patients will present an infinite space of candidate scenarios and all must be provided for and handled with grace.