I can't tell you how bad UI design is in existing EMRs.

Last night I spent 15 minutes trying to get FirstNet (a Cerner system) to accept a medication order so I could discharge a patient.

The problem? Inconsistent UI.

  - 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'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*
  - 

This is the screen for adding a drug allergy. https://ibb.co/Y7gs85h Guess what bit I have to fill out first?

Hint: It is not what you think.

I must fill out the right side of the screen first, because as soon as I either double-click on Morphine on the left hand side, or Hit the 'select' button left-of-middle, it considers that I have completed the details I need to enter, and closes out of this screen. So the 1. at the top is a lie!

So, now I am trying to start by completing the right side of the screen, from 2 down. https://ibb.co/kcgYJw2

  - Note that I have changed the reaction type in 2. from 'Allergy' to 'Side effect'.
  - Now I have to select the side effect; in the search pane on the left.
  - It's vomiting, so I select it once. I can now double click on Vomiting! Horray!
  -

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.

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. https://ibb.co/nM1fXtB

  - In a UI change, I now need to click the green tick in the top left to proceed.

I can'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.

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 actively worked against me achieving this aim.

EMR Designers should be first against the wall when the revolution comes.

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'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.

The NHS actually does have an eMR that it has built itself - Leeds - https://www.digitalhealth.net/2018/01/leeds-teaching-hospita... Apparently it is pretty good (relatively speaking!)