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BMJ. Jun 26, 2004; 328(7455): 1564.
PMCID: PMC437161

How electronic communication is changing health care

Usability is main barrier to effective electronic information systems
Douglas Badenoch, director
Minervation, Oxford Business Park North, Oxford OX4 2JZ ; moc.noitavrenim@hconedab.salguod
Andre Tomlin, director

Editor—Jadad and Delamothe celebrate “the return of the human” to health informatics in their editorial asking what's next for electronic communication and health care.1 The question is not whether we need to merge human centred and technology centred approaches: the question is how to do it.

If electronic resources are to improve health they have to be accessible, reliable, and usable. More than 80% of websites are currently not accessible by all, including most primary care trust and healthcare charity sites.2 And according to our unpublished in-house survey, few electronic resources are subject to the rigour we would expect of reliable, evidence based publications, and many of the high quality resources that exist are prohibitively difficult to use in everyday practice.

Usability concerns whether an information system is structured so that users can get an answer to fit their purpose. The solution to this problem is user centred design.3 So why isn't it happening in health care?care?

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In spite of considerable evidence that user centred design results in cost savings downstream, and a clear need to assess the usability of information systems,4 the perception remains that it is too expensive.

A good first step is the creation of effective, free tools that help us assess the usability of electronic resources quickly, such as our LIDA tool (www.minervation.com/downloads.html). These are needed to show where the problems are in resources that already exist. Once the usability problem has been identified and defined and both users and commissioners have been educated to expect better from information technology systems, momentum will be gathered towards genuinely high quality electronic information systems.


Competing interests: The authors work for Minervation, a company specialising in accessible, usable, and reliable information resources for health care.


1. Jadad A, Delamothe T. What next for electronic communication and health care? BMJ 2004;328: 1143-4. (15 May.) [PMC free article] [PubMed]
2. Disability Rights Commission. The web: access and inclusion for disabled people. London: Stationery Office, 2004. www.drc-gb.org/publicationsandreports/report.asp (accessed 2 Jun 2004).
3. Neal D. Good design pays off. IT Week 2003 May 19. www.itweek.co.uk/Features/1141003 (accessed 16 June 2004).
4. Kushniruk AW, Patel VL. Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform 2004;37: 56-76. [PubMed]

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