
Why we are withdrawing the NHS Common User Interface - DanBC
https://digital.nhs.uk/blog/transformation-blog/2019/why-we-are-withdrawing-the-nhs-common-user-interface
======
Zhyl
I've responded to their email address about what would come next - in short I
think they should publish high level requirements and principles that should
be met by each platform. Rather than trying to create everything first party,
they should allow a mechanism for taking on board permissively licensed assets
(or pull requests to their requirements and principles) as effectively
donations.

The NHS has a lot of good will in the UK and they would be an ideal, if not
THE ideal, co-ordinators of an open source health programme. Creating a
unified look and feel for web services would be a good proof of concept, but I
believe this could be extended to other libraries, components or even full
systems/solutions in time.

~~~
desas
What exactly do you mean? Have you seen the new service manual? They welcome
contributions from outside NHS Digital, anyone can contribute to it in theory,
so long as you can show there's a real need [1].

The NHS are doing more in-house, where it's sensible. For example the NHS
Business Service Authority are building a replacement for
[https://www.jobs.nhs.uk](https://www.jobs.nhs.uk) whereas before it was
basically entirely out sourced to the private sector.

[0] [https://beta.nhs.uk/service-manual/](https://beta.nhs.uk/service-manual/)
[1] [https://github.com/nhsuk/nhsuk-service-manual-
backlog/blob/m...](https://github.com/nhsuk/nhsuk-service-manual-
backlog/blob/master/docs/CRITERIA.md)

~~~
Zhyl
Is this not what is being withdrawn?

But still, just going by the link you have a list of principles:

[https://beta.nhs.uk/service-manual/design-
principles](https://beta.nhs.uk/service-manual/design-principles)

Which are all well and good, but are more akin to a 'vision' than technical
design principles (especially with regard to preference of tradeoffs, data
management, priority of platforms etc).

The rest of it seems to be strongly geared towards the web. It may well be
that the NHS only wants to collaborate on public-facing web services, much
like GOV.UK and the Government Digital Service, but this would need to be
either extended or abstracted to be applicable to, say, administrative
systems.

~~~
trnglina
> Is this not what is being withdrawn?

What's being withdrawn is their original CUI, linked in the article [0]. From
what I can tell, this is very distinct from their new digital service manual,
which seems to be replacing the old CUI.

> ...but this would need to be either extended or abstracted to be applicable
> to, say, administrative systems.

Based on nothing more than a rough skim of the CUI, admittedly, it seems like
the original was a very web/interface-oriented design system in the first
place. A focus on web components makes sense, since administrative systems can
be implemented with a web-based frontend, and web design systems can be
adapted to other user interfaces, because they provide a set of baseline,
expected behaviours to replicate.

[0]:
[https://webarchive.nationalarchives.gov.uk/20160921140920/ht...](https://webarchive.nationalarchives.gov.uk/20160921140920/http://systems.digital.nhs.uk/data/cui)

------
markmark
I spent quite a bit of time implementing the medicines management parts of
this for a product that I don't think ever shipped (I, and the majority of the
dev team left at around the same time due to concerns around management
direction). I definitely thought that side of things seemed well thought out,
and there was a lot of value in having consistent display of medication
details and dosing across systems to try to make it as clear as possible for
the users.

------
robbiep
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](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](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](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...](https://www.digitalhealth.net/2018/01/leeds-teaching-hospitals-
trust-electronic-health-record/) Apparently it is pretty good (relatively
speaking!)

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

It's just so mind-boggling how this shit doesn't lead to more people dying. I
swear, the more critical the thing, the shittier the UI.

~~~
ryukafalz
>It's just so mind-boggling how this shit doesn't lead to more people dying.

Medical errors do cause a lot of deaths: [https://www.npr.org/sections/health-
shots/2016/05/03/4766361...](https://www.npr.org/sections/health-
shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-
errors)

I don't know if any significant portion of that is linked to bad UI design in
EMR software, but it wouldn't surprise me.

~~~
mynameismonkey
See [https://khn.org/news/death-by-a-thousand-
clicks/](https://khn.org/news/death-by-a-thousand-clicks/) for examples

------
sgt101
If I were making this decision, or the decision about what should come next, I
would be trying to create quantative evidence about what works and doesn't
work to inform the choice. I didn't see that in the article.

~~~
IshKebab
I wouldn't. That kind of user testing is _extremely_ time consuming, and often
pointless because it's obvious what works and what doesn't.

Google famously did silly amounts of AB testing on button colours and whatnot,
but material design is much better than any of that achieved and that was just
fine by getting some good graphic designers and thinking about it.

~~~
nradov
But material design is garbage?

~~~
IshKebab
I think you're probably in the minority.

------
DanBC
People may also be interested in this:

"Researchers and innovators requiring access to data to help solve complex
health and care challenges are invited to apply to participate in Health Data
Research UK’s Sandbox."

[https://www.hdruk.ac.uk/news/call-for-applications-to-
test-3...](https://www.hdruk.ac.uk/news/call-for-applications-to-
test-37-5m-new-uk-health-data-research-services/)

------
wwqrd
TLDR version: “it’s making it too hard to privatise services”

