“Indifference towards people and the reality in which they live is actually the one and only cardinal sin in design.” – Dieter Rams

A current trend in software user interface is called flat design, which tries to:

• Embrace the fact that we are working in a two-dimensional (“flat”) digital workspace (as opposed to a physical item, such as a paper chart)
• Clean up visual appearance by embracing the whitespace and removing unnecessary borders and edging.
• Focus keeping the interface minimalistic and efficient.

An example of efficient design that comes to mind is described in Steve Jobs’ biography, where he had recognized (and demanded) the need to limit any user action to as few steps as possible while designing the original iPod with the click wheel.

Flat design is the next evolution of Dieter Rams ten principles of good design.

Compare this to skeuomorphism, defined in this interactive infographic, as “a design element of a product that imitates design elements that were functionally necessary in the original product design, but which have become ornamental in the new design.”

Skeuomorphic design is highly prevalent in EMR systems, which try to mimic paper medical records. The problem with this is assumption that most physicians are used to using paper charts, and that imitating these old design elements electronically is going to improve user experience. As in the Dieter Rams quote above, indifference to the reality that EMRs need to be updated to the modern electronic world is a cardinal sin in their design.

In fact, efforts to make EMRs mimic paper charts may be making usability and understanding worse, increasing training time to as much as 12 hours. Many have an array of redundant, outdated, or unclearly labeled tabs that were previously useful in a paper chart. Most of them still lack any type of advanced search, which is a critical function when trying to make any use of big data. The format by which many lab results and other patient data is often thoughtlessly displayed as just electronic copy of what would previously be printed out, as opposed to a format that is designed to improve understanding and actionability. The simple act of ordering a patient prescription is made much more difficult by trying to copy features of the paper prescription pad, as opposed to giving the clinician ways to make this process more efficient and less error prone. Some examples of poor user interface design in EMRs are beyond explanation.

While I don’t necessarily expect an EMR to be easy to use, we do need efforts made to simplify workflow in the world of modern patient care.

Update (5/28/13): Also check out Designmodo’s Principles of Flat Design

Update (7/2/13): Article from The Economist: What is skeuomorphism?