The problem with clicks, keystrokes and screenviews in healthcare


When I recently conducted a focus group comprised of senior healthcare technology practitioners I must admit I was taken aback by what these graduates from prestigious medical and technology universities felt was one of their top concerns.

Clicks ! Yes, Clicks !

As the videos of the session would confirm, I needed to ask the first panelists who brought this issue up to repeat the word to be sure I understood it. Those in the healthcare world know there are virtually hundreds of acronyms in the industry and I was unsure if it was just something that sounded like “click” but was actually some new government policy called “C.L.I.Q.E.”

But no, it literally was “click” as in what one does with a mouse. Reducing clicks was a top priority.

No one likes clicking any more than they need to whether in a manufacturing company or a travel agency. But my recent experience tells me that no group loathes clicking more than those in the healthcare space, especially at the patient facing level.

This was reinforced by one Chief Medical Information Officer (CMIO) who claimed he literally had nightmares about all the click complaints he gets from clinicians. Making the matter worse was that his wife is an anesthesiologist and that she complains about clicks when she comes home from work.  He said that reducing clicks was actually a key KPI on which he was graded by senior management.

He was not alone. The Chief Medical Officer and the Clinical Nurse from a neonatal ICU unit on the panel were even more passionate about their disdain for clicks and how their wrath is directed to their own CMIO’s. They were quick to point out surgeons who have one hand in the patient and another on a device that requires them to glance away for a few critical seconds during the life saving procedure. When clicks were coupled with keystrokes the frustration level increased exponentially.

One panelists said we’re creating a profession of medical typists rather than caretakers. Keep in mind that in many systems doctors can no longer delegate the task of typing. Consider that handing a post-it note to a nurse — if that note has a medication written on it to be entered into a system — is grounds for firing.

Clicks and keystrokes were not alone on the list of technology gripes. About same degree of disdain was for the number of screen views it took to get to the data needed during a patient engagement. In some cases there needed to be two totally different terminals in the room to get the data. Surprisingly, in the case where it could be retrieved on a single platform ,they needed to negotiate numerous menus and scrolls to get to the patient profiles. Also surprisingly, many of the mainstream electronic health record platforms do not provide reliable usability metrics on movements like pull down menu usage and screens-to-get-to-critical-data ratios (there must be an acronym for that). One attendee from the Veterans administration said they needed to send out “usability observers” to sit behind healthcare workers to manually count the number of screens and clicks to get to critical care data.


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