Error Prevention

Minimize Memory Load

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Consistency	Visiblity	Match	Minimalism	Memory	Feedback	Flexibility
Error Messages	Prevent Errors	Closure	Undo	Language	Control	Help
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It is always better to design interfaces that prevent errors from happening in the first place.

Promote data quality to reduce the occurrence of errors. Anticipate typical user errors. Always provide sufficient instructional information to support data quality and ensure such information is easily visible. For example, normal or recommended range of data should be displayed in default where appropriate or can be easily accessed by users. System must remain stable. Do not permit automatic changes to measurement systems (e.g., lb vs. kg) or replacement of critical threshold following system-wide crush. Any important changes and updates must be notified to users before they act to mitigate the potential errors from unexpected actions.

Eliminate error-prone conditions is also important. For example, invalid or inappropriate selection items or entries can be misleading and advance risks of mis-selection and misinterpretation. Figure 1 shows another typical error-prone condition, where the input box is not wide enough for the users to see the entered data. This advances the possibility of selecting wrong drugs with similar names to the desired drug. Any such conditions that could lead to user errors should be considered and avoided in design.

Figure 1:

This example is bad because the input box is not wide enough to see the entered data.

Ensure automatic check for entered data and provide alerts or reminders for inappropriate data entries to reduce errors. Alerts need to be compatible with, and exist within, the messaging framework. For example, flag that an intended dose is out of normal range. Systems in clinical setting should be able to incorporate alerts into a more complex message structure. Supporting alerts for contraindicated procedures is a good example. Details regarding alert design can be found at Good Error Messages.

Guidelines summary:

Sufficient support information

Display weights in grams and ages in days, weeks, or months under thresholds. [4] NIST7865 VIII p.28
Display normal ranges for medication doses and lab values based upon weight, height, Body Surface Area, Body Mass Index, and age information. [4] NIST7865 III-E p.21
Support custom formulations for liquid medications. [4] NIST7865 II-E p.18
Display sufficient instructional information to support data quality.[3]
Explanations will be available for any alert or preference.[3] CUI (Design Guidance Exploration - Decision Support) p.5
Display the recommended dose range for the selected mg/kg dose.[4] NIST7865 II-H p.18
Support the presentation of drugs with different characteristics (such as Significant Duration, Once Only or As Required drugs) within one view. [3] CUI (Design Guidance) p.21
Distinguish individual clinical phrases from one another, for example through visual format.[3] CUI (Design Guidance - Displaying Adverse Drug Reaction Risks) p.7
Design for working memory limitations. [2] Usability.gov 2:5
Display sufficient information for an accurate interpretation of the administration schedule (past, current and planned) and status of administration events within a relevant time interval. [3] CUI (Design Guidance - Drug Administration) p.21
Mitigate the potential for action to be taken without sufficient information by presenting carefully selected information and explicit labels to clarify what information is displayed and the extent to which it is complete. [3] CUI (Design Guidance - Displaying Adverse Drug Reaction Risks) p.21
Spell out abbreviations, initializes, and acronyms, and immediately follow them by the abbreviation, in the first instance. [1] Nielsen’s 25
Define acronyms and abbreviations.[2] Usability.gov 15:4
Display sufficient content to allow users to act. [3] CUI (Design Guidance - Displaying Adverse Drug Reaction Risks) p.7
Describe substances at an appropriate level, in order to help the user act appropriately.[3] CUI (Design Guidance - Displaying Adverse Drug Reaction Risks) p.7
Use descriptive tab labels.[2] Usability.gov 7:6
Organize information clearly.[2] Usability.gov 16:1
Ensure that necessary information is displayed.[2] Usability.gov 16:3
Label data entry fields clearly. [2] Usability.gov 13:5

Eliminate error-prone conditions.

Mitigate the risks of mis-selection and misinterpretation.[3] CUI (Design Guidance - Search and Prescribe) p.15
Support updating information that is initially inaccurate or unknown (e.g., last names, sex, and weight). [4] NIST7865 VII-B p.27
Support communications to change inaccurate normal ranges. [4] NIST7865 VI-A p.26
Input boxes should be wide enough for users to see and edit standard queries on the site. [1] Nielsen’s 48
Avoid misleading cues to click.[2] Usability.gov 10:4
Protect against mode errors for mg/kg dosing and ml dosing.[4] NIST7865 II-A p.17
Maximize safety in the absence of decision support systems by designing for the reduction of errors from invalid. [3] CUI (Design Guidance - Search and Prescribe) p.15
Minimizing opportunities for human error.[3] CUI (Design Guidance - Patient Banner) p.4
Promoting data quality to reduce the occurrence of errors. [3] CUI (Design Guidance -- Email Input and Display) p. 3
Do not permit changes to measurement systems (e.g., lb vs. kg) unless initiated by the user. [4] NIST7865 IV-A p.22
Do not permit replacing pediatric-specific thresholds with default adult-based thresholds following a system-wide crash. [4] NIST7865 III-B p.20
Support corrections to plotted data.[4] NIST7865 IV-K p.23
Do not permit automated defaults to adult doses.[4] NIST7865 II-D p.18
Avoid truncation of medication names and dosages in menus. [4] NIST7865 II-J p.19
Phrasing of menu items: use familiar and consistent terminology, ensure that items are distinct from one another, use consistent and concise phrasing, and position the key words to the left of the text string.[3] CUI (Design Guidance - Recording Adverse Drug Reaction Risks) p. 15
Minimize content in order to reduce the risk of misleading the user. [3] CUI (Design Guidance - Recording Adverse Drug Reaction Risks) p.7
Describe substances in a common, unambiguous terminology (where possible).[3] CUI (Design Guidance - Recording Adverse Drug Reaction Risks) p.7
Place important Items consistently.[2] Usability.gov 6:2
Highlighting information.[2] Usability.gov 11:11
Minimize user data entry.[2] Usability.gov 13:6
Minimize visual clutter so that formatting and icons are effective for providing emphasis and implying priorities: draw attention to important information without introducing too much distraction. [3] CUI (Design Guidance - Medication Line) p.9
Order lists appropriately. [3] CUI (Design Guidance - Recording Adverse Drug Reaction Risks) p.7

Use informative feedback.

Support alerts for contraindicated procedures. [4] NIST7865 IX-B p.30
Flag that an intended dose is unusual. [4] NIST7865 II-B p.17
Cap the dose at the standard adult dose and allow override with justification.[4] NIST7865 III-D p.20
Alerts need to be compatible with, and exist within, the messaging framework. [3] CUI (Design Guidance Exploration - Decision Support) p.5

Please note:The content provided here are intended as guidelines (recommended, but not mandatory) for design and implementation, not as standards (mandatory, minimum requirements).

References:

[1] Nielsen J. 113 design guidelines for homepage usability. 2001; Available from:www.nngroup.com/articles/113-design-guidelines-homepage-usability.

[2] U.S. Dept. of Health and Human Services. The Research-Based Web Design & Usability Guidelines, Enlarged/Expanded edition. Washington: U.S. Government Printing Office, 2006. Available from: https://www.usability.gov/.

[3] Microsoft. Microsoft Health Common User Interface design guidance. 2012; Available to download from: https://archive.codeplex.com/?p=mscui. (Design Guidance - Find a Patient PDF).

[4] Lowry SZ, Quinn MT, Ramaiah M, Brick D, Patterson ES, Zhang J, et al. A human factors guide to enhance EHR usability of critical user interactions when supporting pediatric patient care. The National Institute of Standards and Technology; 2012.

NCCD