When is a defibrillator not a defibrillator? When it's like a clock radio.... The challenge of usability and patient safety in the real world.

Fairbanks et al describe how usability testing can be used to uncover medical device design flaws that compromise the safe and efficient delivery of care. Their experience is consistent with other published reports, which tested readily available technologies and found dramatic human-automation interactions problems that could be linked to poor device design. These findings are likely the tip of a proverbial iceberg of medical technology and devices, that, by design, have limited usability. And yet health care delivery organizations continue to purchase devices and information technologies that lack usability. This brings up many questions. Why do hospitals and health care providers continue to purchase devices and technology with poor usability? Why don’t manufacturers address these shortcomings? And how, if at all, are regulatory agencies involved in this problem? After all, the US Federal Aviation Administration, Department of Defense, Department of Transportation, Nuclear Regulatory Commission, Department of Energy, and the National Aviation and Space Administration use usability and human-factors engineering design. The full answers to these questions are the subject of textbooks, PhD theses, and international meetings. We examine 3 of the major issues that we believe in part address those questions: lack of understanding usability science, lack of good usability testing practices, and lack of market demand for usability.