Negligence By Design: When Poor User Experience/User Interface In Health Technology Causes Harm To Patient, Is There A Case To Answer? – Healthcare

INTRODUCTION

Technology has revolutionised healthcare, transforming how
patients access care and how professionals diagnose, monitor, and
treat illness. Beyond the physical tools of medicine, such as
surgical equipment or MRI machines an increasingly vital part of
the healthcare system is intangible: digital health technologies,
including telemedicine platforms, electronic health records (EHRs),
and AI-driven diagnostic tools…

These technologies offer tremendous potential. A 2023 World
Health Organisation (WHO) report noted a 30% reduction in
preventable medical errors in facilities adopting advanced
digital systems. Similarly, a 2023 survey by the International
Medical Informatics Association found that 74% of healthcare
organisations using AI-assisted diagnostics reported fewer
misdiagnoses in high-risk areas like stroke and cancer.
Furthermore, a 2022 study by the Journal of Patient Safety
showed that the implementation of AI-based diagnostics reduced
diagnostic errors by 25%. While these statistics highlight the
upside of digital health innovation, they also mask a critical
issue: What happens when the technology fails not because of a
medical error, but due to poor design? When a patient suffers harm
because a digital platform is confusing, inaccessible, or difficult
to use, the question arises is there negligence by design?

This article examines the legal and ethical dimensions of that
question, focusing specifically on telemedicine platforms as a case
study for how poor user interface (UI) and user experience (UX) can
result in patient harm.

TELEMEDICINE

Before we delve into the history of telemedicine, let’s take
a moment to define what it means. According to the Oxford
Dictionary, Telemedicine is the remote diagnosis and treatment of
patients by means of telecommunications technology¹. It
is the delivery of health care from a distance using electronic
information and technology, such as computers, cameras,
videoconferencing, satellites, wireless communications, and the
internet. Also called telehealth.² The history of
telemedicine can be traced back to 1850 when the telegraph was used
to deliver health care. During World War it became important to
communicate with people that are far away for a number of reasons.
One of such reasons is a lack of enough medical personnel at the
war front, and it would be disastrous to rely on letters, as
messages could go missing. As a result, telegraph cables were laid
and transmission of information was made easier. The telegraph made
remote wartime communication possible. It was used to order medical
supplies and transmit casualty reports. The tech was so integrated
that telegraph wagons commonly idled right behind the frontline,
sending and receiving information from the battlefield as
needed.³ Then the advent of the telephone made virtual
consultation easier. Now we have Apps that are designed to provide
health services. Some of these apps use doctors to provide services
to patients, while some use AI, as AI can now diagnose, prescribe
medicine and even provide follow-up on some patients.

LIABILITY IN TELEMEDICINE

Traditionally, healthcare laws place liability on providers for
treatment errors or deviations from medical standards. However, these laws predate
digital health and often don’t address harm caused by flawed
user interfaces or poor UX design in telemedicine areas where AI
and virtual care now play a central role.

In the context of telemedicine, errors can originate from
multiple sources: a misstep by the physician, a malfunction or
limitation in the AI system, or even a design flaw within the
application developed by third-party companies. Between 2014 and
2018, misdiagnosis emerged as the most frequently reported issue in
telemedicine-related health incidents. Interestingly, most, if not
all, of these cases were resolved outside the courtroom, leaving a
legal grey area: should liability rest with the healthcare provider
using the platform, or with the developers and companies behind the
technology itself? The courts have yet to deliver a definitive
answer.

In a situation where a poor user experience/user interface
causes harm, is there a case to answer? Yes, a lot of healthcare
providers are not familiar with the use of technology; hence, they
might encounter problems during the process of using the
technology. Also, some of the developers charged with the creation
of some of the technologies used in telemedicine are not vast in
medicine, so there is a likelihood that an error might occur. The
error might also be from the part of the patient who is not really
vast in the use of the available technology. The issues listed
above create a poor user interface because the features have been
designed in such a way as to make it hard for users to make the
best of it. In a sector like medicine, some of these errors can
cause harm to the patients and in a worst case scenario, it can
lead to death⁴.

In light of the ongoing, it has become imperative to ask the
question: Who would be liable for a harm occasioned by a poor user
interface? Is it the developer whose design made it difficult to
navigate the web or app? Is it the doctor who, although not
familiar with the workings of the app, still proceeded to use it?
Or would the patient be blamed for an error that occurs through
their poor use of the technology? The three parties can all be
liable depending on the role they play. We will discuss instances
where either of the parties would be liable below.

INSTANCES WHERE THE HEALTHCARE PROVIDER WOULD BE LIABLE

1. NEGLIGENCE: The standard in medical practice is that the healthcare
   provider owes the patient a duty of care⁵, where there
   is a breach of this duty, negligence is said to have occurred. As a
   health practitioner, you should take reasonable care when dealing
   with your patients. This duty of care would extend to providing
   services via telemedicine. A healthcare provider who finds it
   difficult to navigate an app due to a poor user experience should
   not use it when providing services to their patient, and if they
   proceed to do that and it results in harm to the client, they will
   be liable for negligence. In Nigeria, the negligence might amount
   to a crime, i.e. criminal negligence and not just a tortious
   liability⁶




2. BREACH OF PRIVACY: Poor user experience may also lead to breach
   of privacy. Some of the technologies employed in healthcare usually
   collect data on patients. A poor user interface can cause the data
   to get into the hands of a third party who might use it wrongly. A
   healthcare provider who knows this and still proceeds to use the
   app or permits the technology to share the data might be liable for
   breach of privacy, which is unconstitutional. Where a healthcare
   provider causes the data of a patient to be disclosed to other
   parties without the necessary leave or exception⁷.




3. USING A HEALTH TECHNOLOGY THAT IS NOT APPROVED BY THE
   GOVERNMENT: A healthcare provider who uses a technology that is not
   certified by the government would also be liable in a case where a
   poor user interface causes harm to the patient⁸.

INSTANCES WHERE THE DEVELOPER OF THE TECHNOLOGY WOULD BE
LIABLE

1. NEGLIGENCE: The principle of negligence in this instance would
   not only apply to the healthcare provider but also to the developer
   of the technology. The developer of a technology ought to take
   reasonable care so that the interface of the technology they
   created won’t cause harm to the users. He owes the user of the
   technology a duty of reasonable care, and a breach of it by
   designing a poor user interface, which amounts to the harm of the
   patient, would amount to the breach of that duty⁹. The
   creator of the technology who created a poor design can also be
   liable under the criminal code for creating something that causes
   harm or endangers the user’s life¹⁰.




2. DESIGN ERROR: Where the poor interface is a result of a design
   error of the developer, they have a case to answer for any harm it
   caused to the patient. A manufacturer has the duty to withdraw a
   hazardous product from the market if they do not and it causes harm
   to the consumer; they will be liable under the FCCPC Act. The court
   has held that where there is a direct link between the product and
   the ailment, the manufacturer would be liable¹¹.




3. FRAUD/MISREPRESENTATION: They can be liable for fraud where
   they hold out that the technology has an interface that it does not
   have. If a company holds out its health technology as something
   that it is not and a patient suffers harm, the developer can be
   liable for fraud or misrepresentation.




4. PUTTING OUT A HEALTH TECHNOLOGY THAT IS NOT APPROVED BY THE
   GOVERNMENT: A developer who commences the use of a technology that
   is not certified by the government would also be liable in a case
   where a poor user interface causes harm to the
   patient.¹²




5. BREACH OF PRIVACY: Like the healthcare practitioner, the
   developer of the technology also has the duty of protecting the
   records of the patient. It cannot sell it to a third party or be so
   careless with its cybersecurity as to amount to the loss of the
   data.

CONCLUSION

Health technology, especially telemedicine, holds immense
promise, but that promise is contingent on thoughtful, inclusive,
and safe design. Where harm arises not from human clinical error
but from digital platforms that are confusing, inaccessible, or
poorly built, the responsibility may shift from the doctor to the
designer.

In such cases, there may indeed be a case to answer ethically,
and increasingly, legally. As healthcare becomes more digitised,
regulators, developers, and providers must treat UI/UX design not
as an afterthought, but as an essential component of patient
safety.

Footnotes

1. Oxford dictionary

2.

3.

4.

5. Section 303 of Criminal code

6. Section 303 criminal code

7. Section 26 National Health Act

8. Section 14 National Health Act

9. Donoghue v. Stevenson.

10. Section 343 criminal code

11. NBC Plc v. Olarewaju (2006)
LPELR-7696(CA)

12. Section 14 National Health Act

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