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
- 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
- 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.
- 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
- 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.
- 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.
- 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.
- 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
- 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
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC9581762/
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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