Blog post by Colin Hung
This week, #hcldr is teaming up with our friends over on #HITsm for a collaborative chat. Much like our collaboration with #InnoPsy, this will be an opportunity for both communities to explore a single topic from multiple points of view.
For those that aren’t familiar with #HITsm, it is a weekly Twitter gathering where topics relating to Healthcare Information Technology (#healthIT) are discussed. The chat is moderated by Jon Mertz (@jonmertz) and Chad Johnson (@OchoTex) and is held every Friday at 12pm Eastern. More information about #HITsm can be found on their website.
For our collaboration, we will start the discussion on #hcldr in our regular timeslot Tuesday August 5th at 8:30pm Eastern. We will then continue the discussion on #HITsm in their regular timeslot Friday August 8th at 12:00pm Eastern.
The topic we have decided on is one that both the #hcldr and #HITsm communities are passionate about – the design and experience of healthcare software/apps and how patients + physicians + nurses can/should be more involved in their design.
“Inclusive Design” in healthcare is like lower taxes – there’s a lot of talk about it, but it rarely occurs.
What is Inclusive Design? OCAD University defines it this way:
Design that considers the full range of human diversity with respect to ability, language, culture, gender, age and other forms of human difference. Designing inclusively results in better experiences for everyone.
If we apply this to the healthcare context, Inclusive Design, can mean the following:
- Designing less confusing infusion pumps so that harried nurses can set them easily
- Creating apps that allow the font/icon sizes to be increased to accommodate older adults
- Building Electronic Health Record (EHR) software that doesn’t require a physician to constantly look at the screen vs the patient they are with
- Developing contextual tools that will translate personal health data into usable/actionable information for patients
Unfortunately, well-designed healthcare software (and devices) are almost an oxymoron. According to an MPI Group and Medical Economics survey, over 67% of physicians are dissatisfied with the design and function of their installed EHRs. In addition a recent study by Localytics shows that 60% of the apps we download are used less than 10 times which means that their features and functions just aren’t hitting the mark. Don’t believe these numbers? Just go to your local doctor’s office or hospital and I bet it won’t take you long to see staff member struggling in front of their computer screen or tablet.
So why are healthcare applications so poorly designed? There are many reasons (maybe that should read excuses) for this, including:
- Too many stakeholders. Often in healthcare, multiple stakeholders are involved in the creation of apps and tools. There are clinicians, IT folks and administrators all on “equal” footing and each asking for their own special feature. The result is a product that feels like it’s been through a design blender.
- Rushing to market. The healthcare IT space is a very hot market right now. In a rush to capitalize on healthcare (read profit), creators of software sometimes cut corners in order to get something “out there”. Design and user experience are usually the first things to be cut.
- Failing to incorporate the needs/reality of actual end-users. It is not yet common practice to include end-users (patients, clinicians, administrators, etc) in the up-front design process of healthcare software. Some show near-final products to end-users but by then it’s usually too late to make significant changes.
Although it is not a “silver bullet” – including physicians, nurses, administrators, patients or even family in the design of healthcare software can yield vastly improved user experiences as well as unique product insights. Just ask Adrian James, co-founder of Omada Health and former designer at IDEO, who spoke about the patient-centric design process his company used to create a 16-week diabetes prevention program (HT to @MedcityNews):
We literally went out with a single printed piece of paper – it was this concept that we might be able to match people with pre-diabetes into small groups and usher them, in a virtual setting, through this clinical trial. We’d walk with people through their homes, we’d hear their story, and then we’d put this concept in their hands and just let them tell us about what it was. The difficult part, then, was synthesizing all of their perspectives to build the best product possible.
It’s amazing the insight you can gain by “walking a mile” in your user’s shoes. If you have never done this, then I highly encourage it.
A few years ago, I had the privilege of leading a Product Management Team at a Healthcare IT company. When we were about to embark on designing the next generation of the company’s flagship product, we arranged several day-long site visits so that we could observe first-hand how our users were using our product. It was an eye-opening experience.
Each day a small group of us would literally walk around with nurses, physicians and administrators as they went about their daily work. By the end of these visits we had over 100 key observations including:
- Tasks rarely get completed in a single sitting. Nurses and physicians especially are constantly interrupted and need to put aside what they are doing in order to handle the latest urgent situation.
- The poor lighting in many of the hospital areas made it difficult for staff to see screens
- Users struggled with drop-down lists – no matter how large the font was, people would spend a lot of time scrolling and reading in order to ensure they chose the right option
From these three observations we built three features into the product: save-in-progress, the option to change the background color of the screen and icons lists instead of drop-downs.
It is vital that we strive to build applications that are well designed. There is growing evidence that poorly designed healthcare apps are putting patients at risk. Jonathon Feit wrote a blog about this in October 2013:
Few complaints garner broader consensus among Fire and EMS practitioners than that leading manufacturers of electronic patient care records (“ePCR”) have abysmally neglected UX and design considerations. Agencies—and their patients—pay the price through decreased productivity and even lost records.
More recently a study by the Journal of Medical Information Association highlighted several patient safety issues relating to the use of EHRs in hospitals. The study found that most EHR related patient safety issues were caused by: poor presentation of data, software upgrades, data integration and “hidden dependencies” within the software. Just a few days ago, Information Week posted and article that highlighted 10 healthcare apps that pose a danger to patients if they are used. Scary.
So what can we do as healthcare leaders and as #healthIT folks to encourage inclusive design or even just consideration for end-users during the design process? How can we get patients involved? physicians? nurses? Is inclusive design just a pipe dream? or is it something that can truly happen?
To give you a taste of what’s possible when great design thinking is applied in healthcare, take a look at this re-imagined Blood Test that was featured in WIRED Magazine:
Join us Tuesday August 5th 2014 at 8:30pm Eastern Time (for your local time click here) for the first half of the collaborative tweetchat with #HITsm. We will be discussing the following topics:
- T1 As a patient, how do you judge whether an app is useful and usable? What’s your criteria?
- T2 What ideas do you have to make health information more useful or easier to understand?
- T3 What type of healthcare app/software would you most like to see improved by good design?
- T4 How can we get patients, caregivers & providers more involved in healthcare design?
On Friday August 8th at 12:00pm Eastern we’ll conclude the collaborative chat with the following topics:
- T5 In your opinion are healthcare apps/software well designed or poorly designed? Why is this the case?
- T6 Is inclusive design in healthcare a pipe dream? Can patients & providers really be included?
- T7 What can be done to encourage better design in healthcare? Standards? Laws? Peer pressure?
- T8 What are some examples of good design in healthcare – software, hardware or other?
*Note, we may decide to change T5-T8 depending on how the conversation on #hcldr goes earlier in the week. Please keep your eye on the #HITsm website as we get closer to Friday August 8th.
“Physician outcry on EHR functionality, cost will shake the health information technology sector”, Daniel R Verdon, Medical Economics, February 10 2014, http://medicaleconomics.modernmedicine.com/medical-economics/news/physician-outcry-ehr-functionality-cost-will-shake-health-information-technol?page=full, accessed August 2 2014
“App Retention Improves – Apps Used Only Once Declines to 20%”, Localytics, June 11 2014, http://www.localytics.com/blog/2014/app-retention-improves/, accessed August 2 2014
“Why Badly Designed iPad Apps Put Patients at Risk: EMS and ePCR”, Jonathon Feit, The Healthcare Blog, October 8 2013, http://thehealthcareblog.com/blog/2013/10/08/why-badly-designed-ipad-apps-put-patients-at-risk/, accessed August 2 2014
“An Example of Bad Design: This App’s Interface for Entering Blood Pressure”, Leslie Kernisan MD, The Healthcare Blog, April 14 2014, http://thehealthcareblog.com/blog/2014/04/14/an-example-of-bad-design-this-apps-interface-for-entering-blood-pressure/, accessed August 2 2014
“Report diagnoses four types of EHR patient safety problems”, Stephanie Baum, MedCity News, June 23 2014, http://medcitynews.com/2014/06/va-analysis-diagnoses-four-types-of-ehr-patient-safety-problems/, accessed August 2 2014
“Medical Usability: How to Kill Patients Through Bad Design”, Jakob Nielsen, NN/g Blog, April 11 2005, http://www.nngroup.com/articles/medical-usability/, accessed August 2 2014
“10 Health Apps That Might Make You Sick”, Alison Diana, Information Week, July 31 2014, http://www.informationweek.com/healthcare/mobile-and-wireless/10-health-apps-that-might-make-you-sick/d/d-id/1297683, accessed August 2 2014
“Including patients in digital health design: Two startups share how they’ve done it”, Deanna Pogorelc, MedCity News, February 19 2014, http://medcitynews.com/2014/02/bringing-patients-design-process-heres-two-digital-health-startups/, accessed August 2 2014
“Recruiting patients for healthcare design research: why and how to do it”, K M McCurdy, Sensical Blog, April 21 2014, http://sensical.wordpress.com/2014/04/21/recruiting-patients-for-healthcare-design-research-why-and-how-to-do-it/, accessed August 2 2014