Refresh Portland, June 25, 2009

User Experience and Healthcare
Sheetal Dube,Sr. User Experience Consultant
Refresh Portland, June 25, 2009

User Experience and Healthcare
Sheetal Dube
Sr. User Experience ConsultantEvantage ConsultingIndustrial Designer (M.DES.)11+ years User Experience2+ years Healthcare
Voice of customer studiesConcepts for medical devicesEducational website on SedationRemote monitoring website redesign
Intranet and extranet for a Fortune 500 company.Set up a design team and process for a large software development firm.
Source: Flickr, pwilson

Outline for today
Emerging concepts in Healthcare
Web 2.0 bridging the gaps
Unmet user needs
Most players are newbie’s
Varied familiarity with technology
Learn about your users
Help them articulate their needs
User Centered Design process for Healthcare
Other challenges
Questions?

1. Emerging concepts
… lots to get excited about
Source: Flickr, benefit of hindsight

1. Emerging concepts
E-Patients:
Patients gathering health information online.
Especially patients with chronic illness and rare illnesses.
User generated content:
Crowd wisdom is better than expert wisdom.
Speed of generating content faster than publishing research.
Participatory medicine:
Shared decision making between patients and physicians.
Better patient compliance due to shared decision making.

2. Web 2.0 bridging the gaps
… between traditional systems and emerging needs
Source: Flickr, downtownpictures

2. Web 2.0 bridging the gaps
Electronic Health Records:
Google Health: http://www.google.com/intl/en-US/health/tour/index.html
Health Vault (Microsoft): http://www.healthvault.com/Personal/index.html
Online concepts:
HelloHealth: https://www.hellohealth.com/main/index.htmlTarget 18-35 (10% of today's market), mainly uninsured, online visits, take second opinions online, send pictures, blogs, online medical records, email exchange part of the medical records, etc.
Patientslikeme: http://www.patientslikeme.com/People with chronic illness, treatment, symptom and outcome-sharing community, patient information turns into data points, patients tap into robust information created by others.
Kaiser Permanente’s My Health Manager: https://www.kaiserpermanente.org/Provides patients access to their health records, make online appointments, etc
Connected heath: http://www.connected-health.org/Remote monitoring for chronically ill and at risk patients.

3. Unmet user needs
… current solutions are short term
Source: Flickr, dreamfreaknicx

3. Unmet user needs
ePatient Dave:
Kidney cancer survivor Dave deBronkart uploaded health records in Google Health.
Using insurance claims to construct the diagnosis made the data unusable.
http://www.forbes.com/2009/04/23/health-internet-records-technology-personal-tech-health.html
Electronic Health Records:
Is the information easy to understand for the patients?
Does it make sense for the physician? Does it work with the clinic workflow?
Do ‘all’ users realize the value?
User voices:
Data entry is a burden – Amy Tenderrich, DiabetesMine
I don’t want to be reminded that I am a patient – Sentiments heard during interviews

4. Most players are newbie's
… at early stages
Source: Flickr,

4. Most players are newbie's
Designers and developers are entering a new territory:
What should the blood pressure trend for vital signs history look like?
How do patients refer to the processes of sending device information to their doctors?
Patient expectations are currently set very low:
We are used to the current workflow and systems http://tiny.cc/RsowR
The current device works great – Heard during interviews with patients.
Role of physicians is changing:
Growing demand for healthcare forces physicians to give up control.
New wave of tech savvy physicians entering the field.
Hospitals and companies are at early stages of accepting change:
Many hospitals are still evaluating digitization.
Innovation might not be a necessity for companies that are market leaders.
Business models are not clear yet:
Who is paying for the change? Patients, organizations, hospitals, insurance companies, etc?

5. Varied familiarity with technology
… adds additional challenges
Source: Flickr, slipstreamJC

PEW Report: The Social Life of Health Information http://tiny.cc/Poera
61% of American adults look online for health information.
The Internet does not replace health professionals.
As usual, there are more readers and listeners than writers and creators.
A majority of e-patients access user-generated health information.
Mobile access and generational shifts will have an effect on social media and healthcare.
E-patients are more engaged with health information.
Patients looking for "just-in-time someone-like-me" to help inform personal health decisions.
One in 3 American adults access social media for health reasons. That's 60% of online users.
Wikipedia is a go-to source among 1 in 2 e-patients. Twitter and other social networks like Facebook -- not so much, but they're still used along with lots of other (non-social but still online) sources.
There is opportunity to engage people to manage chronic conditions on a 24x7 basis given their increasing adoption of wireless, mobile technologies.

Recap Key Challenges
Two big challenges for designing healthcare systems are:
Most stakeholders are at early stages of the revolution.
Users familiarity with technology is varied.

6. Learn about your users
… diverse ways, same goal
Source: Flickr, Maggiesworld, shapeshift, vago

Gather as much information as you can:
Demographic profile
Environment
Attitudes and perceptions
Familiarity with technology
Health conditions
Support system
Age Group:
Gender:
Occupation:
Geographical Location:Attitudes i.e., views on
Technology:
Perception i.e., trust factors: Environment.# outlets (medical device project):
Health Condition:
Support system:
Medications:
Doctor visits:
Scenarios of using the device (current project)
Frequency of doctor visits.
Time spent on computer:
Websites used for work and personal interests:
Online shopping, banking, bill pay:
Other products used like ATM machines, GPS, cell phone, etc..:

CONTEXTUAL INQUIRIES:
Observing users in their environment..
Pros: Terminologies, processes, context, innovation.
Cons: Takes more time and money. Recruiting more difficult.
Gather as much information as you can.
How can you learn about your users:

Make sure you have a plan.
Fields studies/observations are most valuable.
Surveys and interviews help fill the gaps too.
Mixing tools is recommended.
Find innovative ways e.g., interview professionals at a healthcare conference.
Don’t skip the screener (internal or recruiting company).
Recruit participants (physicians, patients, etc).
Collect qualitative and quantitative information.
Be careful with the words you use, be humble.
Make participants feel at ease.
Gratuities are important.
Might need to innovate e.g., charitable donations for gratuity.

SURVEYS:
Helps collect qualitative and quantitative data.
Pros: Easy to implement, more inputs in less time.
Cons: Subtleties get missed, learning is limited.
INTERVIEWS:Face to face or telephone.
Pros: Helps get face time and have a deeper level of understanding about the users than surveys.
Cons: Users rely on memory and thus miss some steps/ details.

Gather as much information as you can.
How can you learn about your users.
What do you do with the details:
Define and prioritize user scenarios.
Make confident design decisions and trade offs.
Facilitate realistic conversations.
Most features could be NEW (not redesigned).
Spark initial concepts, innovate.
Feature 1
Feature 2
Feature 3
OK
Terminology FAILED:Home, Menu, Options, Scroll up, Scroll down, % complete, Icon for wireless connection, keyboard…anything to do with computers.
Navigation/ Interaction FAILED:Highlighting an option and clicking OK.
Which button to click to scroll up?
Learning: Touch-screen seemed intuitive.

7. Help users articulate their needs
… visuals help
Source: Flickr, darydutchy, calramen

Use visualization techniques:
Use sketches, 3D models, etc to help users visualize new ideas/ features.
Create prototypes to demonstrate processes.
Pick realistic scenarios to show/ demonstrate the above.
Show alternate concepts to make it easier for participants to opt out.
Plan for an iterative process:
Plan for smaller/ quicker cycles of learning and improvising.
Start with a broader scope and narrow it down as you get more information.
First, gain confidence about the concept and navigation.
Then focus on detailing and validating the feature set.
7. Help users articulate their needs

8. User Centered Design Process for Healthcare
Specify the context of useIdentify the people who will use the product, what they will use it for, and under what conditions they will use it.
Specify requirementsIdentify any business requirements or user goals that must be met for the product to be successful.
Evaluate designsThe most important part of this process is that evaluation - ideally through usability testing with actual users - is as integral as quality testing is to good software development.
Create design solutionsThis part of the process may be done in stages, building from a rough concept to a complete design.
(ISO 13407: Human-centered design process)
… encourages the iterative approach
Source: http://www.upassoc.org/usability_resources/about_usability/what_is_ucd.html

8. User Centered Design Process for Healthcare
Use techniques to help users understand new concepts.
Show design alternatives.
Select the right tools.
Gather as much information as possible..
Use the details.
First, gain confidence about the concept and navigation or interaction.
Then evaluate the feature set based on user scenarios.
Analysis Phase :
Meet with key stakeholders
Include usability tasks in project plan
Assemble a multidisciplinary
Develop usability goals and objectives
Conduct field studies
Look at competitive products
Create user profiles
Develop a task analysis
Document user scenarios
Document user performance requirements
Design Phase :

Brainstorm design concepts, metaphors
Develop screen flow and navigation model
Do walkthroughs of design concepts
Begin design with paper and pencil
Create low-fidelity prototypes
Conduct usability testing on prototypes
Create high-fidelity detailed design
Do usability testing
Create a design specification

Implementation Phase:

Do ongoing heuristic evaluations
Work closely with delivery team as design is implemented
Conduct usability testing as soon as possible

Deployment Phase :

Use surveys to get user feedback
Conduct field studies to get info about actual use
Check objectives using usability testing

9. Challenges for the Healthcare design process
… if this was not enough

Overall Constraints:
HIPPA laws (patient data, hospital privacy).
NDAs (Non disclosure signed with clients).
Competitive analysis difficult.
Project Plan:
Plan to work across multiple teams i.e., legal, product planning, etc.
Plan to change course during the project.
Plan for higher gratuities.
User Research:
Recruit the right participants.
Get companies internal recruiting team to use a screener.
Work around the participant’s schedule.
Technical Issues:
Not all systems have been updated.
9. Challenges for the Healthcare design process

10. Questions?
Thank You!Twitter id @SheetalDube