The document discusses user-centered design of data tools and health IT systems. It emphasizes that systems should be designed based on how humans perceive, process, and use information (human factors research) rather than just focusing on what computers can do. Well-designed interfaces can improve outcomes, such as a behavioral intervention credited with saving 58,000 injuries and $655 million per year by reducing car crashes. The document advocates asking how systems can augment human cognition rather than automate it.

1. The Science of User-
Centered Data Tools
June 2, 2014
Bradford W. Hesse, PhD
Chief, Health Communication and Informatics
National Cancer Institute
Monday, June 2, 14

2. What behavioral
intervention was credited
with saving 58,000 injuries
per year, & saving
$655,000,000 per year?
Question:
American
Psychological
Association (2004)
Monday, June 2, 14

3. Question:
American
Psychological
Association (2004)
Monday, June 2, 14

4. Why?
Human Factors research
focused squarely on user’s
perspective: Cognitive &
perceptual demands
Intervention based
on human-system
integration
Monday, June 2, 14

5. 4.3% in rear end
collisions
92,000 crashes / year
58,000 injuries / year
$655,000,000 in property
damage
Return on Investment
(ROI)
Monday, June 2, 14

6. “Travel agents
selected flight
on first line
more than half
the time”
American Airlines
Sabre System
Data design effects
November Line of Sale Analysis, memo to R. E. Murray from S. D. Nason,American Airlines, Dec. 3, 1981.
Monday, June 2, 14

7. Website designs
reshape travel &
other industries
Sabre system
becomes
Travelocity
Data design effects
November Line of Sale Analysis, memo to R. E. Murray from S. D. Nason,American Airlines, Dec. 3, 1981.
CONSUMER ACCESS SHIFTS MARKET
Monday, June 2, 14

8. Interface wars part of new business
Microsoft DOS
Graphical User
Interface
Monday, June 2, 14

9. Targets in Medicine?
Monday, June 2, 14

10. Nudging Best Practice:
HITECH & Behavior
Source: Hesse, Bradford W.,Ahern, David K., & Woods, Susan S. (2011). Nudging best practice:
the HITECH act and behavioral medicine Translational Behavioral Medicine, 1(1), 175-181.
• Incentives
• Understand Mental Maps
• Defaults
• Give feedback
• Expect error
• Structure decisions
Monday, June 2, 14

11. Stakes are high
Monday, June 2, 14

12. Stakes are high
Monday, June 2, 14

13. Data smog
• Decisional
paralysis
• Confusion
• Risky behaviors
• Frequent errors
• Avoidance
Source: Shenk, David. (1997). Data smog : surviving the information glut (1st ed.). San
Francisco, Calif.: Harper Edge.
Consequences
Monday, June 2, 14

14. The case of Hugo Campos
Source: Dave deBronkart, through ONC (http://www.healthit.gov/)
Monday, June 2, 14

15. The case of Hugo Campos
Source: Dave deBronkart, through ONC (http://www.healthit.gov/)
Monday, June 2, 14

16. The case of Hugo Campos
Source: Dave deBronkart, through ONC (http://www.healthit.gov/)
Monday, June 2, 14

17. ROI will go to
best design
for each user
niche
Interfaces across ecosystem
Source: Hesse BW, Hansen D, Finholt T, Munson S, Kellogg W, Thomas JC. Social Participation in Health 2.0. IEEE Computer.
2010;43(11):45-52.Monday, June 2, 14

18. Human System Integration
Monday, June 2, 14

19. History: Bad Design Led to
Catastrophic Error
Monday, June 2, 14

20. Mechanistic World View
• Actors: Engineers, biological scientists
• Question: How can we create new
technologies?
• Focus: Physical Object
Humanistic World View
• Actors: Social scientists, physicians
• Question: How can we create new
people?
• Focus: Person
Competing WorldViews
Monday, June 2, 14

21. Source:Vicente, Kim J. (2003).The human factor : revolutionizing the way
people live with technology (1st ed.). NewYork:Taylor and Francis Books.
Human System Integration
Monday, June 2, 14

22. Knowledge in the Head*
Knowledge in The World*
Task Relevant
Schemata
General model
Monday, June 2, 14

23. Computer Human Interaction
Don Norman, 1988
Jakob Nilsen: 1993, 1999
Shneiderman & Plaisant:
2010 edition
DHHS: 2004
Monday, June 2, 14

24. • Strive for consistency
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
See: www.usability.gov
Consistency within
application
Consistency across product line
Predictable Controls
Monday, June 2, 14

25. • Strive for consistency
• Cater to universal usability*
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
Sir Jonathan Ive
*universal across experience, literacy, physical ability, profession
Monday, June 2, 14

26. • Strive for consistency
• Cater to universal usability
• Offer informative feedback
Eight Golden Rules
Shneiderman & Plaisant:
2010 editionSeriously?!
Monday, June 2, 14

27. • Strive for consistency
• Cater to universal usability
• Offer informative feedback
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
Good design:
sequence, progress,
action all indicated
Monday, June 2, 14

28. • Strive for consistency
• Cater to universal usability
• Offer informative feedback
• Design dialogs to yield closure
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
user goal
Deep Support
Monday, June 2, 14

29. • Strive for consistency
• Cater to universal usability
• Offer informative feedback
• Design dialogs to yield closure
• Prevent errors
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
Monday, June 2, 14

30. • Strive for consistency
• Cater to universal usability
• Offer informative feedback
• Design dialogs to yield closure
• Prevent errors
• Permit easy reversal of actions
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
Monday, June 2, 14

31. • Strive for consistency
• Cater to universal usability
• Offer informative feedback
• Design dialogs to yield closure
• Prevent errors
• Permit easy reversal of actions
• Support internal locus of control
Eight Golden Rules
Shneiderman & Plaisant:
2010 edition
Monday, June 2, 14

32. Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
Source: Hesse BW, Shneiderman B. eHealth research from the user's perspective.Am J Prev Med 2007;32(5 Suppl):S97-103.
Asking the Right Question in H.I.T.
Monday, June 2, 14

33. STOP asking the wrong question
Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
“Expert systems in medicine turned out to be
brittle, impracticable, and nontransparent. In
short, they turned out to be bad medicine.”
Source: Hesse BW, Shneiderman B. eHealth research from the user's perspective.Am J Prev Med 2007;32(5 Suppl):S97-103.
Monday, June 2, 14

34. START Answering Right Question
Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
David
Brailer,
First
Na4onal
Coordinator
for
Health
IT
“Everyone thought Health I.T.
was about computers, but we’ve
refined that to say that IT is
about healthcare — it’s about the
experience we really have.”
Source: 1.
Brailer
D.
Ac/on
through
collabora/on:
a
conversa/on
with
David
Brailer.
The
na/onal
coordinator
of
HIT
believes
that
facilita/on,
not
mandates,
are
the
way
to
move
the
agenda
forward.
Interview
by
Robert
Cunningham.
Health
Aff
(Millwood)
2005;24(5):1150-­‐7.
Monday, June 2, 14

35. STOP asking the wrong question
Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
“Intelligent
Agent”
misfires
Root
Cause:
Over-­‐Reliance
on
“Autopilot”
Monday, June 2, 14

36. Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
START Answering Right Question
Reminder
System
Source: Hesse
BW.
Enhancing
Consumer
Involvement
in
Health
Care.
In:
Parker
JC,
Thornson
E,
editors.
Health
Communica/on
in
the
New
Media
Landscape.
New
York,
NY:
Springer
Publishing
Company;
2008.
p.
119-­‐149.
Monday, June 2, 14

37. STOP asking the wrong question
Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
*Zuboff S, Maxmin J.The support economy: why corporations are failing individuals and the
next episode of capitalism. NewYork:Viking; 2002.
Monday, June 2, 14

38. Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
START Answering Right Question
Source:
Hesse
BW.
Harnessing
the
power
of
an
intelligent
health
environment
in
cancer
control.
Stud
Health
Technol
Inform
2005;118:159-­‐76.
.Monday, June 2, 14

39. Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
START Answering Right Question
*Zuboff S, Maxmin J.The support economy: why corporations are failing individuals and the
next episode of capitalism. NewYork:Viking; 2002.
Monday, June 2, 14

40. STOP asking the wrong question
Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
Charlie Chaplin in
“Modern
Times” (1936)
Monday, June 2, 14

41. Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
START Answering Right Question
HITECH Switches Emphasis to
“Meaningful Use”
Monday, June 2, 14

42. Wrong Question:
X What can the computer do?
X How do we automate cognition?
X What is the transactional gain?
X How do we get users to conform?
Better Questions:
✓ What can humans do?
✓ How do we augment cognition?
✓ What is the relational gain?
✓ How do we optimize
sociotechnical balance?
START Answering Right Question
Source: Blumenthal, D. (2010). Guiding the health information technology agenda. Interviewed by David J. Brailer.
Health Aff (Millwood), 29(4), 586-595.
David Blumenthal
Monday, June 2, 14

43. Research on
Communicating Data
Monday, June 2, 14

44. Making Data Talk
Inform Support
Decisions
Educate Persuade
Adapting to a World of Ubiquitous Data Systems
Monday, June 2, 14

45. Making Data Talk
Inform Support
Decisions
Educate Persuade
Adapting to a World of Ubiquitous Data Systems
Monday, June 2, 14

46. Making Data Talk
Inform Support
Decisions
Educate Persuade
Adapting to a World of Ubiquitous Data Systems
Monday, June 2, 14

47. Making Data Talk
Inform Support
Decisions
Educate Persuade
Adapting to a World of Ubiquitous Data Systems
Monday, June 2, 14

48. Chapter 4:Visual Displays
Monday, June 2, 14

49. SOURCE: http://alleydog.com/topics/sensation_and_perception.php
Perceptual Basics
Monday, June 2, 14

50. source: Carpenter PA, Shah P. A model of the perceptual and conceptual processes in graph comprehension.
J Educ Psychol. 1999, 91(4): 690-702.
• Constructive process
• Gaze goes to center
for pattern
• Contiguous labels for
meaning
• Left to right tendency
in western culture
• Perceptual rules
guide meaning
Cognitive / Perceptual
Research
Monday, June 2, 14

51. source: Carpenter PA, Shah P. A model of the perceptual and conceptual processes in graph comprehension.
J Educ Psychol. 1999, 91(4): 690-702.
• Constructive process
• Gaze goes to center
for pattern
• Contiguous labels for
meaning
• Left to right tendency
in western culture
• Perceptual rules
guide meaning
Visualizing Long Term
Change
Monday, June 2, 14

52. • Constructive process
• Gaze goes to center
for pattern
• Contiguous labels for
meaning
• Left to right tendency
in western culture
• Perceptual rules
guide meaning
Hans Rosling, BBC
Visualizing Change
Dynamically
Monday, June 2, 14

53. Monitoring for Change
in EHR Systems
Aging In Place, Intel
Rule of Thumb* for
“Big Data” Systems
•Overview
•Zoom / filter
•Details on demand
*Ben Shneiderman
Monday, June 2, 14

54. Biases & Heuristics
Monday, June 2, 14

55. Overcome “small numbers” bias
Monday, June 2, 14

56. Exceptional Case
Fallacy of small numbers;
Tversky & Kahneman, 1971
Illnesses
322,000,000
Hospitalizations
21,000,000
Prevented
Deaths
732,000
Monday, June 2, 14

57. Improving Decision Making
Problem: Conditional (Bayesian) probabilities
are counter-intuitive, arcane for practice.
source: Gigerenzer, Gerd, & Hoffrage, Ulrich. (1995). How to improve Bayesian Reasoning without
Instruction: Frequency Formats. Psychological Review, 102(4), 684-704.
For example:
Monday, June 2, 14

58. 95 out of 100 physicians
estimated 70-80% instead
of a correct 7.8%
Improving Decision Making
Problem: Conditional (Bayesian) probabilities
are counter-intuitive, arcane for practice.
source: Gigerenzer, Gerd, & Hoffrage, Ulrich. (1995). How to improve Bayesian Reasoning without
Instruction: Frequency Formats. Psychological Review, 102(4), 684-704.
For example:
Monday, June 2, 14

59. Natural frequencies work better
source: Gigerenzer, Gerd, & Hoffrage, Ulrich. (1995). How to improve Bayesian Reasoning without
Instruction: Frequency Formats. Psychological Review, 102(4), 684-704.
Monday, June 2, 14

60. See: Fagerlin,A., Ubel, P.A., Smith, D. M., & Zikmund-Fisher, B. J. (2007). Making numbers matter: present and future research in risk
communication.Am J Health Behav, 31 Suppl 1, S47-56.
Icon arrays convey natural
frequencies more effectively
Monday, June 2, 14

61. Portraying trends to policy makers
Choropleth Maps: CDC Obesity Trends, BRFSS 1985
Monday, June 2, 14

62. Nonsegmented geographic data
Isopleth “Weather Maps,” HINTS
Monday, June 2, 14

63. Juxtaposing geographic distributions
Mortality Maps (SEER):
Lung Cancer Mortality
For Example:
Knowledge Maps (HINTS):
Does Smoking Cause Cancer?
Monday, June 2, 14

64. Added User Controls
14 datasets spanning 6 years
NSF, NIH
Collaboration
Disolving Barriers Between
Clinical and Community Health
Monday, June 2, 14

65. Added User Controls
14 datasets spanning 6 years
NSF, NIH
Collaboration
Disolving Barriers Between
Clinical and Community Health
Monday, June 2, 14

66. Disparities Frame
Framing Effects
Monday, June 2, 14

67. Disparities Frame
Impact Frame
Framing Effects
Monday, June 2, 14

68. Disparities Frame
Impact Frame
Progress Frame
Framing Effects
Monday, June 2, 14

69. Disparities Frame
Impact Frame
Progress Frame
Framing Effects
3.25
3.5
3.75
4
4.25
4.5
4.75
5
Progress Impact Disparity
Lo
Hi
3.5
3.75
4
4.25
4.5
4.75
5
Low Mistrust
High Mistrust
I want to be screened for colon cancer?
Framing X Medical Mistrust Questionnaire
Best influence on
behavior
Monday, June 2, 14

70. Bottom Line
Monday, June 2, 14

71. Data: New “Intel Inside*”
Source: O'Reilly,Tim. (2005).What Is Web 2.0? Design Patterns and
Business Models for the Next Generation of Software.
Tim O’Reilly
Monday, June 2, 14

72. Data = Power
(by itself)
Monday, June 2, 14

73. Data = Power
User Centered*
*i.e., made understandable, actionable, accessible
Monday, June 2, 14

74. Research methods to address gap
See: Brinck, T., Gergle, D., & Wood, S. D. (2002). Designing Web sites that work : usability
for the Web (1st ed.). San Francisco: Morgan Kaufmann Publishers.
Monday, June 2, 14

75. www.slideshare.net/BradfordHesse
http://cancercontrol.cancer.gov/brp/hcirb/
usability.gov
Guidelines
Grants
This slide deck
Thank
you!
Monday, June 2, 14