Tips on optimizing the design process for Healthcare systems - June 25, 2009

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

2. 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

3. 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?

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

5. 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.

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

7. 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.

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

15. 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

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

17. 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?

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

19. 5. Varied familiarity with technology 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.

20. 5. Varied familiarity with technology

21. 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.

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

23. 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): 6. Learn about your users 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..:

25. Fields studies/observations are most valuable.

26. Surveys and interviews help fill the gaps too.

27. Mixing tools is recommended.

28. Find innovative ways e.g., interview professionals at a healthcare conference.

29. Don’t skip the screener (internal or recruiting company).

30. Recruit participants (physicians, patients, etc).

31. Collect qualitative and quantitative information.

32. Be careful with the words you use, be humble.

33. Make participants feel at ease.

34. Gratuities are important.

35. 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.

36. 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. 6. Learn about your users 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.

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

38. 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

39. 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

41. Develop screen flow and navigation model

42. Do walkthroughs of design concepts

43. Begin design with paper and pencil

44. Create low-fidelity prototypes

45. Conduct usability testing on prototypes

46. Create high-fidelity detailed design

47. Do usability testing

49. Work closely with delivery team as design is implemented

51. Conduct field studies to get info about actual use

53. 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

54. 10. Questions? Thank You!Twitter id @SheetalDube