Keeping user efficacy in mind, there's a need to adapt to a user-centered approach while approaching healthcare registry workflow and design.

1. July 2019
UX Design to Improve
User Productivity in
Healthcare Registries
White Paper

2. Healthcare Registries share a long history of joining
forces with providers. It has been a natural partnership
because of a shared goal – provide high-quality
patient care.
A clinical data registry records information about the
health status of patients and the healthcare they
receive over varying periods of time.
Different types of registries track specific aspects of
care –
▪ It may focus on a disease or condition
▪ A specific procedure or medical devices used
They are a well-defined set of data collected by data
abstractors and other healthcare professionals of
provider groups.
Most of the information collected on registry
applications are used to track clinical outcomes with
the aim of identifying best practices and protocols to
improve healthcare quality for patients.
Provider performance incentives and re-imbursements
models depend on providing quality data to
healthcare associations that aid in improving quality of
care.
Additionally, data collected is often used to structure
healthcare policies. This challenges government
regulated bodies / healthcare associations to obtain
high quality, accurate and complete records.
Most of the registry applications are driven by heavily
documented functional requirements that are pre-
defined by these healthcare associations. Such
requirements are created with a shared understanding
of the product’s vision.
To achieve standardization among vendor
applications, key functional requirements need to be
identified and would include –
▪ Key workflows
▪ Interaction behavior of components, modules and
▪ What they provide to the users
OVERVIEW (1/2)
1

3. Despite workflows defined purposefully, users often
face usability challenges undermining their efficiency
of abstraction. This is due to –
▪ Navigation and workflows are designed under
protocol restrictions that often hinder usability.
▪ Lack of good design principles result in situations
where efficiency is compromised.
▪ Cumbersome data represented strictly as per
protocol result in cognitive and visual load.
▪ High volume of user notifications / errors results in
increased tasks for end users to fix.
Keeping the user’s efficacy in mind, there is a need to
adapt to a user-centered approach while approaching
registry workflow and design.
OVERVIEW (2/2)
2

4. The focus of healthcare bodies that enforce protocol-
driven design is to establish standardization in
function and form among vendor applications. While
this is crucial, they minimize usability and overlook
user needs in many aspects and reduce task efficiency.
Functional and design specifications need to be
flexible to provide the intended value and
simultaneously adapt to contextual user needs.
Case Example: Export Workflow
NCDR protocol guideline states - ‘The vendor’s
software must contain an export utility located in the
NCDR Maintenance area of the data collection tool.
This utility (e.g., screen/page/form) must permit the
participant to export quarterly data for submission to
the CathPCI Registry’.
As the extract specifically suggests an ‘export action’
on an export screen only, vendors tend to comply with
the specifications to avoid uncertainties that their
products may not receive the necessary accreditation
and are hesitant to optimize any task flows.
In fig. 1.1, The protocol-driven approach results in a
confused navigation, forcing users go back and forth.
Users must restart their (export) task right from the
beginning post fixing errors. As a result, users' loose
context, increasing their chance of making new errors.
CHALLENGE CURRENT PRE-DEFINED WORKFLOWS (1/2)
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Fig. 1.1
Protocol Driven Approach

5. This lowers their confidence while interacting with the
application. While the suggested usability-driven
approach (Fig 1.2) not only completes the user task
flow but also helps abstractors to be more efficient
and allows them to complete their goal quickly.
4
Fig. 1.2
CHALLENGE CURRENT PRE-DEFINED WORKFLOWS (2/2)

6. Applications with cumbersome data demand adequate
order that vendors could follow. Sequence of datasets
and content in most protocols are well defined and
illustrated. The aim is to ensure that the exported data
and reporting remain in a standardized format for
clinicians to analyze.
Case Scenario of a Registry Design Driven by
Protocol
Here, the sequence, language and structure of forms
are pre-defined and need to be strictly followed by
vendors. The data is pre-defined to maintain
standardization. Datasets within the forms reveal that
changing the sequence within existing datasets may
not affect clinician’s exported data, as the rules and
sequence for export can be coded as per instruction.
Although, shifting the sequence and granting flexible
formatting may drastically reduce the cognitive and
visual load for abstractors. It may also help group
relevant elements for an abstractor to accelerate the
form filling process.
Case Example: Parent-Child Relationships
A usability-driven approach helps data forms to –
▪ Visually look shorter, psychologically increasing the
speed in which they are targeted
▪ Present contextual and interrelated information to
stand together
▪ Minor alterations to the sequence also help
improve the over-all visual representation
FLEXIBILITY IN FORMATTING, ORDER AND SEQUENCE OF DATA
5
Fig. 1.3

7. User Notifications are considered as double-edged
swords.
Error notifications often evoke mixed reactions from
users. The purpose is to persuade users to take
immediate action and help them focus on priorities
within workflows. While these notifications help inform
users on taking necessary action, an excessive use
across the application might hinder workflows and
frustrate users.
High volume of error notifications often results in an
additional task of ‘error fixing’ for users. Often these
situations can be resolved by proactively limiting the
occurrence of an error.
For instance, consider an SSN Field ID with a pre-
defined 9-digit number assigned to a citizen or zip
code. Instead of allowing the user to free input digits,
which if exceeded would result in an error notification.
One may think about limiting and designing the form
component to accept only 9-digit numerical values,
rather than having the field throw an error on wrong
data input.
As designers, it is our responsibility to identify fields
and data that require an error notification (such as
clinical or procedural fields) and those which can be
avoided (general demographic or administrative
fields).
This would help minimize the errors to be fixed by
users. It will also help in regaining their confidence,
attention and focus while attempting the task at hand.
JUDICIOUS USE OF USER / ERROR NOTIFICATIONS
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Fig. 1.4

8. 7
CONCLUSION
Healthcare interfaces, which are rife with data tables,
excess controls, and information-packed screens with
minimal imagery need genuine usability improvements
and continuous practice of human-centered design.
Iconography can be challenging to ensure icons
represents its functionality. Information architecture is
deep, and the cross-functional nature of most
workflows makes it difficult to develop strict
navigational paths.
Systems in healthcare are driven by regulations (mainly
financial) to ensure compliance (which maximizes
compensation), quality of care and security. This often
places good design at the bottom of the priority list.
Doctors, Pharmacists, Nurses, and other healthcare
professionals lack the IT / technical skills to work in a
digital environment, and well-designed applications
should help them optimize and not hinder their
workflows.
It is imperative to have a human-centered approach
and protocols where function and design should focus
on the end user’s contextual need and practice. This
will help users to be more efficient and deliver
monetary savings for provider groups.

9. 8
REFERENCES
▪ https://www.abms.org/media/1358/what-is-a-clinical-data-registry.pdf
▪ https://www.thecentrehki.com.au/news/feeding-a-culture-thats-hungry-for-ux/
▪ https://online-journals.org/index.php/i-jim/article/download/2373/2561
▪ https://cvquality.acc.org/NCDR-Home/data-collection/what-each-registry-collects
▪ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994955/

10. 9
ABOUT THE AUTHORS
Rishi Mathur
Head User Experience Design, CitiusTech
rishi.mathur@citiustech.com
Rishi has 18+ years of experience in strategizing and crafting, delightful user experiences for large enterprise
solutions which meets business objectives and user needs. He has consulted clients implementing user-centered
design methodologies and setting up mature design processes across domains like healthcare, e-commerce, travel,
telecommunications and BFSI. He has coached 1100+ design professionals across globe on user-centered design
methodologies and practical design skills.
Shruti Sadani
Asst. Manager, User Experience Design, CitiusTech
shruti.sadani@citiustech.com
Shruti is a multidisciplinary designer with 7+ years of global consulting experience in improving business
decisions using empathy and human-centered design. She has designed experiences for brands across Healthcare,
Retail, Food and Beverage, Education and other Digital segments. In her current role, she is leading and influencing
business and user-experience discussions around healthcare provider, payer and patient applications. Graduated
from the Hong Kong Polytechnic University, she holds a Masters in Design Strategies.

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