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Know Your User: User-Centered Design in Healthcare

Designing software is both an art and a science. Software developers by nature think about every possibility and edge case, while designers focus on the most common user paths. Handling unexpected failures gracefully is a hard problem to solve.

I’ve been re-reading the classic book The Inmates Are Running the Asylum, about the natural tension between design and functionality in software. While it’s a bit hard on developers (they don’t all think in ones and zeros and many have fantastic design instincts), many of the problems the book outlines are still prevalent today, and you can also see the architectural problems that are inherited by lack of user-centered design in software that’s been around a while.

User-centered design puts the end-user front and center, and it’s not just about thinking of what ‘jobs’ that user needs to accomplish, but also the users purpose for those jobs and mental state while solving them.

It’s often easier to illustrate a point by what not to do, so let’s start with two recent examples, one from my experience and one from an opinion piece in the New York Times.

Our accountant at Wellpepper uses QuickBooks. QuickBooks is designed for accountants and business owners. It’s the grand-daddy (or mommy) of accounting programs, and has been around in one form or another since 1984, so they should know their users and what they are trying to accomplish pretty well by now. Guess what? They don’t.

Here’s the error message I see when QuickBooks isn’t able to pull up my data.

quickbooks error message

What have you done with my data, Quickbooks?

Isn’t that cute? No, no it’s not. The job I’m trying to do is look at bank balances, profit and loss, expenses, accounts payable, and accounts receivable. QuickBooks has the data that runs the financial side of the business. I’d like to think they know where that data is, and take both the delivery and protection of that data seriously. This isn’t a situation like the now retired Twitter Fail Whale when a tweet isn’t sent. Even Twitter realized that when someone is trying to accomplish a task a cute error message is more frustrating than appeasing. Add QuickBooks’ inappropriate error message to the fact that they can’t display my business data, and that I get this message at least once per day, I start to worry about whether I can trust them.

Now let’s look at healthcare, where trust and empathy are really important. We’re all familiar with the whimsical Verona campus of Epic Systems. People clamor to visit during Epic’s annual conference. It’s a source of pride for employees. Some of that whimsy comes across in cow-splotch login screens. Is that appropriate in a healthcare setting? Well, we have a dog as a logo, so I’m not going to judge. What is never appropriate is making your users feel bad, as this physician outlines in her New York times opinion piece.

But on a recent Monday morning when I logged into so-called Epic Hyperspace for the first time, I was greeted with a pop-up box and an urgent message: “You currently have deficiencies that are either delinquent or will become delinquent within one week. Please complete at your earliest convenience.” https://www.nytimes.com/2019/11/01/health/epic-electronic-health-records.html

First run user-experience is so important. It sets the tone for how people will feel about using your product. Doctors have trained for years to be able to care for patients. Why make them feel lacking, and especially not on the first time they meet you?

We know it’s possible for software to be context aware, and deliver appropriate levels of empathy, and also we know when to sound the alarm. At Wellpepper we take user-centered design very seriously, and work with patients and providers to make sure the messages we send, and the overall experience is appropriate for the people using the software. Our patented adaptive notification system is just one example of this. It changes the type of messages people receive based on how they interact with the application.

Since our application is used by people in both acute and chronic conditions, standard messages also provide encouragement but don’t imply that someone will “recover” or “get better.” In the event that a patient records a symptom that indicates a life threatening emergency, we clear the screen of any other tasks, and display a short and clear alert. (We also alert the care team, but we make sure the patient clearly understands what they need to do next.) These are all examples of being aware of not just what the person needs to do, but their potential frame of mind when doing it.

We think a lot about what to leave out of the software. Someone who is recovering from surgery, or newly diagnosed with a chronic disease has enough to worry about. Figuring out a demanding interface shouldn’t be part of that. We like to think about the minimum information we need to help a patient-self manage, and to help the provider track the patient. As a result, we have what we call a deceptively simple user interface, both for patients and providers.

If you’re interested in how Wellpepper patient engagement platform can help support your patients, get in touch!

Posted in: Healthcare motivation, Healthcare Technology, M-health

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