A few weeks ago, Wellpepper took a road trip to the American Telemedicine Association conference in Baltimore. In addition to exhibiting and presenting at the venture summit, we also had the opportunity to attend a couple of the pre-conference sessions, which had some excellent content. In particular, one topic that we wanted to highlight was the Human Factors in Telemedicine session.
The session was presented by Patrick Boissy, PhD, Neil Charness, PhD, and Elizabeth Krupinski, PhD. The focus of this session was on HCI (Human-Computer Interaction) and usability – some of the key tenets that we’ve held from the beginning while we built Wellpepper. Based on some of the healthcare-focused software we’ve seen, there is lots of opportunity here. It’s a shame the session wasn’t better attended, but in fairness it was also at 8am on a Sunday.
Dr. Boissy started by illustrating the importance of Human Factors Engineering with two case studies. First he examined Healthcare.gov. He pointed out many engineering failures that have been well documented in the press, the biggest of which was the limited end-to-end testing, which in some cases didn’t even happen until after the launch. Second, Dr. Boissy walked through a study by Desroches, C.M. et al (2013) on EHR adoption. Looking through the taxonomy of barriers to adoption, Human Factors issues are some of the most-cited barriers to technological acceptance of EHR systems. Essentially: doctors and nurses have trouble using the systems.
While EHR and EMR systems are certainly solving a difficult problem, there seems to be a cognitive disconnect in a world where you can go to an Apple Store and buy an iPhone that is easy enough for 2 years olds to use. If highly educated clinicians have trouble using Healthcare IT, what hope is there for the rest of us?
One theme that emerged throughout the morning is that usability is not something can be added on later – it’s infused throughout the software engineering process. This starts at requirements gathering, includes frequent iteration with user feedback, and may culminate in formal user-centric measurements of acceptance.
One practical technique that was shared is Contextual Inquiry – essentially sitting down with the user in a room, watching them perform tasks with prototypes or functioning software, and using this as an opportunity to understand the user’s thought process and conceptual model. It’s also a good opportunity to gather quantitative metrics like time-to-task, enabling you to measure improvements in your product as you iterate.
It’s a deceptively simple idea, but ever since I started using CI during my time at Microsoft, I can attest that it’s a wonderfully powerful technique that almost forces you to build user-centric products. At Microsoft, we had fancy usability labs with cameras, eye trackers, and one-way mirrors, but the technique can be applied simply, and frankly most effectively when you just get out and go visit users. Even just a few users can make a huge difference. I recall one time where my team and I had spent several weeks building a super-smart machine-learned recommender system, but when we put it in front of a user for the first time and gave them a task, they said something to the effect of “okay… but why do I want this?”. Back to the drawing board. This is actually pretty typical. As software professionals, regardless of how well we think we understand the problem, the first time we put a prototype in front of users, I’m never surprised to hear something that causes a big reset because it’s so easy to make false assumptions early on in the design process. One hint: always capture video when you do CI – it’s amazing how much depth you can extract from an hour-long conversation.
Dr. Charness went on to describe some of the specific challenges of building usable patient-facing healthcare solutions. He argued that even something as simple and pervasive as the pill bottle can be hostile to users, and is emblematic of the usability issues in healthcare IT. “Pill bottles seem fine when you have 20/20 vision, good fine-motor control, and are in a brightly lit office. But what about the diabetic patient who lives in a trailer with a single 60W lightbulb?” This is an area where pharmaceutical retailers like Target have been innovating.