Healthcare UX: a journey just begun
By: Chris Kiess
Tags: Product Design, UX Design, Healthcare, User Experience, UX

Healthcare UX: a journey just begun

Emerging Trends in Designing for Healthcare

Photo by Hush Naidoo on Unsplash

My journey in healthcare design started as a young(er) information architect. I spent an entire summer, head buried in books, applying my newfound knowledge to a portal project for Eli Lilly. That was fourteen years ago. It was an era in which EMRs were not the norm and rather the exception in hospitals. Doctors were carrying Blackberries and pagers, not iPhones. And, patient access to lab results, medical history and treatment protocols was still largely paper-based. In a little more than a decade, all of that has changed.

In a recent article covering healthcare UX, I cited research stating healthcare, as an industry, is more than a decade behind (in terms of information technology). While that does seem to be true, healthcare has still made significant technological gains in the past decade. In terms of user experience design, I have seen growth as well. It is not uncommon to find more and more designers working in the healthcare sphere (though we do still tend to be a rarity in the UX profession). Yet there are still many miles to journey. There are still many challenges to address in designing for better care.

This is not an article about how UX can save the day or the UX hero. I do not subscribe to the hero story. We work in teams and UX provides value just as product managers, business analysts and developers do. Heroes and rockstars don’t build great products. Teams do.

This is not a story about the future. Though I do enjoy sci-fi, I prefer it in a fictional sense and believe it is a precarious position to put oneself in where one is predicting what one could not possibly know. I am more interested in creating the future than predicting it.

What this article is about is identifying the emerging areas of growth in healthcare design. These are the areas where I see the greatest opportunity to apply user experience design methods and where healthcare is in dire need of our services. This isn’t an all-inclusive list but rather a list of the top areas currently trending.

Interface and Information Design

Interfaces have become ubiquitous in our lives. We carry more computing power in our pockets today than we could have dreamed of a decade or two ago. Perhaps the greatest impact user experience professionals can make in healthcare today is in the design of interfaces and the information they contain. Now, it might seem obvious to place interface design as an area of growth or opportunity for UX designers. But this is not just about drawing up new screens. We need a different approach in healthcare.

The problem in healthcare used to be one of scant information. That is, information either was not connected or had never been recorded. This includes the clinical history of the patient, known treatments and large medical studies published in the academic literature. Today, that problem does often still exist. However, an even greater problem is the current overabundance of information. The interesting thing about this problem is the outcome is the same when there is too little information or too much information. We simply become ignorant in either scenario.

Clinicians simply do not have the time to sift through mountains of data, randomized controlled clinical trials or spend an afternoon on the phone with colleagues for every single patient. UX has the ability to begin designing the information and structuring an interface so the information is delivered at the point of need. Obviously, AI can help in this scenario (see below). But there is much that can be accomplished through good design principles before turning to automation.

Atul Gawande’s article, “Why Doctors Hate Their Computers.” discusses the amount of information a physician must sift through daily to complete their work — patient emails, physician emails, test results, lab results, patient history, etc. There is simply too much information to digest. Establishing sound visual hierarchy, good information design and employing informatics principles to deliver information at the point of need are all efforts that would significantly help, but have been largely ignored in healthcare.

User experience professionals are obviously skilled at mitigating or managing these issues. But it is not as simple as hiring an army of UX designers or researchers to fix the problems. The problems are “wicked” and systemic. Fixing a single interface or product is the equivalent of pouring a single drop of water on a forest fire. Right now, there are too many fires and not enough drops of water, which equates to a great opportunity for UX professionals.

Regulations and Standards

Healthcare is a heavily regulated industry. In many instances, we use guidelines and financial incentives to regulate professionals. Indeed, I have worked on large studies where even the simplest of guidelines such as hand hygiene were a challenge. But while guidelines and regulations often help establish better care, they can often hinder it when they bear no flexibility.

I recently spoke with a nurse who shared details of her day with me in relation to regulations. Hospitals are often not compensated from Medicare if a pressure ulcer develops during a patient’s stay even if it was unpreventable. The resulting action from her hospital is to pull two nurses from their appointed duties upon a new patient’s admission and examine them for any existing pressure ulcers. This ensures an existing pressure ulcer will not result in the hospital being dinged for what existed upon admission. Of course, this examination not only results in two nurses being otherwise indisposed during this time, but it also must be documented in the electronic medical record — a process that puts a nurse in front of a computer instead of a patient.

I authored an article, not too long ago, discussing the “numbers game” in healthcare. Metrics are often used to enforce regulations and result in unintended consequences. Yet we have an even better tool than metrics to regulate clinicians — the EMR (Electronic Medical Record). We often enforce regulations via an interface using checklists, specific tasks and controls in the EMR to ensure clinicians are adhering to care measures that are often financially motivated.

UX can play a large part in establishing some flexibility around regulating the user. Understanding how metrics are used and abused is the first line of defense. We also have the ability to see the larger picture and tell the whole story. And our seat at the table is starting to become more firmly established.

There is a great opportunity for us to reverse the knee-jerk reaction in healthcare where we turn to technology as a means of regulating the user. We can begin to use AI, interface design and good information design to put clinicians back where they belong — in front of a patient, not a computer.

Serving More Than One Master

Healthcare is a complicated industry. It is an industry that must turn a profit in order to continue providing services to the ill. In many respects, the user experience is unlikely to largely affect the financial impact of the industry unless it is fully realized. The greatest impact UX can have regards the efficiency of the tools we work (in partnership) to create. Before we can tackle that effort, however, we must clearly set our priorities and determine who we service. That is, which master will we serve?

If we serve the business needs, we’ll create products that are extremely efficient with all of the financial incentives and rules in place to regulate the users. If we service the clinicians, we’ll build tools that make their lives easier but may not serve the business or the patients well. If we place patients as our top priority, we’ll likely establish a noble goal that, with careful pursuit, could serve business and clinician interests. However, even this latter goal could result in an extreme imbalance.

Last year I was in a meeting where our team was faced with a dilemma. If we went one way, we would satisfy business and most patients. If we went another way, we would satisfy all patients but sacrifice a loss of efficiency and thus not satisfy the business. If we satisfied the patient, we could recoup some of the loss of efficiency through reduced material costs. We also had the lifetime value of a customer to consider. Satisfying the business posed a risk of losing some patients but increasing our short-term financial gains. As a UX team, we asked a simple question: Is the gain in efficiency (equivalent to reduced labor costs) worth the loss of a customer considering their lifetime value? The answer was no.

UX teams often find themselves in a unique position in healthcare where we are able to balance the needs of the patient, clinician and institution. Though we often do not have the adequate power to make large-scale decisions in this respect, we often have a unique perspective to see how these varying agendas are or are not intersecting. In the example above, there was a tradeoff and our team helped everyone understand the risks and benefits. In turn, we were able to quickly decide which master we should serve.

AI and Telemedicine

Though healthcare has made great technological strides in recent years, there are still a number of areas to explore. In many respects, healthcare is struggling to keep pace with other industries where technology is concerned. Other than the interface, there are two primary areas where UX designers can make the greatest impact in healthcare technology — automation and telemedicine.

Automation (or what we often refer to as artificial intelligence — AI) holds much promise in healthcare. However, it has, in recent years, generally been deployed for financial benefit (automating claims data and submissions) and in those instances where the application is obvious (clinical decision support). We have yet to explore in-depth the subtle aspects of the healthcare system where automation can save considerable time, provide more efficient care and improve patient safety. Some organizations, however, are taking a deeper dive into this relatively unexplored territory.

Consider GE Healthcare’s Edison project where they use automation and machine learning to reduce alarm fatigue or queue up priority radiology exam results. In the case of x-rays and scans, automated processes can screen test results at a speed greater than radiologists and with surprising accuracy. Alarm (or alert) fatigue is a prevalent problem in healthcare and establishing hierarchies for the levels of alarms has largely been a failed effort in the past. Machine learning can be immensely helpful in staving off false positives and false negatives. These are just two examples of where AI provides promise.

Another area ripe for exploration is telemedicine. The field of healthcare is seeing emerging growth in this area. In the past seven years, I have worked on three large projects devoted to telemedicine. Technology now allows us to remotely access healthcare professionals and even care for an individual remotely. One project I worked on was with GN ReSound where an audiologist could access a patient’s hearing instrument and adjust the settings without having the patient physically present. A current project I am finishing now involves collecting data from home therapy and visualizing the data for clinicians to evaluate and adjust treatment therapies.

Obviously, all of these efforts require the coupling of clinicians and machines, computers or interfaces. And that is exactly what we do in healthcare UX design. Both AI and telemedicine are poised to explode in healthcare over the next decade.

Designing for the Ecosystem

I have written of UX ecosystems in healthcare previously. While healthcare is increasingly able to connect systems from a technological perspective, there is still a lack of coordination in this regard. For example, it is now possible for your healthcare provider to view test results from different systems within your electronic health record. However, this will depend on what system recorded those results. My wife recently had to bring a disk to an office appointment for an MRI she had received because the organizations’ systems did not “talk” to one another.

Additionally, systems are not optimized for the coordination of care. For example, your doctor could prescribe a medication not covered by your insurance. The pharmacy will have very little trouble receiving that prescription electronically. But they will experience greater problems if and when you request a prescription your insurance will cover. This will usually require several phone calls back and forth between the pharmacy and physician’s office to change the prescription. That a phone call is more efficient than our medical systems in this day in age is inexcusable.

First and foremost, automation should clearly have the ability to handle this situation without human intervention. There is no good reason multiple systems cannot be smart enough to know what drug your insurance will cover and advise the physician appropriately as they are prescribing. Supposing that is not possible (which it is), one is then left to wonder why systems cannot talk back and forth to one another in a more efficient manner than a physician and pharmacist playing phone tag over the course of a workday. Were the user experience prioritized in this scenario, we would build systems to support a less fragmented transaction for patients and clinicians alike.

Yet this only addresses the technological ecosystem. There is still the aspect of coordinating care to consider. This involves connected health and continuity of care. How do we ensure a patient is treated holistically across the healthcare system? That is, how do we ensure a patient’s cardiologist, endocrinologist, nephrologist and primary care physician are all managing the patient’s condition as a group rather than as individual practices? One could make a strong argument for technology in such a scenario. Indeed, technology can aid (or hinder) under such circumstances. But it is supplementary and not the primary solution.

Coordinating care requires the health industry to work with new models. A patient with congestive heart failure is not managing a bodily system, but rather a condition in which other bodily systems play a role. This patient is not only managing their condition through a cardiologist’s office but rather through a series of different providers.

User experience professionals have an opportunity to play a unique role herein. We can aid in the identification of those areas where there are gaps in the ecosystem of care. We can aid in the development of user journeys, story maps and artifacts that underscore systemic failures. We can begin to design at the system level rather than the feature and product level. In so doing, we will become part of a larger team, which brings us to the next point — designing for care.

Designing for Care

The healthcare industry has been slow to accept new professions into its ranks. It took a number of decades for nurses and pharmacists to carve out their niche in the profession. As designers, we will need to carve out our own niche with design becoming a greater part of care delivery. But as I point out above, we’ll move beyond designing a feature, a product or even a singular experience. We’ll need to change our approach and begin designing systems of care.

The focus of our design efforts must become less concerned with tools of technology and more concerned with care — the overall coordination of technology, services and disciplines to impact the care a patient receives. This will require designers (along with developers. IT professionals, product managers and policy makers) to work together as part of a healthcare team.

Designs in healthcare have an impact on lives. Medical errors are, according to a 2016 article in the British Medical Journal, the third leading cause of death in the United States just behind heart disease and cancer. A leading cause of medical errors is technology. Our work can, indeed, cause great harm. Or it can aid in creating a higher level of care.

I am convinced organizational behavior and the structures of organizations play a large role in the success or failure of product or system design. Clinicians, designers and administrators must begin to work as a team given they all play prominent roles in the care and wellbeing of the patient. This translates into all parties having a role in designing for care and working shoulder to shoulder.

What About the Patient?

Most of the projects I have worked on in the healthcare sphere concentrate on shaping or changing clinician behavior or supporting their workflow through the design of new or improved tools. It has been a rare occasion when I have been given the opportunity to directly design a patient experience. Yet I always hold the question in my mind: What about the patient?

On a long enough timeline, we will all become patients. We’ll wait in line or wait months for an important appointment. We will all suffer the problem of coordinating our care across multiple providers. We’ll all fill out the same forms over and over and over again for doctors who don’t or won’t ever read them. We’ll all wait in line for a prescription not covered by our insurance and then have to call the physician’s office several times to get the medication changed to one our insurance will cover. We will stand, at some point, in front of a healthcare professional nearly in tears and in utter confusion over a recent diagnosis. We will stare, perplexed, at insurance statements and hospital bills that make no sense to us in any way.

There is tremendous potential for designers to directly impact the patient. Some designers are beginning to tackle this effort. But it is still a marginal field of endeavor in comparison to the efforts devoted to designing new devices, software and ancillary technologies to aid clinicians. When we pull the lens back, the patient experience has been largely ignored and represents an emerging opportunity for us.