STC UUX Community Newsletter
Usability Interface

World Usability Day in Washington DC:
Panel Discussion about Usability in Healthcare

By David Dick

For World Usability Day (November 14, 2006) the Washington D.C. Usability Special Interest Group teamed up with the local Usability Professionals Association to present a panel discussion about usability in healthcare. Did you know that rising costs, an aging population and pressure to adopt new technologies increasingly strain the healthcare system? At the same time, patients and their families have ever-more access to health information, and many want healthcare to become more patient-centered.

New technologies offer promise, but they must be appropriately designed for the medical professionals and patients who use them. Usability professionals are used to applying their design expertise to websites and software applications. And these same principles can and be applied to healthcare products and systems.

Panelists at this presentation:

• Benjamin Chesluk, Ph.D., Senior Research Associate, Design Science
• Peter Elkin, M.D., Professor of Medicine, Mayo Clinic College of Medicine
• Martha Gaie, Ph.D., RN, Postdoctoral Fellow, Consumer Health Informatics, National Library of Medicine
• Sandra Hilfiker, M.A., Public Health Advisor, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services
• Ronald Kaye, M.S., Human Factors Specialist, Center for Devices and Radiological Health (CDRH), Food and Drug Administration
• James Walker, M.D., Chief Medical Information Officer, Geisinger Health System

Benjamin Chesluk discussed how ethnographic research is used to understand how to make tools and technologies more useful. (Ethnography is a form of research that focuses on the sociology of meaning through close field observation of social order.) Successful design of medical products means understanding what surgeons need to do their jobs well. How is this done? By mapping the flow of an operation and observing doctors performing particular tasks, researchers identify how to design products that would simplify complex tasks.

Peter Elkin of the Mayo Clinic began his presentation by emphasizing that the culture of learning, not blame, is essential to improving quality. He stressed how improving usability of health care systems reduces costs to learn and manage, reduces errors, and increases efficiency. He emphasized how the Mayo Clinic is addressing usability as a method of improving processes, procedures, tools, and technologies, just as the leading IT companies do.

Martha Gaie discussed how to put the user into context: how people decide when to start searching and when they stop, and how do they evaluate what they found. She described her work with cancer patients to learn how they understood their condition. Dr. Gaie presented the patients with four stories, and shortened the information into readable chunks of information. Information seekers approached the seeking process based on the decisions they encountered. For example, “What do I do now?” and “What do I do next?” The most common heuristic was sufficiency, “enough”. People could make decisions on the basis of the content of the information. Individuals demonstrated “resource sufficiency”: the emotional costs, time, and access to what the individual has to do. Motivation was the driver for individuals’ using a Web site to find information. Sufficiency accounts for how much individuals will search to find what they are looking for.

Sandra Hilfiker discussed health literacy of Web sites. Health literacy is the degree to which individuals understand what they read. Much of the health care information is written at a 12 th grade level, and some people read at or below an 8th grade level. So what’s the solution? One way to simplify the information is to provide personalized features and prevention content to answer frequently asked questions about health and medicine. Sandra described how usability testing of the Healthfinder Web site (www.healthfinder.gov) revealed difficulties people had with registration, navigation, relevance, and accessibility of content. The challenges, Sandra explained are how to improve the content and quality of information on healthcare Web sites to make it easier to use and understandable for all levels of users.

Ronald Kaye discussed the Human Factors of medical devices. The FDA evaluates the design and safety of medical devices for sale in the United States. Medical products are becoming more complex and it is the job of the FDA to ensure these products are safe to use. He describes how approximately 44% of device recalls are due to design issues, and as much as one-third of the hazards are a result of misuse. Kaye discussed how FDA conducts usability testing of medical systems to make them easier and safer to use. There is a paradox sometimes making products easier to use does not make them safer to use (e.g., removing the plastic guard on a table saw).

James Walker discussed the evolution of patient health records, from paper to electronic systems. Electronic health records are amazingly complex systems, which results in numerous errors. If the profession is to share patient information, then solving usability problems is a first priority. The health care professionals are rarely involved in the design of the systems they use, so it is no surprised that they are frustrated when the systems do not satisfy their way of working. He explained how health care professionals are working with the Human Factors specialists to help them design better systems.

What I like enjoyed most about this event is that I learned that improving the usability of healthcare products and systems follows the same processes as IT products and services. I am confident that technical writers employed in the healthcare community are asking the proverbial question, “Why not improve the product so that documentation is not a solution for poor design?” The good news is that their concerns will probably be heard and acted upon, and could undeniably save somebody’s life: maybe my own.