MedCity Influencers

A user experience revolution is needed to achieve radical productivity in healthcare

“Current EHRs are largely digital remakes of traditional systems, just as many early motion pictures were merely plays captured on celluloid” per an NEJM article. We’ve merely succeeded at designing digital versions of existing processes, but that won’t boost healthcare productivity.

user experience, UX, design, user interface

It was 1998 and we were just starting to imagine how the internet was going to change the world. I joined what was then the largest online professional services agency in the U.S., and the pace was exhilarating. Working alongside the first internet technologists and entrepreneurs, we guided clients launching dot-com businesses or creating their first digital façades.

In those days, my interest was in coding and designing the best-looking websites in the market. But the more time I spent launching sites in that dial-up, slow-modem, pre-iPhone world, the more I realized that what really mattered was not the beautiful creative designs on web pages — what mattered was the user experience (UX). There were so many sites on the internet that were simply unusable. Pages would take eons to load, and when they finally did, users struggled to navigate well-intended, but ultimately confusing interfaces.

It was in this Web 2.0 era that Google changed the game. Its home page was so simple, it almost seemed stark: a white background, a logo, a search box. This was a big contrast to, say, Yahoo or Alta Vista’s busier interfaces — already becoming riddled with buttons, banners, and ads. How was Google going to compete against that? The answer: it competed with usability.

As my passion for user-centered product design methods grew, I went on to lead a user-experience practice that engrained UX principles into client work. Our team would start work on digital projects by first “walking in the shoes” of the target user, then iteratively build interfaces that would be tested with those users and further refined. This user-focused development approach eventually became a key driver to innovation in many industries — Square transformed payments by embracing its mobile-centric constituency, Slack revolutionized team productivity with a collaborative communication platform, and Casper managed to make even the mundane task of buying a mattress a digital delight.

But the user-experience movement has faltered in the world of healthcare, where physician productivity has been hobbled by poor UX. When you have increasingly burned-out physicians having to spend twice as long at the computer as they do with patients, something has gone horribly awry.

I spoke with Dr. Christine Sinsky, Vice President of Professional Satisfaction at the American Medical Association, about how to best turn the tide and drive radical productivity for physicians and health systems. She has written about the need to restore the joy of medicine and address physician burn-out, and what I learned from her ties directly back to those Web 2.0 days.

Dr. Sinsky discussed how well-intended technology solutions can actually detract attention from what matters most: the patient-physician encounter. This finding from The Harris Poll’s National Physician Poll is instructive: “62 percent of time devoted to each patient is being spent in the EHR and half of office-based PCPs (49 percent) think using an EHR actually detracts from their clinical effectiveness.” Dr. Sinsky noted that, generally speaking, most physicians agree that the introduction of technology has driven improvements in care, but the plethora of technology solutions and the outsized amount of labor required to use them is also creating issues.

Yes, I thought, a user-experience issue!

While technology should be driving productivity and satisfaction, much of it just isn’t really usable. It feels like it’s 1998 all over again. Health technology isn’t necessarily built with the users’ daily needs in mind. The overwhelming amount of data on interfaces and bolt-on workflows introduce confusion and navigational busywork, and present a significant cognitive burden in care delivery.

Much of this can be traced to design. As noted in The New England Journal of Medicine, “Current EHRs are largely digital remakes of traditional systems, just as many early motion pictures were merely plays captured on celluloid.” We’ve succeeded in designing digital versions of existing processes, but haven’t acknowledged that designing for digital transformation requires rethinking the way the tools can be used.

Accomplishing this begins with “walking in the shoes” of the target user. After my discussion with Dr. Sinsky, I embarked on a venture exploration with an entrepreneur surveying key technology problems in modern oncology practice. We heard oncologists talk about solutions that have improved care management in their practices. Not surprisingly, we also heard that practices struggle with a variety of workflow challenges exacerbated by technology, and that there is significant opportunity to simplify and better leverage extant solutions. Cancer survivors also shared their stories on the experience of treating cancer. Many feel disconnected — thwarted by an inability to navigate their care journey or find usable solutions that interact closely with their care teams. This exploration was edifying. The end-to-end potential of an optimal user experience from patient to care team has not been realized, and the lack of usable technology lies at the center of the problem.

To achieve radical productivity in healthcare, we first need to embrace the simple, user-centric approach that has catalyzed digital transformation across other industries. With an already complicated healthcare system driven by multiple incentives and diverse stakeholders, we must better shield users from the complexity of their systems and design purposefully for intended use. Good technology makes it simple for the user: simple to get the data that matters most, simple to understand and assign the best treatment, simple to collaborate and interact, simple to communicate and measure outcomes, simple to optimize care.

A user-experience revolution in health tech solutions is desperately needed — and long overdue.

 Photo: exdez, Getty Images

 

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