Why caring about the user is as important as caring for the patient: The importance of UI/UX in Healthcare Clinical Decision Support Systems.

November 28, 2017
By: Sirj Goswami and Gitta Salomon

In computer science, an interface is the exposed 'surface area' of a system, presented to the outside world to mediate between what’s inside and outside.  An optimal interface hides complexity and harmoniously interacts with the user. The disciplines referred to as User Interface (UI) Design and User Experience (UX) Design civilize technology, taking a messy, complicated system and coaxing it toward behaviors more suitable to user interaction.

Historically, the healthcare system has suffered from poor UI/UX design. In comparison to other industries (e.g., manufacturing, finance, retail, information and communication technology), ease of use and integration with typical user workflows has taken a back seat to implementation of raw functionality. 

Ironically, the lack of priority given to UI/UX in healthcare is in direct contradiction to its importance; healthcare user experience is as important, if not more so, than in other industries because patient well-being is at stake. A well-designed UI/UX plays a critical role in hiding software complexity from end users. It emphasizes key features and functionality and crystalizes the clinical purpose of the software for the typical user, organically creating clear and compelling reasons to use the product. Equally important, a well thought out UI/UX reduces the likelihood of errors, minimizing patient risk.

There are several reasons why UI/UX has taken a back seat in the healthcare software development process. Before trying to fix the problem, it is important to understand why healthcare has been historically subject to poor software UI/UX. Understanding the challenges will inspire better design, increase product adoption, and ultimately improve patient care.

Electronic Medical Record (EMR) systems are old and designed for an outdated healthcare system. EHR systems like EPIC and CERNER own a majority of the market share in the U.S. and were originally designed to meet the requirements of fee-for-service systems and not the needs of clinicians or patients. EHR systems were built to manage claims, document basic patient information, and help hospitals get paid. For healthcare technology to take a leap forward, an evolution in the interoperability of existing EHR systems is required (a few companies have made progress in solving this issue). Smart health applications need to be able to extract and process data from EHR systems easily and present results to clinicians in a user-friendly way.

Clinical workflows are complicated. Let’s take precision dosing of complex drugs as an example. Clinicians are in charge of disease diagnosis and treatment selection. Clinical pharmacists undertake calculations and optimize dosing by looking at specific clinical lab data that is displayed in a format that is only understood by them. Finally, nurses are involved in administering drugs to the patients. An optimal UI/UX must pay careful attention to the entire workflow, and manage information transfer in a way that makes sense to all those involved. It requires great care to design a product experience and prioritize features when there are several cooks in the kitchen.

An optimal experience must take into consideration viewpoints of various user types who are involved in patient management. Clinicians have a different workflow than clinical pharmacists and nurses. To design a useable and useful software product, we must consider audience composition and be sure to include key players in the design process from the start of product definition.

Healthcare software typically follows a waterfall software development process – basically, products are developed using lengthy software development cycles. This occurs, in part, because Clinical Decision Support Software must be carefully developed to minimize the potential for any patient risk. The long development cycles are not conducive to validating product usability with typical users. At the end of a lengthy development cycle, developers often find that there are adoption and usability issues. Because they’ve invested significant development effort, they are reticent to make changes and often (inappropriately) attribute problems to user incompetence.

Complexity of data inputs/outputs and idiosyncratic terminology. Let’s look at precision dosing as an example again. Dosing history and drug concentration levels are complicated inputs, requiring domain expertise. Similarly, unless you are a domain expert, “Treatment Probabilities” and “Pharmacokinetic Estimates” are complicated outputs.  Idiosyncratic terminology is also an issue here. Harmonizing clinical/technical language is a difficult task – one that most companies do not anticipate needing to tackle.

To overcome these challenges, it is important to involve end users early and often in the development process. Lessons from user-centered design and design thinking –methodologies successfully adopted by other industries – can equally benefit the healthcare domain. For example, software developers should strive to develop empathy with their target users, and would benefit significantly from observing the context of use, and their needs and goals. Mockups, simulations or visualizations of the final product should be created (if not in actual code, using tools such as InVision or Marvel) to assess user engagement and usability long before the development team is fully committed to building a specific direction. Quantitative surveys can be undertaken to confirm hypotheses uncovered through qualitative work, or, conversely, to uncover trends that need to be further explored through qualitative research.

We cannot overemphasize the value and importance of putting product ideas in front of users well in advance of – as well as during – any significant development effort.

End user involvement need not be a massive undertaking. Conducting qualitative research with as little as five users can provide valuable and powerful insights. However, it is important to cover the spectrum of likely users. As mentioned earlier, users from different professional disciplines will ultimately interact with your product. In addition, both expert and ‘typical’ users’ perspectives are important. Expert users can contribute to the product vision by exposing features and functionalities that help revolutionize a field. These advanced users also appreciate specialized functionality and accept the complexity that comes with more power. On the other hand, typical users provide insight into the most essential features that will lead to widespread adoption. These users are less inclined to learn the nuances of the software and are most interested in minimizing the time required to learn and use the product.

During the early stages of software development, careful attention should be placed on the challenges discussed here. Doing so will increase the likelihood of product success, which in turn will facilitate a smoother translation of scientific research into clinical practice. Collaborating with specialists in the UI/UX domain will help provide the technical expertise to undertake these user-centered tasks, as well as minimize the influence of bias by bringing fresh eyes to your effort. UI/UX specialists are experts at developing empathy with your users, and can ensure that perspective is not forgotten.

Sirj Goswami is CEO and Co-Founder of InsightRX (www.insight-rx.com). Gitta Salomon is Principal of Swim Interaction Design Studio (www.swimstudio.com)

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