134 — Chapter 3: Improving the User Experience

User Experience Issue (UX)

• _____ with health IT products are a worldwide concern

• Expansion of technology has resulted in complex interactions among users, products, and environments

• Can result in patient safety problem and errors.

• Stem from the human-computer interface, workflow inefficiencies, and communication breakdowns

• Lack of interoperability impact patient care can cause difficulties in extracting relevant data, leading to omissions and errors in care continuity mechanisms such as handoffs

• User experience (UX)

• Human factors

• Human - computer interaction (HCI)

• Usability

Basic Consepets

User Experience (UX)

A person’s perceptions and responses that result from the use or anticipated use of a product, system or service.

Human Factors

• It is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system.

• In healthcare, _____ might concern the design of a new operating room to better support workflow, teamwork, and patient flow, or identifying obstacles to intensive care nurses in their task performance.

Human - Computer Interaction (HCI)

It is the study of how people design, implement, and evaluate interactive computer systems in the context of users’ tasks and work.

Usability

Extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction.

• Effectiveness

• Efficiency

• Satisfaction

Goals of Usability

Effectiveness

The accuracy and completeness with which specified users achieve specified goals in particular environments, including worker and consumer or patient safety

Efficiency

Includes the resources expended in relation to the accuracy and completeness of goals achieved

Satisfaction

The level of comfort and acceptability that users and other people associate with the product or work system and deals with users’ perceptions

User - Centered Designs

This kind of design allows us to integrate health data, information, and knowledge into health IT products.

1. Early and central focus on users in design & development

2. Interactive design

3. Systematic measures of the interactions between users and products

UX experts employ a process of user-centered design composed of three axioms:

Why is understanding users important in health IT design?

Understanding users' characteristics, environment, and tasks ensures the design meets their needs and improves efficiency in the care process.

Direct Contact

_____ _____ with actual users is needed early and often throughout a design or redesign process.

Why is a single design iteration not enough?

At least three rounds of design are typically needed to refine effectiveness and efficiency in health decisions.

Designers or Informaticians

Once a design is available, _____ or _____ work with users to determine any issues by having them systematically interact with and respond to the design. Major usability issues are identified and corrected early in the process. Design and evaluation then occur in a cycle until major usability issues are corrected.

• Increased individual effectiveness

• Increased organization efficiencies

Benefits of improved UX

• Increased user productivity and efficiency

• Decreased user errors and increased safety

• Improved cognitive support

Increased individual effectiveness

• Decreased maintenance costs

• Decreased customer and individual training and support costs

• Decreased development time and costs

Increased organizational efficiences

Human - Computer Interaction (HCI) Framework

Study of how people design, implement, and evaluate interactive computer systems in the context of users’ tasks and work.

1. Information

2. Interactions

3. Context

4. Developmental timeline

5. Humans or products

6. Recipient

Elements of Health HCI Framework

Information

• E.g., patient care, administrative, or educational information

• This is the exchange mechanism.

Interactions

These occur in a system of mutual influences where elements (e.g., individuals, health IT) act and respond based on specific characteristics.

Context

This means that any outcomes of interactions are distinct, as they are defined by a context.

Developmental timeline

Indicates that interactions change over time. Thus, the outcomes of interactions are different based on when an interaction occurs in time.

Human or Products

Initiate interactions. The information is processed through either the product or the humans, according to characteristics.

Recipient

Reacts to the information

Health HCI Framework

• The framework builds on early works describing health care worker-computer interaction.

• It was expanded to include groups of healthcare providers and interactions with patients. It further adapted to acknowledge that IT is only one example of an available health IT product.

1. Discount usability methods

   • Heuristic evaluations

2. Traditional usability methods

   • Think-aloud protocol

   • Task analysis

Methods to improve UX

Heuristic Evaluations

• Compare products against accepted usability guidelines to reveal issues

• At least 3 to 5 experts complete independent evaluations and then combine issues into a master list after discussion and consolidation.

• HE violations of guidelines are made and severity scores are then assigned to the identified issues

• Consistency and standards

• Visibility of system state

• Match between system and world

• Minimalist

• Informative feedback

• Flexibility and efficiency

• Good error messages

• Prevent errors

• Clear closure

• Reversible actions

• Use the users’ language

• Users in control

• Help and documentation

Categories for Heuristic Evaluations

Consistency and standards

Consistency across all aspects of the product: methods of navigation, messages and actions, meaning of buttons, and terms and icons.

Visibility of system state

Users understand what the system is doing and what they can do with it from the system messages, information, and displays.

Match between system and world

The technology matches the way users think and do work, uses appropriate information flow, has typical options that users need, and includes expected actions by the system

Minimalist

No superfluous information. System and screen design targeted to primary information users’ needs. Use of progressive disclosure to display details of a category of information only when needed.

Informative feedback

The technology provides prompt and useful feedback about users’ interactions and actions

Flexibility and efficiency

The ability to tailor and customize to suit individuals’ needs. Includes novice and expert capabilities

Good error messages

Tell users what error occurred and how users can recover from the error. Precise and polite and does not blame the user.

Prevent errors

Catastrophic errors must be prevented

Clear closure

Users should know when a task is completed or accepted

Reversible actions

Whenever possible, actions and interactions should be able to be undone within legal limits. If actions cannot be reversed, there is a consistent procedure for documenting the correction.

Use the users’ language

The technology uses language and terms the targeted users can comprehend and expect. Health terms are used appropriately.

Users in control

Users initiate actions versus having the perception that the technology is in control.

Help and documentation

Provide help for users within the context the actions occur (context sensitive). Embed help functions throughout the application.

Think - aloud protocol

Traditional method where users talk aloud while they interact with a product and complete the tasks. As users voice what they are trying to do, they indicate where interactions are confusing and provide other thoughts about the product

Task Analysis

Traditional method where systematic methods used to understand what users are doing or required to do with a health IT product. They focus on tasks and behavioral actions of the users interacting with products.

Patient Safety

• It is the freedom from accidental injury due to medical care, or medical errors.

• It is also the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

• Inconsistent use of language and variations in definitions are barriers to understanding the concepts of quality care and patient safety, as well as to benchmarking beyond the organizational level.

1. Safe

2. Effective

3. Patient - centered

4. Timely

5. Efficient

6. Equitable

Quality of Care - the degree to which health services increase the likelihood of desired health outcomes:

Safe

Prevents injury or other adverse outcomes

Effective

Ensures that evidence-based interventions are used, with patients always receiving the treatments most likely to be beneficial

Patient-centered

Ensures that patient preferences, needs, and values are front and center in the process of clinical decision making

Timely

Delivered when needed and without harmful delays

Efficient

Prevents the waste of valuable human and material resources

Equitable

Provided to all individuals without regard for ethnic, racial, socioeconomic, or other personal characteristics

Why improve HIT?

• HIT is playing an ever-larger role in health care

• Poor design adds complexity, while good design enhances safety and minimizes harm. In a HIT-enabled environment, safety expectations are higher, and software-related issues go beyond coding or human error.

1. Easy retrieval of accurate, timely, and reliable native and imported data

2. A system the user wants to interact with

3. Simple and intuitive data displays

4. Easy navigation

5. Evidence at the point of care to aid decision making

6. Enhancements to workflow, automating mundane tasks, and streamlining work, never increasing physical or cognitive workload

7. Easy transfer of information to and from other organizations and providers

8. No unanticipated downtime

Features of a safe HIT

1. Poor user-interface design

2. Poor workflow

3. Complex data interfaces

4. Lack of system interoperability

Features of an unsafe HIT