Applying User-Centered Design to Healthcare

Good design is important, yet rarely appreciated. A user will rarely notice a well-designed interface, they’ll just use it as they need to. The design of an interface is only apparent when there are problems with it; the user is confused, annoyed and has a negative experience in general. While it isn’t readily apparent to the end user, a good interface is difficult to get right.

As a healthcare technology company creating clinical decision support tools for healthcare providers, we think about the design of our applications often. A widely-practiced method for designing user interfaces is to focus on the user and how they would use your interface. This method is formally called user-centered design (UCD).

The core concepts of user-centered design and how they can be applied to healthcare technology are1:

  • Context. It is important to know the who, how, why and under which conditions people will be using the system. For healthcare professionals, this usually translates to the clinical workflow that they are currently performing everyday. Where in the patient workflow will the user use the system? How do they currently interact with other members of the care team? How will the system being designed affect their use of the EHR? Where are they physically (their office? at home? in a common area?) when they are using the system? What information do they have and not have at that time?
  • Requirements. It’s important to identify what will be needed to consider that the system in question “successful” once implemented. What are the business requirements? What are the user goals? This can include key performance indicators, for example, lowering hospital re-admissions by 3% and financial goals like meeting Meaningful Use 2 standards. These requirements must be satisfied in the system being designed for it to be considered useful.
  • Design. Once there’s context and requirements, the system can actually be designed to satisfy these demands. While it is not always possible in a healthcare environment, it is preferred to do this in an iterative or “agile” approach so that you can verify that your design is on the right track quickly and frequently.
  • Evaluation. Once the system is designed to a certain point, it is important to test it with actual users. Effective user testing usually involves watching a user interact with the system and sometimes asking them their thoughts. Overall, you want to test if the system is effective and meets the requirements as stated above. If there are areas to improve (and there almost always are) than iterate on your design and evaluate again.

At Grand Round Table we design our interfaces around these concepts. We read research and articles on current trends in healthcare and the problems that providers face. We talk to providers and administrators at conferences like the recent Allscripts Client Experience to learn more about their challenges and how they work. We conduct user interviews, comb through data on how providers are using their EHR, and watch actual users use our applications.

Through this process we occasionally realize that our initial approach did not match the needs and reality of our target users. For example, we initially created a clinical decision support web application that a provider could use at the point of care with the patient. Through user testing it became apparent that this perhaps wasn’t the best context in which to engage the provider. By gaining a greater understanding of how data is added to entered and reviewed in the EHR, we realized that a better interface would be a digest messages that the provider could read at the beginning of their day. User interviews and data on provider activity with these messages shows us that we are on the right track.

Others are using user-centered design principles to develop more effective interfaces. Prescribe Design is connecting networks of designers and healthcare providers to “radically transform healthcare.” In July of this year, the Philadelphia UX Book Club brought together a diverse group of healthcare professionals to discuss the Design for Care book with author Peter Jones. Such conversations will continue as the field of healthcare design grows.


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