The Reviews Are In:Implementing an Action Plan

After a Consumer Usability ReviewCharlie GaddyAmy Partilla

NCHICA 25th Annual Conference

Usability is Important

• Usability is the ease of use of a human-made object. It is a science and a discipline.• Good usability helps people complete tasks.• If our digital consumer and patient products have poor usability, people will leave.• In healthcare, digital usability is about consumer engagement and supporting our

transition to value-based care.

I took this photo while staying in a hotel in Miami for a usability conference. I was in room 1011. It took me longer than I’d like to admit to find my room.

We Can Make Our Products Usable

• At Atrium Health, we fundamentally believe that usability is a critical element of the digital consumer experience.

• We regularly perform our own heuristic tests and observations. • For example: Take five people and watch them for half an hour as they try to

complete tasks while using your products.• It’s an inexpensive and vital process that always leads us to make real and

immediate changes to our products. Sometimes we’re just too close to see what needs to change.

• We make intelligent decisions about usability, experience, and design. But our environment is inherently complex, and we aren’t the experts.

Nielsen Norman Group and Usability

• There are plenty of good firms doing great work in this space.• We’d worked with NNG before both for usability tests and for staff

training, and had good experiences.• The founders and staff of NNG are some of the best-known and

influential in the world of usability.• In this case, we had one of their experts develop the report based on

her own analysis of our products in addition to conducting usability testing with a group – both were options.

The Reviews are In

• NNG delivered two reports, one at 78 pages and one at 135 pages.

• It was eye-opening.• The scope of the report included:

• Elements of carolinashealthcare.org (now atriumhealth.org), including the home page, Find a Doctor, and Find a Location

• MyCarolinas patient portal (now MyAtriumHealth)• We took some time to read it and digest it.

We needed that.

Epic MyChart: Identity, Revenue Cycle, eVisits

• Account activation• Authentication and access• eVisits• Patient identity and profile,

demographics• Patient preferences• Direct scheduling,

FastPass and eCheck-In• Open scheduling• Medical Record requests• Customer Service

messages

Cerner HealtheLife: Clinical Functions

• Health record• Lab and test results• Radiology reports• Visit documents and Open

Notes• Health messages• RX renewal requests

Accudoc Bill Pay

• Account balances from Epic and legacy systems (GECB and STAR)

• Bill payment• E-statement preferences

GetWell Network

• Personalized health videos• Access to all health video

content

MyAtriumHealth portal platform is comprised of four vendor portals joined together through Single Sign-On using SAML.

The portals are styled to present a consistent user experience wherever possible.

MyAtriumHealth Portal Components

MyAtriumHealth: Epic MyChartMyAtriumHealth: Cerner HealtheLife

About Our Patient Portal

Patient Usability Report Findings: Good

• Key information (health record) and task-based functionality (appointments, eVisits, messages) available. The site is useful.

• Usability is not how it looks, it’s how it works. And the site generally works without too many bells and whistles or by chasing trends (thanks?).

• It’s comprehensive. When users need information to accomplish a task, that information is available.

Patient Usability Report Findings: Bad

• Offerings and the differences between them are not well described. What’s an eVisit vs. a virtual visit?

• Information paths and calls to action are lacking.At the end of a page or activity, the interface should lead people to the next action like choosing to schedule a doctor’s appointment after reading doctor’s notes. This flow makes a site sticky, as it advertises options to users just in time.

• Information scent is weak.The most critical path for many tasks occurs at the beginning of the web page. The way the user perceives the title, first visible items showing, and content above the fold dictates whether he will scroll. Some pages have poor information scent, so users likely miss many features and content offered.

Patient Usability Report Findings: Ugly

• Navigation is inconsistent, and the global navigation does not include all important features.

The logo, banner, and global navigation menu are not the same on every page of the site. This area is the user’s anchor, and is most helpful when it remains the same everywhere. Even if behind the scenes the sites are different, the user shouldn’t know this.

• Inconsistent UI patterns.Consistent UI elements not only help users predict what to do, they help users feel confident. Consistency also gives the design a cohesive look and feel. Certain design elements—such as subheadings, links, drop-down lists, buttons, and navigation—are presented differently throughout the site(s).

• Text presented in prose.Much of the text on pages is presented in paragraphs of prose. While grammatically correct, this is less helpful for web users. Web readers often scan for small chunks of information, subheadings, links, and key phrases.

Find a Provider• Star ratings – all users checked Press-Ganey reviews

to help their decision• Search box autocomplete – medical terms are hard to

spell

• Patients don’t understand medical specialties• No one knew Family Medicine vs. Internal Medicine

“I sort of read that as… I don’t think it’s a pediatrician… To be honest, I’m not sure” — Taylor (currently studying nuclear medicine technology and working in hospitals)

• Meaningful filters and sorting tools are missing – filter by language, gender, patient age

• No easy way to compare doctors – add retail comparison tool and characteristics of providers

Find a Location

• Current wait times at UC/ED• Adequate contact info…

• … but no appointment CTA“I’d do it more based on the facility than the doctor.” — Jake

• No sort by wait times• Don’t display (or show active)

CTAs when they’re not available.

Attacking the Problem: Divide and Conquer

• Attacking this problem required coordination across multiple IT teams, Marketing, and Medical Group.

• We went through all of the recommendations and organized the work based on effort level, NNG severity level, and feasibility.

• Then, we organized the tasks into workstreams around the functional areas (like activation).

• We had regular status meetings to document progress/stay accountable

Working the Plan

Final Thoughts

• Usability work is never done. It’s a constant evolution.

• Taking a periodic review on progress makes sense, and you can do it yourself.

• Too often, we are too close to the product to see how small changes can make a big difference for users.

• Our technical constraints are not our patients’ problem.

Questions?