5 imperatives of user experience design in mobile health technology
1. Clinician involvement in development.
I first realized the importance of UX design when working on an interoperability project in 2004 between remote monitoring data from implantable cardiac defibrillators and my electronic health record company. The EHR programmer and I worked together with an interesting dynamic, as he had no clinical background and I had no CS expertise. The UX design was dictated by me, the user. The programmer had no idea in what order or visual format (pages, tabs, etc.) was expected by the clinician for optimal UX. This was not a patient-facing mobile technology where attention to UX design is critical to success. I was therefore not surprised to see poor UX design by mobile health app developers in 2010.
The lack of clinician involvement in development of mobile health technologies continues to dominate the landscape today notwithstanding vendor promises of achieving better patient outcomes at a lower cost and better patient experience. Expert clinician input is necessary on a number of levels. It assures accurate and reliable content, and it leads to a better UX for the clinician with regard to how data is obtained, presented and incorporated into clinical workflow.
2. Patient and caregiver involvement in development.
Just as clinician involvement is important in the development phase, so is that of the patient and/or caregiver, who are the data sources. If they are not engaged by good UX design, the technology never takes off and no one knows why.
Many patients don’t manage their medications, appointments or data because they might not have a smartphone. That shouldn’t be a reason not to recommend an app, digital patient education or device tool. A caregiver (typically younger and digitally connected) will likely be more able to engage the product. I have witnessed this many times in my own practice when recommending a digital tool. There is a workflow for a patient that differs from that of the provider. It consists of incorporating the digital interaction with activities such as timing of medications, physical activity, or even those unrelated to healthcare. The content and visual displays to patients are necessarily different.
The same mindset of developers, which marginalizes clinicians, invariably sees the patient as a passive recipient of this tool. The proverbial ‘build it and they will come’ works neither for provider nor patient. The true value of patient involvement in development is easily seen if small incremental alpha testing is performed along the way.
3. Less is more.
The value of an app is simple, intuitive and pleasurable interaction. Crowding a screen with data or words is counterproductive. If the app is about patient data, meds or appointments, then these must take up the vast majority of the screen. Efficiency of the presentation, interaction and feedback are important to a good UX. There must be age, healthcare and educational literacy and ethnic language appropriateness.
4. Privacy and security in the background.
A better user experience might occur at the expense of less personal data privacy. A social community has been a component of successful health apps. It can, however, create (in the absence of chosen anonymity) a great experience at risk of privacy. This is usually made clear with a disclaimer, and many participants are willing members anyway.
The aggregation of pooled or anonymous data is considered by some to be a breach of privacy or ownership. These issues are presently the subject of ethical, legal and business discussions. Lack of privacy or security is often not discovered until after a breach. This has been seen in HIPAA violation cases involving large healthcare providers and payers and cases of large retail companies. Not all people share the same concern for or desire similar levels of security and privacy. Measuring satisfaction of security level is not easy, to say the least. The app must provide the highest level of security that also allows for the best UX. People may opt out of sharing data, identity, etc., but the ‘opt out’ option must be presented.
5. Creation of a sandbox enjoyable to both play in, revisit and benefit from.
UX design should make it enjoyable to experience the app, by using a humanistic and empathetic slant. Empathy is sorely lacking in medicine today. It is potentially the biggest factor in a good physician-patient relationship. It is a large part of the attraction of online patient support groups. Social community interactions around the focus of the app incentivize users to experience as much of the app as possible as well as return to it after it is downloaded (something done in only 10 percent of health apps in use). Medical apps can potentially have a very unique place in digital health by impacting what we value most in life: health.
The UX design part of medical app development is very much underappreciated. It is more than a first impression; it is akin to a good learning experience in school. If it sparks the enthusiasm of a student, it can mean the difference between dropping out and graduating with honors. For more on what constitutes good UX design in healthcare, I would suggest this review from a HIMSS workshop on the subject.
David Lee Scher, MD, is a clinical associate professor of medicine at the Pennsylvania State University College of Medicine, cardiac electrophysiologist with The Heart Group of Lancaster General Health and director at DLS Healthcare Consulting, LLC, which specializes in helping digital health technology companies, their partners and clients. He’s a pioneer adopter of remote patient monitoring and lectures worldwide on technology and its impact on patients and healthcare systems. He blogs at the Digital Health Corner and is also a member of the HIMSS mHealth community.