User experience in medical software projects
By: Agnieszka Bilska
User experience in medical software projects is a book-size topic. Once, while participating in a professional development workshop on the basics of medical imaging and user experience design in medical software I heard one of the participants make an innovative in his mind suggestion concerning the conditions in which radiologists perform their everyday work. The point he made was that it must feel depressing to spend hours in a dark room looking at monochromatic images on the black and white screens. Wouldn’t it be more beneficial to have the MRI scans displayed in colour – he asked. We were all nodding, feeling positive, that the job could become less monotonous and dispiriting then.
Well it wouldn’t – as it turned out our assumption only proved how little we had known of the true nature of the profession. Allegedly radiologists are intentionally trained to distinguish between minute differences in shades specifically in grayscale. Colour-scale would render their task much more difficult.
Why am I telling the story as an introduction to the article whose subject does not concern radiology but the user experience in medical software?
What I am going to do here is to discuss the challenges user experience design in medical software faces while designing for health information technology. And it is the insufficient understanding by IT people of how health systems operate and how healthcare specialists work which is the first and most significant of them.
That digital health systems have bad UX is common knowledge, but they have a good reason for that, or to be more specific, a couple of reasons.
For years healthcare has been, of all industries, the slowest to introduce new technologies, it is even said to lag behind by 10 years. The promise of digitization which was supposed to make doctors’ lives easier has only made them hate their computers.
The amount of work spent in front of the screen added up to two hours per every hour dedicated to addressing a patient face-to-face (Why Doctors Hate Their Computers | The New Yorker, access 1.11.2020). What could be the reason? The software developed for healthcare institutions has to answer the needs of multiple stakeholders. Employers, insurance companies, pharmaceutical firms, the government. Patients and physicians often land at the end of this “food chain” and hardly ever have a say in that matter.
They are not the “buyers,” so their needs do not get catered for in the first place. The software they are confronted with in their everyday practice may answer the bureaucratic needs of non-medical staff but make their own operations a nightmare.
What is more, the needs of hospitals as systems are not homogenous
The multitude of applications they operate on does not come from the same vendor. Oftentimes they are open source or home-built – the end result being incompatible formats, lack of interoperability and standardisation.
Let’s be honest. User experience in medical software has never been high on the list of priorities for the persons making decisions about software purchases for healthcare institutions.
As a consequence the end users have been forced to grin and bear it, to put in a lot of effort and master the user-unfriendly interfaces. Gradually they have learned to literally expect poor user experience as there was no competition on the market. Having grown used to the complexity of the software. Ironically it is them who are not willing to accept changes, which would mean unnecessary time-consuming onboarding processes hindering their everyday routines.
Another element adding to this vicious circle is the length of development of new medical software
Large healthcare organisations are not agile, not able to frequently iterate solutions the way it happens these days for other consumer applications. The inertia of large systems means waterfall planning cycles and the final product rarely meeting the requirements of the end-user.
What makes user experience in medical software even more demanding than in other sectors of industry is the regulatory compliance – standards for risk and quality management, which software as a medical device has to meet. Plus it is not globally uniform, for example US is regulated by Quality Systems requirements of FDA and 510 K approval, Europe is governed by CE marking and ISO 13485 standard, China has its SFDA requirements, Japan follows PAL regulations.
What makes user experience in medical software even more demanding than in other sectors of industry is the regulatory compliance – standards for risk and quality management, which software as a medical device has to meet. Plus it is not globally uniform, for example US is regulated by Quality Systems requirements of FDA and 510 K approval, Europe is governed by CE marking and ISO 13485 standard, China has its SFDA requirements,
Japan follows PAL regulations. A constant concern are the privacy issues. Healthcare systems are in jeopardy of cyberthreats. Data leaks, ransomware attacks – they are the patients’ and healthcare providers’ nightmare and another challenge for the UX designers.
Notwithstanding the multitude of hurdles that await a UX designer when dealing with medical software these days there appears a greater need for improvement in the area as digital healthcare continues to expand dynamically.
Following Covid-19 crisis of unprecedented scale we have witnessed an overnight transformation to the provision of health services by means of telehealth. In order to avoid visiting healthcare facilities patients had to learn how to use new technologies and as a consequence appreciated being able to manage their conditions from home. The process has given more agency to the patient and in the long run will definitely influence the way software medical products are designed to address the practical needs of patients as well as healthcare providers.
UX in healthcare – good practice
Are there any user centered design systems in medical software to look for inspiration, any manuals or guidelines to fall back on? Let me name a few initiatives, which have made waves in medical software UX.
The most recent and highly acclaimed:
GE Healthcare Edison Design System – Launched in 2020, the system aims to evolve the industry and unify UX across the company GE Healthcare with improved usability and consistency. It has won four awards: a Red Dot Award for UI Design, a FastCompany Innovation By Design Award for Graphic Design, and two Design Management Institute Awards.
Edison Design System is a modern, responsive software design system for healthcare spanning design and code that includes styles, web components, CSS, icons, a custom Sketch toolkit, and detailed best practices on topics like AI and imaging viewers. The system replaces four prior systems that had poor readability, usability and low adoption. It offers 3 choices of tech stack and 3 themes (https://beverlymay.com/2020/08/10/ge-healthcares-award-winning-edison-design-system/).
A UX Toolkit for the Life Sciences Community, by the Life Sciences community.
User Experience (UX) practitioners from leading companies in the pharmaceutical, healthcare and scientific software industries – AstraZeneca, Bayer, GSK, MSD, Amgen, EMBL-EBI, Roche, Quattro Research created the UX for Life Sciences Toolkit to enable businesses to adopt UX principles and methods as they develop scientific software. https://uxls.org/ The toolkit comprises UX methods and case studies.
It is the result of a project initiated in 2017 by Pistoia Alliance – a global, not-for-profit alliance of life science companies, vendors, publishers, and academic groups that work together to lower barriers to innovation in R&D. https://www.pistoiaalliance.org/projects/current-projects/user-experience-for-life-sciences/
An attempt to unify the user journey by UX professionals from Google:
X playbook for healthcare. Collection of best practices to delight your users. The publication is a step by step manual illustrated with real-world cases which aims to expand on the 25 Mobile Design Principles and provide a checklist for improving mobile site experience. pdf_auto_healthcare_playbook.pdf (google.com)
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