Embracing UX with beeps and pulses: UX in the medical world!
Recent growth in the medical technology industry and the big hype on digitalization at clinics and hospitals has increased the procurement in developing and producing products that are efficient, effective and to the satisfaction of the users and stakeholders. The growing need to have effective and efficient digital systems that work flawlessly requires experts from different fields and disciplines, especially in the community of designers, product developers and owners. These experts foresee the glitch in the operations of the system and eliminate it even before the concept of a system is passed on to the production phase – the User experience and Usability Professionals. As UX professionals, how would we provide our users and stakeholders with an elite product that is efficient, effective, but still meets the norms of User Experience and Usability in the medical industry?
Digital Health – Hype or Hope?
Digital technologies have slowly been embraced into the daily workflow of clinicians, medical practitioners and other stakeholders at hospitals and clinics. Currently, as digitization sweeping into the medical industry at a seemingly fast pace, this is forcing hospitals and clinics to act and react to the changes at an even faster pace. From the usage of biosensors to digitally recording patient data via the Electronic Health Records (EHR) and long-term tracking of a patient’s health status through fitness trackers, are some of the small examples of the efforts taken to enter the digital transformation process. Before the whole world revolutionized into digitization, the management and the IT department decided which software or system was required in a clinic or a hospital station. Other factors such as the budget, IT-experience, time to learn, how to operate the system etc. played an influential role in the decision-making process. However, the digital transformation process moving at an essentially burning speed has compelled the need to implicate and pursue the expertise and requirements of experts from other professions who play a leading role in the outcome of the product: user experience designers, usability engineers, interaction designers, data scientists. These experts would not only help build and design an effective system but also optimize the workflow and deliver customizable systems that meet the needs and requirements of the users and stakeholders. Therefore, with the involvement and inclusion of users and other stakeholders such as the doctors, nurses, patients, caregivers etc., can we truly achieve workable and efficient systems that can facilitate the growth of the digitization process?
However, digitization is a broad term when considering the convergence of different digital technologies such as mHealth, eHealth, Telemedicine, Big Data etc., which play a key role in enhancing and optimizing the use of information, communication and workflows. On the contrary, the adaptability and interoperability of these technologies can help physicians and practitioners focus more on the health problems and challenges faced by patients under medical treatment.
UX challenges in the Medical field
Medicine poses unique UX challenges in that the potential users including patients, different types of use cases, diverse platforms (e.g. stationary vs. mobile) and tools (e.g. wearables, sensors) are so diverse that carrying out a deeper investigation of the user perspective is still at a standstill. Scientific studies on creating a standardized framework that supports both the development and evaluation of medical mobile applications and digital services are limited . Hence, designing the right device or an interface in the medical technology industry from a complete user perspective scenario can be a difficult task and it should not be taken lightly.
The challenge of having multiple professions with different qualifications and use cases working in the medical industry can increase the diversion of designing the right digital product or service. This raises some questions: How can the right target group be involved in building efficient and error-free systems? Is acceptance and safety considered the only factors that is needed when designing medical products? Is acceptance of technology sufficient to meet the requirements of the users? The answers to the above questions need to be further investigated with empirical and practical evidence. For instance, user acceptance could lead to attractive and sleek designs; however, these too can fail miserably if the expectations do not meet the requirements of the user. Currently there are so many medical mobile applications for download on Google Play store or Apple store, but how many of these apps have actually gone through a research phase to gather scientific research relevant to the information and knowledge related to the purpose of the app from the users’ perspective? [4, 8, 9, 10, 16, 17]. Yes, the content analysis can provide insights into what is available on the market; unfortunately, there is no information on whether specific theories, medical/ scientific research, clinical trials or evidence-based practice have contributed to the concept and design of a mobile application.
The healthcare and medical industry is a complex ‘being’ on its own, with challenges increasing every day and requirements and needs are constantly changing. For example, the needs of the patient are continuously evolving, hence we as designers also need to evolve with those needs to provide them the resource allowing them control over their own healthcare. In this regards I’m asking: how can we as designers ‘break the ice’ of the challenges we face in creating elite, valuable and competent medical products and services?
A beep of User Experience
The role of user experience has slowly seeped its way into the medical industry after a growing number of medical devices and interfaces used to monitor patients’ vitals and treatment have led to incorrect operations or errors of the medical devices. For example, the incident of the Therac 25 , the radiotherapy device used for both high and low radiation treatment. The negligence in finding the software design flaw earlier in the system led to six massive overdoses, resulting in the loss of several lives and injuries to many people.
In overcoming the discrepancies and the unintentional user errors, a perfect match between the user requirements and the user interface of the device should be achieved. Devices that are unsafe or prone to error, difficulties in interacting with the device or reduction of user efficiency and satisfaction are few of the many problems, which can be eliminated by keeping user experience and usability in mind when designing medical devices [2, 14, 18]. Our expertise as User Experience professionals can expand the possibilities and increase the benefits in shaping the future of the digital healthcare systems. By using the expertise of UX professionals we can improve the patients’ access to digital information. Also, by actively involving the stakeholders and their participation in the design and production process of a digital product and services we can effortlessly contribute to making digital health efficient, with improved access, increased quality and personalization of health benefits for patients.
Digital health technologies are currently designed based on existing healthcare system constructs that may not be as effective as involving users and stakeholders in the design process. More often, the designs are based on assumptions rather than the validation with preliminary user input which results in the absence of important features. The mediation of the designers can compromise the effectiveness of the device. Because of this bias user-centered-design process and an evidence-based approach plays a key role in addressing the needs and requirements of specific target groups [1, 19, 20, 21].
Although users and stakeholders are diverse and interdisciplinary, an ‘invisible thread’ connects them that completes the communication cluster. To make this ‘invisible thread’ visible, the integration of user experience competence as a ‘must-have’ in the implementation and production process in a highly standardized industry such as the medical technology industry can bridge the gap between patients and healthcare providers. Therefore, this ‘visible’ connection can have a considerable impact on UX professionals and practitioners not only in the design of a digital product or service but also in the earlier phases of the design cycle i.e. in user research and data gathering.
With the thread made visible, the challenge of having a broad understanding of science and medicine and their key function, relevance and importance in the early stages of design can be overcome, and bridging the gap brings a balance between design and medicine. However, a crucial step for a designer to design efficient medical apps is gaining a profound knowledge and insight into the conditions, treatments, and problems patients and stakeholders face. To increase the satisfaction and optimize the workflow of patients and stakeholders and to ensure a covet outcome, in-depth user research of target groups/users should be conducted. Consequently, the design and development of a product can proceed unhindered into production and deliver a favorable and profitable product or service. By involving stakeholders with medical knowledge and the expertise of UX professionals early on in the design cycle of products with patients and stakeholders at the center, more innovative and cutting-edge solutions can be achieved, giving the ‘push’ into the digital transformation process.
And a pulse of Usability
Usability. “What is usability”, this question is no stranger to anyone reading this article. So, what is usability? The dictionary says ‘anything convenient for use or capable of being used’. The profession of usability engineering is no different except for the fact that we are specifically narrowing the general definition down to human-computer interaction, where computer interfaces are developed that have high capability of use or user-friendliness. Hence, we have the ‘official definition’ from the International Standards Organization (ISO) covering the ergonomics of human-computer interaction. The ISO 9241 defines usability “as the extent to which an interactive system can be used by certain users in a particular context of use to achieve specific goals effectively, efficiently and satisfactorily”. This standard also includes medical devices and interfaces. Hooray, it is official! On the other hand, however, the Food and Drug Administration (FDA) believed that the term ‘usability’ is often confused with ‘design’ and therefore suggested to use the term ‘human factors engineering’. Therefore, as of 2016, the FDA has revised their guidance document to assist and support the medical industry and manufacturers in addressing the applicable human factors and usability engineering processes in the design improvement of new medical devices .
Figure 1: Example of poor usability: Epidural tubing erroneously connected to IV tubing.  CASE STUDY: An anesthetist and a midwife mistakenly connected an epidural set to the patient’s IV tubing. The epidural medicine was delivered to the IV The patient died.
What is bad/poor usability? How can we determine which device/s are allotted in the category of bad/ poor usability? For instance, poor usability of a device in medicine is the reporting of false measurements in infusion pumps .Between the years 2005 to 2009 the Food and Drug Administration (FDA) reported 56,000 infusion pump incidents or 35% due to incorrect data entry. The FDA stated that this adverse event resulted from programming errors, which can be associated with poor usability. According to the authors, Martin A Makary and Michael Daniel  from John Hopkins University the third leading cause of death in the U.S is due to medical errors. According to the FDA , from October 1983 through to September 1989, 44% of medical devices were recalled due to design problems and more than one-third of these problems involved user interfaces. In addition, from 2010-2012 the FDA  recalled medical devices. Leading to 36% were design errors.
Question for thought, doesn’t the design of the interface also play a role in satisfying users and stakeholders? For instance, the choice of colors for the design of the interface needs to be carefully selected concerning the different kinds of users. Users can be color blind or have color vision deficiency. Moreover, the design of an interface is constantly put through tests such as usability and user testing at different stages of the design cycle in the form of questionnaires, interviews and other methods to validate the design. User experience and usability are a pair entwined and destined to be together.One without the other, the success of the application would utterly fail. In layman terms, user experience and usability is like needle and thread, there is no real purpose of one of them standing alone. Usability together with user experience is also central in the medical device or product or service development process. In the design and development process the objectivity of usability engineering consists in planning and ensuring that sufficient time and resources are available. Although the medical design and the usability of digital medical products are a new and modern addition to the development process, the effective integration of medical design and usability into the design process can provide a holistic view into the future of not only the product but provide meaningful insights into the digital revolution.
Today we can see good usability as a tangible asset to manufactures of medical devices, because a system with good usability means frequent buying and use of the systems, which in turn means a larger turnover for the company in terms of purchases and shares. Usability of a system is about not only efficient, effective systems and satisfied users and stakeholders but also a valuable and profitable asset to companies.
Grow & Cultivating UX
The growth of UX in the medical industry is constantly expanding and continuing to push forward with great innovations being created and tested. With the integration of expertise and professional knowledge of user experience and usability professionals, professionals from the medical field along with intensive user-centered-design projects, can skyrocket the efforts of healthcare and digitization. Having patients, users, and stakeholders at the center of a project can increase the growth and cultivation of user-centered-design products and services. The growth of UX in the digital healthcare can further advance by actively associating with medical professionals in their working environment, which can lead to a new illumination of the challenges faced. Furthermore, cultivation of UX is merely being involved, getting involved and learning, and understanding the needs and requirements of patients and stakeholders. Understanding their struggle with digital systems can give us deeper insights into the kind of digital features or even entire systems that we need to rebuild or create in order to uplift the fall to provide more than just an efficient but an essential system..
I am Preetha Moorthy. I am a User Experience Consultant and Usability Engineer at the Heinrich-Lanz-Zentrum at Medizinische Fakultät Mannheim der Universität Heidelberg. As we are also joining the slow progression into the future of a digitized hospital, we started with setting up our own Usability Lab. The intention is to provide support to the different clinics at the hospital and help to optimize their systems, applications and workflows by conducting regular usability tests with patients and stakeholders of the hospital. This would enable us to identify the funding needs and the feasibility of improving the workload and interactions as well as the communication between the clusters of the different clinics at the hospital. I am looking forward to the continuing progress of events, the advancements of innovative ideas, and the production of efficient products and services in the medical technology industry. And to the progress of the digitization at the clinics and hospital here in Mannheim, at our very own Universitätsklinikum Manhheim (UMM). Don’t look at the future cause the future is here, now!