To create our new iPad interface, which just released as a beta version to active providers, Practice Fusion partnered with the award-winning design firm Cooper. Cooper is renowned for its work across the design world, from startups to over a third of the Fortune 500, with its emphasis on creating simple and enjoyable user experiences.

Our iPad User Experience Designer, Kramer Weydt (R), worked closely with Cooper’s Stefan Klocek (L) to make the Cooper design a reality. We met to chat about the process:

First of all, what exactly was your role on the iPad design?

Stefan Klocek: We are user experience designers, meaning we focus specifically on how users interact with the EMR. Instead of just designing from scratch, we first understand our user’s needs and we determine how we can fulfill those needs with the technical resources we have available.

Kramer Weydt: We’re not doctors, but we understand how people interact with devices and we learn from doctors what they need from this technology through research and interviews.

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Last week, I joined entrepeneur Enrique Allen and designer Leslie Ziegler at Kaiser, where we spoke to doctors from their internal innovation program. We hoped to inspire them as well as to illustrate how design could be used inside Kaiser to improve processes and overall care.

I referred to two case studies—Cooper's work on the Practice Fusion iPad-based EMR, and a visioning project around the patient clinic experience. In these, I illustrated how we identify problems, generate ideas, and drive decision-making during detailed design.

Both case studies highlighted ways in which multidisciplinary teams can make progress by using cheap prototypes that are quickly iterated. In the case of the Practice Fusion app, we used paper prototypes to test and evolve everything from content organization to animation. We did not need to get permission of a hospital IT staff or work with an engineer; we simply needed a new piece of paper and a Sharpie. Prototyping a service starts in a similar manner. Using storyboards and cartoons, we were able to generate and evaluate myriad patient journeys without making costly process and staffing changes.

Many of the questions during the Q&A were symptomatic of a large organization that is beholden to fluctuating regulation. One attendee asked how to get front-line staff on board when they're already suffering from change fatigue. This will require both communication and empowerment. At Cooper U we teach the value of a radiator wall (a wall showing the progress and decisions of a project) in rallying a team and communicating with an organization; this kind of tool could help establish a sense of consistency and direction amid large-scale changes.

All of Kaiser's departments were represented at our talk, from general practitioners to specialists. All are charged with improve patient care and overall quality. I appreciated the opportunity to bring some lessons from my experience in healthcare and design, and I'm looking forward to seeing what they tackle next. Read More

(This article was published in the November/December 2010 issue of interactions magazine.)

It seems likely that we find ourselves at an inflection point in the evolution of healthcare. While the situation has certainly been brought to a boil by recent American political events, the opportunities for change fit into a much larger context; they have the potential to truly transform the delivery of healthcare globally.

Unlike some, I don’t believe our current healthcare system is totally broken. I’ve conducted design research in quite a number of clinical settings and have consulted for businesses representing many different aspects of the healthcare industry, including provider networks, medical-device manufacturers, and even health insurance companies. I’ve seen magic worked on regular basis, and from a historical (and global) perspective, the standard of care in the developed world is astoundingly high. I am in awe of the abilities of doctors, nurses, techs, and other clinicians to consistently function at a very high level despite the fact they’re forced to work with archaic infrastructure in less than ideal environments. (As for the insurance companies, perhaps the best thing to say is that they function to make money but could be dramatically more successful as businesses if they changed their approach to things.)

It is at this level—the level of infrastructure—where these big opportunities for transformation exist. It isn’t that we don’t know what kinds of patient and clinician behaviors and medical interventions result in healthy outcomes; it’s that at a systemic level, we’re not doing a good job facilitating these behaviors and driving appropriate interventions. The right changes here will provide a conduit for evolutionary change to cascade throughout the system to achieve dramatic improvements in the quality and cost of healthcare. Which isn’t to say that it also isn’t incredibly important for medical knowledge to continue to evolve; it’s just that we already know enough to dramatically drive up quality and drive down costs.

Many of the opportunities to improve our healthcare system can fit into three big categories: proactively engaging individuals to take better care of themselves; providing better interventional care beyond the walls of the hospital; and improving care delivery inside hospitals through standardization and better collaboration between clinicians, patients, and families. All three of these strategies require new infrastructure and perhaps a shift in the definition, role, and activities that characterize the hospital.

The first two ideas are mostly about what happens outside the hospital. These are things that architects wouldn’t traditionally worry about when designing hospitals. But that kind of thinking has gotten us into our current predicament, where the current built “environment” for providing healthcare is sometimes an impediment to necessary change. If we step back and define a hospital as the nexus for healthcare in a community, we have a platform on which we can imagine the ideal infrastructure for keeping people healthy as possible in a cost-effective way.

In the May+June 2010 issue of interactions, Hugh Dubberly suggested designers ought to help reframe what healthcare is and how it is delivered, as well as to reframe what it means for design to help. I couldn’t agree more, and in this spirit, propose reconsidering what healthcare infrastructure is necessary to better care for people, how design should address this new notion of infrastructure, and what this all means for the institution of the hospital.

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I like to think of Interaction Design in its purest form as being about shaping the perception of an environment of any kind. Yes, today the discipline is so closely tied to visual displays and software that it almost seems to revolve around that medium alone, but that’s only because as of now, that’s pretty much the only part of our environment over which we have complete control.

The one field that has come closest to overcoming this limitation is the video game industry whose 3D games are the most vivid and complete alternate realities technology has been able to achieve. Game designers have control over more aspects of an environment, albeit a virtual one, than anyone else.

Lately I’ve been thinking a lot about this idea that interfaces can be more closely integrated with the environment in which they operate. I’d like to share some of what I’ve learned from the universe of video games and how it might be applicable to other kinds of designed experiences.

In Designing for the Digital Age, Kim Goodwin criticizes the term “Experience design” as being too presumptuous because we don’t really have the power to determine exactly what kind of experience each person with their own beliefs and perceptions has. Even when we work across an entire event from start (e.g. booking a flight) to finish (arriving at the door), there are still countless factors outside our control that can significantly impact how a person will experience it.

Video game designers on the other hand can orchestrate a precise scenario since almost every detail in their virtual world is for them to determine. They can arrange exactly what kind of person sits next to you on a flight no matter who you are or how many times you take that flight.

That isn’t to say that videogames don't have their limitations. Of course, it isn’t completely true that game designers can determine who sits next to you. They can only determine who your avatar sits next to. The most significant weakness of videogames is the inability to truly inhabit a designed environment or narrative. As much control as we may have over a virtual world, as long as we are confined to experiencing it through television screens and speakers, it won’t be anywhere near comparable to our real world.

Fortunately, there’s a growing effort to address this lack of immersion.

A key area of the problem lies in how we’re presented and interact with complex information diegetically, that is, interfaces that actually exist within the game world itself.

Before continuing, it helps to be familiar with some basic concepts and terminology around diegesis in computer graphics, the different spaces of representation between the actual player and their avatar. The diagram above illustrates the four main types of information representation in games.

Non-diegetic representations remain the most common type of interface in games. In first person shooters, arguably the most immersive type of game since we usually see the scenery through our avatar’s view, the head-up display has remained an expected element since Wolfenstein 3D first created the genre. Read More

We’ve all got our own personal benchmarks for what makes a good user experience. My personal list includes a few: Does it delight me? Will I recommend it to my friends and colleagues? Would I have used the same approach if I had designed the product? I’ve found among some product executives one particular pattern for this subjective evaluation criteria that is both humorous and troublesome: “Would my mother/grandmother/Luddite Uncle Bill be able to use this product on the first try?”

While there is a sort of noble aspirational quality to this kind of thinking—let’s make everything so dead simple that any person can use every product—it also sets the bar for the experience rather low. I imagine a sea of step-by-step wizard dialogs that target the lowest common denominator and force everyone else to step through the same predefined (and very explicit) experience. If I’m designing a product for people who have specialized knowledge, I want to leverage that knowledge in the product. Why force people to walk when they can run? I’ll want to provide these people with clear, appropriate pathways through the product, but I also want these specialized users to be able to forge a variety of their own pathways through the interface, dependent on the specifics of their situation or how they want to do things.

I once worked with a client to design an intravenous medication delivery device called an infusion pump. This is a machine that nurses in hospitals use to administer drugs to patients by attaching a bag of medication to the device and specifying delivery parameters such as how long and how fast to dispense the medicine. This is critical stuff; the consequences of a mistake could be catastrophic. Read More

When I picked up Jerome’s Groopman’s How Doctors Think, I imagined that it would give me a useful window into the mind of the busy clinician. On medical projects we often find it a bit challenging to get enough research time with physicians. (Aside from maybe lawyers and CEO’s, there are no better exemplars of the “time is money” mentality—American doctors, in particular.)

Dave, Doug and Noah learning how surgeons think.

While I appreciated the informal history of medical education, interesting anecdotes of diagnostic challenges and satisfying dose of medical atmosphere, I learned just as much about design and design research as I did about medicine. (I'm not surprised to discover that I'm not the first to make this connection. In her blog, Elegant Hack, Christina Wodke discusses how she thinks design education should be thought of more like medical education, with a focus on gaining experience over several years in industry, rather than just technical skill in a design program. She'll get no argument out of me there.)

The part of the book that I found most striking is Groopman's discussion of what he calls "classic cognitive errors" in diagnosing and treating medical conditions. I have made and seen each of these errors in understanding people and devising products and services to meet their needs. While explicit knowledge of these categories of flawed thinking isn't a guarantee against them, I do think that by naming them and affirming their reality (often by reference to the work of psychologists), this book can help us remember the kind of mistakes that top-notch professionals make when they're tired, stressed, egotistical, or just lazy. Read More

In the mid-1980's, a team of physicians, lawyers, and public health experts conducted a lengthy study of the nature and causes of medical errors. They published their findings, entitled "Incidence of adverse events and negligence in hospitalized patients," in the New England Journal of Medicine in 1991.[1] Their research indicated that "there is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care." While the industry evaluations and renovations sparked by these findings have taken effect, physicians and clinicians have simultaneously adopted more sophisticated technologies to provide more accurate and efficient care. [2]

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Healthcare is a target-rich environment for design. Discussing even the smallest design challenge quickly exposes the hacked-together systems and processes that somehow function to help us stay healthy. Designers must understand the context in which they work, yet confronting the complexity of healthcare can be paralyzing. It seems impossible, for example, to discuss the viability of mobile devices at the point of care without discussing the Byzantine network of roles, regulations, and workflows that the device touches: nurse assistants, the lab, the patient, receptionists, regulatory bodies, HIPAA, hospital and lab information systems, IT departments, point-of-care coordinators, ADT systems, and so on.

While it’s important to understand the knotty context of a healthcare design problem, it’s just as important to know when to reach for the sword of methodology to cut through it. To illustrate this point, I’ll discuss some healthcare design challenges I’ve seen during my research and design work and the methods I’ve used to tame the complexity.

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