eHealth Articles & White Papers

Understanding User Experience for Portal Design

By Pete Wendel - User Experience Researcher

Many hospitals are creating patient portals for their divisions and clinics. Many more are investigating or making plans to do so in the future. Given the complex and dynamic nature of patient portals, and the fact we're actively engaged in designing and evolving our patient portal, a number of our clients have asked us to share our thoughts on ensuring the design, development, and deployment of a successful portal.

We believe the key to creating successful portals is to focus on the user experience. To understand user experience is to understand the behavior of your target audiences and how they plan to use your portal.

Let's drill down and take a look at what this means, why it's important, and how user experience should be used to drive patient portal design.

What is user experience?

User experience is the sum of what each patient takes away from the interactions they've had with your hospital. This requires an understanding beyond any one communications channel - experiences cross boundaries. Patients communicate with your hospital via many channels including the phone, Web site, print and social media.

It may seem daunting if you try to understand the various experiences patients have using each communications channel. However, the complexity can be simplified if you focus more on the user-the patient.

By understanding patient behavior and the reasons why they choose to interact with your hospital, you can design or modify your communications to fit their needs. Without a focus on the user and their experiences, you are likely to spend more time, use more resources and have much less impact than originally intended.

When implementing a portal, or any project for that matter, start with what time management guru Stephen Covey calls Big Rocks-those key goals you need to meet before focusing on the details. Big rocks are a metaphor for the important stuff you simply can't skip.

Understanding the user experience is the Big Rock to creating the proper foundation for the rest of your strategic and tactical efforts.

Why is user experience important?

When hospitals, as well as other industries, create a product or service, most efforts are traditionally focused on hospital/corporate needs and metrics first and patients needs second. This is because hospitals don't intentionally plan their customer experiences, and in effect, design from the inside-out.

An article by Edmund Tribue cites customer relationship management (CRM) as a typical example: "Most companies have concentrated on automating processes for their internal users... But what about the customer?

This mindset is perfectly illustrated by the most common CRM objectives: increase sales, drive cross-selling, minimize resources, reduce ancillary expenses, and lower the number of costly channel interactions. Those objectives indicate an inside-out view that implicitly treats the processes and internal metrics as more important than the customer."

There are multiple layers between the systems, processes and rules the govern them, the communication channel touch points, and the interactions patients have with those touch points.

Patients can't see what's going on beyond the "interactions" they have with the hospital. They often believe that all the efforts that are going on around them are simply focused on numbers instead of people-and they're frequently right.

What to do? Focus on your patients' interactions and behaviors. Identify their context of use. Know that understanding behavior means recognizing the difference between what people say vs. what they do (as these are frequently not the same). Use an outside-in approach to understanding your patients and use that knowledge to drive the design of your interactions, touch points, processes and systems.

Using user experience to drive portal design

Geonetric incorporated collaborative design sessions with patients into the latest design of our Patient Portal Edition. The results of these sessions were insightful and pushed us into a different direction than where we had started.

In fact, patient collaboration on a preregistration form led to a key feature of our latest release: gradual engagement. Here's the story:

One of our clients asked us to include the ability to pre-register online into our latest portal release, so we conducted co-design sessions with people who had previous experience preregistering at hospitals in order to refine the design of our online preregistration process and form.

That is, we invited patients into our design process, created ideas with them and exposed them to our sketches to get their reactions. We also listened to their stories and experiences-both good and bad-when preregistering with hospitals and other healthcare organizations.

Our client initially wanted patients to become a registered user of the portal before taking advantage of the portal features and services. The problem we discovered is that patients don't want to be forced to register before using a portal.

In fact, nearly all patients we talked to made it vehemently clear: "I don't want to create an account — ever. Don't even think about trying to get me to create an account."

As we continued through the co-design sessions on preregistration, we began to identify patterns in what patient users were drawing, saying, and doing with our prototypes. We discovered patients wanted to provide critical information (sometimes much more information than necessary) in order to avoid headaches when preregistering at the hospital for an appointment.

Once the patient actually completed and sent in the preregistration form online, patients also wanted to save their information. Or, if they didn't have all the information they needed (for example, missing an insurance card), they wanted to save their progress and return later to complete the form.

When this became clear we introduced some options-the ability to save and return to the form and the ability to save their information in case they needed to send it again. All the patient had to do was answer a couple quick questions and in doing so, the patient also became a registered portal user.

Though patients said "I don't want to create an account," they actually did want and need to create an account once they invested time in completing the preregistration form. In fact, as one patient user put it, it would be offensive not to allow her to create an account and save her work as that would render the time she spent filling out the online form worthless.

Providing the ability to make a commitment and become a registered user after the patient has completed a preregistration form does two things:

• It respects the time and effort the patient has put into filling out a form by enabling patients to save their work so they don't have to repeat this same task in the future. 
• It provides the hospital with patients who are motivated to become a registered user (since there is now a clear benefit to creating a portal account-saving their work).

Trying to force patients to create an account before they see any direct benefit should be avoided. Instead, portals should be designed to provide extended features and functionality progressively or gradually-as the need and benefit arises for the user. This is a design principal we call gradual engagement.

Nike and Apple do this well with their Nike+ iPod/iPhone accessory system for running. Runners get more and more information as they build up an understanding of their patterns of speed, time, and distance over the course of time. As patterns emerge, new options are offered to the runner that allows them to enhance their experience (such as customized music for the patterns of their running or synch with gym equipment).

In other words, Nike and Apple designed the user experience to unfold gradually over time-providing more features and functionality as the need and situation demands. Does it work? The sales growth of the Nike/Apple device speaks for itself-it's become one of the most popular running accessories ever created.

Patient portals should follow a similar approach of gradual engagement, letting user patterns drive what features and functions are offered when.
Portals designed with user experience in mind are more effective

Ultimately, we see great potential for patient portals especially when they're designed based on a user experience framework. Understanding your patients' user experience is the Big Rock that will help you spend time and resources more effectively. It provides hospitals with a blueprint to build and evolve their portals over time. It also increases user adoption and guarantees patients who use your portal will consider it time well spent.