It may be more challenging to make healthcare consumer-focused and tech-enabled than other industries, but that doesn’t mean some of the same design and usability sensibilities that work so well in other services can’t be applied.  
 
In a panel discussion moderated by MobiHealthNews Editor Jonah Comstock at the Digital and Personal Connected Health forum at HIMSS 17 in Orlando this week, innovation specialists shared what strategies they have used to make mobile apps, connected devices and other digital health tools work for their organizations, and what they’ve learned from missteps along the way.

As far as designing for a patient versus the consumer, Pam DeSalvo Landis, Vice President of Information and Analytics Service at Carolinas HealthCare System said one doesn’t necessarily have to think of them differently on basic factors like a good user interface and simplicity of use.

“I don't use the terms interchangeably, but a patient is a consumer and a consumer is a patient,” she said. “What I do is look at what am I designing for – the tasks or the things that I am asking them to do. It might be that you are designing some kind of app or digital property where you are taking them on a journey, maybe they are doing some searching and you are trying to convert them to actually taking an action. So, from my perspective, the design is the same and the same type of hueristic principles that apply to the experience on Zappos should apply to the patient portal."

Similarly, HIMSS Innovation Committee Chair Santosh Mohan viewed consumers and patients as “two sides of the same coin,” wherein roles may change depending on what the context of care is, but the key values remain the same.

“What I have seen in those values are really convenience, outcomes and personal attention – those are common in both segments,” said Mohan. “So I think if you focus on that, you can build loyalty by winning over both sides. And don’t hesitate to lead with non-clinical value if the context permits you to lead with convenience or cost, such as in the case of a patient who wants a virtual visit because it is easier.”

James Hattersly, senior vice president of business development at smart inhaler and respiratory health management company Adherium, said that adage applies even in his organization, where clinical outcomes drive most of their product development.

“It can't be always focused on just physician side or clinical side, although that is the basis for some of the technology for things like respiratory, neurology, obesity, hypertension,” Hattersly said. “But if you can look at another value or outcome for the patient that is, for lack of a better term, closed-loop, a connection that they have with the use of their medication, the use of their devices, I think that is extremely important because then they feel more of a connection instead of feeling like they are leaving something to chance. We all know what can happen when you leave something to chance.”

To have that kind of engagement through connectivity, it takes a seamless, frictionless patient experience, members of the panel agreed. But what may seem like an obvious or useful feature to those designing the tool may be different than what the patient actually responds to.

At Carolinas HealthCare System, Landis said her team does a lot of pre- and post-testing, and they use as many real people as possible. Beyond focus groups, they also take their consumer research to the streets, interviewing people about potential apps or features they could add to their patient portal.

“It is the most humbling and gratifying experience to sit on the other side of the glass and see how someone is interacting with your product,” Landis said.

Landis described a testing round Carolinas had where testers were confused over the search function of the patient portal, believing the first result to be a sponsored ad like it is on Google thus ignoring it, even though that wasn’t the way the portal was set up.

“You ask them to do something like search for a doctor through the portal and they can’t. At first, you think, ‘Well, if they would just do this and this, they could figure it out.’ They also ignored a news function even though we thought it was really important and thought, ‘if they just clicked on it they realize it’s something they have to have.’ Well, if I was 10 inches taller and 30 pounds lighter and 20 years younger I could be a supermodel, but that’s not going to happen. So that’s the wrong approach to take,” Landis said. “It really forced to think about what is important to us and what is important to the consumer.”

Hattersly shared how Adherium takes product design especially to heart, because if an inhaler is clunky, a patient will not use it properly and it will affect actualization and inhalation of their medication.

“It needs to be used properly, and it if is too complicated or not something they are willing to use and get a benefit out of, what’s the longevity of that tool going to look like? Hattersly said. “That’s very important because we don’t want people, especially those who have moderate to severe asthma, to stop using the tool.”

Another thing to consider is how many different digital tools the patient consumer may be using, and there may exist barriers to interoperability as well as an overall sense of fatigue from too many requirements to the user.

“A patient can have as many as six instances fof each patient portal from the same vendor, so when we are trying to design new things, we have to be cognizant of the fact this is healthcare, it’s not LinkedIn or Facebook and every interaction within those portals is linked together,” said Mohan. “That’s what’s really frustrating at this time.”

What Landis has found is patients really crave digital tools that are designed with the least amount of steps to be used.

“What patients are really telling us is, ‘Make it easier and get out of my way’," she said. “We sometimes put up a lot of barriers in the process. When we added Open Notes to our patient portal, we just turned it on. We did no marketing about it. In about two months, 91 percent of people who logged in that month read a note. It is the single most, and remains the most, popular thing on the Carolinas portal.”

Of course, making something seamless and almost invisible, which is a core feature of consumer technology that makes it so appealing to users, runs counter to what digital health tools are trying to do: remind and keep people accountable for their health, such as the case in Adherium’s smart inhalers.

“The reminders are the intervention, because the second there isn’t a puff, there is a reminder,” said Hattersly. “The reminder is directly in the device. You can set it, and that’s incredibly important, but it also gives us the opportunity to take a proactive approach to rewards and constructive feedback.”
 
Additionally, the panel said, that kind of accountability to all parties is where healthcare has an advantage, because doctor-patient relationships are personal in a way consumer technology is not.

“The experience online and digitally might not be where we want it to be, but it’s getting there,” said Landis. “I think that experience you have with a doctor or nurse or midwife is personal. People don’t have that with Netflix. They don’t have a relationship with it. But we still have a lot to learn from consumer industry.”