Effective patient experience design during a pandemic

Or, how not to give patients a heart attack.

In 2018, I went to see my doctor for a routine physiological exam. I’m as healthy as someone who smokes can be (I know, I know…), so I didn’t really have any significant concerns about my health. After the exam, the doctor told me that I should only expect to hear from the clinic if any abnormalities are detected in my lab results. As per usual, good news is no news. I thanked them for their time and went on my way.

A few weeks letter, I got a letter in the mail in a plain envelope addressed to me from the Ontario Cervical Screening Program. My stomach dropped. I caught my breath and sat down, trying to stay calm while I opened it. Inside was a letter addressed to me by a doctor. I felt my heart drop. The letter started with a doctor introducing themselves, and I already had tears running down my cheeks because all I could think about was the fact that this was it. Through tears, I finally made my way to the sentence where the doctor kindly explained that my results, in fact, had been normal.

I’m not the only one who had this experience. This is an example of the letter someone else received, and the person who posted this photo had pretty much the same reaction I did.

Cool, no cancer. Maybe start with that next time?

I’m telling you this story because I decided to get tested for COVID-19 with my housemates yesterday. I didn’t have any symptoms or knowingly come into contact; but recent provincial recommendations include getting tested if you or someone you live with has been at a mass gathering or protest recently.

The test itself was fine and fast. I appreciated how quick the swab was! At worst, I can describe it as inhaling too much water when you jump into a swimming pool, and the uncomfortable sensation lasted a couple of minutes at best.

The e-health nerd in me was especially excited about the fact that we’d be able to get our results with 12–24 hours online using a self-serve system. As someone who has worked in healthcare and civic design for many years, I’ve been waiting for a long time for Ontario to get e-health management in place, and this is an exciting start. I mean, desperate times, but what better way to encourage government towards iterative and agile service design than by force?

Anyways. Here’s what happened.

My test results! I don’t own UHN or its brand, as should be apparent.

Took me a sec, as I was brought back to that feeling you get when you’re waiting to hear about a job. The page loaded as I sat with baited breath, and…

Uh… and…

Hang on, I’m reading…

Oh, there it is! Negative!

So we’re back at square one with the same problem. The information I care about the most takes way too long for me to find.

I’m forced to consider a few things.

What about patients who don’t have this level of grasp of English? I generally encourage use of Grade 8 level English for more accessible service-delivery content, as it can be easier to translate and understand than using specialty language.

Accessibility matters too. Users with assistive devices like a screen reader might not be able to tell their result immediately from the way this content is architected.

And here’s where my Product Designer brain kicks in. Healthcare systems are absolutely rammed right now with providing front-line care to folks with COVID, and I am frankly nothing short of impressed with how quickly provincial workers have rolled out e-health systems, and I understand that the potential for iteration and improvement is there.

So if I got ten minutes alone with the results screen, what would I do?

First, I’ll start with minor interface improvements based on best practices for touchscreen devices.

1. Reduce the amount of space the menu takes up on my phone screen. Most folks will be checking their results on the go, so there’s a good place to optimize the amount of space for actual content.
2. The “Back” and “Print” buttons have been re-positioned. Remember, your finger takes up more room on a touchscreen device than a cursor, so it’s imperative to have mobile-friendly positioning with enough space to click for your average-sized finger.
3. What’s the most important information? Test results, obviously! We’re using colour coding to tell you what you need to know first, but we aren’t relying on colour alone.
4. Remove the alert bar that notifies users about access to PocketHealth. Given especially that it’s a fee-based service, it should be marketed accordingly (i.e. a pop-up when the user first accesses the website) and not be integrated into the overall structure of patient information. Remember that we have limited space on mobile devices, and to optimize what matters.

Following the hierarchy of information, here’s what’s most important to me.

1. Whose test is this? Healthcare records should always have a clear identifier indicating who the record belongs to because leaked tests aren’t just private and confidential information being released, they also constitute a massive violation of provincial e-health privacy guidelines.
2. What were the results? Most people understand clinical testing by virtue of “negative” or “positive”. Stick to patient friendly language and make it very, very clear.
3. What test is this? Remind folks where and when they got tested. Part of effective health record-keeping is making it easy for patients and care providers to assess the chronology of lab tests and results.
4. About the test: Most folks who don’t have a background in biological sciences aren’t aware of what BGI Real-Time Fluorescent RT-PCR 2019-nCOV Assay is. While I do have a minor in Biology, I only mostly remember crying my way out of dissecting a frog. As such, your typical patient doesn’t need this information. Their care provider may, however, so this information doesn’t need to be removed entirely. It just need to be re-prioritized in the overall structure of the patient record.

So here’s my take! Thoughts? Considerations?

And why yes, how nice of you to ask, I am seeking new remote Product Designer opportunities. Please reach out to me if you want to build beautiful user experiences together for government, healthcare, or civic issues. Or anything related to space. Do they need a UX designer on the ISS yet?

As always, Sidra Mahmood