5 RULES to help your next website avoid the mistakes of Healthcare.gov s launch

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1 5 RULES to help your next website avoid How to apply general design principles in a healthcare-savvy manner June 18, 2014 MEDULLAN, INC. 625 Mount Auburn St., Suite 201 Cambridge, MA 02138

2 The launch of the Federal Healthcare Exchange website had many problems: slow loading, application freezes, users getting dropped, frequent error messages, etc. While some of the technical or project management problems may be attributed to the inherent nature of a large government project, the user experience (UX) design blunders are fairly common in healthcare. It s no surprise, as most challenges with usability and user experience are rooted in the complexity of healthcare and consumers unique relationship with the health system. If this unique complexity is left unheeded, it will certainly result in big UX problems. Medullan s designers surveyed and evaluated it against the user-centered design principles used by Medullan s User Experience team. Our goal was to highlight the UX problems that we see all too often in healthcare (our sole industry of focus) and highlight them in a way that helped project managers or even more senior executives manage their designers. In fact roughly a third of our UX design projects are cleanup projects where Medullan was asked to fix a recently designed website because either an internal team had focused too much on internal processes, or the originally hired design vendor had primarily non-healthcare experience that resulted in insufficient skillsets. While some of these websites were corrected before the embarrassment of a public launch, others were not. All of them suffered from costly delays that could have been avoided. In other words, from a UX design blunder perspective; the original launch of Healthcare.gov is not an exception It s an all too common experience and cautionary tale for all players in the healthcare space. 5 RULES to help your next website avoid 2

3 EXECUTIVE SUMMARY By following 5 basic rules, you can increase the chances of a successful online experience (mitigating the risk of following in the footsteps of the Federal Healthcare Exchange). 1. Understand your users and their goals Simple in concept, but requires an understanding of healthcare from a consumer perspective 2. Provide users with location, cues, & context Providing consistency and clarity is not just about cool or modern look-and-feel design elements 3. Allow users to control interactions and move freely throughout the site Consumers vary considerably in their use of, and familiarity with, the healthcare system so a good UX must accommodate a range of users 4. Use aesthetics & design as a means to support functionality, not an end Yes, if this were a simple consumer packaged good or a service aimed at young hipsters, perhaps aesthetics could be the dog but when it comes to healthcare, aesthetics is the tail that must follow functionality 5. Prevent user errors where possible, but plan for recovery Healthcare is complex - expect at least a third of the users to get it wrong the first time around, and be prepared to get them back on the right track While these 5 rules are not in themselves specific to healthcare, their full and effective application requires in-depth experience with healthcare from a business, technical and consumer perspective. Healthcare is, in fact, unique. So it s no surprise that design shops with general consumer expertise, however impressive their aesthetic or creative abilities, usually get tripped up in the unique complexity of healthcare. The result, all too often, is a mess that requires extensive re-work. 5 RULES to help your next website avoid 3

4 1 PROVIDE USERS WITH LOCATION CUES & CONTEXT All too often healthcare user experiences are flawed because designers focused on cool/modern aesthetics or mistakenly applied consumer insights from nonhealthcare aspects of people s lives. Healthcare has a unique role in most consumers lives that is quite different from buying a car, fast food or online music. To ensure how the site architecture and task flow aligns to the primary use cases and users mental models requires healthcare expertise. Additionally, compliance with the complex regulations implicit with healthcare often takes precedence in system design. This can result in the focus being solely on the business and compliance goals without any regard for what the user is looking to accomplish. The best place but often overlooked or poorly understood to start when designing an online experience is to determine what users expect from the site. Consumers shopping for healthcare coverage typically have the following goals: Browse and compare healthcare plans Estimate price reductions based on household size and income Get information on what is needed to ultimately apply for health insurance Register and apply for coverage Return to the site to log back in and check on application status The Federal Healthcare Exchange only accommodated one of these 5 goals registering and applying for coverage. The others were either missing or near impossible to find. Throughout the site, the user is repeatedly prompted to Apply Online, whereas links for non-registered browsing are hidden. It seems that no matter where you click, you are trapped by the system and the only way out is to apply for coverage, which requires registering for an account along with identity verification, a long and cumbersome process which can take as long as 60 minutes. 5 RULES to help your next website avoid 1

5 2 PROVIDE USERS WITH LOCATION CUES & CONTEXT First and foremost, provide clarity not confusion. Healthcare.gov suffers from inconsistent and confusing navigation. The buttons and links seem to go in circular paths without providing and new information or progress. As a user, it is unclear where the users is, why the user is there or how to get back to where user came from. For returning users, there is no indication as to whether they are logged in or not. In the example below, upon selecting the state of residence, the look-and-feel changes from the original home page. This type of abrupt transition occurs throughout the site requiring the user to repeatedly learn a new navigation scheme each time this happens. This leaves the user wondering if this is the same site, a related site or a different site with similar look and creates uncertainty as to whether they have made progress or if they should go back to where they came from. 5 RULES to help your next website avoid 2

6 Second, keep users informed about location, status and next steps, and provide easy to access instructions and help at all times. Use clear navigational clues such as highlighted navigation items, progress indicators and breadcrumbs so users know where they are within the site or process. Descriptive and consistent labels for navigation, headers and calls-to-action will ensure users know what to do next. 76% of consumers say the most important factor in a website's design is "the website makes it easy for me to find what I want For example of what not to do, the 3 circle icons in the screenshot above are not only unclear/unlabeled, they re deceptively simple and therefore misleading given the multiple complex steps in the actual process flow of providing lots of personal data and a lengthy identity authentication process (without any assurance as to how this data will be used or protected). Soon, the user is left with the feeling that this is a dark rabbit hole without any indication of where and/or how far it goes. Consider an introduction or overview to give users an idea of what they are in for. How long will this take? What do I need to get started? Will I have to pay anything? What happens with my private information? What if I m not ready with all my documents? How long will this take? Can I stop part way, save and resume from the same place later? 5 RULES to help your next website avoid 3

7 3 ALLOW USERS TO CONTROL I NTERACTIONS AND MOVE FREELY THROUGHOUT THE SITE Provide users the type of information that gives them a sense of control. Online shoppers are often wary of making a purchase or providing personal information without understanding the trade-offs of their decisions and clear benefits they will get in exchange for making a commitment of time (not to mention money and sharing of personal information). For example, users should have the ability to view cost comparisons before initiating a lengthy registration and application processes. Provide flexibility to account for differences in personality. The site should allow for different kinds of site exploration since some users will want to search, others prefer to browse whereas some may want to dive right into a process. Make sure the navigation and location cues allow for these different ways of navigating your site and allow users to easily jump from one mode of navigating to another. Remember to always keep users informed about location and status. Provide immediate and appropriate confirmation and feedback for user actions. Allowing users to control the interactions with the system to the extent possible results in a high degree of satisfaction. Provide the ability to move vertically and horizontally with clearly marked alternatives and options. The Healtcare.gov site, once in the application process, provides a Next button, but not many other choices. There should always be clear and easy to follow pathways for essential tasks as well as options for accelerated/experienced users and novice users. Always provide options to exit and return to the previous destination. Pathways are based on user-scenarios, which comes back to the importance of understanding user needs and goals. 4 USE AESTHETICS & DESIGN AS A MEANS TO SUPPORT SYSTEM FUNCTIONALITY, NOT AS AN END Visual patterns support and reflect the purpose of the system as well as the hierarchy of information and actions. In healthcare, they must often be complemented by explanatory language that avoids specialized terminology in favor of phrases that are familiar to the user. The information is arranged in an order that makes sense to the user with an eye on completion of their goals. The use of icons in UI design is often over utilized in that many designers look to achieve a clever or aesthetically pleasing design rather than one that is actually useful for the intended audience. Consider the 4 circles on the Healthcare.gov homepage modern looking but not particularly helpful for a large portion of the healthcare target market population: Visual elements such as these icons that don t help the user understand the functionality are at best pure decoration or in this case, a hindrance since the user is required to click on each of the icons to understand what 5 RULES to help your next website avoid 4

8 Design should strive to solve problems by providing visual clues that enhance the usefulness of the system for those intended to use it. these options are. Most often the best way to let users know what something means is to spell it out in plain English: 4 Ways to Apply for Coverage: 1) Online, 2) Phone, 3) Fill out an application, 4) Apply in person. 5 PREVENT USER ERRORS WHERE POSSIBLE BUT PLAN FOR RECOVERY Prepare for and directly address questions. Even if you ve followed the guidelines for navigation and location cues, a complex site or process may still require instructions and/or help in order for users to orient themselves and understand the context or details of what they are being asked to do. An easy-to-find FAQ could serve to allay fears and correct misconceptions. Design should help prevent the user from making errors but should allow for easy recognition and recovery when they do. Error correction and recovery was one of the most complained about problems with the healthcare marketplace site. When there was a problem the user had to start over. This was made worse by the lack of progress indication as you may have to start down this path of unknown length several times without ever knowing if you were getting anywhere close to completion. Your site should account for user errors. Typing in an address incorrectly should not result in the user having to start a process from square one. Help should be contextual and reflect the most-likely needs of a user in that place in the process. Focus users attention on missing or incorrect information and provide them with guidance on how to correct mistakes and quickly move forward. Help users recognize, diagnose, and recover from errors. Error notifications should be expressed in everyday language and clearly indicate the problem. They need to outline most-likely possible solutions and provide a means of contacting someone who can help them if all else fails. 5 RULES to help your next website avoid 5

9 CONCLUSION & IMPLICAT IONS The patient/member consumer perspective is indeed different in the healthcare space than other typical consumer markets. Each of the general 5 Rules need to be considered in the context of healthcare-specific details. Any list of rules is only as good as the team assigned to implement the project. The key for a product manager or more senior executive is to avoid the 2 extremes that many healthcare companies swing between: Utilizing an internal team whose prior UX designs have reflected the complexity of internal processes, but have not truly incorporated the consumer perspective; or Hiring a design agency with consumer expertise, but little or if any grasp of the complexities of healthcare. Yes, healthcare does need to be more member/patient-centric but healthcare is too complex to entrust user experience to designers who are not healthcare experts. Healthcare.gov and many less public delays have shown the need for a middle path: the combination of healthcare expertise and consumer perspective. While this combination may not be easy to find, assemble, or fund, it is nonetheless the critical key to success. CONTACT INFORMATION James Williams, Senior UX Design Manager james@medullan.com Weston Headley, Innovation Principal weston@medullan.com Medullan Inc. is a healthcare consultancy that provides strategic technology innovation services from product strategy and definition, to rapid prototyping of UX design and software development. ask@medullan.com 625 Mt. Auburn Street, Suite #201 Cambridge, MA RULES to help your next website avoid 1