“Morning! And how are you today?” asked Katie the ever-cheerful Occupational Therapist as she bustled into Mum and Dad’s small living room, weighed down by her large computer bag. Like many people with chronic conditions both the old folk now need help with daily activities, and a recent car accident had upped the ante. Katie extracted a large bulky laptop out of her bag and sat down to talk things through with her grateful clients. After a few minutes of irritated prodding of the keyboard, Katie abandoned the laptop and pulled out a note book and pen. “It won’t connect again,” she said pulling an apologetic face. “I’ll sort it when I get to the office. Now, Joe, tell me how you are getting on with the new walking frame?”.
Despite huge investment in technology across the health and care sector, in many cases we are not getting the benefits that were anticipated. There are a variety of reasons for this, including insufficient training, poorly specified and inadequate technology solutions. However, time and again the core reason for poor adoption and take-up comes down to usability, or rather lack of. In the scenario above, the dedicated and experienced care professional ‘worked around’ the issue that the technology had thrown up; not letting it get in the way of the service she was delivering, but knowing full well that she would have an extra 30 minutes of keyboard time added onto the end of her already busy day.
Whilst some of the variability surrounding health technology adoption can be explained by demographics, geography, personal preference, and other factors; the matter of usability is key in adoption and take up.
We have seen an exponential growth of digital channels providing access to health advice and services - most of us could not now imagine searching the bookshelf for the battered copy of ‘Family Health’ to check their symptoms, instead Googling or searching NHS Choices on our smartphone.
The development of trusted online services has not been without its challenges, and one of those has been usability. HealthSpace, an early version of an NHS online record for patients to access their information and communicate with their clinicians, never got beyond a few hundred users despite significant government investment, and it was canned in 2012. Dr Charles Gutteridge, the clinical lead at the time admitted that, although he had used HealthSpace to communicate with patients, he did not think it was a technology that would ever take off. "It is too difficult to make an account; it is too difficult to log on; it is just too difficult," he said.
Luckily, innovators, entrepreneurs and government alike have taken the lessons and only four years later we are making significant headway towards a healthy marketplace of NHS, voluntary and private sector services. Accessible from smartphones, tablets and pretty soon smart watches, usability will be a key factor in gaining, and keeping users. If you haven’t already, check out some of the following: Patient Online, NHS Choices , NHS111 , Big White Wall, Sheffield Flourish , and AXA PPP HT&Y finalists and winners, PsyOmics , Patients Like Me , Patients’ Know Best , and Babybuddy.
A second key element in adoption and take up is engaging the users in the design and development of technology aimed at them. Despite Steve Jobs and others quoting the old Henry Ford adage, “If I had asked people what they wanted, they would have said faster horses.” (which he apparently never said anyway! ), working with and consulting the people who will use the technology inevitably leads to greater usability and adoption. As with most areas of science and industry that form a major component of UK development and prosperity, there is a massive body of evidence and research about this topic. This includes significant insight into the so-called ‘socio-technical aspects of digital systems design’; how people feel and react to technology in their lives .
In my long career in health ‘informatics’ I learnt early the importance of bringing the techies and the users (patients, carers, health professionals) together to design and implement new systems. In my first senior job I visited a community clinic in West London to try and find out for myself why they were having so much trouble getting their new electronic patient record system running. I was led to a small, and very full, supplies cupboard – and there was the shiny new terminal! The staff had no idea what it was for, and had no room on the reception desk for it – no-one had thought to include them in the choice of the system, or the planning for its implementation. Needless to say, we swiftly revised the approach and plans for the new system to ensure that the users, patients as well as healthcare professionals, were at the centre.
As the digitisation of our world continues apace, affecting both health and care professionals and organisations, as well as patients, carers and citizens generally, the themes of usability and user engagement will be central to widespread and successful adoption. The HT&Y programme recognises that usability underpinned by good design is crucial to take up of personal health technology; the partnership with the Design Museum is not by chance and the central role of design in personal health technology is one of the central criteria that the Awards are measuring entries against.
About the author
Kathy Mason is an associate of 2020health, a social enterprise think tank working to improve health through research and one of our partners for the Health Tech & You programme. With over 25 years’ senior management and board level experience across both public and private sectors, Kathy is passionate about increasing the use of digital technologies to activate people to take greater control of their own health and wellbeing.
*The AXA PPP Health Tech & You programme discovers, promotes and supports health tech inventors and innovations from across the world. Founded by AXA PPP healthcare, Design Museum and 2020health, our mission is to grow awareness of digital health and to help people understand how technology can give them more control of their health and wellbeing.