The current state of UX in health
The COVID-19 pandemic wasn’t exactly the Renaissance to the Health industry we expected. Where should UX Designers in the industry be focusing their time and attention for the future?
In 1960, and Dr. Frances Oldham Kelsey is just starting her new job with the FDA as one of only seven full-time physicians tasked with reviewing drugs for approval to the United States. Upon starting work, one of the very first drugs she reviewed was thalidomide, a tranquilizer and pain-killer given to pregnant women experiencing morning sickness. It had already been approved in Canada and more than 20 European and African countries.
Instead of pushing the drug through approval, Kelsey asked for further studies. Resisting pressure from their manufacturer, she asked for data that the drug was not harmful to the fetus. Vindication came in the form of tragedy when it was revealed that cases of birth defects in Europe were linked directly to the prescription of thalidomide. The Washington Post concluded Kelsey’s actions “prevented… the birth of hundreds or indeed thousands of armless and legless children.” In doing so, her example allowed rigorous drug approval processes to be put in place in 1962.
In 2019 I was starting a new job as well, though notably not as important as a doctor. By trade, I’m a UX Designer working for an ad agency that services the Health industry. In terms of clients, this means health insurance, pharmaceuticals, and medical technology — the same companies that both manufacture and prescribe the drugs reviewed by those like Dr. Kelsey. Unlike physicians, there is no design degree or bootcamp that comes with an ethics course as a prerequisite.
In this article I hope to outline why we designers need a similar code of ethics as the physicians we hope to assist. I will talk about design trends, both good and bad, that have emerged in the field. as well as where we should choose to focus our attention. Finally, I want to make the assertion that Design plays an important role in the future of healthcare, for better or worse.
The thoughts and opinions of this article are my own, along with a number of informative sources that deserve credit. When talking about ethics I’m referring to the book Ruined by Design by Mike Monteiro. It was also where I first discovered the story about Dr. Kelsey. Whenever I mention rules dictated by psychology in user experience, I’m using the source Laws of UX by Jon Yablonski. My opinions on the state and future state of UX in Health are from my own experience working 2.5 years as a UX Designer for an agency focused on Health clients, combined with opinions and information from 2 articles, Healthcare UX: a journey just begun by Chris Kiess and Why Doctors Hate Their Computers by Atul Gawande.
The Case for Ethics
Creatives immediately clam up when we talk about ethics. Who will regulate them? How will we agree on everything? Where is the business case? I’ve heard all kinds of reasons, but because they’re stupid reasons I’ve also chosen to ignore them. Designers need to hold themselves accountable because they’re adults and it’s what we’re supposed to do.
Expecting industry leaders in Design to step up and show us the way is unrealistic. Look no further than Facebook in 2014, when they knowingly experimented on 600,000 human beings by flooding their newsfeed with negative news to see if it had an effect on their mental health. No one had the opportunity to opt out. It was designed that way. How can we be expected to solve the problems facing Health with technology like AI and Telehealth (aspirational goals that I will talk about later) without building trust in the industry? When asked whether AI was a safe way to approach modern health care, 38% of adults strongly were in support, while 26% saw it as dangerous. The remaining 37% didn’t know or had no opinion.
With that said, I see the glaring problem of accountability. It would be impossible to hold everyone with the word “designer” in their title to the same standards. For that reason, a code of ethics needs to be a living document, one that can be updated to the work you are doing. This one is stolen from the book “Ruined by Design” by Mike Monteiro:
A designer is first and foremost a human being.
A designer is responsible for the work they put into the world.
A designer values impact over form.
A designer owes people who hire them not just their labor, but their counsel.
A designer welcomes criticism.
A designer strives to know their audience.
I’m sure in less than a year I’ll be revisiting this document to make amendments, add language, and throw out some ideas completely. But this is the starting point. I am not proposing this is the best starting point for every designer, nor am I implying that some designers don’t yet have their own code. I speak only for myself.
Living up to this code in the world of healthcare will be difficult. This is a heavily regulated industry, and sometimes rightly so (remember the thalidomide.) But while hired to provide technical expertise, an ethical framework is foundational if we are to even consider disrupting a system. And there are many problems that need solving.
Health Trends in Design
In my line of work, the audience I design for is either a patient or a doctor. But rarely are both talked about in the same context. This is a shame, considering for every 1 hour spent with a patient, a doctor is spending twice that time in front of a computer. We find ourselves in an era of health misinformation campaigns, coupled with so much data collection in the past 10 years, it would take the next hundred to be fully comprehended.
From the patient side of the equation, they are faced with an onset of technical information, manipulative language, addictive software, and targeted advertising. All of this before they get a chance to sit in front of a doctor. When asked how social media companies were handling the spread of anti-vaccine misinformation, 35% of adults rated their performance as “poor.”
There is serious work to be done in design in the field, and we need to choose our work wisely. Instead of focusing on one end-user, we can be addressing broad areas of focus that are in dire need of assistance. Here are those areas of opportunity:
Information Design
When in the exam room, doctors are spending half their time looking at a screen. Patients can spend years of doctor visits and research before reaching an accurate diagnosis. Health information is dense, legally strict, and inflexible. To allow our brains to comprehend this language, we need to be making strides in how it looks on a digital interface. Information needs to only be provided at the point of need.
Postel’s Law states that we should be liberal in what we accept, and conservative in what we send.
Telehealth
The greatest KPI we can aspire to in Health is optimizing the experience between doctor and patient, and technology will play a big part. Kaiser Permanente has seen 152 million outpatient Telehealth interactions in 2020, 76% consumer interest in using it, and 57% of providers viewing it as more favorable since the COVID-19 pandemic. Getting that appointment sooner, reaching an accurate diagnosis, and giving a patient the resources needed to communicate their symptoms to a doctor more effectively are all goals worthy of praise. User sentiment towards new technology in Health has also seen great strides taken due to the pandemic, with increased awareness of QR codes, AR, digital passports, and other applications that can improve this industry.
Health Ecosystems
The fact that a phone call is more efficient than any other aspect of the medical system is a sobering thought for any designer. These systems are 10 years behind any other industry, and they require structural shifts. I’ve seen data on patients taking upwards of 16 months to reach an accurate diagnosis. While the thought of freedom to choose and move across ecosystems sounds appealing on the surface, it opens up a host of problems that increase time and headache. Doctors live in this world every day, this is old news to them. The public needs the tools necessary to navigate it.
Designers’ Roles in the Future of Health
Designers should not just be providing their labor, but their counsel in this field. Our abilities are better served dealing with structural changes instead of singular requests to make visual updates to a product. We should be minimizing the time we ask our doctors and patients to sit in front of a screen, and bring them together.
Tesler’s Law states that for any system there is an amount of complexity that cannot be reduced.
To be clear, I believe we should not be removing the human interaction completely from the equation. So forces in technology such as AI will need to be a part of the conversation.
We must set the right goals. Driving traffic or user engagement are not accurate measurements when looking at something as nuanced as an individual’s mental health. Working in this field is only fulfilling when its goals are rooted in the context of humanity. Let’s give patients the agency required to make their own informed decisions.
