UX in Healthcare Portals
The Good, the Bad, and the Ugly
May 10, 2017

Progress in the digital healthcare experience has been frustratingly slow. There are several factors, including a general lack of organization and rigor when crafting user experience (UX). This article explores several case studies our UX Lead Kristen Davis faced involving UX-focused analyses of patient healthcare portals.

Case #1: Federal Health Insurance Marketplace

The first case study involves an assessment of the registration process for a federal healthcare insurance marketplace. This case demonstrates what can be achieved by involving the UX team throughout the entire project. Iterative rounds of user research and usability testing produced a product that is cleaner than many we have seen.

Federal Healthcare Insurance Marketplace Registration Form

The Good:

  • Help the User: The design guides the user through every step of the registration process.
  • Reduce Friction: The system uses a third-party vendor for identity validation. This way, users don’t need to wait for a PIN letter or directly interact with customer service. As a result, the application process was faster and easier.

The registration process worked well overall. However, we should still assess the user experience with a critical eye and identify opportunities for improvement. In this case, some issues did remain.

The Bad and the Ugly:

  • Information Overload: The number of fields to enter (name, phone, email address, security questions, answers to ID proofing questions, etc) was intimidating and confusing. The form presents all of the fields at once. Several of the fields request sensitive information (including social security numbers) that users may not be comfortable providing.
  • No Ability to Opt-Out: The healthcare insurance system forces users to participate in this process. It doesn’t matter if it is difficult or confusing or if they have concerns about the privacy of their information. If users don’t register and obtain insurance, they may be penalized for being uninsured.

Case #2: Regional Healthcare Provider Patient Portal

Due to low engagement rates, this client wanted to conduct usability tests to learn why people weren’t signing up to use their patient portal. Our team assessed the big picture. We wanted to understand how people learned about the portal, registered for it, logged into it, and interacted with it. In our research, we investigated how physician offices promoted the portal, what materials they used and how, and their impressions of the portal and the electronic health record (EHR) training materials.

Regional healthcare provider patient portal registration form

The Good:

  • User Assistance Makes a Difference: Some providers told their patients about the portal and gave them PIN letters with their personal login information. This was effective. At these offices, account creation and patient portal engagement rates were high.

The Bad and the Ugly:

  • Inconsistent Processes: Providers in different offices and regions had vastly different approaches to promoting the portal
  • Lack of User Assistance: When providers and front office staff saw no value in the portal, utilization rates were predictably low. The staff might mention the portal, but didn’t explain how to use the PIN letter to create an account. If patients didn’t receive instructions, they often didn’t get complete the registration process.
  • Confusing Forms, Confused Users: There was a significant issue with the PIN letter design: it didn’t explain the account creation process and it didn’t provide information about the portal. As a result, users would receive the letter and not know what to do with it.
  • Unforgiving Data Entry: During the account creation process, a patient must enter their name exactly as it was entered on insurance forms and the EHR system. However, the letter did not state this clearly. As a result, users often entered their names incorrectly and couldn’t create an account.

Case #3: National Insurance Provider Member Portal

The third case study involves a client who faced the same basic problem as the others. Making matters worse, most users don’t really care about portals. They don’t care about it until they need it.

National Healthcare Insurance Provider Member Portal Registration Form

The Good:

  • Simplified Interface: The form keeps the number of fields per page to a minimum. This produces a straightforward and understandable interface.
  • Contextual Help: Fields that are not obvious have help links. Users don’t have to look for help or navigate a separate help interface.

The Bad and the Ugly:

  • Unforgiving Data Entry (again): As in Case Study #2, the system requires members to enter their names exactly as they were entered in other records. This caused issues with the registration process.
  • Additional Steps Required: Despite the online form, completing the registration process still required members to call customer service for a PIN. This was an inconvenience for people who work during regular business hours and could not easily make time to call customer service.

How do we Improve?

Across case studies, there were several recurring themes that can be used as guidelines when designing the user registration process for a healthcare portal:

  • Standardize Processes: Implement an organization-wide process to standardize patient communication across physician offices. Provide training to all staff members on promoting the value of the portal as well as providing portal registration assistance and general help.
  • Communicate Clearly: Analyze patient communications (e.g. PIN letters and registration forms) to address usability issues. Clearly organize the steps of the registration process and include explanations for any required fields (including consistency requirements and justifications for sensitive fields like social security numbers).
  • Help them Understand: Avoid overloading the user with a lengthy form that is crammed on one screen. Break up forms into focused sections and provide contextual descriptions and help.
  • Sell the Product:  Tell the patient why they should use the healthcare portal. Highlight the perks and benefits. Motivate them to use it so they don’t feel forced to do so.

Where do we go from Here?

In most of the case studies, it wasn’t hard to see the Good, the Bad, and the Ugly. It’s true that identifying the problem is only half of the battle. But, it’s certainly easier to fix a problem once you’ve identified it. Integrating user experience research and design throughout the entire project lifecycle is critical to identifying and addressing problems early and often, rather than late or not at all.

Many of the problems with improving technology in the healthcare industry are not technology-based at all, they’re human.

A little effort focused in the right manner can have a huge impact to the project goals and overall user experience. We can’t lose sight of the fact that we’re caring for people. Many of the problems with improving technology in the healthcare industry are not technology at all, they’re human. To succeed, we must address the human side of the digital healthcare experience through a proper focus on UX and good design. If we don’t, it won’t matter what technology we’re using.