Eight out of ten unable to sign up to e-health record

Press release originally published on PulseIT in August 2014

User-centred approach to design key to increasing PCEHR uptake says Navy Design

New research by a design consultancy specialising in health and medical software, Navy Design has highlighted poor design and usability as key contributing factors to the underwhelming performance of the Personally Controlled Electronic Health Record (PCEHR).

Navy Design’s Ollie Campbell, said that future versions of the product needed to be designed with end users in mind. Navy Design suggests that at the moment, the record may simply be too hard to use.

Navy Design’s research used a technique called contextual inquiry, which involved visiting people in their homes, and observing them signing up to the PCEHR in their natural environment. Government marketing claims that it should take one minute of your time to create an account.

“We wanted to test that in a real world context.” said Ollie Campbell. “The results were compelling. Each of our research sessions was an hour long. In that time, only two out of ten people were able to sign up,” he said.

The majority of participants began the signup process on their phone. Yet, despite the fact that over 50% of mobile devices in Australia use the Android operating system, the PCEHR doesn’t support them.

“Of the people we observed, eight out of ten started the signup process on a tablet or a mobile phone, and the majority were using Android. At a certain point in the process, the button to continue was simply missing from the screen. While the technology landscape has changed a lot in the past few years, Android should clearly be part of the device strategy for a product like this.” said Mr Campbell. “Once a product like this is in the market, it’s important to have a strategy for monitoring statistics about who’s using it and how. That’s a great way to identify trends like this and address them quickly.”

He said the number of steps in the signup process had also caused problems.

“To sign up successfully, you need to understand each step, why you’re doing it and whether you’ve been successful. What is a myGov account? How does it link to Medicare? Very few people were able to answer these questions because of the conceptual complexity involved. Even when people managed to sign up, they weren’t sure whether they had an e-health record. People said things like ‘Have I finished now?’ or ‘Is that mine or my son’s?’.
“These issues could be resolved in one of two ways,’ he said. ‘The ideal approach would be to simplify the process by reducing the number of steps and conceptual entities. If that’s not possible, a clear framework could be introduced early in the process to orient people, communicate progress and gives feedback on success. This is particularly important when there are subtasks like the myGov signup which the user didn’t think they were initiating.”

Navy design’s research showed general usability issues also hampered users.

“Hitting the back button causes the process to break. The password strength requirements are unclear. These are small things, but they can easily cause people to abandon a process.” said Mr Campbell. “We’ve designed products where a single line of text has increased conversion by 10%. Certain details can make or break a design, and often research of this kind is the only way to uncover what they are.”

Despite their difficulty using the system, most participants in the research were positive about e-health.

The majority saw value in the concept, and several planned to continue the process with help from their doctor. Statistics from Apple’s App Store support this. Of the 27 reviews of the PCEHR app, 52% are from people who want to use it but are unable to log in to it.

Mr Campbell says the main lesson is to involve users in the design process. “We design and test a lot of products of this type. It was clear that nobody had done research like this on the PCEHR before. A relatively small investment in user-centred design and testing early in a project like this can have a huge effect on success. If research like this had been done a few years ago, we’re confident it would have had a significant effect on the amount of people using the PCEHR today.”

Navy Design also had some advice for the panel set up to review the PCEHR.

“There’s still plenty of time to adopt a user-centred approach for the remainder of the rollout. The people we spoke to saw real value in the product. But we think it’s critical that the government changes the way they’re approaching design. As a first step, more extensive testing of the current PCEHR could be a great way to involve end users in the design process. It could also form a really valuable input into the next iteration of the product.” 

Written by Ollie Campbell
Co-founder & Designer at Navy Design