Consumer study shows PCEHR too hard to sign up for

An observational study of people in their own homes who tried to sign up for the PCEHR found that eight out of the 10 people involved failed in their attempt, with poor design and usability the main culprits.

The study, carried out by Melbourne-based Navy Design, a consultancy specialising in health and medical software design, suggests that a user-centred approach is the key to increasing uptake of the PCEHR amongst consumers, and more extensive testing with end users was needed.

As reported by Pulse+IT last year, Navy Design planned to conduct the research with a view to informing the ministerial review into the system from an end user perspective. At the time, Navy Design's general manager Michael Trounce said the consumer perspective had been lost in the debates over the clinical utility of the PCEHR.

“When it comes to eHealth, the quality of the user experience can have a direct impact on health outcomes,” Mr Trounce said. “That’s when good design is really critical. This perspective can be lost when projects are delivered with a focus on IT rather than people.”

The results of the research have been released this week in the hope that it can also inform the current consultation meetings being staged around the country with different user groups by the Department of Health and Deloitte.

Navy's design consultant and director, Ollie Campbell, said poor design and usability are key contributing factors to the underwhelming performance of the PCEHR, and 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.

The company'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. Navy Design said government marketing claimed that it should take one minute to create an account.

“We wanted to test that in a real world context,” Mr Campbell said. “The results were compelling. Each of our research sessions was an hour long. In that time, only two out of 10 people were able to sign up.”

The majority of participants in the study began the sign-up process on their phone. However, despite the fact that over 50 per cent of mobile devices in Australia use the Android operating system, the PCEHR doesn’t support them.

“Of the people we observed, eight out of 10 started the sign-up process on a tablet or a mobile phone, and the majority were using Android,” Mr Campbell said. “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. 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 sign-up 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 eHealth 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. 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 sign-up which the user didn’t think they were initiating.”

The research also showed that simple usability issues was hampering the process. “Hitting the back button causes the process to break,” Mr Campbell said.

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

However, despite their difficulty using the system, most participants in the research were positive about eHealth. The majority saw value in the concept, and several planned to continue the process with help from their doctor.

Mr Campbell said the main lesson was 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.”

Mr Campbell said there was 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.”

Posted in Australian eHealth

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