The Solution

Research

We began the research phase of this project by completing a review of current Telehealth research. As existing literature focuses primarily on provider acceptance of the use of Telehealth in medical practice, exploratory research to pinpoint user issues experienced by both the provider and the patient was needed.

After speaking with faculty advisors from the Digital Media and Public and Community Health departments, we came up with these questions to guide and focus research tasks:

1. What does a provider need to comfortably take care of patients remotely?
2. How are current digital solutions meeting or not meeting provider needs?
3. What gaps in patient care need to be filled?

Focusing on providers in the first phase of our project served to guide future research into how issues in the provider user experience impact patient outcomes.

One of the issues that was discussed in the early stages of this research is poor Internet connectivity. Developing a medical resource app that would be available offline was considered. In an audit of current medical resource technology, however, 16 apps with user reviews of four stars or higher were identified, seven of which are available offline. We refocused our research activities on how to improve existing digital solutions.

In a review of the literature regarding design research methodologies, two concepts were emphasized repeatedly by UX researchers: the importance of variety in obtaining valid results and the use of research as a tool to fuel the design process. Instead of designing a perfect quantitative study with a large N, researching a diverse set of circumstances can save time, be cost-effective, and deliver useful insights. Sample size is important; however, a large sample of very similar participants may produce results that are not representative of the target audience as a whole. For results that are externally valid, a diverse set of users and conditions should be tested.

Since time is frequently a limitation, designing a perfect study may not be feasible. Researchers from the Nielsen Norman Group, a premier resource in UX research and design, say that it is most important to start somewhere and keep learning. Research activities should be planned and executed to inform the next step in the design process.

Methods

For a more accurate analysis of the Telehealth provider experience, quantitative and qualitative user research methods were utilized. To first identify, and then quantify provider user experience issues, we created a 10-question, multiple choice survey using the Qualtrics platform. This survey was designed to be taken by providers in approximately two minutes. Question topics included how digital solutions are used by providers in daily practice and what issues are encountered during digital solutions usage.

The survey link was sent to twenty healthcare clinics and a teletherapy organization, all located within the United States—one respondent was located in Europe. Additionally, the survey was advertised on the personal social media channels of the researchers. No incentive was offered for completion of the survey.

User interviews were utilized to gather qualitative data. The final question of the survey asked providers to share their email address if they would be willing to answer additional questions regarding their Telehealth user experience. The SignUp Genius platform was used to schedule interview time slots. Providers were invited in an email to sign up for a 30-minute remote interview which would take place on Zoom. Interview invitations included a digital recording release form.

Interview questions were designed to probe for the underlying cause of Telehealth user experience issues without leading the interviewee to give expected answers. Providers were asked to identify which user experience issue had the greatest impact on their ability to provide medical care. Additional questions asked providers to describe the functionality of digital solutions given an ideal world. A script was used to standardize each interview and to avoid variations in interview questions that may have biased the responses.

Results

49 clinicians in 17 different medical professions completed the survey. Of the 49 respondents, 58.5 percent utilize a digital solution to find information regarding best practice at least once per day. 26.8 percent of the survey sample uses digital solutions for this purpose multiple times per day.

The frequency in use of digital solutions as a resource for medical information was not surprising. However, lack of Internet connectivity or a digital solution “not working” occurred within our sample population less frequently than was expected. Issues were experienced only several times per month by 43.9 percent of our sample. Another 43.9 percent never experienced these issues.

Although these issues were experienced relatively infrequently, 61 percent of our respondents indicated that their ability to provide care was impacted when their Internet or digital solution was not working.

Additional issues were experienced as providers navigated the UI of their digital solution. 34 percent of our sample stated that their digital solution was difficult to use or navigate.

View an interactive infographic of the survey results.

One of the proponents of user experience research is that three to five percent of participants in a usability study identify 85 percent of the usability issues. Of the 49 respondents, 88 percent were willing to participate in a user experience interview, however, only six providers responded to our interview invites. Interviews were conducted with each of the six providers who practice in the following care areas: nursing and nurse education, speech therapy, psychology, respiratory therapy, and certified nurse midwifery.

Although technical issues such as Internet connectivity were less frequent than expected, user experience issues were noted by each provider during their interview. Three of the user experience problems mentioned in the interviews were identified by providers as having a significant impact on their ability to provide care: difficulty with patient onboarding to Telehealth technology, searchability or navigation of digital solutions, and issues with charting, such as a non-intuitive user interface in the charting platform.

Next Steps

This research did not focus on the patient user experience or how issues experienced by providers impact patient outcomes. Research that explores the patient user experience and patient outcomes is essential to prioritize the significance of user experience issues and to guide future research and design decisions. Direct observation of user behavior in a field study may be useful in avoiding response biases.

Four provider personas were created as a tool for future researchers. After exploratory research based on the patient user experience is completed, patient personas should be utilized to guide the design process. Proposed solutions of a chatbot and/or voicebot, and voice-enabled search and charting will need to be re-evaluated based on the results of patient user research.

Once research is completed, the design process should include testing of both low- and high-fidelity prototypes before building the design. User testing of prototypes is essential to evaluate the validity of design decisions. After the design is built, the final step in the design process should include user testing to identify any user experience issues.