“Improve usability…but don’t change anything!”

  • Ross Teague, Ph.D.
  • 06/08/2016

Organizations and users in the Health IT world desire products with better usability and efficiency, but they hesitate to embrace changes to familiar interfaces and interactions. Humans don’t like change for many reasons.

In Health IT, changes to interaction models, layouts and workflows can mean retraining, which costs money and takes time away from work. There are also concerns that users will be less efficient using something different, or that it will reduce satisfaction.

Many times what we are comfortable with is not what is best for us, even though we have adapted to it. Users may not realize the physical, mental and safety “costs” of sticking to what is most familiar.

While familiarity associated with software is often related to steps in a workflow, it can also be familiarity to icons, colors and layouts. Users may not see how a change in colors can improve their experience with a product, but color can have a big impact on readability, distraction and cognitive load.

As an example of how familiarity can get in the way of usability, one of our products used bright colors to highlight status on a display board. We found through analysis that a change in colors would have improved the readability and reduced the “cognitive tax” that users pay each time they interact with the display, but the consistent message from clients was “We’re familiar with it. Don’t change it.”

Balancing usability with familiarity

How we deal with these competing interests is important. At Allscripts, we try to address this familiarity-usability issue in a number of ways:

  1. Make sure that change is necessary. All changes should benefit our clients in some way.
  1. Follow a best-practice User-Centered Design (UCD) process. We base our designs on understanding the goals of our users, and measuring the product with users during development to make sure that the product continues to meet these goals.
  1. Don’t dismiss familiarity. Understanding our users and their experiences is an important part of our process. The design process benefits from knowing what tools, workflows and interaction models that are familiar to our users (inside and outside of a clinical environment).
  1. Clearly explain the ROI of making the change. We communicate the measurable benefits of learning a new process, retraining or a short-term loss of efficiency for the more important long-term gains of output, safety and satisfaction.

Balancing usability with familiarity is an important aspect of any design effort. Familiarity is important, but it can’t get in the way of usability and improved performance. Our goal is to create products that support our clients’ needs for safety, efficiency and effectiveness. For solid improvements in these areas, the effort to change is worth it.

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About the author

Ross Teague, Ph.D., director of user experience research, leads the cross-functional team that provides user-experience (UX) and user-centered design (UCD) support for Allscripts. His team provides the research, design (conceptual and detailed) and evaluation necessary for the UX needs. Ross also manages the Allscripts effort to meet Meaningful Use UCD requirements and update of our development process to include UCD activities and measures. Prior to joining Allscripts, Ross was partner and director of research at Insight Product development, a design and strategy firm specializing in the planning and development of medical devices. Prior to Insight, Ross worked as a human factors psychologist in a business and design services group at Intel, helping to develop internet based products for companies outside of Intel. Ross holds a Ph.D. in Applied Cognitive Psychology and Human Factors.


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