User Experience Guide
for VA Health Systems
U.S. Department of Veterans Affairs
The User Experience (UX) Guide is an organizational resource intended to enable positive user experiences with VHA health information technology (HIT) systems by promoting human-centered approaches to system design, development, assessment, and implementation.
The UX Guide contains libraries of various content types that are central to making HIT systems usable, useful, and satisfying. These libraries enable HIT project teams to:
Human-Centered Design is the approach best suited to optimize the usability of HIT systems and enhance the user experience. The organizational adoption and maturation of human-centered design practices require engagement from various domain experts in VHA. These domains include usability engineering, interaction design, clinical informatics, safety engineering, and human factors engineering. The UX Guide, through libraries of methods and artifacts, is intended to enable an asynchronous collaboration between domain experts and HIT project teams.
We encourage feedback from the VHA community. Recommendations for integrating human-centered practices into VHA projects are welcome. And we encourage HIT project teams to share artifacts they found useful and practices they found effective. This sharing of institutional knowledge is expected to facilitate the implementation of HIT systems that improve user effectiveness, enhance user satisfaction, and support the delivery of quality healthcare for our nation’s Veterans.
What is ‘User Experience’?
User Experience (or UX) refers to a person’s overall attitude and emotion associated with using a product or service. Experiences are formed by a first impression and shaped over continued interactions with the product’s various features, or with a service’s multiple touch-points. Many factors can influence user experience; but among the most impactful is usability — the extent to which users are able to carry out their goals with efficiency and effectiveness. This is especially true in the healthcare domain.
For an HIT system used by clinicians, the UX is likely tied to factors such as the time required to access needed information, or a number of steps required to perform frequent tasks. Such factors are directly related to the clinician’s overall goal of providing quality care. A highly usable HIT system is more likely to provide a target clinician UX goal: ‘Using this technology enables me to provide better care for my patients.’
For products or services intended for Veteran patients (and their caregiver family members), UX may be tied to different usability factors. For instance, an HIT system that is easy to use with options clearly explained in plain language will likely support the patient’s goals to receive quality care. Products and services must be highly usable to achieve a target patient UX goal: ‘My healthcare organization understands my care needs and cares about my health.’
Creating positive user experiences through highly usable HIT systems is achieved by applying a human-centered approach to system design and assessment. The UX Guide is intended to support VHA project teams by providing Human-Centered Design guidance, methods, and tools for HIT systems.
Scenarios of Use
Scenarios of use, support human-centered HIT system design and assessment. Scenarios describe user goals related to a specific context of use, and how the user’s interactions with the HIT system support those goals. A scenario can describe user interactions with the current ‘As-Is’ HIT system or a proposed ‘To-be’ systematic. Although both types of scenarios have utilized for various human-centered activities in the development lifecycle, the To-Be scenario is necessary for human-centered assessment (such as a usability test).
The UX Guide Scenario Library contains current state scenarios. These scenarios describe common patient care situations (including those unique to VA) that VA clinicians have used to elaborate their goals, their interactions with HIT systems, and even contextual factors that could impact system design. Current state scenarios can help jump-start some early human-centered design activities, as well as enable the rapid creation of proposed To-Be scenarios.
Methods for Human-Centered Design
The UX Guide Methods Library will provide descriptions of the various types of methods used in human-centered design and assessment of HIT systems. For methods that can be carried out without a trained expert, the UX Guide will provide practical guidance and tools.
User personas are realistic representations of intended users of an HIT system. A set of personas helps the project team consider the unique characteristics of users during HIT design and assessment. Although fictional, personas should be evidence-based in order to accurately describe user types.
Clinician personas typically represent a specific role within a clinical domain. These personas should include goals and common tasks, and they may describe some of the day-to-day interactions with patients, colleagues, and the health IT system. Veteran and caregiver personas often combine important user characteristics that could impact interactions with HIT systems. These characteristics may include specific patient conditions (PTSD, diabetes), technology preferences (mobile devices, phone calls), and attitudes about health and healthcare. Personas in the UX Guide Persona Library can help project teams rapidly orient to their intended users.
Usability Principles for Health IT Systems
Distilled from human factors and informatics research, these principles will provide project teams evidence-based guidance to design and assess human-system interactions.
(Available in Fall 2018)
The development of highly usable HIT systems that enable positive user experiences is achieved through a human-centered approach to HIT system development and implementation.
The International Organization for Standardization (ISO) defines human-centered design (HCD) as “an approach to interactive systems development that aims to make systems usable and useful by focusing on the users, their needs and requirements, and by applying human factors/ergonomics, and usability knowledge and techniques. This approach enhances effectiveness and efficiency, improves human well-being, user satisfaction, accessibility and sustainability; and counteracts possible adverse effects of use on human health, safety and performance.” (ISO 9241-210:2010: Human-centred design for interactive systems)
A project team that adopts a human-centered approach to HIT systems development plans and executes project activities in a way that follows these basic principles:
The design is based upon an explicit understanding of users, tasks, and environments.
Users are involved throughout design, development, and implementation.
The design is driven and refined by human-centered evaluation.
The process is iterative.
The design addresses the whole user experience.
The design team includes multidisciplinary skills and perspectives.
The application of HCD to health IT systems has unique challenges. Some users (clinicians) are highly trained for specialized and technical work. Other users (patients and family members) may have little familiarity with the healthcare domain and may by first-time users of a HIT website, product, or service. For many HIT system applications, the environment of use (medical centers and clinics) is complex, dynamic, and safety-critical. For this reason, a human-centered approach to HIT systems design and implementation often requires technical analysis and design methods, as well as rigorous testing of system usability.
The mission of the UX Guide is to provide guidance, methods, and tools for VHA project teams that support the development of highly usable HIT systems.