We hear a lot of complaints about bloated government IT projects being doomed to failure, but what if it’s not the IT project that’s the problem? Could the NHS’s well-meaning attempt to allow us online access to our own medical records fail for other more mundane reasons?

Case in point…

I recently received a letter from my local NHS primary care trust telling me that my county is piloting the new HealthSpace online access to health information and summary care records.  Thinking this a big step forward in personalising what is (after all) an intensely personal part of life, I jumped at the chance to register and start taking control of my own medical care.

If only it were that easy….

Registration

This is the process for registration:

1. Register for a new healthspace account.  This is a fairly straight-forward process, involving collecting relevant information and then activating by email.  The basic account gets you access to a personal health planner and calendar but no personal data. Small Obstacle 1. In the instructions, there is a link for a new account but also reference further down the list to a Basic account without a link. This seems to be the same thing, but it’s not clear.

2. Register for an Advanced Account Part 1. Once activated, you need to fill in a more substantial form with additional information to get an Advanced Account. This is OK in itself, as you want to feel your personal data is secure. Once the form is complete, you receive an Application Number. You either need to print the form or be able to produce the Number, which at least means lack of printer isn’t a blocker. Small Obstacle 2: Only some NHS trusts are currently taking part in the NHS Care Records Service and it appears you’ll only know if yours is one of them if you receive a letter beforehand or if you are told by email after you register for the Basic Account. A list of participating trusts would be helpful.

3. Register for an Advanced Account Part 2. Now comes the dysfunctional part. (Massive) obstacle 3. Why do you need to print the form or be able to quote the Application Number? Because you have to email the trust to find out where your local Registration Office is and then physically take it and a variety of proofs of ID and address there or to an occasional informational session at some other locale.

Now this may be marginally acceptable in a large population centre with good transport links, but it’s a complete blocker in my rural county. This is an anonymised email exchange I had with my local NHS in December:

________________________________________
From: Nancy
Sent: 01 December 2009 13:37
To: Healthspace
Subject: HealthSpace registration

Hi.

I’ve printed off my form and need to take it to my local Registration office to be checked and activated. Please tell me where this is. I live just outside [local town].

Thanks very much.

Nancy

_______________________________________
From: [person] [mailto:person@county-pct.nhs.uk] On Behalf Of Healthspace
Sent: 07 December 2009 14:50
To: Nancy
Subject: RE: HealthSpace registration

The Drop in Sessions double up as Healthspace Registration Office. Alternatively you can take along your printed application form and relevant ID to Healthpoint in Boots, [distant town] (Healthpoint is open 9.30am-5pm, Monday-Friday and 9am-1pm, Saturday).

[Attachment listing two sessions on next day in a distant part of the county]
________________________________________
From: Nancy
Sent: 14 December 2009 09:57
To: Healthspace,
Subject: RE: HealthSpace registration

Hi there. Please clarify: it seems like if I can’t make it to [distant town 1] or [distant town 2] tomorrow morning (which I can’t), this means I have to make my way all the way across the county to Boots in [distant town 40 miles away on bad roads] just to get registered on the website. Can’t I do this at my local surgery?

Regards,

Nancy

_______________________________________
From: [person] [mailto:person@county-pct.nhs.uk] On Behalf Of Healthspace,
Sent: 22 December 2009 13:02
To: Nancy
Subject: RE: HealthSpace registration

Unfortunately most surgeries are not offering this service at the moment. There will be some drop in sessions in the [wrong part of county]  next year, but these won’t be until March.

Conclusion

So there you have it. The website could be absolutely brilliant. It could potentially give fast, seamless access from home to everything you want to know about your health and medical records. But the whole thing fails at the start with ill-considered registration processes that create huge blockers to getting started.

Moral: usability extends well beyond the bounds of the webpage and interaction design.

Any comments or similar usability failures you want to share? I’d love to hear them!

I want to call your attention to an excellent blog post, 15 Common Mistakes in E-Commerce Design, which describes the most egregious and irritating problems customers frequently find when trying to do online shopping.  These mistakes are easily avoided as long as you know about them.  They are (in summary):

1. A lack of detailed product information
2. Hiding Contact Information
3. A Long or Confusing Checkout Process
4. Requiring an Account to Order
5. An Inadequate Site Search Engine
6. Poor Customer Service Options
7. Tiny Product Images
8. Only One Product Image
9. A Poor Shopping Cart Design
10. Lack of Payment Options
11. Not Including Related Products
12. Confusing Navigation
13. Not Including Shipping Rates
14. Not Including Store Policies
15. Not Putting Focus on the Products

Go read the full post by Cameron Chapman, which includes examples and tips for addressing these mistakes.

Usability is the word for “making products and systems easier to use and matching them more closely to user needs and requirements” (UsabilityNet). A whole industry has grown devoted to usability, user interface (UI) and the user experience (UX) of computer applications and environments.  User surveys, focus groups and even experiments that map the way users’ eyes move on the screen can be involved.

You might think that attending to the needs of users goes without saying, but in the same way that a business can be so wrapped up in itself that it forgets to put its address in a print advert (I see this all the time in my local rag and wonder whether they only want customers who already know where they are!), web professionals and businesses alike can lose sight of the forest for focusing on the trees.

A recent blog post by a usability specialist says it very well, complete with analogies and examples (do go read the blog, linked below), but this excerpt sums it up nicely:

Lots of organisations . . .  are so engrossed in what they do, that they speak in a way that is confusing to others. Unfortunately this tends to include their customers.

Such organisations usually reflect this on their website. They tend to:

• use vocabulary that customers don’t understand
• organise information the way they see it and not how the customer does
• swamp their site with content that few people want or need
• fail to provide the content that people do need

These failings drastically affect how useful and easy-to-use the website will be. (David Hamill, Good Usability)

If you read my previous blog post about the importance of getting and responding to criticism of your site, you’ll see how usability fits into the picture and forgive my harping on the benefits of a fresh look and outside opinion.