Usability in the Era of HealthCare.Gov

It is hard not to be frustrated at all of the glitches that have surfaced during the recent deployment of the US government's HealthCare.gov website.   Since the website was planned to play an integral role in making "Obamacare" a reality for a large segment of U.S. citizens, I assumed that strict attention to details would have been followed, from the initial conceptualization of the site until it was "ready" for the world.  

I was wrong. 

Maybe there was a miscommunication between the folks at CGI Federal, the company contracted to work on the HealthCare.gov website, and the HealthCare.gov project team, I don't know...

My guess is that there weren't enough people knowledgable about usability and user-centered design on the planning teams from the start.  Whatever the case, it seems like someone forgot to check the US government's very own Usability.Gov "Improving the User Experience" website!   

Usability.Gov

The wealth of information on the Usability.Gov  website been available for years - online, in books, and taught in a number of IT-related courses.  Usability is not limited to ease-of-navigation principles for websites and software user interfaces - a common mis-perception. It is an important component of user-centered software engineering and design, and more.  

In the following video, featured in the User-Centered Design (UCD) section of the Usability.Gov website,  it is noted that "at least 50% of a programmers' time during a project is spent doing rework that is avoidable."   Citing a 2005 study by IEEE, the narrator explains that the three top reasons for tech projects to fail are poorly defined requirements, poor communications, and stakeholder politics.   

So true for the Healthcare.gov website!


Was the Healthcare.Gov website doomed to fail, given all of the confusion and controversy surrounding the Affordable HealthCare Act from the start? 

Perhaps.   

So how can things be prevented?

If this is a topic that interests you - even if you aren't a developer, take the time to soak in some of the information from the Usability.Gov website to learn more about user-centered design, usability, and ways to prevent costly mistakes.  

If you are a computer science, software engineering, or preparing for a career that intersects with technology development or implementation in some way, plan to take a course or two that covers topics such as Human-Computer Interaction (HCI),  Human Factors, and User-Centered Design (UCD). 

Consider joining professional organizations, interest groups, or meet-ups if you are already working in the tech world, but lacking in up-to-date knowledge and skills in this area. 

Places to start:

ACM SIGCHI  - Association for Computing Machinery, Special Interest Group on Computer-Human Interaction
Usability Professional's Association
IXDA - Interaction Design Association
HFES: Human Factors and Ergonomics Society
IEDO's Human-Centered Design Toolkit

RELATED
Why Obama's Healthcare.gov launch was doomed to fail
Adrianne Jeffried, The Verge, 10/8/13
How we're working to improve HealthCare.gov  (Health Insurance Blog)
HealthCare.gov contractors testify they warned of glitch risk before launch
Hari Sreenivasen, PBS Newshour Transcript
Health Care Site Rushing to Make Fixes by Sunday
Sharon LaFraniere, Eric Lipton and Ian Austen, NYT, 11/29/13
Software, Design Defects Cripple Health-Care Website
Christopher Weaver, Shira Ovide and Louise Radnofsky, WSJ, 10/6/13
Meet CGI Federal, the company behind the botched launch of HealthCare.gov
Lydia DePillis, 10/16/13
CGI Federal
Why Software Fails: We waste billions of dollars each year on entirely preventable mistakes
Robert N. Charette, IEEE Spectrum, 9/2/2005
The ROI of User Experience with Dr. Susan Weinschenk (Video 1/27/11)
Usability.Gov
Aquilent Proudly Supports Usability.gov "Re-Boot" to Further User Experience Best Practices"  Business Wire, 7/18/13Aquilent
Digital Government (Whitehouse.gov)

Kinect Interaction to support people with disabilities: DoubleFine's Happy Action Theater/Kinect Party; OAK Air Switch and Face Switch, resources

I've been experimenting with gesture and touch-based applications for many years and I'm excited to see how things have unfolded over the past couple of years, especially in the field of special education.

Last week I downloaded DoubleFine's Kinect-based Happy Action Theater/Kinect Party,  to use during some group activities with students I work with who have significant disabilities (including severe autism).  I wish I had discovered this suite of games sooner!

I had loads of fun with students and colleagues as we explored some of the 36 creative, and sometimes zany, minigames.  I had heard that DoubleFine had launched something special, but didn't realize how awesome it was until I spent some serious playful time with it at home last weekend. I then tried it out at work this past week.  

If you are planning to explore Happy Action Theater/Kinect party, keep in mind that it plays best when there are at least two people and an audience to cheer everything along.  Through the use of blob detection algorithms, the games can handle up to 6 players at a time, which is perfect for small-group special classes.

The following trailer gives just a little hint of what this suite of mini-games is all about!


I noted that many of the games were effective in helping students become more aware of their peers. They began to play and interact with one-another in ways I hadn't previously imagined.  I especially liked the fact that many of the mini-games made it possible for students in wheelchairs to participate.  

I look forward to exploring more of the games over the next few months and will follow up with a future post after I get more input from my colleagues (and students).

I learned about Kinect Party through my contact with people involved with the GestureSEN wiki. The wiki was created as part of a Professional Learning Community (PLC) for people who work with students in specialized schools, similar to the school where I work, and contains a wealth of information about the use of newer and emerging technologies, such as the iPad, Leap Motion, the Kinect, and eye-gaze systems to support young people with significant disabilities  including autism  Some members of the GestureSEN wiki have learned to code or are in the process of doing so, motivated by what they've experienced so far with their students.  (More information and links are listed in the "RELATED" section of this post.)

OAK

OAK was developed by RCAST at the University of Tokyo in collaboration with Microsoft Japan Co., Ltd. It uses the motion-tracking capabilities of Microsoft's Kinect sensor to create non-contact switches for people with limited mobility, enabling them access to computers and other electronic devices and systems.  The video below provides a nice overview of the OAK system.

The OAK Pro bundle includes the following applications:

The Air Switch software uses the distance/depth capabilities of the Kinect sensor to support gestures of the head, hands, or larger body part to turn things off or on. The infrared from the Kinect also supports the use of the Air Switch in the dark.   The color mode function captures movements from smaller parts of the body, such as a fingertip.

The Face Switch software uses facial recognition software that can track the movements of the face, mouth, tongue, and eyes.  It can identify facial parts that have moved significantly, and records motion data 

The Motion History software observes  the movement of a person's body using the video component of the Kinect sensor.   This customizes the system to the individual and ensures accuracy of the switch.   Movements are color coded and provide the person who is setting up the system a means to fit the system to the specific capabilities and needs of the user.  

The OAK system can be enhanced by the sue of peripherals, such as a USB 4 channel relay box, an IR remote control device or outlet, or other on/off switches/outlets.

The Assist-i corporation has made the OAK system and peripherals available on Amazon Japan.  From what I can tell from the company's website, the OAK software can be downloaded free for a 30-day trial.   I'd love to see how it would work with some of the students I work with who have difficulty accessing conventional switches!  It would be wonderful to come up with ways for these students to access a wider range of digital media activities and games.

RELATED
University adapting videogame technology to help physically disabled computer users
Philip Kendall, Japan Today, 10/10/12
OAK Air Switch (PC Kinect)
OneSwitch.org.uk 4/30/13
OAK Air Switch, Face Switch, Motion History Pro Bundle (pdf)
Assist-i Corporation
Amazon Ai store: Assist-i Corporation (Prices are in Yen.)

Below is a partial list of links to resources related to using or creating engaging interactive applications and games for people with special needs: 

Using Kinect in Special Ed Classrooms: Advice from Loudoun County, Virginia Teachers
Microsoft in Education Team, Microsoft in Education Blog, 6/1/12

KinectSEN-Kinect and Special Educational Needs round-up
Greg Dunan, Microsoft Coding4Fun, 10/11/12

Monkeying Around with Autism Assessments: Kinect-based game by Vectorform andKaiser Permanente therapists offers a barrel of possibilities!
Lynn Marentette, Interactive Multimedia Technology, 7/23/13

Behind the Scenes: Creating Marty the Monkey (The character from Vectorform's autism assessment app) John Einselen, Vectorform Blog, 7/24/13


Kinect Party Review: More Fun from the Fun Kings
Casey Lynch, IGN, 12/20/12


The Power of Kinect in Special Needs Education
Willemijn de Lint,  Hans Smeele, mytylschool De Ruimte

Sign Language Recognition and Translation with Kinect (pdf)
Ming Zhou, et. al.

Cool Kinect move: Reading sign language in real time
Christopher MacManus, CNET, 7/18/13

Anthony Rhys, Trinity Fields ICT

James Winchester, SENClassroom blog

PMLD Eyegaze Project at Trinity Fields

Kinect hacking using Processing

Kinect SEN and Processing Resources
Keith Manville, Oak Grove College OpenSEN

Mat's Classroom Blog

GestureSEN Wiki
KinectSEN Wiki; KinectSEN News
ProcessingSEN wiki
LeapSEN Wiki
EyegazeSEN Wiki

SEN Students and Coding
OpenSEN, 3/5/13

Processing2

Kinect for Windows Blog

Kinect For Windows
DoubleFine

Understanding Engagement, Module 3.2, Training materials for teachers of learners with severe, profound and complex learning difficulties, UK Dept. for Education


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Drawing with Sounds, an Interactive Musical Drawing App Created with Processing

This is my first creation using the Drawing with Sounds application. This cause and effect application was created with Processing 1.5.1 and produces musical sounds and patterns, along with random abstract shapes that are triggered through movements of a mouse. The application has been adapted for switch users, making it accessible to those who have motor impairments.

Processing is an open-source programming and integrated development environment that was build on the Java programming that has been easy to learn by people who have limited technical backgrounds. It is used by people from from a range of fields, such as art, music, journalism, and data visualization.

The fact that Processing is easy to use makes it great for people with just a little bit of coding knowledge to adopt a variety of open-source applications and tweak a few of the variables to according to the need.   Using the Drawing with Sounds app as an example, I wanted to change the size of the interactive canvas.  By typing in a few keystrokes,  I changed the original size of the screen from 800 x 800 to something larger, as shown below:

I then typed in another variable for the background color, and was pleased with the results:

The application was developed from Andrew R. Brown's tutorial on "SoundCipher", based on the SoundCipher library for Processing.  According to the description of the application, "The sketch is intended for use....as a sensory stimulus using sound, shape and color to create engagement". 

Below is a videoclip created by Keith Manville, demonstrating what happens when you interact with Drawing with Sounds: 

I look forward to sharing more on this topic in future blog posts.  I'll be sure to include basic "how-to" information for my "low-tech" readers and colleagues who desire to learn a bit more about using and creating basic interactive applications that appeal to young people with special needs.  

RELATED

Note:  SEN is the UK acronym for "Special Educational Needs"

Drawing with Sounds Processing sketch

James Winchester, SEN Classroom Blog, 10/31/13

Drawing with Sound

Keith Manville, opensen blog, 10/27/12

"Open-source, Sensory and Interactive Technology in SEN"

ProcessingSEN Wiki

ProcessingSEN Drawing with Sounds Download Page

(An accessible switch-enabled version of Drawing with Sounds can be downloaded from the above link.)

Free sensory applications built in Processing 1.5.1"Download links for sensory applications built in Processing 1.5.1, designed to assist SEN students in engaging in learning through the the use of ICT, interactive “Smart” boards, touchscreen or tablet technologies.  Our experience is that using applications on these devices or with natural user interfaces such as the Microsoft Kinect can increase the opportunities for engagement and social communication with many students."

I will be posting more information about emerging interactive technologies for special needs in the future. In the meantime, take a look at the following resources:

The SHAPE Project, technologies to enhance learning for young people on the Autism Spectrum

Keith Manville, opensen blog, 11/10/12SEN Classroom "Ideas and Tech used in a SEN class"

iPadSEN

GestureSEN Wiki

LeapSEN

KinectSEN Wiki
"Using Kinect in Special Schools for Pupils with Severe Learning Difficulties"
iGazeSEN
OPENSEN Videos

Monkeying Around with Autism Assessments: Kinect-based game by Vectorform and Kaiser Permanente therapists offers a barrel of possibilities!

"The goal was to build a game that is extremely accessible, non-complex and includes simple mechanics that children with autism can quickly understand to retain their attention, prevent over-stimulation, encourage play, and prevent frustration." -Vectorform "Monkey Business" Team


I recently had the chance to visit the team at Vectorform's Royal Oak (MI) headquarters and experience a demo of one of their newest applications, a Kinect-based game developed to assist in the assessment of children with autism. The game, known as Monkey Business, was designed in collaboration with physical, occupational, and speech therapists from Kaiser Permanente, a large health care service provider in California. The project was supported by Kaiser Permanente's Innovation Fund for Technology group.

I was impressed!

As I watched the demo, it was clear that much time and attention was given to the input of the therapists at Kaiser Permanente. The avatar in the game is a friendly monkey who embodies the mannerisms of a friendly, curious child.  The artwork is visually appealing and not too busy. The sound effects relate to the interaction at hand and provide feedback to the child as they engage in various game-like tasks designed to assess visual-motor, gross motor, and basic receptive language skills.  Another good feature of this application is the simplicity of the screens designed for input of the child's information and viewing data regarding progress.

In my opinion, the Monkey Business assessment game has the potential for use in school settings, and would be enhanced if additional assessment activities are provided in the application.  Expanded activities within the Monkey Business environment could support a range of treatment, education, and related intervention efforts. In addition to supporting assessment and intervention of children with autism, the Monkey Business concept would be especially useful in working with children who have experienced a traumatic brain injury.


Below are screen shots and descriptions of a few activities from the Monkey Business game:

Lily Pad Jumping Test
In the jumping test, the child is asked to jump across a pond, from one lily pad to another.  The child is provided with a set of toy lily pads on the floor.  As the child jumps, the Kinect sensor picks up movement and displays the jumps on the screen in the form of the monkey.

Balance Beam Test
The following screen shot depicts the monkey avatar crossing a stream on a balance beam. The monkey's movements reflect the child's movements across a real balance beam in front of the Kinect sensor and a large screen display.

Block Building Test
In the block building test, the monkey avatar encourages the child to build a tower of blocks to match the one displayed on the large screen.  The child uses real blocks, placed on a table, to build a tower while the monkey provides encouragements.  Objects other than blocks can be used, as the Kinect sensor is capable of identifying a variety of objects that can be use for building and stacking.

Clinician Screens
The screens designed for inputting and reviewing data regarding the child are designed with simplicity and ease-of use in mind, as shown in the pictures below:

In the present version of Monkey Business, a TV remote is used to control the application. It is possible that future versions of Monkey Business could integrated with a Smartwatch to input student information and control the activities in the application.  


Comment: As a school psychologist who works with children, teens, and young adults with autism and other significant disabilities, I know how difficult it can be to conduct assessments using traditional test materials.  If a student has difficulty interacting with unfamiliar adults, has communication challenges, or has motor difficulties, it may not be possible to administer an assessment that generates meaningful or valid results.  Even if the student is capable of completing some of the traditional test tasks, much time and effort is required on the part of the evaluator to sustain their interest, effort, and attention.   

To get a better picture of a student's emerging skills, I use interactive multimedia applications during my assessments of children with autism.  Newer technologies such as interactive whiteboards, larger touch-screen monitors, and tablets have proven to be useful tools in assessment.   A significant drawback to my approach is that it is cobbled together and might be difficult to replicate by other evaluation teams.  I see a growing need for a range of technologically-enhanced tools for assessment, including applications that offer opportunities for playful engagement.  Monkey Business holds potential to fill the bill.

What next?

I'd like to share some stories about the people who make things come to life at Vectorform. During my visit, I learned that they are involved in a number of projects related to health care and are always brainstorming new ways to harness technology for their various clients.  

Over the past several years, I've followed Vectorform's journey as they've jumped off of the desktop and transformed from web-developers to Post-WIMP explorers of natural user interfaces and interaction.  The most recent area of exploration is Google Glass. 

Intrigued by Google Glass?  So am I.  

During my visit to Vectorform, I had a chance to see the world - or rather Vectorform's basement conference room - through Google Glass.  As soon as I put them on I was flooded with ideas, and will expand on my ideas, and those of others, in future posts.

In the meantime, take the time to read an excellent post by Kevin Foreman, Vectorform's Director of Product Vision.  In "The Glass Experience", Kevin provides an in-depth reflection of his experience wearing Google Glass throughout his daily routine.  He also explains the inner workings of the hardware, the strengths and limitations of the Glass system, details about the user interface, the "on-board" accessories, and a few comments about what it is like to be a new Glass-wearing celebrity.


RELATED
Here are just three of the innovators I met during my recent visit to Vectorform, left to right: Jennifer Tonio, Marketing Manager, Kevin Foreman, Director of Product Vision, and Patric Samona, Director of Health Solutions.

Below are a few links related to the use of games for the assessment and intervention of autism, along with links to information about the use of games and emerging technologies for rehabilitation, health care and health promotion:

Vectorform Partners with Kaiser Permanente to Assess Autism Spectrum Disorder Through Innovation  Patrick Samona, Vectorform Blog, 7/10/13


Kaiser talks up monkey game, talks down EMR integration Jonah Comstock, Mobihealth News, 7/9/13

Using Kinect and Happy Action Theater as therapy: how one school is reaching autistic children Ben Kuchera, The Penny Arcade Report, 11/19/12

Microsoft Kinect and Autism (SlideShare) Susan McCarthy, Little Angel's School 2/09/13

Hacking for autism: Apps to help everyone on the spectrum Donna Tam, CNET, 2/22/13

Italian Team Uses the Kinect to Treat Autistic Children Andrea Lorini, Epoch Times, 12/13/12

Microsoft Surface Multi-touch Application for Pediatric Neuropsychology Assessment (Featuring Vectorform) Lynn Marentette, TechPsych Blog, 8/26/09   

Video: http://vimeo.com/4141208

Microsoft Gaming Technology Helps Children with Cerebral Palsy eHealthNews, 8/16/12

Should We Integrate Video Games Into Home-Based Rehabilitation Therapies for Cerebral Palsy? Elaine Biddiss, Future Neurology, Medscape Today, 7/2012

Xbox One, Kinect 2.0 and the future of health technology Marcelo Calbucci, Mobihealth News, 5/26/13

Games for Health Website

Kinect: Interactive Multimedia Technology Posts

Accessible Games for Health and K-12 Education: Lessons from the Classroom (SlideShare) Lynn Marentette, 5/9/08, Games for Health Conference Presentation

Researchers: Microsoft Kinect is a Money-Saving Telemedicine Device Gabriel Perna, Healthcare Informatics, 2/15/13

Lowes, LP., Alfano LN, Yetter BA, Worthen-CHaudhari, L, Hinchman W, Samona P, Flanigan KM, Mendell JR Proof of Concept of the Ability of the Kinect to Quantify Upper Extremity Function in Dystrophinopathy

PLoS Curr. 2013 Mar 14; 5   doi:  10.1371/currents.md.9ab5d872bbb944c6035c9f9bfd314ee2