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)

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

Google Earth and Leap Motion - I'll experiment with this after work today!

Leap Motion + Google Earth

I have the Leap Motion dev kit and can't wait until I can use it with Google Earth. Hopefully I'll find time tonight after I get home from work! For now, here is the promotional video:


RELATED
Leap Motion
Leap Motion: My Dev Kit Arrived - Now What?!   Thoughts About "NUI" Child-Computer-Tech-Interaction -- and More

UPDATE: What's New for Kinect? Fusion, real-time 3D digitizing, design considerations, and more.

The Evolution of Microsoft Kinect

I've been following the evolution of Microsoft's Kinect, and recently discovered a few interesting videos that show how far the system has come. According to Josh Blake, the founder of the OpenKinect community and author of the Deconstructing the NUI blog,  the Kinect for Windows SDK v1.7 will be released on Monday, March 18th, from http://www.kinectforwindows.com.  More details about this version can be found on Josh's blog as well as the official Kinect for Windows blog.


It is possible to create applications for desktop systems that work with the Kinect in interesting ways, as you'll see in the following videos. I think there is potential here for use in education/edutainment!

Below is a video of Toby Sharp, of Microsoft Research, Cambridge, demonstrating Kinect Fusion.  The software allows you to use a regular Kinect camera to reconstruct the world in 3D.



KinEtre: A Novel Way to Bring Computer Animation to Life
According to information from the YouTube description, "KinÊtre is a research project from Microsoft Research Cambridge that allows novice users to scan physical objects and bring them to life in seconds by using their own bodies to animate them. This system has a multitude of potential uses for interactive storytelling, physical gaming, or more immersive communications."




The following videos are quite long, so feel free to re-visit this post when you have time to relax and take it all in!

Kinect Design Considerations
This video covers Microsoft's Human Interface Guidelines, scenarios for interaction and use, and best practices for user interactions.  It also includes a preview of the next major version of the Kinect SDK. 


Kinect for Windows Programming Deep Dive
This video discusses how to build Windows Desktop apps and experiences with the Kinect, and also previews some future work.




RELATED
Kinect for Windows Developer Downloads
Kinect for Windows Blog
Deconstructing the NUI Blog (Josh Blake)
Microsoft Kinect Learns to Read Hand Gestures, Minority Report-Style Interface Now Possible
Celia Gorman, IEEE Spectrum, 3/13/13
Kinect hand recognition due soon, supports pinch-to-zoom and mouse click gestures.
Tom Warren, The Verge, 3/6/13
Microsoft's KinEtre Animates Household Objects
Samuel K. Moore, IEEE Spectrum, 8/8/12

Kinect Fusion Lets You Build 3-D Models of Anything Celia Gorman, IEEE Spectrum, 3/6/13
Description of Kinect sessions at Build 2012
Kinect for every developer!
Tom Kerhove, Kinecting for Windows, 2/15/13
Kinect in the Classroom
Kinect Education

Note: Although I recently received my developer kit for Leap Motion, another gesture-based interface, I haven't lost interest in following news for Kinect.

Tips for Apps and the Web: Designing for Teens, Part I

Jakob Nielsen, of the Nielsen Norman Group, recently wrote an interesting post about designing website for teens. He provides good information for anyone considering this age group.  The study includes tips for designing for smaller screens such as laptops with track pads, touch-screen tablets, and smart phones.

Teenage Usability:  Designing Teen-Targeted Websites

Jakob Nielsen, Alertbox, 2/4/13

The research shared in Nielsen's post is important. The results of research conducted 8 years ago are compared with current findings.  Nielsen discusses some of the myths about teens and technology. As Nielsen points out, teens might appear to be tech-savvy in some ways, but they possess brains that are in the midst of cognitive development,  just one factor to consider when designing web experiences for this age group.

Nielsen Norman Group's related product, "Teenagers (Ages 13-17) on the Web" provides additional information on this topic. It includes 110 design guidelines informed by research conducted with teens.  Busy web developers might find the fee of $149.00 for this report appropriate.   

The information in this report would also be useful to design/development teams who aim to provide web-based educational content for this age group.

Pew Internet & American Life

Another good resource for designers/developers targeting applications or websites for teens is the Pew Research Center website.  The Pew Internet & American Life Project continues to investigate a wide range of topics related to the use of technology among people of all walks of life.  What I like about the Pew Research Center is that their reports are free, and include summaries as well as samples of interview questions.

Researchers from the Pew Internet and American Life Project share their knowledge in a variety of forms.  Data is available for download in SPSS and comma-delimited format, crosstab files and questionnaires.

The website also provides access to number of presentations, such as the one below:

Teens 2012: Truth, Trends, and Myths About Teen Online Behavior from Pew Research Center's Internet & American Life Project

RELATED/SOMEWHAT RELATED

Nielson-Norman Group Research Reports

Children 3-12 on the Web

Teenagers (Ages 13-17) on the Web

College Students (Ages 18-24) on the Web

Pew Research Center Resources
Featured Research: Teens
Pew Research Center Trend Data (Teens)
In-store Mobile Commerce During the 2012 Holiday Shopping Season

Teens and Education Resources 
The following websites also provide resources for other age groups and related topics.
Edudemic
Edudemic Ed-Tech Tools 
Edutopia
Edutopia: 6-8 Grade Level Resources
Edutopia: 9-12 Grade Level Resources
Mind/Shift

Part II will focus on teens and considerations for educational technology.

Designing for Touch & Gesture: Tips for Apps and the Web (Updated)

In the past, our fingers did the walking, sifting through files, papers, pamphlets, and phonebooks, and then by point-click-clicking with a mouse to interact with images and text, in essence, electronic imitations of the paper-based world. Traditional forms, brochures, ad inserts, and posters informed much of the design. 

How much have things change?   It is 2013, but you'd think it was 1997 from the PowerPoint look and feel of many apps and web sites!   Touch is everywhere, but from what I can tell, not enough designers and developers have stepped up to the plate to think more deeply about ways their applications can support human endeavors though touch and gesture interactions.  

For an overview of this topic, take a look at my 2011 post, written after a number of ugly encounters with user-unfriendly applications:  Why bother switching from GUI to NUI?  

For an in-depth look into the history of multi-touch, the wisdom of Bill Buxton is well-worth absorbing.  He's worked with all sorts of interfaces, and has been curating the history of multi-touch and gesture systems since 2007:


Multi-Touch Systems that I have Known and Loved
Bill Buxton, Microsoft Research, Updated 8/30/12



Even if you are not a designer or developer, I encourage you to explore some of the links below:

Touch Gestures for Application Design
Luke Wroblewski, 10/9/12

Common Misconceptions About Touch
Steven Hoober, 3/18/13

Designing With Tablets in Mind:  Six Tips to Remember
Connor Turnbull, Webdesign tuts+, 9/27/11

Finger-Friendly Design: IDeal Mobile Touchscreen Target Sizes
Anthony T, Smashing Magazine, 2/21/12

Best Practices: Designing Touch Tablet Experiences for Preschoolers (pdf)
Sesame Street Workshop


Are Touch Screens Accessible?
AcessIT, National center on Accessible Information Technology in Education

iOS Human Interface Guidelines
Apple

Android User Interface Guidelines
Using Touch Gestures
Handling Multi-Touch Gestures
Android

Designing for Tablets?  We're Here to Help!
Roman Nurik, Android Developers Blog 11/26/12

Touch interaction design (Windows Store apps)
Microsoft - MSDN

Multi-Touch Systems that I have Known and Loved
Bill Buxton, Microsoft Research, Updated 8/30/12