An interview with athenahealth’s design leaders: part 2
Jen Cardello, Executive Director of DesignOps and Scott Mackie, Executive Director of Design
In part one of our interview we sat down with Jen and Scott of athenahealth Experience Design to hear their thoughts on all things healthcare, user experience, and technology. Here in part two, we discuss the big challenges in designing for healthcare and their vision for the future:
What do you think the largest challenge is in healthcare as a whole now and why?
Jen: I think the biggest challenge is incredibly ironic: Physicians have been burdened by these data-thirsty EHRs for years; they spend so much of their time entering information into these systems, yet we have trouble, as an industry, turning those mountains of data into insights that improve patient outcomes. It’s a data problem, an information problem, and an analytics problem. There’s a lot to be learned from other industries who have learned to take large bodies of data and turning that into something useful.
Scott: What she said. The artificial intelligence that helps me get to my drinks downtown via the fastest possible route is often far more advanced than what we have in most places in healthcare — and that’s really a travesty. The experience design problem is figuring out how to drive and enable the integration of that kind of artificial intelligence into a field that’s so very worried about getting it wrong (and therefore evolves quite slowly).
Risk aversion is a central and often valid principal, The medical ethos of “First, do no harm.” holds the field back. Nobody ever got sued for the silent deaths of the status quo — The people who are injured by healthcare not being as advanced as it should, those people are invisible. But as soon as somebody tries to do something innovative and takes a risk and something goes wrong, that’s very very visible. So there’s this bias towards taking the safest possible route that leaves us lagging behind where we should be.
Across all industries, UI design is often about showing only the information that is most important. We strike that problem constantly in the EHR, where we’re told by physicians that everything is important. But as they say, “If everything is important, nothing is important.” So when we’re making a decision about priority in the EHR, we are effectively thinking about a risk. Every time we bump information a little bit further down the page or — heaven forbid — ”below the fold”, we have to think about whether that could be a critical piece of information for patient care. That constant risk management is what makes designing in health so challenging.
athenahealth has been in the healthcare space for about 20 years now. How do you think healthcare IT has evolved in that time? Has our user base changed over that time?
Jen: A lot of early healthcare IT work was about digitization of paper (and associated processes), so there wasn’t a lot of innovation and reinvention of workflows. There’s been some ground made over the past few years in reinventing those processes, but there’s danger in reinventing processes. Healthcare professionals already have to spend so much time learning things, and there’s always patient safety risk. However, we see not just athenahealth, but other healthcare IT innovators, starting to rethink these traditional workflows. [We’re] getting braver in identifying and challenging long-standing conventional workflows that can benefit from re-invention.
Shifting gears a bit — looking outside of athenahealth, what are some other UX projects or teams that you admire, and what kind of work are they taking on that you think could translate into healthcare design?
Scott: I think the artificial intelligence realm, there’s a lot to admire… The other day apple popped up and reminded me, without me asking, how long it was going to take to get my kid to a swim lesson. Although swim lessons had finished by that point but it was just an impressive demonstration [of how] they’d figured out that pattern. And another example is Airbnb, who’ve done just a great job in the realm of design systems. They have this new post, Painting with Code, where you can code things in React and see that appear on your Sketch file. Slack we’ve been a great admirer of, for the way that they’ve been sort of insidious in their approach to the enterprise world; rather than making a big sale off the bat to the enterprise technology group within a large company, they do it by groundswell so users can sign up and start using it within the company. And eventually it gets to a point where the corporate IT just has to concede and get on board. That’s a great example of great user experience being an effective business strategy. And this one’s boring, but: I always admire Apple for their ability to stay focused on the end experience. At the 2017 WWDC, they announced so many different products in which every one of them showed their usual attention to detail — and yet, at the same time, they also released a bunch of pretty great platform technologies. They didn’t take their eye off the ball — they both build great experiences and they create the platforms for others to do the same. That dual product and platform strategy is something that we’re trying to build as well.
Can you talk about the way athenahealth is pushing for design as a business priority to really help differentiate us in the healthcare and technology spaces?
Scott: The EHR arose as mostly a billing tool; it was there to record what the physicians had done in order to charge the insurer for their effort… There was a long term goal for it to be an aid to clinical work, and I think early on they saw some gains in terms of reducing errors and things like that. But I think [experience design] beyond basic usability, as a [differentiator], came very late to the industry. But — credit to Jonathan Bush and others leaders at the company for spotting the potential earlier than most. That’s part of why I did work as a consultant for athena — because Jonathan Bush and Ed Park and others realized that this was important, and that it was a way for athena to compete on a factor that matters. That continues to be a priority; there are other priorities as well, but I’ve been very impressed. It was one of the reasons I joined athenahealth — that continued interest and commitment amidst many struggles to really up the level of experience design in athenahealth’s products and thereby I hope to raise the standard across the industry as well. We have a long way to go, but we are making progress and [athenahealth’s] leadership remains committed to that as well.
Jen: An important piece of the progress that we’ve made is being able to convey and illustrate user and customer pain, and the business consequences of that pain, in order to build empathy. When you think about an application that a healthcare professional stares at all day long — and doesn’t really have a choice in that matter — we want our teams to be intrinsically driven to improve that experience. What can we do to make it worthwhile engaging with this application so that you feel accomplished, and that you’re doing great work for a good cause every day? An example of a company that got this right is Intuit. TurboTax is an application that you have to use for what many of us consider a terrible chore — doing your taxes. At the 2017 Enterprise UX conference, Kaaren Hanson, a former design leader at Intuit told an amazing story of re-invigorating user-centeredness at Intuit. Design Leadership convinced leadership across the organization that they needed to make a deliberate and intentional investment to improve the user experience — something they had long- touted as one of their core values, but were no longer delivering on. They developed an amazing, multi-faceted program called Design4Delight that drove exponential user experience improvement. Now, Turbotax is a completely delightful application to use, and they don’t stop there — they keep inventing and investing in it every year. It is incumbent upon us as design leaders to make sure that our organization understands the power of design and how that can be a benefit for us in the marketplace.
If you were trying to persuade an experience designer to move into the healthcare space, what would you say to them?
Scott: I talked about it earlier in terms of a worthy cause, a fascinating challenge and a place that’s in need of help. But I think the best thing you can do if you want to persuade a designer to dive into healthcare is to take them into the field. Because that, more than anything, gives people a deep sense of the challenge, the need, and the opportunity to do something great for people. I’ve seen people run for the hills after some of those experiences! But I’ve also seen people just feel like they can’t work on anything else after seeing that — so there are compelling problems, both from an emotional and rational standpoint, in healthcare.
Jen: One of the things we are cognizant of is that healthcare can seem rather intimidating to designers because of the complexity of the domain. We’d like to reduce the complexity — or at least perceived complexity — of healthcare to make it easier for designers to do their best work, to get involved and be productive quickly. There’s so much need in healthcare for great design; we don’t want designers to be scared away by complicated language, government regulation, and niche knowledge. The design system that we’re building is one of our approaches to helping make healthcare design more accessible. And there are other things we can do to make it so that designers see healthcare as a great opportunity and somewhere where they can have meaningful impact.
Scott: And to be honest, we need people to come in from outside of healthcare. You know, there is a risk of going native — once you understand all the constraints, it’s easy to get, sort of, penned-in by them. We want to bring in talent and experience from beyond healthcare, to make use of that experience, and to bring that energy.
So — very broadly — what is your hope and vision for healthcare in the U.S.?
Scott: I’m always amazed when I look at the international data. My hope is that the U.S can find a way to take up, emulate, or steal the best parts of other countries’ healthcare systems, which do — as the facts say — tend to provide better outcomes across the whole population while also still maintaining the points of excellence and innovation that the U.S. approach delivers. I’m hoping that we can lift that general level while also maintaining that hunger and speed of some parts of the U.S healthcare system.
Jen: Making healthcare more accessible to more people and maintaining that is very important. But, as far as technology and experiences — radically simplifying the rats’ nest of complexity that has taken over the sector — it’s unacceptable in its current state. I really hope that we can apply some design thinking to solving that problem.
So what are you most excited to see move forward at athenahealth in this coming year that will contribute to that vision?
Jen: Truly, making good on our vision of being a platform company. As a piece of that, we have a series of technologies that are being put in place to help other entrepreneurs, inventors and designers take part in helping make healthcare better. I think that is a massive undertaking and a very important goal for us as an organization. This isn’t just about us solving all of the healthcare problems, it’s about enabling others to solve those problems. We can’t do it alone. The design system, in particular, from a design perspective and development perspective, that’s a big achievement for us. We need to make that happen so that designers and developers can amplifying healthcare IT innovation.
Scott: One of the things I’m incredibly excited about is the work that’s going on in design platforms — so, all the points that Jen just made — that enables us and people outside of the company, a much bigger community, to do great things. Second, we’re in the middle of refactoring a lot of the technical stack and platform at athena. It’ll make it a lot easier for us to move faster and to build great experiences. The microservices architecture will make that innovation more achievable; the whole company is becoming more focused upon that end user experience. Product management, as I mentioned earlier, is getting more and more engaged in delivering those end experiences, and that’s pulling all of the staff here into a deeper user focus. I think that, at a large scale, is incredibly exciting. There are some specific projects that we have going on: looking into artificial intelligence, voice systems, mobile — there’s a bunch of things that we’re finally going to make some real progress on on behalf of our users. Those are all exciting.
Anything else you’d like to leave us with before we all part ways?
Scott: Yes! Join us! We need the best talent possible if we’re going to achieve all of these great things for healthcare. We have numerous job postings up at the moment for the design group. There are individual contributor jobs at all levels of seniority. We have positions for managers and leaders, senior leaders, in the design group, across our locations from Watertown, Austin, and in India as well. We also have positions in Jen’s design platforms group for design researchers and quantitative researchers, UX engineers, product owners, and developers who will be working on the design system itself.
For more information on opportunities with athenahealth, please visit us at https://www.athenahealth.com/careers/design
