At Healthx we are constantly working hard on our design capabilities, and it’s not just because we want to make things pretty. Rather, we understand that the true value behind a well-designed product or service goes beyond a pretty face and translates into real value that impacts the bottom line of a business. Truly good design has a much higher set of primary goals. and while an improved set of visuals is often involved in the process, there are much more interesting powers at work behind a great design.

Design that Matters

Good design can be measured in a few ways beyond ‘ooohs’ and ‘aaahs’, specifically: usability, accessibility, loyalty and behavior. In order to understand how we can achieve these in a healthcare portal, we need to have an understanding of where we stand today on the state of the internet.

The web is growing up all around us. In its youth, the web was made by tech people for tech people, and a deep understanding of just how the internet worked provided a clear advantage to actually using it. Fast forward to today and we are starting to see some signs of maturity in what we use online. Websites like Facebook and Twitter derive mass popularity because of intuitive interfaces and an incredibly low barrier to entry. So low that my 81-year-old neighbor informs me that he just uses his computer for Facebook.

The popularity of sites like this and the explosion of Apple devices is no fluke. In all of these cases, design has been used to convert complicated interactions and behaviors into easy-to-understand tasks for the user. As any designer can tell you, achieving simplicity is no simple matter. Our challenge at Healthx is to deliver complex sets of data to a wide variety of user groups that represent different needs and ensure that each of these groups can interpret the content that they need efficiently. It’s far from simple behind the scenes, but our users shouldn’t be the ones that suffer from this complexity.

Usability as a Design Component

Our business, like many, is largely data-driven. This is exciting because it allows us to innovate great tools in order to make sense of all the data, but also daunting because we need to innovate great tools in order to make sense of all the data.

As part of the health information exchange industry, we deliver a lot of critical and very sensitive information to our users. Being able to easily reach and quickly understand that data is a crucial part of what really makes our system tick. When given the choice between a really pretty health claim report and one that is really easy to read, we will take the latter every time.

Unfortunately this isn’t always the case online. The rapid pace of technology is always providing us with new tools to work with. It’s not uncommon for some companies to get caught up with all of the things they can do for their users and lose sight of what they should do for them. Design and decoration are two different things and decoration can be a costly distraction in the case of medical or personal information. Decorating instead of designing takes a hit to usability, something we are not willing to sacrifice at Healthx.

Much like usability, accessibility plays a huge role in our design process. We want to serve our product up to everyone. This means providing our content to as many devices, environments, and users as possible, ensuring that upgrading or changing one group doesn’t leave any other behind. At Healthx, having accessibility standards means going well beyond Section 508 compliance. We consider usability and accessibility to be requirements in the websites we develop and design; we know them like the back of our hands. Naturally these things alone are not good enough for us. Mastering the fundamentals is essential but in order to take things to the next level we tap deeper into the power of design.

Emotional Design

Emotion is a basic component of human nature. Oftentimes we look at emotions as having negative consequences, even going so far as to say our emotions ‘get the best of us’ at times. However, the truth is that our emotions do a lot of good work for us on a day-to-day basis. We use them to make snap judgments and quick assessments of situations where we don’t have the time to critically process the pros and cons. We get on a plane with strangers to travel hundreds or thousands of miles because we have a mutual trust in the professionals tasked with getting us to our destination. We avoid dangerous situations based on fear and gut reaction more than a time-consuming assessment of our surroundings. These same basic tenants of human emotion are not lost on the web.

A particularly useful case study can be seen with the success Mint.com has found, in large part due to the decisions made in their design. When Mint was founded in 2006 they ran into some tough problems before they ever had a user base. Potential investors feared that the public was not ready to place enough trust into a website to share their personal financial information with it. To address this concern Mint turned to design.

The first iteration of Mint.com stood in contrast to a lot of the sites that their user base had grown accustomed to seeing online. Instead of a flat interface that screamed ‘standard spreadsheet’, Mint carefully designed their site to include rich color and graphics, and intriguing displays of financial information and personal trends. The result is a beautiful interface that provides potential users with a sense of the time and effort that this company has put into their product. From there it’s not a far stretch for the user to believe that the same care and effort will be extended to their personal information. After their launch, it took Mint just over three years to reach a huge level of success and be acquired by Quicken. Today they have over five million unique users.

The valuable lesson here is that design can play a huge role in the level of trust that your site conveys to your users. When your users trust the site, they are more willing to have an in-depth experienceand interact with their online health exchange systems more frequently, helping to reduce phone calls, mail, and customer confusion. Over time we can help patientss develop new patterns for using the latest tools and healthcare management technology to access their information quicker and easier.

No Longer Skin-Deep

Design on the web has evolved over the years to a practice that is about much more than just the visual image of a site. Its roots are now much deeper than that. We understand that what the user can see and how they interact with a site will have both an immediate and a lasting impact on their experience with a product, service, or entire company. This is why we take the time to do design the right way; it’s about a whole lot more than just looking good. We aim to have a high impact with users through design and leave the right type of impression, empowering them to get the best use possible out of the platform that we provide.

Like we mentioned in our recent blog post, these devices are helping their users track the health metrics of their everyday lives, including things like miles run, calories eaten, blood pressure, etc. Many stakeholders are hoping that these daily metrics could potentially serve as integrated healthcare solutions by rewarding patients who choose running over relaxing and salads over cheeseburgers -  ultimately engaging them in healthier lifestyles.

Healthx is looking even beyond the payer scope; we see this technology not only benefitting insurers, but providers and patients as well. By effectively storing and managing this metric data, providers can better treat their patients supplemented by the insight from their wearables. Improving patient care is a huge tenet of the Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) models that most organizations are currently striving for.

Some experts within the industry have even called wearable health devices the latest battleground for “platform wars”, which includes Apple, Google, Microsoft, Facebook, and Amazon. Once these wearables do hit the major platforms, it’s only a matter of time before healthcare IT organizations realize the full potential of this big data in better understanding patient behavior.

Healthx is currently looking to develop health exchange technology that will manage wearable metrics between payers, providers, and patients.

The PwC study found that patients are increasingly relying on social media to find and share medical information. Almost half of the respondents said the information they found via social media could influence them to get a second opinion, and one-third reported using social networks to obtain medical information from other patients.

This report highlights the growing importance social media is playing in health insurance in the United States. Due to the expanding need for these communications, researchers behind the study say that social media should be part of an organization’s healthcare business intelligence strategy to increase engagement among members. Medical director of the Mayo Clinic Center for Social Media went so far as to say that social media is a “moral obligation” for healthcare companies, adding “This is not marketing. This is the right thing to do.”

Soon after the study was released, it was also announced that Facebook was initializing an organ donor program where the social website would help connect potential donors with transplant-needy patients, proving that social media is most definitely making its mark in healthcare.

Social media serves as yet another health exchange system to effectively engage healthcare consumers. And since it is so readily accessible, it’s no surprise patients and organizations are slowly moving towards that arena. Patient engagement is a top priority, making the tools to engage them just as imperative.

For future healthcare in the United States, self-tracking can increase the effectiveness of physicians by painting a more accurate picture of a patient’s health and helping the doctor visualize that data to better absorb the data. This medical information draws a contextual picture about a patient’s overall health condition, complementing a doctor’s past experience, expertise, and test results. Most providers do not have access to this information unless the patient actively tracks it and brings it to their physician.

In light of this opportunity to increase engagement and communications between patient and provider, Healthx has created a new service that gathers this data and makes it accessible to doctors via an online healthcare portal. This service utilizes Application Programming Interface (API) calls to deliver a seamless, flexible, and expandable health exchange solution that allows our client to leverage the power of this data.

We think this innovative new concept could serve as a huge force in achieving the revered managed care model while filling the technology gap between doctors and patients.

The mounting volume of health information is what those in the healthcare IT space call ‘big data’, which are data sets that grow so large that they become cumbersome to work with using on-hand database management tools.

In the past, processing big data has caused all kinds of headaches including server blackouts, slower database responses, and increased file-load times. Enter Healthx’s ‘Delta Process’, which helps us automate the loading process and improve overall file loading. The Delta Process acts as a moderator, determining how many files load at a time and which ones need updating.

For example, loading a host of files simultaneously can significantly hamper the efficiency of the server; therefore, Delta reduces the amount of data going into the database at one time to prevent it from becoming overwhelmed and bogged down by files. Likewise, Delta identifies only the records that have been deleted, added, or changed. This way it only focuses on updating those files instead of comparing every single file coming in and slowing down the server.

Healthx implemented Delta about a year and a half ago and it still remains revolutionary in our healthcare management solutions today. Experts agree that how organizations handle big data in the future will become a primary competency in the market, separating the winners from the so-called losers. Streamlining big data provides all of our clients with just what they expect – a seamless portal experience with efficient and reliable back-end processing.

Samitt himself has helped implement an Electronic Health Record (EHR) system for his organization, but thinks the healthcare industry may be putting too much focus on making EHRs ‘meaningful’ and not enough on other relevant and equally significant technologies. Samitt says to truly make healthcare in the United States “accountable”, we need to expand our idea of what health IT is to include systems such as kiosks, online healthcare portals, computer-enabled triage systems, expansive online access to medical evidence, sophisticated data analytics, remote patient monitoring, and social media. Samitt says he is not alone in this thinking.

It is thrilling to see such an accomplished healthcare leader bring light to other health technologies that aren’t mandated by law but are perhaps just as important as those that are. As a leading provider of healthcare portals and applications, we also believe in the power of our own technologies to transform the industry.

Our own experience has shown that web portals and applications can help payers and providers improve quality of care, better engage patients, cut rising costs, and much more. Technology helps both healthcare payers and providers cut down on the sluggish, administrative work that prevents them from being more strategic insurers and physicians. It also helps healthcare entities better coordinate and improve care quality while slashing costs, which are the major tenets of accountable care.

Healthx technology supports virtually all healthcare goals. The barrage of upcoming mandates certainly makes an EHR state-of-mind understandable; but our clients would also agree that investing in supplementary healthcare technologies like ours is truly what makes all the difference in building a more accountable industry.

Only 5% of the respondents answered ‘somewhat important’ and NONE said found engagement to be unimportant.

Overwhelming as those statistics are, they may not be surprising. Of course, most players in the healthcare IT industry hope to impact patient lives in positive ways.

But when it comes to defining exactly what the term ‘patient engagement’ means, the stakeholders were at odds. Respondents were allowed to pick two of ten definitions to describe how they measure patient engagement. The top five included:

Definition 1: Patient uses educational material and online resources to learn about better health or their own health conditions.

Definition 2: Patient uses tools and resources to manage his or her medical record and other health data.

Definition 3: Patient feels comfortable challenging doctor when something doesn’t seem right or explanations are not clear.

Definition 4: Patient feels comfortable discussing health issues and questions with doctor or nurse face-to-face.

Definition 5: Patient communications with doctor about changes in health status in a timely way.

Interestingly enough, a majority of respondents favored the definitions for self-managed healthcare technology solutions, with definitions one and two receiving 64 percent and 58.7 percent of the votes respectively. Only 38.4 percent felt engagement occurs in a face-to-face setting (definition four), indicating sinking support for in-person engagement.

What’s interesting about this report is that those within the healthcare industry are realizing that patient engagement isn’t what happens when you walk into the doctor’s office anymore; it begins with the technology that can reach those patients on a consistent, daily basis. Healthx is staying at the front of this movement by offering engagement services such as Paperless EOBs, Mobile Apps, our brand new Heartbeat Apps, and other Text Messaging services.

We know engagement doesn’t begin with the patient; it begins with the tools you give the patient to connect with their healthcare. How do YOU define engagement?

While strategies for increasing visits to your site can fill a book, I humbly ask you to consider the five following ideas, specifically tailored to sites built using the Healthx platform:

1. Make it easy. Ease of use is not just about making something accessible to people of all skill levels. Even if you are quite handy with technology, there is a certain satisfaction with turning something on and having it “just work”. Regardless of your skill level, the easier a technology is, the more likely and more often you will use it. While the topic of ease of use can be wide ranging, the most important area for a health benefits site (where most content lies beyond authentication) is at the start - the login. For this reason, establishing a single sign-on (SSO) mechanism from your site to ours can be critical. But regardless of whether the sign-on happens at your site or ours, the way you authenticate can have a big impact upon a user’s perception regarding ease of use. Does your site require an arbitrary username (where the user must find a username not already taken, and then remember it), a fixed member ID (where the user must locate his insurance ID card every time he logs in), or a much easier to remember email address? In regards to passwords, consider the balance between security and excessive complexity requirements (a minimum password length of 20 characters does not “make it easy”, and discourages use of your site). Better yet, consider options such as OpenID, which eliminates the need to remember a username and password in the first place. At the very least, make sure your “Forgot” service is quick and easy to use. This is so that users who check on their health benefits infrequently can get back into their account after a long absence. See Mark’s posting from last month for the vital importance of this last item.

2. Keep it fresh. At least with websites that I visit on a daily basis, the last thing I want to see when returning to a site is the same content I’ve already seen. Popular sites (news, e-commerce, etc.) change their content multiple times throughout the day. Some even change each time you refresh (pulling from a set of front pages randomly selected with each page load), or change as the page sits in the browser (cycling through several topics that may interest you). Of course, such extreme turnover in content may be overkill in the case of a site dedicated to health benefits. But logging into a site that hasn’t changed in five years does not encourage repeated use. The simplest way to “keep it fresh” in a site built on the Healthx platform is to pull in content elsewhere, such as through our RSS Feeds content items. But be warned that this has the risk of irrelevancy, or of users seeing right through it. (“Why would I go to my health benefits site to read news from CNN about the latest research in diabetes management? I don’t have diabetes. And why not just go to CNN directly?”) Often “keeping it fresh” means having someone dedicated to content creation, or an entire team as we do here. In short, the model of creating a website and calling it “done” works no better than with most other forms of media in the publishing business (newspapers, magazines, etc.).

3. Make it personal. A site full of generic images and static PDFs to download may be functional, but does not generate a sense of familiarity for the user that the site is uniquely theirs. Fortunately, “making it personal” is where Healthx excels. Whether it is checking on the status of an FSA claim, reading a message from your doctor, or printing a new ID card, our model sites provide a wealth of personalized information after logging in. Of course, you may still need the generic content, but be sure to always emphasize the personal nature. For example, instead of making claim information buried within a menu, consider displaying it on the home page, using one of our Dashboard content item types. By making it personal, the user comes to appreciate why they had to remember yet another website username and password.

4. Incentivize. When all else fails, bribe! While this is meant to be somewhat tongue-in-cheek, the “what’s in it for me?” aspect of human behavior cannot be ignored. While some blatant forms of incentives (giveaways, sweepstakes, rewards programs) may seem out of place in the health benefits industry, they may not be as alien as you might first think. Wellness programs, for example, often provide reductions in premiums through voluntary participation. Even if incentives are not paid for by you, highlight the benefits of visiting your portal. These can be financial (encourage your policy holders to check on claims to see if they were overbilled by their provider), or medical (state the importance of managing chronic medical conditions by staying in regular contact with a provider, using our Express Requests system), or matters of convenience (advertise the 24/7 and instantaneous nature of self-service). If your organization is motivated by these three incentives (reducing the cost of coverage, reduction of catastrophic claims, reduction of calls to customer service), why assume that visitors to your site are any different? Your customers want to call customer service and listen to hold music even less than you want them to.

5. Advertise! This may sound obvious, but all the above effort could be for naught if this last point is overlooked. While some means of advertisement can be exotic (QR codes - cute, but are they really effective?), the most compelling forms of advertisement are often the simplest. Do you include your URL in printed EOBs (which is the perfect place to target those who have yet to go paperless)? Do you provide and encourage enrollment online (versus paper-based enrollment)? Do you send out a regular electronic (permissions-based) newsletter? Unlike the daily websites, a health benefit site is typically something people don’t think about on a regular basis. So the constant reminders through advertising go a long way.

While sites dedicated to health benefits will likely never rise to the same level of visibility as an iTunes or a NetFlix or a FarmVille, maximizing the online engagement of your existing customers can still mean everything to your business. The more you focus on strategies like the above, the more benefit you receive from the investment you made in creating your Healthx-powered site.

The addition of the NoMoreClipboard PHR will add value to Healthx self-service communication and data integration portals that serve more than 130 payer organizations and 39,000 groups. “More than 12 million individuals use our applications to enroll in health plans, manage benefits and improve their health and wellness,” said Mitch Hansen, Healthx Executive Vice President. “Adding the NoMoreClipboard PHR to our cloud-based offering enables our health plan and employer clients to provide a valuable tool to their covered populations – helping them organize, manage and share their family health information.”

“Healthx has carved out a powerful position with medium-sized health plans, health system payer organizations and self-funded employers,” said Jeff Donnell, President of NoMoreClipboard. “The NoMoreClipboard PHR is a great complement to Healthx self-service portals, and Healthx shares our vision of giving consumers access to health information in order to improve communication and coordination of care while reducing unnecessary healthcare cost. We have integrated our PHR into the Healthx application suite, creating a seamless, single sign-on consumer experience.”

About NoMoreClipboard
NoMoreClipboard, a wholly owned subsidiary of Medical Informatics Engineering (MIE), is a web-based, personal health record management system designed to consolidate medical information in one convenient and secure location for easy retrieval and updates. NMC enables consumers to share personal or family member medical information with medical professionals electronically; reducing the need for repetitive medical paperwork.  For more information, visit http://www.NoMoreClipboard.com or http://www.mieweb.com.

About Healthx, Inc.
Healthx was formed in 1998 and has rapidly grown to be the healthcare industry’s leading developer of self-service communication and data integration portals serving more than 130 payers and 39,000 groups, representing over 12 million individual lives. Healthx develops and manages the most widely adopted online portals and applications for the healthcare market. Healthx provides SaaS solutions for payers, providers, employers and brokers. Healthx is privately held and headquartered in Indianapolis, Indiana. Healthx is SAS 70 audited and HIPAA compliant. All Healthx clients are supported on a cloud-based platform that is housed at a SAS 70 certified data center in Indianapolis.

Suga has longstanding experience within the healthcare informatics and technology sectors. An Economics major from University of Massachusetts, Suga began selling payer products 22 years ago, and went on to make multi-million dollar deals with big-name health plans such as Kaiser Permanente and Blue Cross Blue Shield.

Suga’s most recent position was with Anvita Health, an analytics technology company that specializes in clinical decision-making. During his time as Director of Business Development there, Suga immersed himself within the payer, provider, and PBM markets to help triple sales quotas last year alone. He says he will continue to connect with the payer and provider markets so that Healthx can break annual sales records for the twelfth year in a row.

“What excites me about Healthx is their solution approach,” says Suga. “Healthx clients have, at their disposal, a toolbox for which they can address their critical business issues. I’m looking forward to helping Healthx increase their already growing footprint in the payer space.”