Most medical assessment forms that patients are asked to complete feel like a combination of eye test and ancient history quiz. When were your tonsils removed? Has anyone in your family ever had diabetes or high blood pressure? Have you ever suffered (insert fine-print list of about 80 more problems ending with the boggling "Other, please specify.").
The folks at QualityMetric, a medical assessment company based in Lincoln, R.I., have advanced that ball considerably by using the Internet. On a consumer-oriented site called amIhealthy.com, they've created Web-based medical forms and surveys that patients can fill out at home, print out, and just bring with them to a doctor visit. Plus, in so doing, users can create their own "health notebook," better enabling doctors to track their progress over time. This could be particularly important for those suffering from chronic diseases such as diabetes, pain, or asthma, where better treatment often involves understanding whether a patient's disease is worsening, stable, or improving. Finally, amIhealthy.com uses a survey technology called "dynamic assessment" to actually make the surveys smarter and able to collect more meaningful data in less time. For example, if the survey asks if you can walk and you say no, it doesn't then make you slog through six more questions about whether you can run, climb stairs, or do the tango. It jumps to logical questions about other aspects of your health.
All this makes perfect sense. But the company has been frustrated in getting patients to actually register and fill out the survey forms. "It's a product that could change the state of health care, but it's proving to be a difficult sell for us," explains Martha Langer, creative director. The company markets these e-health surveys via links on the pages of pharmaceutical industry, managed-care, and insurer Web sites. All have an interest in making sure patients are giving doctors an accurate picture of what their health status is and tracking disease sufferers' experiences over time.
CHANGE OF PACE. Unfortunately, the company is finding that consumers follow the links to the survey but just aren't following through. "Some of the complaints we've heard are that registration is confusing -- 'why should I fill out this survey? what's in it for me?' And from potential clients -- 'what do I do with these scores once I have them?'" says Langer.
We were happy to try to help QualityMetric address some of those issues. This is a change of pace from some of our previous makeovers, which often involve cleaning up cluttered designs or reinforcing a site's business model instead of general content. Fact is, though, registration and surveys are a widely frustrating design issue on the Web today: Site developers of every stripe, from retailers to service providers to information-only sites, have found that despite the ease and efficiency of online forms, both their existing customers and potential customers absolutely hate registering at a site unless there is a powerful, obvious, and immediate incentive to do so.
We've enlisted the help of two returning panelists. Usability guru Jakob Nielsen has been trying to get sites to understand the difficulties of registration and surveys for years. "For any site, it is crucial to offer users a large amount of services before they are required to register. Hitting people with a demand to become registered users too early places a barrier in their smooth use of the site. Anytime you ask users to climb a wall, they have two choices: Do so or go away. The lower the barrier, the better the chance that users will choose to proceed. The more they are committed to the site and the more they feel that it is useful, the more likely they are to start climbing."
San Diego designer Steven Morris, meanwhile, has some suggestions for visual changes that could help reinforce amIhealthy.com's need to appear solidly professional and trustworthy. In general, though, he cautions anyone dealing with the issue of forms to aim for empathy with busy users with many places to go: "This is what the crux of human interface is all about. Getting into the psychological, emotional, and intellectual aspects of the person you are communicating with."
As always, we offer the reminder that our panelists have graciously volunteered to assist us -- and thus our readers -- in understanding broader Web-design issues by focusing on a specific site. These comments do not reflect the depth of analysis and comprehensive services they provide to their clients when they are retained to design or redesign a Web site.
CREDIBILITY ISSUE. Let's start with Jakob Nielsen. Nielsen points out that amIhealthy.com follows some vital rules for online content that others would be wise to emulate: "In general it communicates using short paragraphs, bulleted lists, highlighted keywords. The survey forms are easy to answer, and the resulting reports are easy to scan and interpret."
However, "trust is an issue for all Web sites, too, and anybody who wants to get people to answer highly personal health questions needs to establish credibility to a much greater extent than somebody who simply wants $20 in return for shipping you a book," says Nielsen.
One reason trust is so important is that all sites seeking customer or user information today are burdened by the misdeeds and controversies sparked at other sites -- Amazon sharing the preferences of corporate users' book-buying, for example, or Toys.com attempting to sell its database of users after its privacy policy explicitly stated it would not. Nielsen believes that a new arrival to amIhealthy.com immediately sees a homepage with words including employers, insurers, pharmaceutical companies, and could logically wonder: Is the site going to tattle to the insurance companies so that I can't get covered? Will the site report back to my boss? Are they just going to sell me drugs I don't need? It's a disincentive to engage in the process at all, he believes.
"Users have been burned in the past and they have read many stories about
cases where a site's privacy policy turned out not to be worth the pixels it was written on. But this site doesn't even have a privacy policy on the first page," Nielsen notes, and just a tiny link to one on the bottom of page 2.
So, one clear priority is to address privacy and use of information gleaned by amIhealthy.com, right on the homepage. But Nielsen also found a problematic related issue: The privacy policy refers users to a "terms of use" link, which is written in impossibly impenetrable legalese ("The provisions of this Agreement are severable, and in the event any provision hereof is determined to be invalid or unenforceable, such invalidity or unenforceability...") Nielsen is adamant: "I recommend never to allow lawyers to design any major component of the user experience for a Web site aimed at normal people. Sure, let the legal department 'draft' the documents, but then test them with real users to see how many customers they scare away."
WHAT ARE THE BENEFITS? Another strong suit of this site is that it realizes it's important to give users some samples of the experience and service before they register. However, he feels amIhealthy.com could improve that process. Clicking on the "Dynamic Health Survey" link does not bring the user to a page that explains the survey or allow them to start answering questions. Instead, the user is shown a page that demands a login or provides the option "I'm not a Registered User, but would like a preview of the surveys!"
Nielsen: "Having a guest feature is great, but not when it is referred to as a 'preview.' The term 'preview' is often used for a noninteractive canned overview of a service, so users may think that they are not getting the survey at all. It would have been better to take the user directly to the survey and have them complete it while they remain anonymous. Then, at the very end, the site could prompt users to save their survey results for later use. If the user decided to do so, the site could offer an option to remain anonymous (at the penalty of losing some features) or to register. Note that by delaying registration until the time when users are committed to the site, the initial experience allows for uncommitted exploration, thus pulling more users into the site and allowing them more time to build up trust in the site."
"The ability to take a survey is a feature, not a benefit," Nielsen continues, so the homepage admonition "Take Surveys! Monitor your health," isn't compelling. In rewriting the site's homepage language, Nielsen urges amIhealthy to focus sharply on answering these key questions for consumers: What benefits will I gain from spending time completing the survey? And how can I trust you to keep my answers confidential?"
Nielsen's main advice for a redesign:
Unify the two homepages into a single page aimed at patients, with clear links for where other users should go.
Tone down the fancy graphics on the homepage to accelerate download.
For registered users, show some of their personal information directly on this first screen.
For unregistered users, use the space for explanations of the specific benefits offered by the site. Also link directly from the homepage to a few good surveys that people can take without being asked to register. Explain the benefits of these surveys right on the homepage.
Add more prominent privacy explanations to the homepage. Also add an explanation of the site's business model in terms that make it clear to users how the site can make money without cheating them.
Rewrite the user agreement -- in English.
Nielsen concludes: "The very concept of interactive surveys is a great use of the fundamental capabilities of the Internet to be interactive and only ask those questions that are necessary. The ability to save previous surveys and compare results over time is also a good use of the computer. The site might be even better if it provided links to other health sites with more extensive content to allow users to read more about the issues that were covered in the surveys. But even as a stand-alone site, this is a great service."
Now, Steven Morris: "It seems to me, part of the difficulty that amIhealthy.com is having is through an image-positioning standpoint. To be respected by companies often bigger than you, one has to project the image that you speak their language. This means looking as serious as you are about your content. In this case it's a challenging thing to do based on all the forms content you're dealing with. But starting from the beginning and creating one new logo identity foundation on which to build is step one.
(click for full-size view)
"The amIhealthy.com logo identity is ripe for a redesign or at least a simplification. I agree in the initial direction to keep it simple and build it based on typography. The next thing I would recommend is creating a stronger visual hierarchy for the site. When you go from your homepage into subsequent pages, continuity is lost. You feel almost as if you go entirely into another site from level 1 to level 2 to level 3. This creates the danger of losing or confusing the viewer. There are also some simple details that seemed to get overlooked in the process of creating the site. For example, things like the use of the 'register now,' 'email,' and 'log in' buttons are not consistent with the other design elements on the site. Lack of consistency, in fact, is the biggest single issue that this site suffers from."
In this redesign of a survey page, Morris has created a more uniform navigation bar on the left side, an easier-to-read treatment of the logo, and a stronger visual image overall.
(Click for full-size view)
"Getting down to basics, there are two things every site should do for viewers upon landing on a homepage. 1) The homepage should tell the viewers where they are and what the company does. Clearly and simply. This sets up a clear relationship from the beginning. 2) The navigation should be intuitive to the point that the viewer doesn't have to think about where to go -- they're guided by the interface created for them. By achieving those two simple items up front, you have the viewers in your hands, which enables you to take them where you want them to go, let them feel what you want them to feel, and to lead them to what you want them to think about your company and services."
"One of the companies who I think handles a massive amount of forms in a thoughtful manner, with clear navigation, and consistently throughout their forms is emode.com (www.emode.com). The purpose and treatment are more lighthearted than that of the health-care industry, but the seriousness in which they treat their forms could teach a lot to any like e-company. Their navigation, graphics, and visual hierarchy are simple and clear from the beginning. Their forms are very well handled and very consistent from one to the next. Each form also gives you an indication of its length as you enter it, giving you an idea of what kind of time commitment you are getting into, and it shows your progress as you fill out the form."
Our panelists: Jakob Nielsen (www.useit.com) is a "user advocate" specializing in Web usability and a principal of Nielsen Norman Group (www.nngroup.com), which he co-founded with Donald A. Norman, former Apple Research vice-president. Nielsen's most recent book, Designing Web Usability: The Practice of Simplicity, currently has a quarter-million copies in print in 11 languages. Nielsen's Alertbox essays about Web usability have been published on the Internet since 1995 (www.useit.com/alertbox) and get about 6 million page views per year. Nielsen holds 50 U.S. patents, mainly on ways to make the Internet easier to use.
Steven Morris is Head Honcho of Morris Creative Inc. in downtown San Diego, Calif. Since its inception in 1994, his firm has provided an eclectic arsenal of creative services for their wide array of local, national, and international clients, including Hasbro, ebill.com, and the California Center for the Arts. Morris Creative has gained a local and national reputation for its effective creative and marketing collaboration efforts. Emphasizing and understanding the marketing audience and objectives of their clients is at the crux of their work. Steven Morris holds a BFA in fine art from Salem State College (1986), an MFA in graphic design from Tyler School of Art at Temple University (1988), and has received numerous awards and honors from various national and international competitions and publications.
Copyright 2000, by The McGraw-Hill Companies Inc. All rights reserved.
cases where a site's privacy policy turned out not to be worth the pixels it was written on. But this site doesn't even have a privacy policy on the first page," Nielsen notes, and just a tiny link to one on the bottom of page 2.
Jakob Nielsen (
Steven Morris is Head Honcho of Morris Creative Inc. in downtown San Diego, Calif. Since its inception in 1994, his firm has provided an eclectic arsenal of creative services for their wide array of local, national, and international clients, including Hasbro, ebill.com, and the California Center for the Arts. Morris Creative has gained a local and national reputation for its effective creative and marketing collaboration efforts. Emphasizing and understanding the marketing audience and objectives of their clients is at the crux of their work. Steven Morris holds a BFA in fine art from Salem State College (1986), an MFA in graphic design from Tyler School of Art at Temple University (1988), and has received numerous awards and honors from various national and international competitions and publications.
