Saturday, September 06, 2008

A Note From An Interaction Designer

On occasion, someone actually believes me to be wise in matters pertaining to PACS. It's amazing how far you can get on self-promotion.

Anyway, I've been working with several companies on their PACS designs, taking great care to avoid any cross-talk. Today, I received the email below from one company:

A request for your thoughts. . . You're unique in that you have notoriety in the medical imaging world, and actually have advocated for the need for interaction design. . . .

I am the interaction designer who works on user research and interaction design; as well as working with programmers to actually try to get the designs built. My goal is to make physicians happy and fully engaged in their software, or at least get rid of some of the "grr" :)

The questions I have for you:

1) How much of what you (or the average "Joe" rad persona) cares about in a PACS system is in the interaction design (behavior/workflow) and visual design?

2) Do you think other vendors have picked up on having dedicated interaction designers? I wonder what our best competitors are doing. If they don't call it interaction design, do they have people continually focusing on users and the user interface, planing the workflow of a user through the interface toward his goals rather than on how to architect-build-code-program the user interface?

3) How effective are seeing designs in giving you a sense of the final user experience (and workflow)? The intention of the this early review is always deeper understanding to fix on an initial plan of what to build (a design); that design is then built in software and can be tested out by rads hands-on. Having users try out an iPod is the best way to make alterations to the iPod experience, but you need to design an iPod in the first place, and not a Zune or worse a Sandisk player (I hate the Sandisk, the buttons change meaning on each level of navigation argh! Impossible to use, a pure waste of $45).

Wow. I have notoriety! Is that sort of like credibility? Oh well....

If you have a look at my old post, The Inmates Are Running The Asylum, you will see more or less where I'm coming from. Alan Cooper, of Cooper Designs, promotes the concept of software tailored for the user, and not simply cobbled together by the coders/programmers, the "inmates of the asylum".

Cooper designs interactive products that deliver power and pleasure to the people who use them. Our design methodology is founded on the observation that people will gladly use and recommend products that are designed to advance their goals, while they dislike products that merely satisfy feature checklists or are informed solely by abstract notions of simplicity.

Cooper’s Goal-Directed design methodology places the goals of the user at the center of the design process. Rather than focusing exclusively on underlying technologies or the tasks that users must perform to use their current products, our process identifies what it is that users want to accomplish in the first place and results in designs that satisfy those goals.

Thoroughly understanding the environments in which people use products, and determining the goals they expect to accomplish, yields designs that deliver a satisfying customer experience. Goal-Directed design delivers power to users without intimidating them and guards against the development of products that lack features and affordances essential to the satisfaction of users. Conversely, Goal-Directed design also prevents the addition of features that, however clever, are rarely used or irrelevant to core goals of the product users

There is a major PACS product that was revamped with the help of Cooper Design. Sadly, no one appears to have actually listened to Cooper's advice that must have cost them hundreds of thousands, if not millions to obtain. The result of the interaction was a "prettier" product which was far more esoteric and harder to use than its predecessor.

But let me answer the questions. First, how much of what I care about in a PACS is in the interaction, etc.? Are you kidding me? Is this a trick question? You could say that the images are the most important thing, and of course, that is the purpose of the PACS, to show me those images. Every single PACS out there, from the very worst to the very best, from free open-source software to the most expensive gold-plated diamond-encrusted magnum opus extravaganza will do that. The ONLY differentiating feature IS the interaction design! I guess this is one of those universal truths that is so very fundamental that it is not as obvious as it should be.

What makes one PACS easy to use and another difficult? It is the consideration of the user's needs, the interaction design as Cooper calls it, and perhaps to a bit lesser degree the visual design, the skin if you will. The designer (in general, this should NOT be the same guy that writes the code, although I know a few folks in the business that excel at both) needs to see how the radiologist will use the program, and make that interaction smooth and easy. I have said in numerous posts that the PACS shouldn't get in my way, and that is perhaps the simplest explanation of how to design it. This doesn't just happen; the program has to be written such that the images are easily available, and amenable to whatever manipulation is needed for their interpretation. Like a fine automobile connects you to the road, PACS connects you to the images. When driving, your focus should be on the road, and the car should allow you to make that connection without demanding so much of your attention that you become dangerous. When reading imaging studies, PACS should let you focus on the patient, without superflous controls or buttons, or sliders, or tabs, or whatever. Distracting me from the images can be rather dangerous to the patient, and profitable for the litigators.

In essence, PACS IS the workflow, it IS the interaction. I care about this. A lot.

Have other vendors figured this out? Yes, to varying extents. No one seems to call it interaction design, but then Cooper's influence may not be all that wide-spread. But those systems that have won my admiration definately zero-in on my interface goals. Do they have people that focus on users and interfaces? Yes, they do. Some of them do the coding, some don't, but all of them understand that the damn thing is being written to facilitate radiologists interpreting images. Such a simple concept.

The design reviews referred to above certainly do help. Like my friend's example of the iPod vs. the Sandisk player, having a functioning framework for testing is certainly one of the best ways to see what works and what doesn't. I can't really think of a better way to do this. You have to see how your model performs in the hands of the users doing with it what they do every day. A focus-group or questionnaire won't get you very far in the real world.

It's sort of ironic that my friend hates his Sandisk because the buttons change meaning on each level of navigation. Kind of like screens toggling in a state-dependent manner isn't it? Arrrggghhh is right!

I don't have a handle on what the rest of the radiologists in the world think about the various interface issues, but I know what works for me. I have said a number of times that Amicas has come close to figuring this out, and they have done so by listening to their users, perhaps more than many other companies. Creating a great PACS is simple if you follow this simple recipe. Lots of happiness, little "grrrrrr".

How much of what I care about in a PACS system is in the interaction design (behavior/workflow) and visual design? A heck of a lot. But then I've been saying that for a long time, in my quest for notoriety.


Anonymous said...

Hello - while I respect your opinions, I have to say I do not feel that strongly about Amicas as you do and wonder what you really see in it? The worklist is not intuitive, the image streaming is terrible, at least in previous versions and not the vaporware they are showing, and the overall functionality is just not really that good. The best UI is Dynamic Imaging, though I am sure GE will "screw" it up!! Dont get me wrong, Amicas is nice, but everyone has their issues, and Amicas (to me) has plenty of them.

PACS Lover

Anonymous said...

> Sadly, no one appears to have actually listened to Cooper's advice
> that must have cost them hundreds of thousands

Actually, the sad part is they DID listen.

Anonymous said...

We use Cooper in the design of our PACS product, and it has paid off, although it was an addition to our existing approach, not the basis for it. I'm a programmer/interaction designer, but I'm unusual.

The best thing I can say about our product is that I've seen a physician being shown the product for the first time by another physician, and they got so engrossed in the patient that the first physician grabbed the mouse from the demoing physician and just started using the product.

That was great.

I care a *lot* about interaction design for our PACS product. I'm the last defense against craziness around here most of the time, and I keep the interface as clean and functional as I can. It's a constant battle requiring a lot of social as well as intellectual skill. In fact, I'd say it requires more social skills than anything else.

Anonymous said...

I'm an interaction designer/programmer as well. And I find Cooper & Reimann's book Interaction Design 2.0 to be useful in educating programmers about generic user expectations and behavior. It also introduces some important concepts which we use in our design guidance documents.

As much as I agree about the importance of good interaction design, market forces are such that what people pay for (from among what is offered) is what the market will provide more of. So I have some questions related to that.

1) When purchasing a PACS, how do radiologists evaluate the software interaction? To what extent are they willing to try out unfamiliar(but possibly better) interaction models, and how much time are they willing to give to that process?

2) Does anyone evaluate the ease of use of anything besides the radiologist's workstation? If so, what?

3) How much is usability weighted in the purchase decision? And how much of a premium (in purchase price) is a superior design worth?