Written by Frank Tucker

Usability is more of a science than an art.  The science is referred to as human factors engineering or ergonomics but are also referred to as user interface design, user experience (UX) design, user centered design,  among others.  The concept is to take an understanding of human behavior, cognitive abilities, social characteristics to design and engineer better human-systems interfaces that help make systems more usable, efficient, meaningful, safe, accessible and useful for the target audience and desired outcomes.  That was a mouthful!  Unfortunately, many treat it predominantly as an art. The result is that dreaded application you can’t find the print button, you’re left feeling overwhelmed or frustrated by inconsistency.  There are many principles of usability.  My top 3 principles are those of Hierarchy, Internal & External Consistency and the Eight Golden Rules of Interface Design.  I think my math is wrong as that added up to top 11 rules instead of 3.  To make things worse, I may have violated a few of my favorite principles on this website and within this article. In all seriousness, I always tell people you can design the ugliest application but if it’s useful, well-organized and consistent it will be well received.  Even poor designs will overcome usability if it’s consistent since repeatable patterns help reduce learning curve.  That is, a bad way of implementing a control can be successful, though not advisable, if that control is implemented consistently across the application.

Health applications have some of the most complex user interfaces that depart from the science of usability.  Strides have been made over the last few decades but still so many myths with regard to clinician usability have become the norm in health care applications particularly electronic health records.  The Veterans Affairs (VA) had a great brief at HIMSS 2013 about 10 Usability Myths Debunked on electronic health records (EHR).  Usability is in part why so many providers are making their EHR switch in addition to cost. To learn more, Usability.gov is an amazing resource for those that would like to better understand and apply the basics of improving user experience.

I also find many health applications frustrating due to the lack of clinical workflow integration.  It is in fact, the number 1 usability pain point the VA pointed out in their HIMSS 2013 presentation on usability myths. Certainly, business process re-engineering is always important when coupled with training.  However, there are many things that can be done to address workflow technically in addition to process optimization.  The Agency for Healthcare Research and Quality (AHRQ) has done a wonderful job providing a framework for clinical and administrative workflow.  The information used to collect and analyze clinical workflow contributes not only to process re-engineering and training, but also  technology design.  Information about AHRQ Workflow Assessment for Health IT Toolkit can be found here http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit.  With that said, there continues to be some usability rules that persists as guidelines that are nothing more than myths today.  In this blog, we will explore my top 10 usability myths from a broader perspective not just health focusing on web applications.

1.  Myth – The Three Click Rule

The three-click rule says that if your users need to click more than three times, they will decide that it is too much bother and will give up.  This has been widely considered a main usability rule, and it is one of the oldest usability rules.  However, recent studies have shown that the three-click rule does not actually apply to most users.

It is not the number of clicks that determines whether users get frustrated, but rather how easy the interface is to use to get their task accomplished.  In other words, as long as the interface is easy to use, the number of clicks does not matter, as long as the customer can complete their task easily and with little frustration.

2.  Myth – Your Content Needs to be Above the Fold

It has long been said that content should all be above the fold, which means that all of the content should be on the page, without requiring the user to scroll down.  However, studies have shown that users do not mind having to scroll down to see more content.  In fact, the opposite can be true, that when a website does not try to cram everything above the fold, that users are more likely to explore the rest of the site.

When you adhere to this rule, your content can look too crammed in.  Users are perfectly willing to scroll down to see the rest of the content so you do not have to keep everything above the fold.

3.  Myth – Don’t Sweat the Small Details

Web developers are often too focused on the big picture for their web site design and that can leave a lot of little details unattended too.  However, the little details go a long way towards determining how usable a website is and to a user, those little details are important.

Small things like making sure all the links and buttons work, or how things are worded may be small details in the overall picture, but to the user, they are important.  For example, instead of a generic error message, replacing the wording with something informative and specific, such as including a customer service contact number for additional help will make a big difference in the usability of the site.

4.  Myth – Architecture  and Navigation is Less Important when there is a Search Feature

This is a myth that says that if you have an easy to use search feature, the information architecture of your site is not that important because users can simply use the search function to find what they are looking for.

This is incorrect because most users do not rely solely on using search, they also expect there to be a hierarchy of information through links and menus.  Do not skimp on your architecture in favor of expecting users to use the search function because navigation is a huge issue when it comes to usability.

5.  Myth – Your Homepage is the Most Important

Because new users often find pages through search engines, it is very likely that your home page is not the first page that they see.  By switching focus from the home page to the landing pages, you can increase your usability and your user retention.

6.  Myth – Using Icons Increases Usability

Icons actually have the opposite effect, and using them can lower the usability of a website.  Icons work best when they have text labels that clearly define what the icon means.  Icons that are not easily identifiable can be confusing.  Using icons that are easily recognized have the best impact.

7.  Myth – The More Features a Website has the More People will Like it

People love when a website is interactive and that they have choices about what features to use, but when a website’s interface includes too many features, it can be confusing for users.  Too many options are not always a good thing, because your users can get lost in the interface.  Simple is sometimes better; find a good blend of features and simple solutions for your users to use the site successfully.

8.  Myth – Redesign your Website Often

Revamping your website periodically will not increase your usability and it can end up confusing your returning users. The theory is that if you continually redesign your website that you will attract new customers and increase conversation.  Instead of redesigning, use your customer feedback to make small design changes instead.  Small changes that improve how your website functions are a better choice over a total revamp.

9.  Myth – Graphics are a Needed Visual Element

When trying to highlight relevant content, the line of thought was that by including eye-catching graphic elements in the page that it will draw the user’s attention to the graphics.  However, studies show that users will look at the links and texts over flashy graphics elements.  When a page has graphic heavy presentations, they look like ads at first glance and will be ignored by the majority of the users.   Avoid using any graphic elements that can be mistaken as being an advertisement.

10.  Myth – Users Read all Content

If you got this far, this myth must be actually true or the article is just that interesting.  In all seriousness, eye tracking studies have shown that users skim pages rather than read the full page.  Users will look for highlighted words, lists, headings, links, and shorter paragraphs.  Long blocks of content may not hold the interest of the reader and will be skipped over.  Instead of one long article, it should have elements that break it up, such as sub-headers. When it comes to website content, it should be informative and concise.