Trained in internal medicine and infectious diseases, Sheila Bond, MD has been caring for highly immunocompromised patients at Brigham and Women’s Hospital and other Harvard-affiliated hospitals for more than ten years. When she’s not at the hospital, Bond focuses her time on UpToDate as the deputy editor for infectious diseases.
Bond has worked in medical publishing for the past eight years, and says clinical decision-making, or decision-making in general, has always been a part of her career. “I studied formal logic as an undergraduate and how different presentations of information influence how you think. Today, on top of my editorial and clinical roles, I teach a course on clinical reasoning at Harvard Medical School.”
Mark Munzer, the director of user experience at Wolters Kluwer Health, Clinical Effectiveness, approaches clinical decision-making from the viewpoint of a technologist. Before joining the engineering team behind UpToDate, Munzer had been leading user interface (UI) and user experience (UX) at software solutions companies for more than 15 years.
“When people think of UX, they typically think of visual design,” says Munzer. “But UX really starts with understanding users.”
For Munzer, an example of UX done well is Amazon. “It’s complex information that serves a huge, worldwide audience, and it’s incredibly easy to use because the Amazon engineers pay attention to what users need in the moment.”
Setting the bar high for editorial content and the user experience
Collaborating with the world class editorial team and UX team members behind UpToDate, Bond and Munzer focus on the clinician-centered experience — what information clinicians need, the exact moments they need it, and how to deliver it in the most efficient way.
“Our editorial team applies their deep domain expertise to ensure that every line of content is current, accurate, relevant to clinical practice, and supported by the best available evidence,” says Bond. “As physician authors and editors, when we create content, we explicitly think about the branchpoints in clinical decision-making and predict the situations that our users will be in when caring for patients.”
Bond says that design decisions and how content is displayed have a big impact on scan-ability, readability, legibility — meaning how quickly users can absorb the information. “Now, working closely with the UX and technology teams, we’re able to bring out the most important information users need in our design of UpToDate.”
Munzer stresses the importance of these design decisions given the wide variety of UpToDate users, from different specialists, clinicians of various ages, and clinicians in different areas of the world, to clinicians who use UpToDate on their mobile device.
“Understanding the needs of clinician support across those different sets of users helps understand how users’ traffic through UpToDate in common situations,” he says. “We have the power to do this because of our immense usership, which provides us with rich data insights into how clinicians practice at the point of care.”
This marriage of editors who understand the content and designers who understand different ways to present information ensures that UpToDate users find the right answer, at the right time, and in the right format. This is what sets UpToDate apart from other clinical decision support solutions.
Understanding the clinical decision-making process
When thinking about the steps needed to make a good clinical decision, from the data sense and from individual experience, “It’s about being able to quickly access the information you need, when you need it,” says Bond. “We’re constantly evaluating how the power of design can help improve clinical decision-making.”
“Sometimes the right information is a clinical study, sometimes it’s practical guidance or pharmacokinetic data, and sometimes it’s understanding the science. There’s a robustness to what a sound clinical decision is that’s represented in UpToDate.”
The hallmark of UpToDate, says Bond, is that it delivers what you need to know before you know you need it. “I’ve heard users say, ‘I didn’t even know I needed to know this thing, but UpToDate gave it to me.’”
At its core, user experience really means clinician experience. “We take a user’s mental model and overlay our expert content about what clinicians are going to need in that moment before they know they need it,” adds Munzer.
Clinicians don’t come to UpToDate just for a fact, they’re coming for help with a decision, which is often fairly critical. “It could be a micro decision or a major decision, but it’s about making a decision,” says Bond. “For example, it’s much different than the way you would search Google.”
Keeping pace with the ever-changing needs of clinicians
By understanding how clinicians are actually using UpToDate and UpToDate® Advanced, Bond and Munzer are able to continually evolve the solution for better ease of use. They outline a two-fold process:
- Analyzing the data and looking for the most common search queries and where those queries lead. Then determining if there are easier ways to deliver users to their desired destination.
- Conducting contextual inquiry by interviewing users about their jobs, their use of technology, and their mental models, as well as asking them about the last couple things they looked up in UpToDate and how they did it.
“Marrying real-world user questions with sound decision-making and the practical guidance of our editorial network is game-changing,” says Bond.