How Healthcare Marketers Can Improve the Mobile Experience

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With the dramatic rise of mobile-enabled devices, healthcare marketers are looking for new ways to connect with mobile users. Stand-alone mobile sites and mobile apps just aren’t cutting it.

It’s time to consider a whole new approach to the mobile Web. One that is much more efficient for healthcare marketers to maintain and improves the mobile experience for visitors to your website.

It’s called responsive design.

Responsive design enables a website to automatically adjust to the device being used. Every site visitor has an optimal experience regardless of whether they are accessing the website with a Smartphone, tablet or on a desktop computer.

Geonetric’s Vice President Ben Dillon shares how Cone Health and Rush-Copley Medical Center leverage responsive design in his latest article “Connecting With Mobile Users: Responsive Design Offers a New Approach” which appeared in Issue 2, 2013 of the Healthcare Strategy Alert! published by the Forum for Healthcare Strategists.

Check out the article and see how responsive design helped these healthcare organizations meet their online goals.

eHealth Symposium 2013: Creating, Innovating, Pushing Boundaries

Last week we held our 8th annual eHealth Symposium. Clients from all over the country came to Iowa to work together on pushing the boundaries of healthcare marketing. With a jam-packed agenda of topics ranging from the latest website design trends to agile marketing methods to newsjacking, clients left with brains full of new ideas, knowledge and relationships:

Clients also received a healthy dose of Iowa hospitality, which consists of overwhelming friendliness, and over-the-top food:

It helps that we hold the event at The Hotel at Kirkwood Center, which is unlike any hotel you’d expect to find in Iowa:

Is this a Vegas Hotel? No, it's Iowa. Really.

Is this a Vegas Hotel? No, it’s Iowa. Really. Credit: The Hotel at Kirkwood Center.

The entryway to the Hotel at Kirkwood. Gorgeous, fantastic coffee, friendly staff, and cozy places to hang out between sessions.

The entryway to the Hotel at Kirkwood. Gorgeous, fantastic coffee, friendly staff, and cozy places to hang out between sessions. Credit: The Hotel at Kirkwood Center.

The Hotel also happens to come with a culinary school serving up delicious meals every 2-3 hours. In fact, that’s how we kicked off this year’s event, with Chef Anthony Green, talking about ways to take an ordinarily mundane recipe, Caesar salad, and kick it up a notch or three.

Chef Anthony Green kicks a mundane Caesar salad recipe up a notch.

Everything’s better deep fried: Chef Anthony Green kicks a mundane Caesar salad recipe up a notch by making it from scratch, then deep frying it or pureeing it.

Our clients are such good sports – they volunteered to help whip up a deep fried Caesar salad on TV in front of everyone.

You never know what you're volunteering for when your raise your hand. You might wind up making a deep fried Caesar salad from scratch.

Chef Green asks for a volunteer from the audience – did you know you’d have to touch anchovies?

Having pushed culinary boundaries, it was time to move into more serious material. Two days full of speakers and presenters covered topics showcasing the best in eHealth.

Speakers and presenters covered a dozen topics showcasing the best in eHealth.

Geonetric experts doing what they do best: helping clients get the most from their relationship with us.

John Morgan, author of Brand Against the Machine, was our keynote speaker. He blasted apart conventions about branding. His entertaining and irreverent message was pitch-perfect, as Geonetric and clients work together to shake up the staid industry of healthcare marketing.

Author and brand guru John Morgan, our keynote speaker, discussed building brands in today's social world.

Author and brand guru John Morgan, our keynote speaker, discussed building brands in today’s social world. Fun fact that I learned: they have a pharmacy at Disney World. You’ll have to read his book to learn why it matters. *shameless plug*

Ben Dillon presented on emerging trends in our industry, and how they affect clients.

eHealth Evangelist, Ben Dillon, presents on emerging trends in the industry.

Geonetric’s eHealth Evangelist, Ben Dillon, mesmerizes the room with that same sultry radio voice he uses in webinars. It makes statistics much more exciting!

There’s so much to learn that we used “Date-a-Geek” speed dating to make sure everyone had a chance to discuss critical topics around content, mobile vs. responsive design, and keeping up with the latest technologies and practices.

Relationships have to start somewhere. Why not start by speed dating?

Relationships have to start somewhere. Why not start by speed dating?

With clients representing hundreds of hospitals, there’s issues that are unique to larger hospitals or rural hospitals. Our peer group roundtables let them focus on those topics, and learn what’s working and what’s not with peers facing the same challenges.

Peer group roundtables let clients with similar market needs and competitive situations discuss areas most important to them.

Peer group roundtables let clients with similar market needs and competitive situations discuss areas most important to them.

We’re renowned for our deep relationships with clients. One of the best ways clients get the most out of symposium is to spend some one-on-one time with their client advisors to work through the next year’s plans:

Clients love spending 1:1 time with their client advisors.

Clients love spending 1:1 time with their client advisors. And our advisors love it too!

We ended the program with a panel featuring Leslie Kelly Hall from Geonetric partner Healthwise and Gabrielle DeTora of DeTora Consulting, who gave us insights on the evolution of marketing’s role in engaging patients more deeply in their health, and how technology and data are fundamentally changing the role of marketing in healthcare.

Panelists Leslie Kelly Hall and Gabrielle DeTora

Panelists Leslie Kelly Hall and Gabrielle DeTora gave an important outside perspective on eHealth.

To add a little serendipitous fun, we hid Amazon gift certificates and gave out clues:

By the end of the day, with brains overflowing, we had switched to beer while playing darts, pool, and laughing at a local pub, followed by a good night’s sleep back at The Hotel.

Geonetric upstairs: Closed to the public

Sure, we’ll rent out the whole floor of a bar for a party. Of course we brought the deep fried green beans if you’re hungry.

Our post-Symposium surveys reveal that clients loved the event, learned a lot, made new friends, and are excited to come back! We’re already planning for the 2014 eHealth Symposium, to push the boundaries even further! We might even find something else tasty to deep fry.

Three Ways to Improve Your Landing Page

number-pathIt doesn’t take long for website visitors to make decisions. Within a few seconds, they’re either taking the next step to interact with your organization or(gasp!) moving to the next site.

Your landing page plays a huge role in which choice your visitors make.

Here are three easy things you can do right now to improve your landing pages:

  1. Match Creative Pieces – Does your landing page coordinate with your ad? Do you use similar creative, with logos and imagery? Is the content related? Keep the experience coherent. Logos, imagery and text all matter.
  2. Remove Extra Navigation – Your landing page should focus on one goal: conversions. If you include multiple links that allow visitors to wander off, your conversions will suffer.
  3. Add a Strong Call to Action – What do you want users to do next? Think long and hard before asking them to fill out a four-page form. Short forms, phone numbers and easy downloads are excellent ways to encourage immediate action. Bonus tip: keep your call to action near the top of the page! Don’t bury it.

If your landing pages break any of these rules, it’s time to get to work. These easy changes can boost your conversion rate significantly!

Is Your Future Site Headed Toward Responsive or Mobile-Optimized?

SHSMD March/April 2013 Spectrum NewsletterWondering what kind of mobile website you should build?

I’ve got some news for you. You already have a mobile site. Whether you think about it as mobile or not, the site your hospital has right now is being accessed by smartphones and tablets.

What kind of experience are those site visitors having?

If you’re not sure, it’s time to make mobile a priority. You have two main options for presenting online content to your growing mobile market. The first option is to create a mobile-optimized site that is separate from your main website. The second option is to have one website built using responsive design, which allows it to adapt to different screen sizes.

Both options are better than not having any mobile-optimized presence; but choosing one path for your mobile future is important.

Geonetric’s Vice President Ben Dillon gives you all the information you need to make this tough decision in his latest article “Choosing Your Mobile Future” which appeared in the March/April 2013 issue of Spectrum.

Ben goes into detail on the two options, explaining the advantages of each. He even showcases a great example of each – Methodist Medical Center of Illinois mobile-optimized site and Altru Health System’s responsive website.

So if you’re not sure how to choose your website’s mobile future, start reading!

What Disney Can Teach Your Doctor’s Office

Our family did something a little different this Thanksgiving. Rather than the traditional turkey, parades and football – we headed down to Disney World with my parents, my brothers and their families.

If there’s one thing that Disney does well, it’s creating an immersive experience that allows the child in all of us to suspend our disbelief and accept talking mice and dancing teapots. Disney’s built a leadership institute that teaches other organizations to apply the operating philosophy they’ve developed for maintaining that experience and delighting visitors at every turn.

When I’ve talked with graduates of the Disney programs they routinely focus on the concepts of on-stage vs. off-stage spaces. A child’s Disney experiences would quickly be ruined by seeing Goofy holding his puppet head under one arm or Cinderella having a smoke backstage, after all. To prevent this, Disney pioneered a physical plant design approach that keeps all of the details of how the sausage is made out of the sight of visitors.

What I found most interesting during my time in the house of the mouse was a growing focus on waiting around as a part of the experience. Waiting for rides and attractions is a fact of life in any amusement park, and the Thanksgiving crowds put a lot of pressure on the queues.

While waiting may be inevitable, it’s clearly a risk to the experience that Disney wants to mitigate. So they’ve found some very creative ways to address this:

  • For starters, Disney gets good data to work from. Periodically, someone is given a red card when they get into line that they turn in before boarding. This gives reliable timely data on the current wait. While I anticipate that someone somewhere analyzed that information, the more practical implication is that they post wait time information at the ride entrance and on smartphone apps.
  • Disney also understands the psychology of the waiter and has given a lot of thought to how they set expectations. I believe that they pad the wait times that they report to avoid that all-to-frequent restaurant negative point of waiting longer than you were told.
  • Another clever solution to the wait question is Disney’s Fastpass system. They realized many years ago that only certain attractions get the really long wait times while others were underutilized. Why not let visitors use the less busy rides and attractions while they wait for the most popular? While the details of Fastpass are complicated, this is essentially what the system accomplishes.
  • With the Fastpass system in place, Disney has been able to use it in creative ways. For example, adults staying behind with children can get a special similar pass to board rides after the rest of their party returns. Disney also uses the high perceived value of the passes to their advantage, handing out the passes to those just entering the park to fill under-attended shows or offering them as compensation for bad experiences like getting stuck on a ride.
  • Most impressive to me was the ways that Disney integrated waiting into the experience for an attraction. Sure, you might wait 35 minutes for the Muppet show, but that seems less onerous when there’s a 15 minute Muppet-filled warm up act in the waiting area before you go in. And the interactive games built into the waiting lines for some attractions were as much fun as the attractions themselves (the Haunted Mansion is a great example here – I highly recommend the graveyard).

For all of that, there were also times where the system simply failed. The busses from our Disney resort to the parks were the most painful example. Sometimes the busses were efficient and convenient.  While other times waits for a bus were excessive – only to have several busses for the same park arrive at once or several busses in a row would stop only to be too full to accommodate any additional passengers.

Unfortunately, this looks a lot like the waiting system that we find at many doctors’ offices and hospitals today!

Waiting is part of the healthcare experience, too. While it may not be inevitable, we could take some pointers from Disney and think about that wait differently:

  • Get good wait time data from our EMR systems. Post that in the waiting rooms, and make it available on our websites and mobile apps to help patients make better decisions. Also, make sure someone somewhere is analyzing that data.
  • Let patients do their wait somewhere other than your waiting room with remote online appointment check-in or call ahead urgent care. Either set a time for them to come into the office or send them a text message 10 minutes before it’s time for them to come in.
  • Integrate waiting into the experience. If the patient is waiting for a test or is being seen for a particular condition, provide them with resources about that test or condition before they see the doctor. It makes both their waiting time and the limited face time that they get with their physician more productive.

But most of all get creative with the solutions! Like it or not, waiting around is part of the experience and it can take a great experience with a provider and ruin it in the eyes of the patient. Take a new outlook on this patient pain point and your organization can turn these experience killers around too.

The Business Case for Responsive Web Design

We’ve talked a lot about how mobile strategy is changing. We’ve examined why mobile is so important and how changes in Web access is leading to the need for responsive sites. We’ve discussed how responsive design works and given tips for constructing content in responsively designed sites. We’ve even created an awesome video to introduce responsive design concepts.

Now let’s put all this together into the overall business case for creating a responsive site.

Why Responsive?
One out of every four visitors to many health system sites come from mobile devices. Ignoring your mobile audience isn’t an option. You need to create a mobile site for your visitors, and responsive sites offer some real advantages:

  • Optimal experience for all users: Sixty percent of mobile visitors leave sites that don’t work well on their device. Responsive sites give visitors the content they want regardless of the device they use. The site works equally well on all devices.
  • Search engine optimization: Health topics continue to be one of the most popular searches. Google understands mobile searchers want sites that work on mobile devices, so they prioritize mobile-optimized sites in search results. Compared to dedicated mobile sites, where different URLs and duplicate content are the norm, responsive sites preserve the value of inbound links and avoid duplicate content penalties.
  • Improved conversion rates for mobile: When sites work better for users and offer all of the functionality of your traditional website, your calls to action will be more effective.

But it’s also important to understand that amidst all the excitement, there are some additional costs to “going responsive.” These costs are a result of some back-end complexity, such as:

  • Design: Responsive sites use several coordinated designs, representing some common screen sizes along with plans on how the site adjusts between these anchor dimensions. In addition, the information architecture and navigation is more complex to ensure that the site is navigable on mobile devices.
  • Templating: Templating is more complex. You need templates that respond to various screen sizes as well.
  • Testing: To be honest, you should be testing your site on mobile devices. But since your traditional website likely doesn’t functional well on most mobile devices, you’re probably not bothering.

Resultant additional cost – design and template development costs 50-100% more when creating a responsive site than a typical website.

Other Options?
If you don’t utilize responsive design, then you need another option for reaching your mobile audience. The alternative is to create one or more dedicated mobile sites. But this can also become expensive. In fact, creating a responsive site can result in cost savings when compared to multiple dedicated mobile sites because:

  • Multiple mobile sites require multiple site designs and construction. Because these sites tend to be light on design, this only offsets a portion of the incremental costs of responsive.
  • Dedicated mobile sites require all of the same testing as the responsive site.
  • Each dedicated mobile site requires its own copy of the content. Factoring in the costs of duplicate content entry and maintenance during setup and over time adds to the cost too.

Do the Benefits Outweigh the Costs?
What’s it worth to have your site work better for one in four visitors? (Which could be two in four by next year.) Your hospital’s website likely brings in millions of dollars in direct online payments, cost savings, and patient revenues every year. Today, most of that value isn’t available to the fastest growing segment of your online audience.

Maybe the real question isn’t if the value of responsive design outweighs the costs today, but how long before it gets there? Join us on November 8, 2012 for our webinar Connecting with the Growing Mobile Audience to learn more about responsive design and if it’s right for your organization.

Becoming the Amazon of Healthcare

Healthcare marketers spend a lot of time thinking about how their website compares to other hospital websites. They even put a lot of energy into figuring out which sites to evaluate. Do you look at how you compare to peers around the country, or to that competitor up the street?

Although useful, this information doesn’t give a complete comparison. That’s because you don’t just compete with hospital sites – they don’t set consumer expectations. Consumers spend over 13 hours each week online, and most of that time isn’t spent on hospital websites.

When consumers come to your site, they don’t care how it stacks up with national healthcare leaders. They compare your site to the sites on which they spend serious time.

Look at popular sites across the Internet like Facebook, Google, Amazon, Expedia, Kayak, Mint and others. They all help consumers make decisions and complete transactions. And they create great experiences – consumers easily interact with the site and feel good about the purchases they make.

These sites do a particularly good job at helping consumers:

  • Find the products that interest them
  • Understand the products
  • Evaluate and compare options
  • Buy or sell
  • Share their experiences with their social networks

Take, for example, Apple’s website. The goal of the site is obviously to get you to buy an Apple device. Now consider Expedia. The goal of their site is also to facilitate a purchase, and they help you compare options to make it easier for you.

What is the top goal of your site? Is it to have the visitor make an appointment? Pay their bill? Sign up for a class? Do you help them make their decision or do you carry them part of the way and then leave them high and dry?

Let’s consider class registration. There are only certain points in a health consumer’s life when they can be influenced. Classes and screenings give you the opportunity to build relationships with prospective consumers.

What should an incredible class and event system look like? It should definitely cover all of the bases listed above – the visitors should be able to find the products, understand them, evaluate them, buy them and share their experience with their social network. Going a step deeper, the system should allow consumers to:

  • Search for classes in a way that makes sense to them
  • Read great information in the description so they can make a decision about what’s right for them
  • Compare dates in one place
  • Register and pay for the class online
  • Register and pay for several class registrations at one time
  • Use promotional codes and coupons
  • Create an account and save information to avoid re-entering it in the future
  • View recommendations for other classes that might interest them based on their original selection

To learn more about how to improve your site’s eCommerce capabilities, sign up for our next webinar Revenue Drivers: Improving Your Site’s eCommerce Capabilities on October 18 at 3:00 p.m. CT. Our next three webinars are dedicated to looking at how hospital websites measure up to the best of the best.

Snow Globes and Security Checkpoints

I was standing in a lengthy security line at LaGuardia Airport last month, when I came upon this sign.

My first response was, “Seriously?” My second response was, “And now you tell us?” Because a traveler needs to know about the sanction on snow globes before they get to the security checkpoint. In fact, wouldn’t the right time to share this rule come before you fork over cash for the snow globe at the airport gift shop?

Given this restriction, I’m not even sure why they sell snow globes at LaGuardia. My theory is that there are only six snow globes in the entire airport, which are sold at the gift shops, confiscated at security and resold again. But I digress.

My point is actually about the Web. It’s about the responsibility we have to our audience to give them what they need where and when they need it.

Take individuals experiencing chest pain. If they’re deciding where to go for help, they’re most likely looking at ER information – not searching through your cardiovascular content.

So meet them where they are. Include signs of a heart attack – and signs of a stroke – in your ER section. Anticipate what else they’ll need:

  • Wait times
  • Maps and directions
  • What to bring – lists of medication (or the medication itself), information about allergies, recent test results, an insurance card

And of course, if they have symptoms of heart attack, emphasize the need to call 911 immediately. Lifesaving care doesn’t begin at the hospital. It starts the moment the call is made – with instructions from the dispatcher and when EMS arrives on the scene.

Follow this thinking throughout your website. Identify some of the most common reasons people come to your site – such as scheduling a mammogram, paying a bill or signing up for a class – and give them what they need to complete that task.

Step into your users’ shoes. What do they need to know? What information should they have before they start? How can you avoid snow globe scenarios?

Make it as easy as possible for them to take action – and avoid surprises – and you’re well on your way to positive user experiences and patient satisfaction.

Is it Better to License a Health Library or Write One?

We received lots of great questions during the webinar. More questions than we were able to answer in the hour we had. A few, like this one on licensing or writing health content, were worth answering in a blog post of their own. You’ll see a few more of these trickle out in the next week, but for now let’s tackle this one.

There are some great advantages to utilizing your own, unique, high-quality health content on your website rather than licensing a syndicated content library from a vendor. For starters, the content showcases your expertise as an organization, specifically represents your organization’s approach to specific conditions and protocols for treatment or management, and it’s much more effective from a search engine optimization perspective.

However, my first thought when receiving this question during our recent webinar Intermediate Writing for the Web was – are you nuts?

One of the biggest challenges the health systems we work with face when launching and managing their online presence is content. Tapping the expertise in the organization, getting a clinical review process in place (a must-have for health library content), and building the thousands of pages needed for coverage of general health topics is a tremendous undertaking. One that most healthcare organizations will choose not to take on.

I think the underlying question being asked here is better phrased as, “What is the role of a licensed health library on my website?” So let’s dig into that question in a little more detail.

Few organizations are going to take on the task of writing a reference guide for diseases, conditions, symptoms and treatments. It is done from time to time, but it’s rare. Mayo Clinic’s done it and, as they so often do, have worked to monetize that asset in a variety of ways (through their consumer site and by licensing), but most of our organizations don’t have the resources of Mayo Clinic.

National Jewish Health in Denver has done it as well. It made sense for them for two reasons – first, they’ve been the #1 ranked respiratory hospital for 15 years so they felt that licensing content from a third-party talking about those areas where they are the world’s top experts seemed to undermine the brand. Secondly, and just as importantly, this approach was possible because they are a specialty facility with a manageable number of conditions to cover. So the task, while large, was far more reasonable an undertaking than what a traditional community health system would need to tackle.

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Ignore Your Home Page

Last week Jonah Peretti, co-founder of BuzzFeed and Huffington Post, shared his advice for Marissa Mayer, the former Google executive who was recently appointed president and CEO of Yahoo!:

“It is amazing how having a huge home page can be a curse. People start fighting over existing traffic instead of trying to make awesome new things that are exciting enough to attract their own audience. Marissa Mayer should exclude home page traffic from all metrics used to evaluate performance…”

It’s a great thought experiment. If the product you’re promoting – whether that’s a service line, facility, care provider, event, or simply information – isn’t enough to draw visits on its own, then putting a link on the home page isn’t the solution.

In short: if you’re still focused on driving traffic to your home page, you’re missing the point.

Check the stats for your site and, if you’re like most Geonetric clients, you’ll find that 80-95% of pageviews are for pages other than the home page. So how do you make the most of traffic that is distributed across thousands of pages?

Geonetric’s VitalSite content management system has a great answer to this question – it’s something we call SmartPanels. All content in VitalSite can be tagged, organizing it for navigation and searching. Using these tags, site administrators can efficiently show links to highly relevant content in multiple ways across thousands of pages. And because it’s all driven by VitalSite, keeping all of those links up-to-date happens automatically.

SmartPanels can be used to drive calls-to-action, promote care providers, highlight upcoming events, and more. They interconnect all of the non-home page content on your site, making the most of all of those pageviews.

Learn more about VitalSite’s SmartPanels in this short video, then contact us for a demo.

Winning the Content Battle with Strategy

Do you know the stages of the ever-evolving Web content lifecycle? How about what makes your online content effective? To be successful in today’s online world, website managers need to approach content strategically. They need to know who their content is targeting and how to stay consistent across both online and offline media channels.

In the March 2012 edition of Healthcare Marketing Report, Geonetric’s Ben Dillon explains not only what content strategy is, but also why it is so important to healthcare marketers. Ready to learn more? Read Ben’s article, “Winning the Content Battle with Strategy.

Nielsen Misses the Mark on Mobile

“Good mobile user experience requires a different design than what’s needed to satisfy desktop users. Two designs, two sites, and cross-linking to make it all work.” – Jakob Nielsen

“Interesting, but no.” – Me

It’s been a time of explosive growth for mobile internet use and healthcare websites are no exception.  We’ve seen average growth of 300% in mobile visits to hospital and health system Web properties! It’s no surprise, therefore, that we’re spending a lot of time exploring solutions for better serving mobile visitors.

Through that exploration, our understanding of mobile Web usage has evolved as devices have progressed and consumers have become increasingly savvy in their use of these tools.

So I was quite surprised to read the opening quote from Nielsen which feels like an outdated approach.

Reading through Nielsen’s writings on mobile, he makes the following observations:

  • Traditional websites are very difficult to use on mobile devices
  • Sites designed to be optimized for mobile devices don’t serve desktop users well
  • Both mobile and desktop users are best served (i.e. best able to complete tasks) by Web interfaces that are optimized to their personal use cases

All of which is very logical. From that, Nielsen concludes that you should have separate sites for mobile and desktop. Further, your mobile site should not only have an optimized user interface, but should cut features and content to support the mobile use case.

This is what Geonetric’s been doing for mobile visitors for the past several years.

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Defining Readability

As professional communicators, we understand the importance of writing for our audience. But as healthcare communicators, the topics we cover can get complex quite fast. We’ve got a tough job – attempting to strike the right balance for explaining the latest oncology treatment with the fact some of our readers might not even know what oncology means. How do we justify the terminology choices we make on the Web?

It all comes down to readability. Readability is the term used to describe how easy something is to read and understand. On the Web, readability relates closely with accessibility and usability.

Readability refers to health literacy in healthcare and plain language in government. Researchers have designed formulas to measure readability’s quantifiable characteristics: sentence length in words and vocabulary level. Content quality, style, design and organization play major roles, too, but are more difficult to measure.

If you’d like to learn more about readability and health literacy, check out the Health Literacy of America’s Adults report of 2003. The National Center for Education Statistics (NCES) set four levels for health literacy: Below Basic, Basic, Intermediate and Proficient. 53% of American adults rated Intermediate, 22% Basic and 14% Below Basic.

Select health literacy tasks illustrate what the different levels require. The study demonstrates a variety of demographic variations to help identify audiences, including which audiences used which channels for health information, like the Internet, by proficiency level.

Test your own pages using online readability calculators like Read-able.com to get an idea of your writing level. You’ll get reports from a variety of formulas. If your text explains medical vocabulary terms using common health vocabulary, remove the technical terms and run the calculator a second time to see if you can achieve a 6-8th grade level on your pages.

Addressing health illiteracy is our job. Paying attention to readability is one way to make access to healthcare services and patient education materials as easy as possible.

Improved Health Literacy Won’t Fix Healthcare

In many of the discussions about creating empowered, engaged patients, I hear a common theme: that improving the general health literacy of Americans will largely solve the problem. It’s a view that, in hindsight, I’ve generally agreed with. If only health consumers understood the problems, challenges and tradeoffs of healthcare more fully we would stop bad behavior and when injury or illness occurred, we would make better decisions.

I have come to the conclusion that I’ve been wrong.

This idea has been percolating for a few weeks in the back of my mind after listening to a podcast debating a similar question for financial products. The always thought provoking Freakonomics podcast, an extension of the successful books of the same name, looked at the question of financial literacy as a way to prevent the next financial crisis.

We know the recent financial crisis had many causes, but at the bottom of the food chain were a lot of individual consumers who took out loans they couldn’t afford. Some of those loans couldn’t be afforded because the monthly payments were simply outside what’s reasonable for that individual’s income while others were very complex instruments in which payments ramped up dramatically over the course of the loan and, in some instances, included expensive penalties which made refinancing all but impossible.

So the argument which follows states that a consumer with greater financial literacy would have understood the intricacies of these instruments and never would have agreed to the preposterous terms of the loan. This argument appeals to my laissez-faire streak. After all, I was presented with adjustable rate mortgage options when I refinanced in that same timeframe, realized immediately that the loans were ridiculous, and rejected them outright. If we gave the consumer my level of financial literacy, then we’d have no crisis – right?

But the counter-argument recognizes the impracticability of this answer. I have an MBA with a lot of finance courses under my belt. If that’s what it takes for consumers to make bad decisions then the process is fundamentally broken.

The counter-argument states that financial products are complex. The contracts explaining them are complex. Building a base of knowledge in the general population that would allow them to work through all of that and understand the implications is far too expensive given that this is the sort of transaction that they’ll deal with only a few times in their lives.

Implications for healthcare.

Now look at healthcare. The same assumptions underlying the financial products problem certainly hold true. Healthcare is complex. Building an understanding that would allow for general good decision making in those relatively few occasions in an average consumer’s lifetime is difficult if not impossible. Certainly, it’s a very expensive undertaking and probably prohibitively so.

In the field of usability design, for both online usability and usability of real-world products, there is a general rule that you should design so consumers aren’t able to make bad decisions. In the Web world, for example, you shouldn’t allow a search form to allow for combinations of options that return no results.

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With One Hand Behind Their Back

Healthcare is awash with difficult decisions. Patients need to choose between treatment options that having no guarantee of working. Care providers are on the other end of that decision process, evaluating what options are worth sharing with patients and their families and which are not. Payers have an entirely different role in the process, attempting to encourage appropriate use of healthcare resources by choosing to pay for certain procedures and not for others.

There’s no question that it’s a messy process. Differing groups with differing priorities all weighing in on the same choices is a recipe for conflict. The conflicts bubble to the surface when someone says no on  an issue when someone else wants the answer to be yes.

This issue has come up more and more often and we’re going to have more issues in the future. Drug shortages in recent years have forced some facilities to choose one patient to receive a particular medication while another does not. In other scenarios we see healthcare providers stockpiling medications, protecting their patients in the process but exacerbating shortages elsewhere. Likewise, as attempts to rein in healthcare costs continue, more patients in dire circumstances will get treatment pre-approval requests rejected.

This happens every day, and families are most often the ones left feeling disappointment and anger. Typically, though, these discussions, decisions, and the aftermath play out behind closed doors.

What happens when they don’t?

What happens when a disappointed family turns to social media and through a clever bit of jujitsu uses your own success in social media to turn your fan base against you? How do you respond?

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