Healthcare UX—Design that Saves Lives

The interesting thing about digital technology is  that it can help older adults perhaps even more than it can help everybody else who's younger. You get quotes like these: 'A Mac laptop opened the world to me right here from my kitchen table. This is a blessing because my mobility is now extremely limited due to my physical disability.' Or someone else said, 'I can keep in touch with people all over the world. I feel so connected to so much of the world, art, music, nature, comedy, humanity.

Technology has helped me move 19 times in nine years.' That only works if the digital technology is easy for older adults to use. If it isn't, you get comments like these: 'How can I make the font bigger? I can't see it.'; 'I wish they'd stop changing things.'; 'All the new technology is so confusing to me.'; 'Who thought thin gray letters was a good idea?'; 'So much to remember.'

And the kinds of things that *can cause problems* for older adults are: illegible text,  passwords that you can't remember, lost objects, hard-to-solve CAPTHCAs, mysterious icons and symbols, small targets, confusing navigation, not understanding where the focus is on the screen. So, these are the kinds of problems that older adults can face. And guess what? Younger adults face some of these problems, too. The other thing to say is that *everyone is impaired at least some of the time*.

Even young people can have trouble in certain situations. So, for example, suppose you're  on a bus and you're trying to text your friend, and the bus is driving over a bumpy road, and suddenly that gives you hand tremors. So, maybe it would be nice to have a design ... where it didn't matter whether you had hand tremors or not;

you know – you could use voice dictation, for example, on your phone.

So, I think the whole domain of 2D user  interfaces and 2D design is really well understood, but 3D design or design for virtual reality is  not very well understood. So, a very basic thing is, 'How do I get from A to B? How do I move through the environment?' So, people say, 'Okay, it's very easy; you get the controller and you press a button on the controller and it moves you forward in the direction you're pointing or the direction you're looking.'

But if you do that, you get sick. So, okay – then you need a treadmill so that you really walk; the treadmill is expensive and it takes a lot of space and just people are not going  to do it. And then there's another idea about, for walking – walking in place. So, you simulate walking by just walking in place, the system recognizes that, and it moves you in the direction. That's better, certainly better than pointing and clicking.

... There's another paradigm, where you just point at an area, you click, and you are there, but then you lose complete orientation about where you are in the environment. So, a very basic thing like moving through an environment, a virtual environment which is  bigger than the real space you're in, where you can't really walk (inaudible) this is  unsolved; it's still there after 30 years.  So, the most important thing in terms of design  is virtual reality, as I said,

is this new media and our natural inclination is to use it to simulate things that happen in the real world. And that's important. Like if you're learning to use some complex machinery which is dangerous, learn it first of all in virtual reality – like with flight simulators, for example – and then you do it in physical reality. ... That's important, but virtual reality is much more than that. This is an example of something you can't really do in physical reality;

you can only really do it in virtual reality. And this has always been my interest in virtual reality, which is how you can  use it to push the boundaries and get experiences that you just can't have in physical reality but  which nevertheless have a positive outcome. Many examples have shown that when you change the body, you also change the mind. So, one example is racial bias. When you're embodied in the body of a minority group or a discriminated-against group,

it reduces your bias against that group; it can change how you move; it can be used to reduce pain; it can induce cognitive changes – if you  get embodied in a body that looks like Einstein, then you do better on a cognitive test, and  we've even used it in a context of fear of death. So, the first main example I want to talk  about is using this idea of embodiment for self-counseling.

So, as I said, this is about narrative. This is a narrative with yourself. Let me explain how it works. So, it's based on something  called *Solomon's paradox* from social psychology, where it's known that we're much better at giving  advice to a friend than we are to ourselves. But suppose you could objectify the you that you  talk to when you talk with yourself on the inside. So, you can make it as if your self is  the friend – the other person. So, maybe talking with yourself as if with another person  might be helpful for personal problem solving.

So, here's how it works: We take the person, we scan them, and we make a virtual body that looks like them – we put them in virtual reality; so, if he looks in the mirror in virtual reality, he'll see a replica of his own body. But also in virtual reality we can embody you as anybody – in particular, with *first-person perspective* – you look down; you see the body – and *real-time motion capture* – you move and the body moves with you.

We can embody you as anybody – in this particular case, as Sigmund Freud. So, what happens is that first of all you are as yourself and you explain a problem to Sigmund Freud. Then you become Sigmund Freud; you're in his body, and you see and hear yourself explain the problem – now as Sigmund Freud, remember, change the body, change the mind, and also seeing yourself from the outside as a friend, you can maybe come up with some ideas to help this person – you – with the problem.

So, embodied as Freud, you could talk back to yourself, and this process keeps changing back and forward until you've reached a resolution. So, basically you're having a conversation with yourself. A journalist from The New Yorker came and he tried this, and he wrote something very interesting afterwards. He spoke with Freud about a problem he had about guilt that he writes about in this article – a guilt to do with his mother being in

a care home, and he said, 'Soon I fell into a rhythm. Freud and I talked for about 20 minutes.' Of course, it's himself talking. 'He was insightful. He said many things I'd never said to myself in ordinary life. When I took off the headset, I was  moved. I wanted to tell myself, "Good talk." From his perspective, I'd seemed different, sadder, more ordinary and comprehensible. I told myself to remember that version of me.' In VR, we're at that stage where the paradigms for how to do things

and operate in VR is still not invented, other than, 'Oh, let's put up a menu.' This is the wrong way to go. So, for designers interested in this field, it's wide open I think.

I think the primary argument for early UX design in AI projects is the *credibility argument*; how you gain trust when you have a persuasive technology, because the gist of any persuasive technology is to *achieve credibility*. And this has been studied  at great length in the HCI world as well, that effectively there's a fairly simple formula:  Perceived Trustworthiness + Perceived Expertise

will lead to Perceived Credibility. So, if you look at the dimensionality of this, actually, and it may seem a little silly... but I'm going to overstate this – that the actual visual design quality and *usability* of the solution that you're delivering is extremely important in determining whether people will trust your system. If you have a sloppy user interface

and go to a doctor and you can't get the  fields lined up and you can't get the label names spelled correctly and the thing is highly unusable, why would a medical person or scientist believe that you can even do the calculations accurately? So, there is quite a lot that you have to do in general to achieve trustworthiness. So, if system credibility is low, the potential to influence the user pretty much goes to zero

irrespective of how sophisticated the technical models are or what your motivations are or even the patterns that you  choose to deploy in the UX. So, my first case study is a product that I am involved in. This is for rare and undiagnosed disease diagnosis. And the input is basically the genomic sequencing of typically three people: two parents and a child, sometimes the siblings.

The process is that you do the genomic sequencing, you find every variant, you map to the phenotypes. The phenotype is the part of the genome that expresses things physically, so the color of your eyes, the  color of your hair, and in particular any kind of abnormal symptoms that you might experience.  And the goal is to come up with a diagnosis.

Now, the user has generally a Ph.D. in genomics and a specialization in this case in rare disease. And the goal basically is actually pretty simple, which is a physician – usually a neurologist – is trying to figure out what is going on in a  child, and the goal is simply to generate a report for what is the likely thing. But the risk level is high because you're trying to diagnose a needle in a haystack: rare and even undiagnosed diseases.

I think the main takeaway here is, no human being unassisted could do this work. They might be able to do one case every 10 years or maybe one case every 20 years, trying to sort through all this information; whereas here the AI is basically saying, 'We see 200,000 variants. These five are  probably the ones of interest for this diagnosis.'

The one thing I would say, and it is incredibly important for products like this, is you need to *co-design it with your pilot customers*. You will never have the expertise, no matter how many PH.D.s and MDs and genius programmers you have. It's very much always a co-design activity with your lead customers because  they will have different fringe use cases,

different data situations. So, don't assume – I guess the main thing, I say this in my classes at San Jose State: The doctrine of infallibility does not apply to UX designers; you need to work with your users on this stuff because your users are really, really experts and they do this every day; this is their job. A person will sit in front of the software eight hours a day. But remember, in the case study that I just showed you, *the AI is not practicing medicine*.

The Ph.D. genomic analyst is using this  as a power tool to make a recommendation. *But that genomicist is not practicing medicine.* The *referring physician* is the one practicing medicine. Right? And in the end, the referring physician or the physician who wrote the order for the genomic sequencing is the end responsible person.

And since AI is in service to human beings, I off the top of my head can't  imagine a case where UX isn't relevant. Even a self-driving car has a user experience. You know – my 92-year-old mother has to be able to get into it and program the GPS and say where she wants to go. So... I'd have to be shown

a case where that's not UX-relevant. And as I said, if you blow the UX design, it doesn't matter how good the AI is.