Usability

Several simple steps -- such as implementing a decision-support tool and providing explanations of health insurance industry vocabulary -- could significantly improve the usability of HealthCare.gov, according to a study published in the Annals of Internal Medicine, the Los Angeles Times' "Science Now" reports.

Details of Study

The study was conducted by a team of health economists, health policy experts, lawyers and physicians from the University of Pennsylvania. They observed 33 volunteers between the ages of 19 and 30 as they attempted to navigate and sign up for coverage on the federal health insurance exchange website (Kaplan, "Science Now," Los Angeles Times, 7/7).

The volunteers were considered "highly educated" and they "explained their thinking in real time."

After they were finished navigating the site, researchers interviewed the volunteers about their experience, impressions and suggestions for improving the federal health insurance exchange site (Annals of Internal Medicine, 7/8).

Findings

Overall, researchers found that participants faced several obstacles to using the site.

For example, volunteers often did not understand health care industry terminology on the site, and many terms were "inadequately explained," according to the study.  For example, the term "catastrophic" was misunderstood by some of the participants to mean that the health plan did not cover preventive primary care.

Participants also had trouble matching their preferences with available health plans, in part because of an "overwhelming" amount of information displayed on the site, the study noted.

In addition, health plan costs listed on the website did not always adequately reflect tax credits or cost-sharing options ("Science Now," Los Angeles Times, 7/7).

Recommendations

Researchers identified six actionable improvements for the site that could be implemented prior to the upcoming open enrollment period, which begins Nov. 15:

• Provide more accessible and understandable explanations of health insurance industry vocabulary;
• Highlight the mandatory inclusion of preventive primary care services in all available plans;
• Clarify or expand options for adult dental coverage earlier in the sign-up process;
• Implement a sorting or decision-support tool to help consumers determine health plan options that align with their preferences;
• Include potential premium tax credits and cost-sharing subsidies in the cost of health plans; and
• Rename the "catastrophic" health plan category to "value" or "minimal" to reduce confusion.

Researchers said the findings show how relatively small changes to the website "could improve [users'] understanding of a typically difficult process" and the usability of HealthCare.gov (Annals of Internal Medicine, 7/8).

Designer Directory

Some of the nation's top hospitals struggle to create a strong online presence and offer patient-centered websites, according to a new report from Evolve Digital Labs, Becker's Hospital Review reports.

Report Details

For the report, titled "The Digital Health of Today's Best Hospitals," researchers between January 2013 and January 2014 analyzed the digital presence of 57 of the top hospitals in the U.S., as identified by U.S. News & World Report.

The researchers used various search analysis and social media tracking tools to determine the patient "reach" of each hospital's website through:

• Domain and page authority;
• Inbound links;
• Linking domains; and
• Traffic.

The study also examined various website functions, such as those that allow patients to:

• Complete medical forms before appointments;
• Make appointments;
• Pay medical bills;
• Request refills;
• View discharge and rehabilitation information; and
• View medical records and/or test results.

To determine the hospitals' rankings, the researchers' search terms included all of the 16 health specializations in which the top hospitals are ranked nationally.

Report Findings

Overall, the report found that:

• 67% of the hospitals did not offer online rehabilitation and aftercare information;
• Nearly 50% of hospitals did not support post-prescription refill requests;
• 49% of hospitals did not have a mobile website;
• 33% did not allow online bill pay;
• 20% allowed patients to pre-register online; and
• 18% had website errors that affected the patient experience.

According to the report, the top 10 patient-centric hospital websites belong to:

• Mayo Clinic;
• Cleveland Clinic;
• University of Texas MD Anderson Cancer Center;
• Massachusetts General Hospital;
• University of Pittsburgh Medical Center;
• Duke Medicine;
• Thomas Jefferson University Hospital in Philadelphia;
• Massachusetts Eye and Ear Infirmary;
• Mount Sinai Medical Center; and
• Florida Hospital.

Comments

Derek Mabie, president of Evolve, said the findings highlight the need for digital governance throughout hospitals and health care systems to reduce the communication gap between health care professionals and patients.

He said, "If there were digital governance, these top hospitals would all have mobile-friendly sites" (Gamble, Becker's Hospital Review, 4/17).