Medullan, Inc.

• Featured Client: Massachusetts Health Care Quality and Cost Council
• Tech Insight: Why companies should invest in making their website ADA compliant
• Designing consumer friendly websites. New Game. Old Rules.

Featured Client: MA Health Care Quality and Cost Council website goes live.

State sponsored, interactive website to provide healthcare quality and cost information to consumers

For the first time, cost and quality data on Massachusetts hospitals is publicly available and readily accessible. The Massachusetts Health Care Quality and Cost Council (HCQCC) was established by the Health Reform Law in 2006 to establish statewide goals to improve quality, contain costs, and reduce racial and ethnic disparities in health care. The Council has launched an interactive, consumer-friendly website per the mandate.

The HCQCC site, developed by Medullan, allows consumers to compare health care procedures at different hospitals and outpatient facilities. The goal intends to help consumers select high quality, lower cost care, and to encourage health care providers to improve quality and contain costs.

You can visit the website at http://www.mass.gov/myhealthcareoptions.

In an interview with Medullan, Katharine London talks about the Council, Medullan’s work on the site and the relationship between cost and quality in healthcare.

Q. How will the site help consumers make decisions about where to obtain treatment?
In focus groups, we asked people what kinds of information would be helpful to them, they were interested in seeing data on mortality rates, infection rates and the patient experience. We showed our focus groups how wide the range in price difference can be from one hospital to another. They were astounded that in some cases it was a fourfold difference. They wanted to know why the differences are so great. The information could be very useful to consumers and also to physicians making referrals. Additionally, we hope this site will prompt statewide conversations about cost between consumers and their physicians.

Q. What should consumers know about the relationship between cost and quality?
In healthcare, high quality often means lower cost. If you come into the hospital for a procedure and get an infection, you may be in the hospital for an extra six weeks. If there is an error, you take much longer to get better and require extra services. Efficiency of care, delivery of care at the right time affect cost, too.

Q. How do hospitals feel about making this information public?
Hospitals are most concerned that the data is accurate and they have reviewed the data that has been posted. There are also some concerns about competition. In Massachusetts, most people can drive to more than one hospital so there is a lot more choice and a lot more issues for the hospital to consider. For people who have high deductible plans, where they have to pay several hundred or thousands out of pocket, they want to know how much it costs. We get calls from consumers pretty regularly who are looking for cost information for their own treatment.

Q. How did HCQCC decide to work with Medullan?
As a state agency we were required to go through a strict and open procurement process. We received bids from a number of firms. The contracting was done in two phases. First, we hired a communications firm to do market research and some initial design work. The communications firm actually brought in Medullan as a partner to help with the web design piece of the initial phase.

The second phase, to actually build the website according to the design specs, was a separate procurement. We were very impressed with Medullan’s experience with similar kinds of websites that were consumer-focused and healthcare-based and really made an effort to make this kind of complex information easily accessible to ordinary folks. The two sites that I remember in particular was one for Web MD and another for Partners Healthcare. Medullan’s ability to use graphics and color to make very complex health information easily understandable was key.

Also, the flexibility of the staff at Medullan was another factor. They are more than willing to work with us. This is a new website for us, a new data set for us and a new experience for a brand new agency. There were a lot of unknowns from the beginning and we were looking for a firm that could really partner with us to explore all of these issues and make decisions to meet the requirements as we went along.

Q: Are there councils in other states similar to HCQCCC?
There are entities within every state concerned with healthcare quality improvement and cost containment; however, they may not have such explicit goals and such a broad range of expertise similar to the Council. Other boards are often focused on cost or quality but not both together.

The Council consists of half state officials including the attorney general, the state auditor, the inspector general, the commissioner of health and human services, the insurance commissioner. The other half is comprised of private citizens who have knowledge and expertise in healthcare and are appointed by the governor.

Q: Is Massachusetts the first to develop a website with quality and cost data?
Many states have a website with some kind of healthcare information on it. Some of the websites are more directed towards policy makers. None of these sites have met our standards for consumer friendliness.

We have not been able to find any site that has quality and cost information available on the same page. Currently, there are a number of sites that post quality information. Generally, different types of quality information are available in different places. One of the things we are trying to do is to pull in all of the available quality information into one place to make it easy for people to use it.

We are posting actual cost information, which we define as the average of what private insurers pay to providers.

Q. Following the launch of the site, what are the plans for expanding on the current information that is available?
We are starting with hospital information on about 20 inpatient procedures and 20 outpatient procedures. Our directive is to expand that as much as we can going forward.

On the outpatient side, we are starting with some basic radiological procedures, such as MRI’s and CT scans. But at this point, we only have the data on the hospital fee and we want to work on being able to combine the physician fees as well. People are interested in getting the price for common types of visits.

We are also going to start collecting dental claims later this year. This is key because many people pay for dental care out of pocket and are interested in that information.

Additionally, we will be looking at home health, long term care, mental health. There is a vast area that we could explore and so the difficult part is setting priorities on what to do first.

Q. What are the challenges and advice to share with other states looking to build a similar website?
We took on a very big task in a public way. To some extent we were able to pull this off because we did have so much public scrutiny. Our greatest challenge was in dealing with the data. We are in unchartered territory and figuring this out as we go along. I would certainly advise people to bring in people who have expertise working with this type of data before taking on a project like this.

Building the website has gone much smoother. Medullan has done a phenomenal job building the site to the specs. The challenge is still in the data, making sure our data is loaded appropriately, characterized correctly. We are making sure we have text in place explaining the data, issues with the data.

We are grateful for Medullan’s flexibility and comfort with a lot of problem solving along the way.

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Tech Insight: Why companies should invest in making their website ADA compliant.

By Julliette Thompson, Medullan Technical Architect

Most website sponsors and developers are well aware of the various forms of testing that are used to develop a website or application, such as integration, user acceptance, or usability, to name a few. Many, however, are not as experienced with another critical form of testing: accessibility. Nor are they familiar with the positive impact that building a website for full accessibility can have on the final product.

Those with a cursory knowledge of “accessibility” tend to concentrate on a narrow definition that focuses on complying with the Americans with Disabilities Act (ADA) and other statutes that govern access for people with impairments. This level of understanding usually leads to imperfect accessibility solutions, such as text-only versions of sites.

In reality, web accessibility is about offering your application to the widest audience possible. Sites need to maintain accessibility for users with older technologies (slower internet connections or text-only browsers, for example) or even for those with newer technologies (mobile phones). One can even go so far as to include computer literacy as an accessibility factor.

In addition to making sure your potential audience is as large as possible, there are other benefits to making your site fully accessible. Such sites are more attractive to search engine robots, since they, too, are able to understand the content more easily. Accessible sites are also easier to maintain over the long-term because by being built to accepted and well-documented standards, chances are minimized that your site will need to be redesigned as browsers evolve or as more legislation is enacted.

Simple techniques, used while developing the site (as opposed to once the site is built) can make any site well on its way to being accessible. These techniques include:

• Minimizing the use of JavaScript or providing alternative means of accessing or using the affected content
• Not using color to denote meaning
• Ensuring your web pages are well-formatted (W3C compliant)
• Using CSS for formatting and layout (instead of strict HTML or tables)
• Ensuring any audio or video is captioned or has a transcript available

In addition to following these rules while building your site, consistent and frequent testing of the site as it is constructed prevents any major rebuilds later. Medullan recommends the following tools:

• aDesigner – a disability simulator to ensure that sites are accessible and usable by the visually impaired (http://www.eclipse.org/actf/downloads/tools/aDesigner/index.php)
• Web Accessibility Toolbar – aids in the manual examination of web pages for a variety of aspects of accessibility, including color contrast and W3C compliance (http://www.visionaustralia.org.au/ais/toolbar/)
• WAVE – an online tool to visually highlight possible accessibility errors in a web page (http://wave.webaim.org/)

In addition to these simulators, sites should be tested with common assistive technology tools. Popular software packages include:

• JAWS by Freedom Scientific – a text to speech screen reader (http://www.freedomscientific.com/fs_products/software_jawsinfo.asp)
• ZoomText by AI Squared – a screen magnifier with screen reading for vision impaired computer users (http://www.aisquared.com/Products/ZoomTextMRD/index.cfm)
• Dragon NaturallySpeaking Professional by Nuance – voice recognition software for users with motor deficiencies (http://www.nuance.com/naturallyspeaking/)

For more information on web accessibility and available tools, see the Massachusetts Information Technology Division Web Accessibility website (http://tinyurl.com/mass-gov).

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Designing Consumer Friendly Websites - New Game. Old Rules.

By Sarah Morton, Medullan Information Architect

New game. Old rules.

The World Wide Web may not be an organic construct but it has evolved over the years. As technologies have adapted to meet people’s social and societal needs we’ve seen the game change. But throughout it all—from brochure-ware, to ecommerce, to user-generated content—the rules (the usability rules, that is) have stayed the same. The latest shift to Web-enabled consumer-driven healthcare requires Web developers and designers alike to continue following the same basic guiding principles they’ve always followed. In fact, unless there’s another new AJAX-like shift, the only difference we may see is a lot more medical-scrub green.

Here are our top 10 usability rules, updated for the healthcare Web.

1. Make your search look like a search: a single-line text-entry field with a button labeled “Search” or a single-line text-entry field with a label that says “Search” and a button labeled “Go”. Steve Krug and Jakob Nielsen updated these rules in 2000 and 2001, respectively, after Nielsen initially published them in 1997. These rules haven’t changed since.
2. Save your physician locator or hospital finder for a separate call-out feature or sidebar tool area so it’s not confused with the site search. And don’t mix up your results. The physician locator is where they will find doctors. The site search is where consumers will find tips for evaluating physicians or questions to ask their doctor.
3. Remember that not all consumers search all the time. Even in our Googlized world, consumers still rely on traditional navigation tools (menus, in-page links, breadcrumbs, etc) both to get to know a site and to understand their place in it.
4. Keep your content current. That doesn’t mean that every site needs a Facebook News Feed on its home page. But consumers notice quickly if a site has content over a week old and they will abandon your site for fresher content pastures.
5. Only slightly less important than keeping your content current—keep it relevant. All of your content all of the time must be relevant to your product or service and your brand promise. This includes your editorially controlled content, your user-generated content, discussion forums, blog posts, videos, advertisements, and non-text content like photography and other imagery.
6. Skip the icons unless they are part of the common Web vocabulary. Any icons that are not immediately recognizable (like a floppy disk for saving, a printer for printing, and an envelop for emailing) can cause more harm than good. Unless you’re willing to spend heavily on usability testing, stick with the tried and true ones.
7. Don’t ask for personal information unless it’s absolutely essential to providing a service to your customers. As we recently experienced when one of our usability testing participants was put off by the zip code field in a physician search tool, you never can tell what may offend a potential customer.
8. Use your AJAX powers for good. Don’t get us wrong; we love it. Especially when we can drag-and-drop movies to update our Netflix queue. But when it’s used for evil…well, all we can say is, don't overdo it!
9. Reuse old-timey ecommerce shopping tools like product comparison tables to help consumers make smart decisions about their healthcare options.
10. Make the site accessible whether you need to or not. The demographics of a typical Web surfer are changing. Low-income Americans are using the Web in rising numbers, as are Baby Boomers and seniors. And it turns out they are all looking for healthcare information on the Web. It’s important that your site be easy for these new-to-the-Web consumers to use. Even if they don’t need printer-friendly pages or adjustable font sizes, they will feel good about your site just knowing the tools are available.

Bibliography

Jakob Nielsen, Alertbox, “Search: Visible and Simple”, May 13, 2001:
http://www.useit.com/alertbox/20010513.html

Jakob Nielsen, Alertbox, “Search and You May Find”, July 15, 1997”:
http://www.useit.com/alertbox/9707b.html

Steve Krug, Don’t Make Me Think, 2000 Macmillan USA

Susannah Fox, Pew Internet & American Life Project, “Wired for Health: How Californians compare to the rest of the nation: A case study sponsored by the California HealthCare Foundation”, December 14, 2004: http://www.pewinternet.org/report_display.asp?r=105

Susannah Fox, Pew Internet & American Life Project, “Wired Seniors: A fervent few, inspired by family ties”, September 9, 2001: http://www.pewinternet.org/PPF/r/40/report_display.asp

Press Releases, Pew Internet & American Life Project, “22% of Americans age 65 and older go online”, March 35, 2004: http://www.pewinternet.org/PPF/r/79/press_release.asp

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