Bridging the Gap: Accessible and User-Friendly Healthcare for All Ages

How can we make healthcare technology more accessible and inclusive for all, especially older adults? Join us as we welcome back Cordelia McGee-Tubb, now a staff design technologist at Color Health, who shares her valuable insights on navigating the complex US healthcare system and the importance of digital inclusion.

In this fascinating conversation, we explore Cordelia's unique journey from an MFA in comics to a Masters in Gerontology and how her eclectic skill set helps her champion accessibility and inclusion for older adults. We discuss the significance of using plain language, personalizing tablet interactions, and designing easily recognizable icons to create a more user-friendly healthcare experience. Cordelia also shares her thoughts on bridging the gap between physical and digital experiences with QR codes and the importance of guiding people through digital accessibility settings to find the best option for their needs.

We wrap up the episode by examining the implications of design changes in products and the ongoing conversations around accessibility and inclusion in the digital space. Discover how we can ensure these changes are inclusive of all users, particularly older users, and join the discussion on Twitter and other social media platforms. Don't miss this engaging episode with Cordelia McGee-Tubb as we dive into the world of designing for change and making healthcare technology truly accessible for everyone.

Chapters

• 0:01 Designing Accessible Healthcare Technology
• 13:51 Accessible Aging Design
• 30:49 Accessibility and Personalization of Tablet Interactions
• 35:23 Designing for Change in Products

Transcript

Neil Milliken: 0:01

Hello and welcome to AXSChat. I'm delighted that we can welcome back Cordelia McGee-Tubb. Cordelia, you're in a new role since last time we spoke, so you're now at Color. Can you tell us a little bit about yourself? For those that have not watched the last episode, shame on you and also what you're doing at Color.

Cordelia McGee-Tubb: 0:24

Absolutely. Thank you for having me back. I realized the last time we all chatted together was, i think, three years ago, right after the world totally changed at the start of the pandemic. So it was very weird times, super excited to be back.

Cordelia McGee-Tubb: 0:42

And yeah, i have been working for the past year and a half at Color Health, which is a health tech company, working on a lot of things ranging from COVID-19 testing and vaccination to cancer health screenings, and my role there is as a staff design technologist, which kind of sits it's a role that sits at the intersection of design and development. So I get to work on design systems and our shared component libraries, but I also get to focus on accessibility and how we build accessibility into our products, our patient experiences at scale, thinking about accessibility both in terms of disability but also other dimensions of access around language access, people with low internet connectivity. So it's been really fun working on that. So my official role has changed from I used to be working solely as an accessibility engineer in previous companies And now I'm a little bit broader in terms of design technology, but accessibility is still foundational to everything that I do, yeah.

Neil Milliken: 2:06

And that's great. And, yeah, the world could change And it feels a little bit like we lost a chunk of time. My sense of perspective on the past is all warped because of the last few years. I think it's great that you're taking accessibility into the wider world and part of my role around digital inclusion, which is also that sort of wider piece in understanding.

Neil Milliken: 2:36

I think it's really absolutely crucial in something like health care that people have access to the benefits of the digital tools that are available, and we all know that social determinants of health have a significant impact on people's lives and quality of life, so designing stuff that everybody can use is really super important. I'm also fascinated slash horrified because obviously you're working in the US health care system, which has a very different approach to what we have in Europe And it's insurance-led And we talk about payer systems and all of this kind of stuff. So how does that affect the way that you design systems as well? And, my privileged European judgment aside, how does that inform the way that you design systems for people? Because it adds another layer of complexity?

Cordelia McGee-Tubb: 3:55

It does. It does And my company's mission is to really make health care more accessible in the broad sense, and so there's definitely the layer of making it accessible within the climate of the US health care system. So a lot of it is actually a lot of what we do is think very intentionally about the text that we use in our product experiences to make sure that we're giving people all the right information they need, given that the health care system can be very just, very confusing to navigate. So trying to be really clear and again, accessibility plays into this of using plain language, which is really important too when you're talking about things like COVID vaccines or COVID antiviral treatments that have these long, complex medical names. Of trying to make it really easy for people to understand what steps they need to do to get the care that they really need.

Cordelia McGee-Tubb: 5:07

A lot of our customers are US states, so they have their own kind of accessibility requirements, their own approaches to healthcare, in addition to the kind of federal healthcare. So a lot of it is our goal is to really meet people where they are, figure out what our service can provide and make sure people have the right information to make informed decisions. But yeah, it is tough because healthcare is confusing. It's confusing. You're often approaching these situations in a very vulnerable state because you or someone you're caring for is maybe unwell, and so we just try to treat our patients with respect, make sure that the UI is super clear of where should you go next to get the care that you need. I don't know if that made sense, but it's all about providing that clarity when people are navigating these really complex systems at a heightened sense of anxiety.

Neil Milliken: 6:21

Yeah, go on, Antonio.

Antonio Santos: 6:27

And we know that sometimes in the space of healthcare, people are still sometimes resistant in terms of using technology. They might prefer to go to a place and talk with someone because they feel that there are barriers. So how do you see the role of digital in creating experiences that provide and somehow address the needs of different types of users, lowering the barrier in terms of access to health and also facilitating the adoption of technology to keep people more informed?

Cordelia McGee-Tubb: 7:16

Yeah, yeah. And something I've really enjoyed working on is that kind of intersection of when are we using a physical, in-person experience versus a digital experience, and how does someone transition from one of those things to the other, like I've found with. Qr codes, for instance, are something that we use a lot of. When you're on site and by we I mean just the world, not necessarily by company but when you're on site trying to experience something physically and then being brought into a digital experience, there's often a QR code to kind of help you easily get to that. But I've found, especially in my volunteer work at a senior center, a lot of older adults or people who are not as technically literate are confused about the QR code. It doesn't always work super well to hold your phone camera up to a QR code If it's on a laminated this is something we found at work. Actually, if it is on a laminated piece of paper, the glare from the sun might not let someone get to that QR code. So how do we even just very small things about, like how do we make sure that any URL that someone needs to access if they're in a physical place and trying to move into a digital space, is very easy to type in if they can't do a QR code, for instance. Making sure everything is like mobile first, because many people are using smartphones. They don't have computers. They're again interacting with these kind of hybrid healthcare experiences that are both in person and online, so being able to pull something up on your phone while you're at the doctor or at the clinic so that you can make sure that you have that information before you walk away.

Cordelia McGee-Tubb: 9:14

I think a lot of what we're seeing, too, is people will have you know, like in person care, but digital follow ups. So I think there's a lot that we can do in terms of training clinicians who work, or clinicians, healthcare workers, anyone who works in person with someone or works with them on the phone to help guide them through. This is what you can expect in the digital experience. So really it's kind of about meeting people where they are, making it really easy to cross that threshold. But then also, if someone is not ready for the digital experience, making sure we still have these physical, physical experiences.

Cordelia McGee-Tubb: 10:01

At Color, for instance, we have a antivirals product. That is for you know, if you test positive for COVID, you can get an antiviral. You can get a prescription for some antivirals to help you recover quickly, and you can either with Color. You can either go through an online questionnaire to determine, you know, are you eligible for this prescription, or you can use our phone hotline because a lot of people don't want to do the digital experience. I also like I talked with one participant who was deaf who said, like I would rather go through the phone experience because I can use video relay service and sign with someone, rather than going through this whole experience digitally in English, which is my second language because American Sign Language is my first. So that was a long, rambly answer. But it's really about providing these flexible spaces where people can have can get the care they need in person or through traditional means or digitally, and that there's a really seamless path to get between the two.

Antonio Santos: 11:33

Healthcare also involves a lot of personal data and private data, very sensitive data, and you know people from a certain age, or people are not so technically savvy. How do you somehow design systems that provide that type of assurance and try to find ways to mitigate fraud, because we know today we're all bombarded by text messages; so you miss it, to do this, to complete your task, you need to go here. How you make sure that the systems are accessible but at the same time, they also bring that trust and security to the user.

Cordelia McGee-Tubb: 12:12

Yeah, that's really tricky because, I mentioned, i volunteer at a senior center helping older adults with technology and I do that once a week And a lot of what we talk about is internet safety. How do you know if a website is trustworthy? where you can and this extends beyond healthcare, i think healthcare is really a critical example of a time when you really need to enter that information. But how can you differentiate like a credible health website from you know some random spam or like fraud or some other website that's like hey, give me all your information And a lot of that is a few different things I mean I've trained folks on always look for that lock at the top of the, at the top of the browser, to indicate that it's a more secure connection. That's one way to look for it. But also on in terms of the creators of that website.

Cordelia McGee-Tubb: 13:22

When you're designing systems, a lot of what we do is make sure that when we're asking someone for information, we're telling them why. So we're not just saying like, tell us your social security number, tell us your date of birth, tell us all this personal information about yourself, like, just and just, trust us. We're saying, please give us this information because we will use this to make sure you have the right care for X, y and Z reasons. So, trying to make it a little bit more conversational, so it's not so transactional, just like fill out, you know, give us all your personal info.

Cordelia McGee-Tubb: 14:02

And I've seen this too, and I remember this is an old story from the senior center lab, but it stuck with me for a long time of someone was just trying to log into their Yahoo email account And they were logged out because they were locked out because they typed their password incorrectly too many times.

Cordelia McGee-Tubb: 14:23

So then Yahoo was like all right, give us your all this information to prove that it's you, your birth date, your, you know, your full name, your backup email, all these things. And the person was really caught off guard. This was an older adult who didn't use technology very often and was like why do I have to type in all of these personal details about myself? They already know those, i already signed up with that information. So, as much as possible, if we can explain why we're asking for information when we ask for it, if we can only ask for the information that we really truly need and not just ask a bunch of questions, it'll help. We won't overwhelm the users. We will also just give them that kind of peace of mind of you're not selling your soul to this website. You're giving us the minimal information needed so that we can provide the right care for you or the right experience for you.

Neil Milliken: 15:29

So you mentioned that you've done this volunteering at the senior center, but that then was obviously interesting enough because you took an MA in gerontology, which is kind of an interesting. I mean I'm interested in your sort of academic career path because you've gone from an MFA in comics to you know and doing computing and technology as a first degree. You know it's quite a sort of eclectic, polymath kind of approach to things, but I can see how actually, when you're working in the field that you are, all of those things are going to be useful, because you need to understand the technology stack, you need to be able to understand how to communicate in comics, and drawings are a great way of communicating ideas, and then core audience for healthcare is older people. So do you get to bring all of those skills to play in your day-to-day work? Yeah, yeah.

Cordelia McGee-Tubb: 16:32

So, as you, mentioned, i got my Bachelor of Arts in computer science.

Cordelia McGee-Tubb: 16:37

So that was kind of the technical, but still it was a Bachelor of Arts versus a Bachelor of Science. So I was in my undergrad, i was studying computer science as my major, while also taking a lot of anthropology classes, which I think really informed my approach to you know technology, and I think that's a really important thing. You know, technology is cool as a vessel to help other people. So I got my Bachelor's in computer science. Then I got my Masters in Fine Arts, in comics, mainly because comics was a hobby of mine. I love drawing comics and I wanted to figure out how to turn that into a craft. And what I really found, actually through doing that that master's program is I learned so much about how to do good critique with other visual artists, which has like directly applied when I'm doing design reviews with colleagues, especially when doing design reviews that are accessibility focused, of how do you do a kind of like complement sandwich, of like I'm not just gonna tell you it's inaccessible, right, that's not helpful for anyone but say like, i really like this. You know this design might be a little bit challenging for a keyboard user, so how do you thought about X, y or Z. So having that more you know both. That approach to how do you talk about art and creative things has directly applied to how I work with designers and how I do code reviews too. But then also just making comics made me think very intentionally about when do I use words versus images to convey concepts, and that's something that directly applies also in the field of accessibility of like, what is the alt text that we use for things? When do we provide audio descriptions? I mean, we should provide audio descriptions, but what are the moments that need audio description and what moments don't? So it's really kind of actually been very relevant to my accessibility career in a way that I didn't expect comics to be, and I also think we talked a little bit on our last call three years ago now about the importance of making accessibility fun and approachable, and I've been able to do that using comics.

Cordelia McGee-Tubb: 19:16

But then, yeah, i also actually at our last call I was just three years ago I was just wrapping up my master's in gerontology, which is a big word. It's an intersectional study of aging And I really got that degree because I was working in this field of accessibility. I was working with older adults at the senior center every week and I really wanted to be focusing more on how do I make technology that really adapts to people as they age. And I realized, like I mean, i have a lot of anecdotal experience of working in the field with individuals who are aging, who are going through age-related changes, but I really wanted to understand the process of aging more from a psychological perspective so I could figure out how I could apply my accessibility, interest and skills into making, making great products for people who are getting older.

Cordelia McGee-Tubb: 20:29

And the biggest, i think one of the biggest learnings there was just a lot around the psychology of aging and the loss of agency over time. Like society has a lot of moments where we are taking agency away from older adults, a classic example being you know an older person whose family is like maybe you should stop driving, like maybe now you should stop driving because your vision is changing or whatever reason, and so suddenly that person has this loss of agency. So how can we give that agency back to a person? How can we empower them through technology? And, yeah, it's been really fun to try and apply that And there's something we also talked about with healthcare earlier in this conversation of giving the person agency, letting them know this is where you are in this healthcare process. This is all information to help you make informed decisions about your care.

Neil Milliken: 21:33

Yeah, i think that's great And I like the point about agency. They may not be in the driving seat, but you want to put them in the driving seat of the application, or the process, yeah, yeah, love that And I think that you know.

Neil Milliken: 21:54

the interesting thing about dealing with aging is, you know, most people don't come to realize that they're disabled or don't want to admit that they have a disability for a long time after they would technically qualify. So how do you design systems that are where the inclusive features are attractive enough and useful enough and signpost them so that people can go? well, i feel that that sounds quite useful. I don't really have to admit that I need it because of my disability. That just seems like the thing I need right now. How do you go about that?

Cordelia McGee-Tubb: 22:36

Yeah. So I think a lot of it is providing people with user-based customizations. And it's a tricky thing if you don't want to overwhelm a person by giving them a million different customization options right, that's too much. But figuring out those little ways that we can enhance the experience for the user. I think Apple is actually a really good model of this. So you know, if you look at Apple had all of these accessibility features that were kind of nest like buried in Apple's accessibility menu for a while around. Like dark mode, like inverted colors, for instance, was something that used to be kind of buried within a bunch of accessibility settings And people would only know to look for that if they kind of acknowledged that they maybe had a disability or wanted to explore the accessibility set. It was just kind of a little bit hard to reach. They moved that up into general display settings And now most people I know, you know, have that kind of dynamic light mode, dark mode throughout the day, and so even just like moving these things up to be general user settings rather than accessibility settings. Another example just the ability to change the text size. That also, i feel, used to be very buried in different accessibility menus And now it's just a general display setting And it's also something, when you look at it at an operating system level, that you know if I set that on my phone, if I want larger text, it'll cascade through every app that I go to, and so also that idea of these persistent settings is really helpful And, like most people I know, also increased the size of the font on their phones now that that feature is more discoverable. So I think it's about making those features discoverable so it doesn't seem like it is some intense customization you need to do, surfacing those.

Cordelia McGee-Tubb: 24:51

What I do in the senior center. So I tutor for this program where older adults learn how to use iPads And one of the classes that they have is all on accessibility settings And it's actually like one of the most intense classes because it's an hour long class where they learn about all the different accessibility settings under the sun, and I usually in my tutoring sessions with individuals after those meetings I'm like I know that was a lot, but it was really just showing you the range of things. Like let's talk about what might work best for you Like. Personally, i like using dark mode at night because you know it helps with my eye strain. You might wanna make the text larger, like those are the two big things that I see people gravitating towards, as well as just like various audio settings. So, yeah, as much as possible, just surfacing those in an easily discoverable way and making it something where they can set it once and it cascades across everything.

Cordelia McGee-Tubb: 25:55

I think one of the challenging things right now is like people will go to a website and like I love seeing websites that have their individual you know text size adjustments, like it's great that they're providing that, but it's not persistent across websites. So you have to learn each websites or each apps accessibility capabilities versus setting it once. So, anyway, i think oh, and another cool example, Like my other favorite example of that recently is just like prefers reduced motion, which is like a kind of new setting, new in the grand scheme of the web, but it's been around for a while of I can turn that off in one place on my operating system and every website I go to that has an animated GIF that people just have the image paused. So that's really exciting that we're having these more mainstream settings. Yeah, but it's also about discoverability. As long as we are putting those higher up, it makes it easier for people to explore them and not feel like they're changing something drastic.

Neil Milliken: 27:18

I discovered search in settings and it was a revelation, because stuff changes all the time, so I know there's a setting in here, but where have they put it in this version? And then I found the search bar and it's like, oh brilliant, now I can do it. I think that persistence settings can be super useful and you've given good examples of that And sometimes you want contextual settings.

Neil Milliken: 27:48

Yeah, that's, true So persistence of some things may not be appropriate. So I think maybe the next thing that we need is something that understands your context as well, so you can personalize your settings and they carry over in a work situation, but they might not be the same if you're using a phone or you happen to be driving, for example. So the context changes and therefore your preferences change and the features you need change. So I'd love to see some sort of thought going into that, because sometimes I set accessibility settings in one context and they come over into another And I'm like, oh, why does that?

Cordelia McGee-Tubb: 28:45

do that. I don't want them.

Neil Milliken: 28:47

Yeah, exactly, so I just want to put a text on my phone, because everything's tiny, i don't necessarily want it on my monitors or my PC, where I've got more real estate And I can sort of customize stuff anyway. So I think that that's a new depression. And then just the other point that you made and I think it's a really valid one is around how do you find that balance between giving people choice and allowing people the discoverability of it, like you said, in the mainstream settings, because sometimes choice can be overwhelming. So when you're dealing with your seniors class, for example, how do you sort of start those conversations with them about what would work for you? What are the things you find to be challenging, to be difficult?

Cordelia McGee-Tubb: 29:54

Yeah, i mean, and it can be the smallest thing, like if you think about copy and paste on a touchscreen, and so to copy and paste on a touchscreen you can, there is a button that you can press to. Well, first you have to select text And then often there's a copy button. But you can also just tap and then press copy, and I've worked with several people on copy and paste where it's OK, you can highlight and then tap for a long time And then you get this option to copy or paste or you can use these buttons And those are two very different interactions of more of like a dragging, touch-based interaction versus using explicit buttons, and it seems like a very simple action. But it's something that really I kind of get to know how a person likes to interact with their tablet and then suggest to them which option. Well, i tell them that there is both, but if I see that they're really more of like a button person who's less comfortable with gesture-based interactions, then I gravitate towards teaching them the button option. That was a weird example, but I like to really see what works best for an individual like, especially on tablets.

Cordelia McGee-Tubb: 31:24

There's a lot of shortcuts you can do with gestures and swipe here to do search. Some people like to do search because they are a very they know the name of the thing that they're looking for. Other folks prefer to kind of scroll through to find something because they're more visual learners and they have the visual icons. So it really kind of depends on the individual, and what I often do when there are multiple ways to configure something, multiple ways to do an action, is kind of briefly show. These are three or four different ways you can do this thing and see what resonates best with them and then dive deeper into. Let's do this one which you clearly are more excited about. I'll do it, then you can practice it. A lot of people write things down by hand of. These are the instructions I'll see people write out, draw little pictures of different icons. So I think another and we might have talked about icons last time icons are really tricky And so a lot of times I walk folks through.

Cordelia McGee-Tubb: 32:38

Let's think about the analog version of this thing. This icon is two rectangles. Going back to copy and paste, this icon is two rectangles on top of each other. That represents two pieces of paper. So you're making a copy. So that's going to be the button you press to copy. So trying to ground it in something that's familiar to them is important. But yeah, you don't want to overwhelm people with options, so I try to kind of ease people into what seems like the best thing for them In terms of accessibility settings. I often ease people in through here are you know, probably to start out with you might just want to make your text larger, but there's also magnification settings. We can explore magnification if that is helpful to you, but it takes a little bit more getting used to. Let's start with text size and then go from there based on their comfort levels. It's always just meeting people where they are.

Neil Milliken: 33:40

Yeah, great Gosh, i was smiling when you were talking about copy and paste, because it's actually something that drives everybody. It's hard, everybody nuts because the gestures are really inconsistent as to whether they work or not. Quite often you'll select something, you go to press the button and it actually deselects stuff. If you've got dexterity problems, it's really challenging. More than once I've watched my wife throw her iPad across the room in frustration. Also, the changing icons can be hugely disabling The design that goes into icons. The thought process needs to be really careful. Yes, i normally give really great plaudits to the BBC, but I'm going to actually say that on this occasion, the icons that they've designed for their apps recently bear no resemblance to the apps that you would use. They've been abstracted to the point that they become meaningless. The weather icon no longer looks like. It's a weather icon. The news icon is like a square and a triangle. I think it's meant to represent a camera for news, but they're so abstract that people suddenly go well, i've lost my app.

Neil Milliken: 35:19

I can't find it. I think that, especially older people, where change is really much more challenging, then as people that create products, we need to be much more mindful of the impact of that change. And Tanya put in the chat the new icon of the Google Authenticator is also somewhat abstract, so it's been a fascinating chat. I know we're going to have fun answering and discussing stuff on Twitter as well. I need to thank my clear text for keeping us captioned and Amazon for keeping us on air and supporting us. So thank you for being here. It's been a great pleasure, as always.

Cordelia McGee-Tubb: 36:10

It's been lovely talking with both of you and, yeah, I look forward to our Twitter chat. maybe we can get more into icons and gestures, because, yeah, absolutely So. thank you for having me on your show again, Tasha.