Identifying Digital Rhetoric in the Telemedicine User Interface

Abstract

Telemedicine is an alternative healthcare delivery system whereby patients access digital technology to consult with a physician virtually. Patients first interact with telemedicine via a consumer-facing website. Telemedicine promises numerous benefits to patients, such as increased access to healthcare, yet poor usability of the telemedicine user interface (UI) may hinder patient acceptance and adoption of the service. The telemedicine UI moderates patients’ ability to utilize telemedicine, and therefore it must be usable, but it must also be rhetorical to motivate patients to perform certain actions. Digital rhetoric refers to UI elements that influence user actions and knowledge and is tied to usability because of these same human–computer interaction (HCI) factors. This study examined the usability of three telemedicine provider UIs and by identifying usability problems, reveals digital rhetoric that is significant to telemedicine UIs. The article concludes by offering heuristics of digital rhetoric that lead to optimal usability.

Keywords

telemedicine UX design HCI visual rhetoric digital rhetoric user interface

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References

Albers

M. J.

(2003). Multidimensional audience analysis for dynamic information. Journal of Technical Writing and Communication, 33(3), 263–279. https://doi.org/10.2190/6KJN-95QV-JMD3-E5EE

Ashwood

J. S.

Mehrotra

Cowling

Uscher-Pines

(2017). Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Affairs, 36(3), 485–491. https://doi.org/10.1377/hlthaff.2016.1130

Bashshur

R. L.

(1995). On the definition and evaluation of telemedicine. Telemedicine Journal and e-Health, 1(1), 19–30. https://doi.org/10.1089/tmj.1.1995.1.19

Bashshur

R. L.

Goldberg

M. A.

(2014). The origins of telemedicine and e-Health. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association, 20(3), 190–191. https://doi.org/10.1089/tmj.2014.9996

Bashshur

R. L.

Reardon

T. G.

Shannon

G. W.

(2000). Telemedicine: A new health care delivery system. Annual Review of Public Health, 21(1), 613–637. https://doi.org/10.1146/annurev.publhealth.21.1.613

Bizzell

Herzberg

(Eds.) (1990). The rhetorical tradition: Readings from classical times to the present. Bedford Books.

Borycki

Kushniruk

(2005). Identifying and preventing technology-induced error using simulations: Application of usability engineering techniques. Healthcare Quarterly, 8, 99–105. https://doi.org/10.12927/hcq.17673

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Brooke

(1986). SUS - A quick and dirty usability scale. Digital Equipment Corporation Ltd.

10.

Burke

(1950). A rhetoric of motives. University of California Press.

11.

Campbell

J. L.

(2020). A mixed-methods approach to evaluating the usability of telemedicine communications. SIGDOC ‘20: Proceedings of the 38th ACM International Conference on Design of Communication, October 2020. Article No.: 20. https://doi.org/10.1145/3380851.3416755

12.

Campbell

J. L.

Monkman

(2021). The application of a novel, context specific, remote, usability assessment tool to conduct a pre-redesign and post-redesign usability comparison of a telemedicine website. 31st Medical Informatics Europe Conference Proceedings, Id No.: 371. https://doi.org/10.3233/SHTI210311

13.

Cline

(2018, September 18). “World’s first physician focused virtual care platform ‘Carie Health’ is making virtual concierge care the standard of care, and it's FREE to every doctor.” Intrado. Retrieved June 1, 2022, from https://www.globenewswire.com/news-release/2018/09/18/1572705/0/en/World-s-First-Physician-Focused-Virtual-Care-Platform-Carie-Health-is-Making-Virtual-Concierge-Care-The-Standard-of-Care-and-it-s-FREE-to-Every-Doctor.html

14.

Ericsson

K. A.

Simon

H. A.

(1984). Protocol analysis: Verbal reports as data. The Massachusetts Institute of Technology Press.

15.

Eyman

(2015). Digital rhetoric: Theory, method, practice. University of Michigan Press. https://doi.org/10.3998/dh.13030181.0001.001

16.

Gardner

M. R.

Jenkins

S. M.

O’Neil

D. A.

Wood

D. L.

Spurrier

B. R.

Pruthi

(2015). Perceptions of video-based appointments from the patient’s home: A patient survey. Telemedicine and E-Health, 21(4), 281–285. https://doi.org/10.1089/tmj.2014.0037

17.

Gray

W. D.

Salzman

M. C.

(1998). Damaged merchandise? A review of experiments that compare usability evaluation methods. Human–Computer Interaction, 13, 203–262. https://doi.org/10.1207/s15327051hci1303_2

18.

Harst

Lantzsch

Scheibe

(2019). Theories predicting end-user acceptance of telemedicine use: Systematic review. Journal of Medical Internet Research, 21(5), e13117. https://doi.org/10.2196/13117

19.

Inc

E. O. P.

(2021, January 19). Carie health announces joint venture with Swys Inc., combining health tech and fintech. GlobeNewswire News Room. https://www.globenewswire.com/news-release/2021/01/19/2160608/0/en/Carie-Health-Announces-Joint-Venture-with-Swys-Inc-Combining-Health-Tech-and-Fintech.html

20.

International Organization for Standardization (2018). Ergonomics of human-system interaction -- Part 11: Usability: Definitions and concepts (ISO Standard No. 9241-11:2018). https://www.iso.org/obp/ui/#iso:std:iso:9241:-11:ed-2:v1:en

21.

Jaffe

D. H.

Lee

Huynh

Haskell

T. P.

(2020). Health inequalities in the use of telehealth in the United States in the lens of COVID-19. Population Health Management, 23(5), 368–377. https://doi.org/10.1089/pop.2020.0186

22.

Jain

Mehrotra

(2020). Comparison of direct-to-consumer telemedicine visits with primary care visits. JAMA: Journal of the American Medical Association, 3(12), e2028392. https://doi.org/10.1001/jamanetworkopen.2020.28392

23.

Jain

R. J.

Mehrotra

(2019). Prescriptions on demand: The growth of direct-to-consumer telemedicine companies. JAMA: Journal of the American Medical Association, 322(10), 925–926. https://doi.org/10.1001/jama.2019.9889

24.

Johnson

R. R.

(1998). User-centered technology: A rhetorical theory for computers and other mundane artifacts. State University of New York Press.

25.

Jones

(2015). Information graphics and intuition: Heuristics as a techne for visualization. Journal of Business and Technical Communication, 29(3), 284–313. https://doi.org/10.1177/1050651915573943

26.

KADAN Institute (n.d.). KADAN Institute [Instagram profile]. Instagram. Retrieved June 1, 2022, from https://www.instagram.com/kadan_institute/

27.

Karsh

B.-T.

(2004). Beyond usability: Designing effective technology implementation systems to promote patient safety. Quality and Safety in Health Care, 13(5), 388–394. https://doi.org/10.1136/qshc.2004.010322

28.

Kostelnick

(1996). Supra-textual design: The visual rhetoric of whole documents. Technical Communication Quarterly, 5(1), 9–33. https://doi.org/10.1207/s15427625tcq0501_2

29.

Kostelnick

(2016). The re-emergence of emotional appeals in interactive data visualization. Technical Communication, 63(2), 116–135. https://www.stc.org/techcomm/2016/05/11/the-re-emergence-of-emotional-appeals-in-interactive-data-visualization/

30.

Kushniruk

A. W.

Patel

V. L.

Cimino

J. J.

(1997). Usability testing in medical informatics: Cognitive approaches to evaluation of information systems and user interfaces. Proceedings of Conference of the American Medical Informatics Association: AMIA Fall Symposium, 218–222.

31.

Kushniruk

Borycki

Kitson

Kannry

(2019). Development of a video coding scheme focused on socio-technical aspects of human-computer interaction in healthcare. In Studies in Health Technology and Informatics: Volume 257: Improving Usability, Safety and Patient Outcomes with Health Information Technology. (pp. 236–243). https://doi.org/10.3233/978-1-61499-951-5-236

32.

(2022). Defining the racial and ethnic “other”: Constructing an American identity through visualizing census data in the U.S. Statistical Atlases. Journal of Technical Writing and Communication, 004728162210865. https://doi.org/10.1177/00472816221086523

33.

Miller

C. R.

(1989). What's practical about technical writing? In B. E. Fearing & K. W. Sparrow (Eds.), Technical writing: Theory and practice. Modern Language Association of America.

34.

Nielsen

(1993). Usability engineering. Academic Press.

35.

Nielsen

Molich

(1990). Heuristic evaluation of user interfaces. Proceedings of ACM CHI 1990 Conference, (Seattle, WA), 249–256. https://doi.org/10.1145/97243.97281

36.

Norman

(1988). The psychology of everyday things. Basic Books.

37.

Parmanto

Lewis

A. L. J. R.

Graham

K. M.

Bertolet

M. H.

(2016). Development of the telehealth usability questionnaire (TUQ). International Journal of Telerehabilitation, 8(1), 3–10. https://doi.org/10.5195/ijt.2016.6196

38.

Peute

L. W. P.

Jaspers

M. W. M.

(2007). The significance of a usability evaluation of an emerging laboratory order entry system. International Journal of Medical Informatics, 76(2–3), 157–168. https://doi.org/10.1016/j.ijmedinf.2006.06.003

39.

QSR International Ply Ltd. NVivo 12 qualitative data analysis software. Release 1.4.1. QSR International. https://www.qsrinternational.com/nvivo/home

40.

Redish

(2010). Technical communication and usability: Intertwined strands and mutual influences commentary. IEEE Transactions on Professional Communication, 53(3), 191–201. https://doi.org/10.1109/TPC.2010.2052861

41.

Rosenbaum

Bugental

J. O.

(1998). Measuring the success of visual communication in user interfaces. Technical Communication, 45(4), 517–528. https://www.semanticscholar.org/paper/Measuring-the-Success-of-Visual-Communication-in-Rosenbaum/a86621f971f288c12e9176a509d6a2ac67e88980

42.

Rude

C. D.

(2009). Mapping the research questions in technical communication. Journal of Business and Technical Communication, 23(2), 174–215. https://doi.org/10.1177/1050651908329562

43.

Sauro

(2011, February 2). Measuring usability with the System Usability Scale (SUS). MeasuringU. Retrieved June 1, 2022, from https://measuringu.com/sus/

44.

Schneider

(2005). Usable pedagogies: Usability, rhetoric, and sociocultural pedagogy in the technical writing classroom. Technical Communication Quarterly, 14(4), 447–467. https://doi.org/10.1207/s15427625tcq1404_4

45.

Schoenfeld

A. J.

Davies

J. M.

Marafino

B. J.

Dean

DeJong

Bardach

N. S.

Kazi

D. S.

Boscardin

W. J.

Lin

G. A.

Duseja

Mei

Y. J.

Mehrotra

Dudley

R. A.

(2016). Variation in quality of urgent health care provided during commercial virtual visits. JAMA: Journal of the American Medical Association, 176(5), 635–642. https://doi.org/10.1001/jamainternmed.2015.8248

46.

Slack

J. D.

Miller

D. J.

Doak

(1993). The technical communicator as author: Meaning, power, authority. Journal of Business and Technical Communication, 7(1), 12–36. https://doi.org/10.1177/1050651993007001002

47.

Spinuzzi

(2001). Grappling with distributed usability: A cultural-historical examination of documentation genres over four decades. Journal of Technical Writing and Communication, 31(1), 41–59. https://doi.org/10.2190/8GBC-J04R-VKCF-NJJP

48.

Spinuzzi

(2003). Tracing genres through organizations: A sociocultural approach to information design. The MIT Press.

49.

St. Amant

(2017). The cultural context of care in international communication design: A heuristic for addressing usability in international health and medical communication. Communication Design Quarterly, 5(2), 62–70. https://doi.org/10.1145/3131201.3131207

50.

Yen

P. Y.

Bakken

(2011). Review of health information technology usability study methodologies. JAMA: Journal of the American Medical Association, 19(3), 413–422. https://doi.org/10.1136/amiajnl-2010-000020