Optimising the register and login flow of a digital patient portal for holiday emergencies

On behalf of several healthcare insurers Eurocross assists over 40.000 Dutch patients during medical emergencies abroad. Before the release of their patient portal (DiDo), every touchpoint was a phone call. DiDo allows users to safely share more information about their condition, conversations with professionals and receive updates on their case.

Analyse the existing registration and login flow to identify opportunities which block users from activating and logging into their DiDo. The number of active users should increase as a result of the optimisations.

Since Eurocross is healthcare focused, there’s some strict requirements around medical files in digital environments. These had to be taken into account whilst working on the registration and login flows.

In addition, when our project started there was already a clear desire for biometric authentication to optimise these flows. Guiding our stakeholders to look beyond this as a solution, shouldn’t be disregarded.

I started the project as a Product Designer with a Lead. His focus was stakeholder management and being a sparring partner. As the nine week project progressed, he stepped back from these responsibilities since he felt I was managing well myself.

• Analyse the existing DiDo activation and login flows. Identifying opportunities for improvement.
• Prepare and facilitate a scoping session with stakeholders to prioritise opportunities.
• Design and iterate optimisations for the flows. Present designs along the way in reviews with stakeholders.
• Prepare and facilitate user tests with former Eurocross patients.
• Share learnings with stakeholders and iterate designs according to user test insights.
• Document design decisions and support development during implementation.

Optimisations included a biometric authentication flow as an alternative to SMS and email, polishing error and active state interactions, a new activation email, color adjustments to meet accessibility guidelines and onboarding flow optimisations. All validated in the usability tests and confirmed to be beneficial to the experience.

Research

Eurocross informed us that of the users eligible for a DiDo around 60% activated theirs. Prior patient interactions highlighted SMS verification issues. A crucial step for activation and login due to the DiDo containing medical information. Eurocross asked to look into biometric authentification to resolve this and review whether there might be more holding users back from using the patient portal.

Expert Review

My expert review focused on identifying areas of improvement from the activation email to the onboarding flow. The insights were used as input for the scoping session. Together with my colleague we presented these and prioritised via an Impact Effort Matrix.

• We expect that Biometric Authentication or other 2 Factor Authentication (2FA) alternatives replacing SMS verification help users complete activation and login.
• We expect that activating the CTA’s, allowing users to get feedback and providing clear feedback in error states helps users move forward in their activation and login process.
• We expect that adjusting colours to meet WCAG AA accessibility standards will help users in their overall interaction with DiDo.
• We expect that improving the content of the activation email will help convince users to use their DiDo.
• We expect that keeping users logged in for longer time will improve to comfort of use within DiDo.

Competitor Analysis

I conducted a competitor analysis to learn how other organisations used biometric authentification, learn about requirements and discover alternative solutions. This analysis included devices beyond mobile, since Eurocross informed us patients often use tablets and laptops for their DiDo as well. I analysed a variety of flows from hospital files to google login.

• Biometric Authentication can be used on both Android and Apple devices from mobile to desktop via WebAuthn.
• Some organisations require both biometric and SMS or email authentication, probably due containing sensitive information.
• Authentication management is often offered in registration flows and then managed via the account settings.

The analysis rose some questions on technical limitations and legal requirements around healthcare information. To answer these we discussed them with the legal department of Eurocross and the development team during our first design review.

Design

Since the design primarily focuses on optimisation, these were the most important adjustments in the process.

Authentication

I learned in alignment with development that biometric authentication only works after account registration. It still was relevant from there, but we didn’t resolve the SMS authentication issue. So I proposed to review whether email would be sufficient as well. Since I had seen this occur with competitors. After aligning with legal and development we pursued this route. Which resulted in a refreshed login and registration flow. Simplified in steps, including better error state communication and guidance on setting up biometric verification.

Accessibility (WCAG)

Based on insights from the expert review I proposed optimisations on the colour pallet, error state language and removing the disabled state in forms to allow users to always get feedback. Which improves the accessibility of the overall experience.

I revisited the entire activation email as well. Here, I focused on using B1 language as much as possible. Assuring the understandability of the information for all users.

Simplification

Other core adjustments included simplifying the experience as much as possible. For example by pre-filling the users email when possible, dropping redundant onboarding screens and removing an overkill in snackbars that cover important content.

Validation

The validation consisted of a Usability Test with former patients of Eurocross. I performed the prepared and conducted these tests myself. During the tests it was our priority to learn how users experienced the optimisations and whether they would use and understand the biometric verification.

• Define and align assumptions with stakeholders.
• Create a script with scenarios and tasks for the user to perform.
• Fill in the gaps of the flow with additional screens and states to service a realistic experience.
• Conduct the interviews with participants and take notes along the way.
• Analyse user test insights and summarise these with recommendations on what to adjust and how.
• Present insights and recommendations to stakeholders.
• Incorporate optimisations in final design iteration.

Usually I prefer doing a script session with stakeholders to learn more about their assumptions and ideas for the test per scenario. In this case, we only had one important stakeholder and the optimisations were straightforward. So we moved on without a script session and simply aligned our outline with them over email.

• Do users understand the value of DiDo based on the new activation email?
• How do users go through the activation process?
• Do users understand and value the Biometric authentication?
• Do users understand where to manage Biometric authentication?

The outcome of the user test was positive. Users described the flows as easy to interact with and understandable. Their behaviour in the tests showed the same. Biometric authentication was understood consistently and deemed as a relevant addition. Opportunities for improvement solely consisted of small tweaks in content.

• Allow users to switch between email and SMS verification, instead of making them choose upon registration. Switching is important when a user struggles to authenticate via a certain route.
• Don’t refer to Biometric Authentication with the term ‘Beveiligingssleutel’. Use terms such as ‘Face ID’ or ‘Fingerprint’. These reflect the right association for users.

After sharing the recommendations, I implemented the final adjustments and made the handed the design over to development. Since many tweaks were small optimisations I added an update log to guide development in what had been adjusted. Preventing tweaks to accidentally be overlooked.

Reflection

This project on design level wasn’t the most challenging. However, I did thoroughly enjoy conducted usability tests myself. This was something prior employers hired research partners for. Thanks to being on the sideline these other tests, I did learn a lot about script writing, test setups and how to neutrally ask questions. Knowledge that I was able to apply comfortably myself in this project.

Something that I would have approached differently now was how the participants were gathered. I know from prior experiences this takes a lot of effort. However, its costly to have an external party do so. Therefore, clients often want to do this themselves. Which put our timeline in danger. Having a more elaborate conversation with the client about this would’ve helped us manage expectations and improve planning.