Observations on eBook usability

One interesting if emotional event had happened recently that has helped me understand the advantages and usability disadvantages and my observations about use of eBooks with the terminally ill.

One of my clients was admitted into a hospital and then later moved to a hospice (they have since died) and they had become very attached to their Amazon Kindle prior to their illness as it allowed them to read a large array of books without carrying around kilos of paper. When hospitalised then this certainly was an advantage as they were bedridden for around 3 months until they had died.

They had purchased the Kindle mid last year so I unwittingly ended up looking at a lot of usability issues of this device for older people right through to the day they died albeit with just this one example.

Other than the charging issues which I had blogged about here, the device worked well up until the client started to lose manual dexterity towards the last week of life and the loss of visual acuity around 36 hours before death.  Given all the eBook readers I have seen at the electronic stores have similar delicate and flush controls there is no clear solution here other than someone bringing out a more rugged device with a more chunky (think Steampunk or Industrial-Military) design and no one has done that yet.

The floors at hospitals are always smooth and hard so there is never the chance of a safe landing if the device is dropped. You must put the device in a hard case. The device also has the risk of being crushed or similar with either the patient or the nurses moving the patient so a hard cover that is visible is neccessary. The client had commented on the case I got that “Pity it was dark”; again this is an issue of visual acuity in finding the device on the bedside or bed covers. Modern beige, greys or black are not the best – it needs to be bright and eye-catching – maybe just retro-fit sticky fluorescent safely tape to the case ?

The device case or cover can’t be smooth plastics and slip out of fingers or slide off surfaces so a high-friction surface is needed but equally the device case or cover will get food on it so it must be a wipe-clean surface.

The electronic ink has a good contrast and the ability to scale fonts is certainly essential to help readability and I understand pretty well all eBook readers do this though towards the very end you will find that the client (patient) may significantly lose vision and cannot read at all. I don’t think there is much that technology can do to overcome this but it would be a helpful feature if you could get a reading summary or statistics page that detailed what was read e.g. as pages/words per session. I had to make a guess based on what the screen was on and what the percentages were of the books being read – based on the completion bars but I was only guessing. Even a basic statistics screen to allow per-session and/or per-day page flip counts would be extremely useful objective feedback to help provide an early warning of changes in the client’s (patient) mental or physical wellbeing.

Other ideas I had were that it would be nice if the reading spot light in the hospital room could come on automatically when the eBook was turned on (I was thinking infrared remote¬† – this could be aft-market in the retro-fitted case – and uniquely key-coded lights a bit like X10 – IR shouldn’t interfere with medical devices). I though that because the client had to fish around for the light controls and get those right and then find the eBook: I believe that technology should anticipate what you want to do thus if you pick up the eBook then you want to read so you want the reading lights on.

When the patient wanted a new book it was hard to work out what they wanted and how to get it to the device. If the online web site could also have a printed book listings with codes (including QR codes) so you could print out a cheat-sheet of new and related books for your client and then give those to them to choose. They can then decide and you can then buy and download via, for example, your mobile phone. Not all hospitals have WIFI built-in to rooms but cell phones usually work somewhere though they like you to turn them off in places but you’ll get service in public places – if the eBook was tethered to the cell (even if it was via USB or Bluetooth bridge) then this could be a way of synchronising the eBook with new material. The Kindle Whispernet is a good idea and worked well even on GPRS but navigation is naturally hard for the patient and the Whispernet is only Amazon’s not eBooks in general. Just ideas for now.