Current Site Architecture
The current IMA website (Figure 1) embodies a basic hierarchical structure that is very broad and shallow.
There are fourteen major categories and content areas that are each between one and three levels deep (Figure 2).
Most top-level pages have a general structure that is also applied to pages no more than 1 level down. Deeper and older site pages tend to have varying layouts and attention to content proportions. The page-level wireframe below illustrates the layout of the Home page as well as the screen real estate percentages afforded each major section. The green border around the main content area makes up approximately 32% of the entire page, navigation areas account for a little over 20% and the actual interactive main content area is provided 19%, approximately 1/5, of the entire screen.
A content inventory was recorded by hand on November 12, 2003 to generate an outline of every page in the site (see Figure 4). Each individual page was given a unique number and both its page name and URL recorded. Major categories of content are designated with a blue background. (*credit to Jeff Veen for the format of this report). This analysis revealed that in addition to ~20 top level pages, there are six major categories of information designated by the underlying implicit file/directory structure which encompass another ~110 site pages. The categories are, in descending order of magnitude:
Categories & Ordering
In terms of more explicit categories (indicated by navigational links), there are over twice as many to choose from. Theoretically, top-level content categories listed on the home page are ordered according to anticipated importance and frequency of use by end-users:
The current ordering assumes that the following user scenario is typical:
Patient "A" visits the IMA site because she needs to see a doctor. The first place she looks is the Physician Directory in order to select a physician who specializes in her symptoms. After checking here, she makes sure IMA has the appropriate types of health care for her symptoms and so decides to look at the Specialties category. She then wants to make sure IMA is within driving distance and looks for a conveniently located office under Office Locations or Outreach Clinics. Next, she wants to contact IMA with a general question about parking so checks Contact IMA for a phone number. Next, she uses the Appointment Request form to make her appointment. Finally, since she wants specific information related to her symptoms, she contacts one of the listed physicians directly using the form under Email Your Doctor and also investigates health-related articles in HealthSmart and outside sites available through the Patient Education page.
After more detailed investigation of the content in each category, one finds that this logic is a bit flawed. For one thing, the Physician directory does not really provide information that is useful to the patient in terms of medical information. Physician profiles list medical credentials, but only rarely specify the doctor's specialty areas. So, unless the patient is already familiar with the medical staff at IMA, they are not likely to find useful information here. This is also likely to be the case for the Nurse Practitioners category. Indeed, it is probably more likely that a patient will want to know what types of health care services IMA offers, information that is found under the Specialties page. As well, since patient education is such a major goal of the stakeholders, a better strategy may be to place categories such as Patient Education and HealthSmart before other categories not critical to this goal, such as Office Locations, Contact IMA, Appointment Request, and Email Your Doctor (which could be characterized as serving an "Administrative" function).
Content Organization Schemes
A main flaw in the design of the IMA site is a differing of perspective between the designers and users of the site in terms of content organization. Although the designers have correctly ascertained the reasons why users come to the site (to find a doctor/learn about IMA, to obtain medical information and contact IMA), this information is not grouped into intuitive categories and is not arranged in a useful way.
The organizational scheme that structures the site does little to group items by their shared characteristics and as a result gives the user too many closely worded choices (fourteen top level categories). Since the hierarchy is very broad and shallow there are an overwhelming number of menu options to choose from. Also, there is currently no way provided for the user to engage in known item searching (such as a search box). Incorporation of this type of exact organizational scheme would speed up the user's searching process for exact medical information (e.g. a search for 'flu').
It would be beneficial if the common topic areas within these fourteen categories were grouped logically according to subject area and functionality. Instead, the site has been divided into several ambiguous categories that defy exact definition (e.g. HealthSmart, Patient Education, My Health Zone). Because of the subjective nature of language, it can be hard for the user to decipher these categories and they are also difficult to design and maintain. When used correctly, though, ambiguous organizational schemes (e.g. an encyclopedia) can be more useful than exact navigation schemes (e.g. a phone book) because the user does not need to know an exact term.
Finally, the current top-level categories demonstrate difficulty with natural language classification, a process that is particularly hard to use in the organization of abstract concepts such as Objects, Topics and Functions. Specifically, rather than separate them well, the top-level categorization is a mixed collection of Topics (e.g. Patient Education) and Functions (e.g. Request an Appointment) of different granularity and content.
The second-level categorization schemes are organized haphazardly and differ widely by page. The Contact IMA page is structured according to the exact organizational scheme of a directory (a table with Specialties in alphabetical order with phone numbers). On the Physician's Directory page doctors are listed alphabetically by last name. However, since they are not listed last name first, it is difficult to read/find the name of the doctor you are looking for (browsing is possible, but it is really known item searching).
The Nurse Practitioners page has the nurse's names listed at the top, like the Physician's Directory, but it also has some topic-based categories on the page grouped according to questions about what a nurse does. The Specialties page also follows an exact organizational scheme and is categorized according to medical names for specialties (e.g. Endocrinology, Hematology). Office Locations and Outreach Clinics are organized by chunking the text and the use of white space between the listings, but not in any other way (not alphabetically, for instance).
Appointment Request, Email Your Doctor and Billing Information and Contact IMA pages are organized by task (one task per page). However, these functional categories are not grouped in a separate scheme, but mixed in with the topical categories.The HealthSmart (patient education), My Health Zone (online healthcare management), and Patient Education are three different pages organized by topic in three different ways around general health related issues. These labels all sound the same and each link to very similar issues, which will not trigger an association in the users mind. The only difference is the content type/format: HealthSmart has only articles, Patient Education is a list of links to other health sites grouped by topic and My Health Zone is an outside site.
The Job Opportunities page is organized chronologically by when the jobs were posted and labeled by job and facility. IMA News is random chunks of information posted about IMA.
Finally, in some cases, content is organized according to the organizational structure of IMA itself. For instance, the "Specialties" category groups content according to the various areas of medical expertise that the IMA practice specializes in. Some examples include Cardiology, Infectious Disease/Critical Care, and Family medicine.
Because powerful categories come from simplicity, these blended schemes will cause confusion and are not scalable throughout the site. Deep hybrid schemes that mix functions and topics prevent the user from forming a clear mental model when using the site and often sacrifice both accuracy and clarity.
The IMA site uses a left side navigation column for its main content links. This placement is consistent throughout the site, however, the labeling and order of the links change throughout the site (See Figure 5). In addition, the look of the links varies throughout the site because one set is a graphic navigation and the other is text. The text navigation does show link color changes to indicate where a user has already been, but the graphic navigation does not.
The site also has a bottom navigation. Similar to the side navigation, the bottom navigation is also inconsistent (See Figure 6). This navigation attempts to repeat the side navigation; however not all of the links are included in this section (e.g. Outreach Clinics), some links are not labeled the same (Office Locations vs. IMA Locations vs. Locations and HealthSmart vs. To Your Health), and two new links appear: the sitemap and a comments (mailto) link. Also, there are a few mistakes with this navigation showing users they are on a page that they really are not. For example, on the Specialties page the bottom navigation indicates that the user is in the Physician Directory.
Thirdly, a top navigation scheme occurs within the Specialties pages to help users navigate from one specialty section to another (e.g. Cardiology to Pulmonary). Like the bottom navigation, there are instances where the navigation indicates to users that they are on a page which they are not really on, or limits their linking options. For example, on the Ancillary Services page the top navigation indicates that the user is in both the cardiology section as well as the ancillary services page. Because the cardiology link is inactive, a user cannot use the top navigation aide on this page to get to the cardiology section.
A user's location within the structure is not always explicit. All pages have a title and that title usually corresponds with the navigation but there are a few instances where the user cannot see how they got to a section. An example of this is on a page about the Lipid Clinic. Once on the page there are no indications of how the user might have gotten there or what he should do to get back.
The home page is accessible from any of the subordinate pages by clicking the IMA logo in the upper left corner and from the bottom navigation "Home" link. On the pages with the graphic navigation, there is an "Internal Medicine Associates, Inc." link at the bottom that goes to the home page. This is confusing because the name is spelled out, whereas the rest of the site usually refers to itself as IMA.
Ultimately, although well-meaning, the wealth of navigational options on the site is probably a hindrance rather than a help to end-users. Cross-linking abounds as does lack of consistency in navigation scheme links, increasing the chance of users getting lost and forming false mental representations of the site's structure.
In general, much of the layout is inconsistent from page to page. The site attempts to follow specific content and navigation layouts (see Page Wireframe), but ends up changing in a manner which appears in many cases to be dependent on the age of the page.
Some specific content layout issues include:
Navigation layouts are also frequently inconsistent, often shifting depending on the depth of a page within the overall structure. Closely related issues are dead links, and inconsistency in link placement and associated link actions.
Some issues which make these problems explicit include the following:
Additional layout issues are caused by inconsistent underlying HTML code. One specific instance of this problem shows up in the way the IMA logo is displayed on the
Appointment vs. Ancillary
Services pages. Inspection of the code reveals inconsistency in
the height specification, an error which causes the logo to appear to
stretch and shrink and, further, causes the layout of the entire rest
of the page to appear to shift:
A sample of other layout issues include the following:
One major issue regarding accessibility on the IMA site is the fact that not all graphics have "alt" tags. On the homepage alone there are 5 instances of graphics which do not have alt tags. Users who have vision disabilities may use screenreaders to "read" the website content. Without an "alt" tag, the user has no idea what the image portrays. Also, existing "alt" tags should be as descriptive as possible. For instance, the alt text for the IMA logo on the home page says only "IMA" and would be improved by using the actual logo text which says "IMA Caring Within...Caring Completely". Finally, in some cases the alt text is incorrect, such as on the Patient Education page. In this case, the graphical text page header says "Patient Education" but the mouseover alt text displays "Appointment Request". A minor issue is the presence of dead or incorrect links, such as that to Infotrieve Online - Medline which returns a "HTTP Error 403 - Forbidden" page error. In addition, there are no alternative forms of the site available, such as one that is "text-only".
Another accessibility problem is the non-standardized code that is used to generate the pages. Errors in code, although not necessarily visible to the end-user, are a detriment to the validity of the pages and indicate that care has not been taken to ensure they are cohesive. Upon running the Home page through an HTML validator provided by the World Wide Web Consortium an initial error is found via lack of an encoding tag; after setting that to be found automatically, 35 additional errors are found.
Some notable features on the IMA site include a link to the integrated "My Health Zone", a site where patients can manage their health care online as well as several online forms for patient-IMA communication: Appointment Request, Email Your Doctor, and Billing Information.
The IMA Website slogan states that they are, "Leaders dedicated to delivering high-quality, compassionate, comprehensive, and accessible healthcare." Unfortunately, many architectural weaknesses with the current Website do not reflect this sentiment. The broad and shallow architecture of the current IMA Website suffers from many organizational flaws including ambiguous langugage choices for categorical links and content redundancy. Categories are not organized or grouped in an intuitive manner nor in a way which addresses typical user needs. Page layouts change at all levels of the site, although older, deeper pages seem to be the most out-of-date. A number of navigational schemes contain many errors which make it difficult for an end user to form a correct mental representation of the structure of the site. Accessibility problems include simply a lack of, or errors in, image alt tags and invalidly coded pages. Although the content attempts to cater to the needs of users, attention should be given to fixing the above issues so that the Website may more truly reflect IMA's concern for all its community members.