Sponsor 

Shareable Ink, Nashville, TN

Team

Stephanie Vore Apple, Dan Orth, Michelle Hevesi and Sandra Romero

Challenge

This was an investigation of a medical space, specifically around the pains and anxieties from medical personnel filling out countless medical forms while confronted with the risk of making a mistake with dire consequences, not just financially but in human lives.

This was an comprehensive project, almost end to end from concept research, to us familiarizing with pertinent medical terminology and regulations to interviewing subjects and researching technology that could be incorporated into our final concept. 

The final concept revolved around one poignant quote by one of our doctors' interviews: 

 "If you don't chart it, it didn't happen". This statement resonated with a variety of issues, from legal to the personal anxiety and the need to overcome alert fatigue that these fine professionals are put through every day by the use of EMR systems (Electronic Medical Records) that are cumbersome and lead to mistakes.

 

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Analysis

Our deliverables included: User, Task and Context analysis, Personas, Scenarios, conceptual model and finally our criteria of what a usable EMR system should have. 

During the discovery and exploration phases we focused on solutions that address the pain points that our client surfaced during their presentation, as well as pain points that we discovered through research. Identified pain points included:

a. Lack of health care provider engagement during process

b. Susceptibility to errors during data input

c. Alert fatigue for software and system notices

d. Insufficient information available

e. Time constraints on doctors’ time

f. Steep learning curve to memorize new forms

We iterated four times with various prototypes until one that met our client's criteria. Our final solution focused on creating a new interface that will allow doctors to complete and output forms in a more engaging manner while increasing efficiency and free time they could instead spend with their patients.

Below is a sample of a paper form that requires a level of detailed information. When this information is missing or is inaccurate it can lead to legal issues or worst case scenario risking a patient's life. 

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Process

We shadowed several professionals who use our client's products to further learn about their days, the tasks they perform and their environments. We also shadowed a few other customers that were still working on paper form, customer who our client was trying to sign up. Below is our analysis of these sessions: 

User Analysis

  1. Who is the user? Anesthesiologists and their assistants
  2. General: age, language skills, sex, etc. (men & women, 29+ yrs. - 65 yrs, various language skill backgrounds)
  3. Technical and/or computer skills (competent technical users - competency varies from medium to high)
  4. Domain knowledge and skills (extremely competent in medical field, extremely confident)
  5. Goals: why is he or she doing these tasks? (required forms for medical procedures, required for insurance billing,                                required work for insurance purposes/medical malpractice)

Task Analysis

According to priority we decided to classify these tasks as: required, useful and cool 

  1. Run monthly reports (cool)
  2. Patient snapshot (synopsis) (cool)
  3. Overview of patient surgery schedules (useful)
  4. Review outstanding items (useful)
  5. Support on drug interaction information (useful & cool)                 
  6. Intake patient’s medical history (required)
  7. Confer with patient on medical history (required)
  8. Document patient’s medical history (required)
  9. Output patient’s medical history (required)   
  10. Review medical record post-surgery (required)
  11. Document medical record post-surgery (required)
  12. Self audit: system flags missing pieces of information (required)
  13. Submit medical records to insurance company for billing/medical malpractice (required)

           

Context Analysis

  1. Physical: Hospital setting (pre-op, post-op, waiting room) sometimes at doctor’s office, nurses station
  2. Mobile Capability/Portability: Screen Glare Challenges
  3. Sanitation Concerns: May have gloves on
  4. Noisy, very quiet? Both noisy and quiet. Could be distracted by patient and patient’s family
  5. Other people around (privacy, collaboration) Yes, other people around
  6. May collaborate with nurses and other physicians
  7. Technical Hardware limitations: Cost of devices is a factor
  8. Ease of enterprise support and administration
  9. Wireless access, bandwidth, sometimes hospitals internet is unreliable

Personas

We considered demographic factors, technical skills, domain knowledge and goals. We combined this information with additional research to develop three personas that represent potential users of the product. It is important to note that although these were the three personas identified based on the research conducted there are likely to be other personas that were not uncovered in our research

  1. Dr. Dougherty The High Tech Anesthesiologist
  2. Dr. Allen The Traditional Forms Anesthesiologist
  3. Nurse Williams

In order for us to fully understand who is the person that becomes an Anesthesiologist, we set out to find their more trending personality traits. We found an article written by an actual Anesthesiologist on this subject: https://adobe.ly/2nn7bCP

 

For more information on our personas goals and motivators please see our final report.

Iterations

With our First Prototype we wanted to explore the use of dictation for a hands free approach. 

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After evaluation, we decided to explore the more traditional tablet input format with newly found information on patient / doctor interactions prior to surgery. But we still wanted to make use of latest breakthrough in technology so we instead incorporated an implementation of google glass in combination with a traditional interface. 

sketch.1.jpg

This led to this horizontal navigational Second Prototype with a timeline that could be dragged back and forth to look for specific events during the patient/doctor interaction. At this stage we incorporated information about the patients, their history and dabbled on collaboration between the doctor and the nurses

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As our research converged, I captured what would become the conceptual model and the integration of new elements such as the dashboard, and the monitoring components and the use of google glass.

mind.map.png

The third prototype was now high fidelity with entire interactions addressed and a workflow separating pre and post ops activities. 

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Compromises in the design

As we zeroed into our final prototype, it became clear our users kept bringing up the absence of the traditional grid. This grid was ingrained in their culture, it is taught still in school and the symbols used are part of their lingo. We decided to bring back the grid, so in essence our design became a hybrid of traditional elements merged with new exciting high tech. 

At this stage, we also experimented with interactions to manipulate the grid, selecting vital symbols and a few ideas around floating menus and lastly dual mode where people could see the data in grid format or in a timeline's mode.

Final Report

In terms of innovation, we reached an important juncture in the project when one of our interviewees shared that any distraction into capturing information for the forms would take away from the care of his patients.

 

We explored voice dictation, styluslike hardware with builtin intelligence, but in the end we concluded Google Glass was the appropriate technology already in existence and would fit our concept of capturing data quickly and in realtime
nicely. 

 

The Google Glass has the potential to interact with the system to upload information on vitals and other checks that otherwise the medical staff would have to manually enter sometimes backdated at the end of a long day. Because of its availability and other reports of its use in the medical field, we concluded Google Glass could be a feasible solution in the range of 3 to 7 years down the road for Shareable Ink.

 

Link to our final report and references: https://adobe.ly/2ppR5t3