Healthcare

MANAGING HEART FAILURE

research - prototyping

 

 

WHAT

Partnered with the College of Pharmacy to perform qualitative and quantitative research to produce an initial user interface design for an electronic health record (EHR) application to facilitate the management of heart failure.

 

WHEN

January - April 2019

 

ROLE

I was part of the UX research team and I conducted observations, interviews, and made a prototype.

TEAM

Michael Dorsch, PharmD, MS

Scott Hummel, MD

Kelly Murdoch-Kitt, MGD
Denise Anthony, PhD

Mark Newman, PhD

Juan Arzac, Developer

Adrian Choi, Researcher

 

METHODS

Observations, contextual inquiries, interviews, 

 

RESEARCH

SYNTHESIS

IDEATION

PROTOTYPE

Prototype

RESEARCH

 

Heart failure (HF) is the most common hospital discharge diagnosis among older adults in the United States.

 

The management of HF patients is evolving from the traditional model of face-to-face follow-up visits toward a proactive real-time technological model of assisting providers to more efficiently care for patients in the community.

40%

Nationally, over

of patients are readmitted to the hospital within 1 year following their first admission for heart failure

The proposed project will establish a user-centered electronic health record clinical decision support application for HF that can improve patient care by optimizing evidence-based medical therapy and allowing quick response to clinical worsening.

Qualitative Study

15h

of observations focusing on the providers use of the EHR for taking care of HF patients

4 nurses

1 physician

1 resident

Michigan Medicine

VA Hospital Ann Arbor

Henry Ford Hospital, Detroit

VA Hospital Ann Arbor

What we observed:

  • The tools inside and outside the EHR they use to take care for patients

  • Tools they use to streamline their workflow taking care of a patient

  • The pain points in using their EHR system to take care of HF patients

  • The time it takes to review a patient in the EHR

journey map + Pain points

Affinity Mapping: We synthesized our observations, creating
categories to understand relationships and major concerns. We identified three primary areas of opportunities:

 

SYNTHESIS

 

affinity mapping

KEY FINDINGS

 

Notes

  • Extensive use of the “notes” and subjective information about the patient;

  • A lot of information to find/fill while talking to a patient;

System

  • Information from other systems are hard to get;

  • Nurses/Pharmacists/Physicians each focus on different information;

  • The system does not remind when to follow up with a patient;

Patients

  • Patients forget recommendations.

Specific goals for the application

  • Less scrolling to use and find information on “Notes”;

  • Less clicks to find results from exams;

  • Make it easier to compare exams results and notes while talking to the patient.

IDEATION

Sketching: bla bla bla

affinity mapping

 

Wireframing: low fidelity wireframes based on the initial sketches that accomplished the goals for the application better.

Card-based design, rearrangeable according to provider needs, which may vary for each patient. Easy access to objective and subjective information. 

On the left side, a similar structure of the current notes, but with bookmarks. Card-based design on the right, for the objective information.

I decided to go forward with this one because its structure is more familiar to the providers.

PROTOTYPING

Style guide

Better way of showing the colors

Explain each icon

Prototype: high fidelity clickable prototype, created with Adobe Xd

Interaction flow

The prototype focus in the opportunity areas by having the objective (graphics, test results) and subjective (notes) data in the same space.

Most relevants aspects to consider:

To deepen our understanding of the pain-points experienced by staff, we analyzed the current screen and identified the four aspects most relevant to ED hallway bed challenges:

 

Analysis of current ED screen:

The current screen has three panels and two hinges and can be used in either a straight line or “Z” configuration, as shown. Although it is mobile and easy to store, its poor stability and Z form does not provide consistent or adequate coverage.

Alternative screens available in the market:

Analysis of alternative screens:

We chose four of the most appropriate available screens and ranked their coverage, mobility, storage and stability.

Existing screen recommendation:

Our short-term privacy solution recommendation would be to buy two models of screens — a single and double panel — that could be used separately or in combination. Both screens offer good mobility, stability and ease of storage.

 

 

The panel width is similar to that of the hallway bed.
The single panel could be used easily by patients and the use of two in combination provides a good 
balance of coverage and accessibility for staff to perform exams.

 

Developing a custom privacy solution:

Our long-term privacy solution recommendation
would be to develop a new screen specific to the needs of a hallway bed.

From observing and talking to patients, as well as understanding staff needs, these are the important features that all the screens should have:

  • Non combustible materials

  • Material that reduces noise

  • Blocks light

  • Easy access for staff to perform exams

  • Ease of use for patient to control level of privacy

  • Ease of storage

Free standing enclosure

 

Type

 

 

 

 

 

3 panels, 2 hinges that close as an “U”

 

 

Features

 

Patient can control amount of visual privacy

 

Ok for fire code (same size as current screens)

Suspended enclosure

 

Type

 

 

 

 

 

Lower curtains that do not block exit signs

 

 

 

Features

 

Patient can control amount of visual privacy

 

Easier access for staff to perform exams

 

Easy storage

Fold down enclosure

 

Type

 

 

 

 

 

Curtain that folds down from wall

Features

 

Patient can control amount of visual privacy

 

Easier access for staff to perform exams

 

Easy storage

Patient canopy

 

Type

 

Canopy that attaches to bed

 

 

 

Features

 

Patient can control level of privacy

around the upper body

 

Blocks light

 

Can be attached to any bed/area in ED

Bed attachment enclosure

 

Type

 

 

 

 

 

Screen that attaches to bed and rolls out + canopy

Features

 

Patient can control level of visual privacy

 

Blocks light

 

Can be attached to any bed/area in ED

 

Easier access for staff to perform exams

 

Easy storage

We recognize that the challenges for both patients and staff

in the hallway bed context are many, but hope that some

of the ideas we have proposed can contribute to improving
the care experience. We are grateful for the opportunity to work
and learn in the ED.

MDes in Integrative Design, cohort 3, 2017

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