(2) Managing Heart Failure

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,

Prototype

RESEARCH

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

SYNTHESIS

Journey Map

affinity mapping

KEY FINDINGS

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

Pain Point

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.

Notes expanded

Last visit selected, exams to be updated

Notes expanded

Social history selected

Exams results expanded

Notes expanded

Last visit selected, exams to be updated

1/4

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:

Screen Analysis

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.