While we had selected a problem area given to us by our sponsor, my team knew virtually nothing about the space save for what we knew as patients ourselves. We set about conducting both secondary and primary research to better understand what the current state of the doctor's appointment experience was for patients of varying backgrounds and health journeys.
Something that became clear to me early one was that sentiment varied greatly between patients who suffered from chronic conditions vs patients who did not. Patients with chronic conditions had much more polarizing sentiments on their healthcare experience. In order to investigate this, I talked to patients with chronic conditions about their healthcare journey.
Telehealth was not as preferred as we thought, especially by those who frequent the doctor the most. They remained distrustful of a doctor’s ability to correctly diagnose and prescribe. One of our interviewees told us that they were constantly under-dosed when prescribed medication via telehealth, something they hypothesize is ironically also due to the doctor’s distrust of telehealth as well.
“There have definitely been instances where, during the pandemic, I only had the option to be virtual. And that was really challenging, because there were symptoms that I felt required actual examination, right? ...They literally told me ‘take your phone and can you shine it in your mouth. So we can see?’ You're not gonna get as accurate as an in-person appointment.”
Health management and consequently check-in can be exhausting and take a lot of time. The burden is really on the patient to document and actively manage. This becomes infinitely trickier if you are suffering from certain long-term conditions which require specialist care and multiple doctors.
“I had to steer my own ship. I kept a long Google Doc of all my symptoms, treatments, medications, recommendations, and I would pull it up whenever I went to see a doctor.”
Our participants who required more closely monitored care or suffered from specific chronic conditions had multiple doctors they saw regularly. Oftentimes, their main doctor was not their primary care physician but a specialist who has more knowledge on their specific condition.
“I see 3 or 4 doctors regularly.”“My main doctor is my integrated medicine doctor, but I also have a PCP, a neurologist I was seeing for awhile, and a couple others.”
We now knew intimately how thoroughly the current American healthcare system was failing patients dealing with chronic conditions. But, what did people working in the system think? What systemic problems exist that place so much of the burden of care on patients dealing with their chronic conditions? I talked to a group of healthcare subject matter experts to figure out what was happening on a larger scale in healthcare.
The current healthcare system model is not designed for chronic conditions, rather it takes an “episodic” approach - come in, get treated, then come back when something crops up.
The first big distinction I made through talking to subject matter experts was realizing that check-in could potentially be very different depending on whether or not you have an acute or chronic condition.
With the way healthcare is structured in the United States, there isn’t really incentive for hospitals to share information with each other as that means potentially losing “customers” or patients.
The healthcare industry is starting to move towards integration and unification across systems. A big barrier to this is lack of market incentive.
Market solutions my team looked at earlier on showed a lot of innovation happening around making the wait time at doctor's offices more bearable. However, are there cases where check-in and consequently wait time can be completely removed from the equation?
A better appointment process may mean completely bypassing or rethinking the entire current experience. Other areas may benefit more from incremental optimization.
The last piece of my research consisted of talking to doctors to figure out how they navigated patient care.
Doctor’s have too many tasks and too little time. These have only increased with modern healthcare technologies which make the amount of patient information captured much more robust but require doctors to maintain and update this information.
Consolidate communication and information channels that a doctor and patient must manage.
Doctors aren’t always compensated for the extra work they do to care for patients. For example, doctors have many tasks outside of just seeing the patient. They also need to read through patient files, work on health recommendations, and input information into a patient's file. These are all things doctors must do that they may not be paid for if it is outside of a patient's appointment time.
If we can’t decrease the tasks, we need to make it easier for patients to manage extraneous tasks and communicate this to doctors.
Newer technology has enabled faster, more dynamic communication but can sometimes be a friction point during appointments. Relating to the first and second observation, doctors may feel pressure to try and input information during the appointment time to make sure they're getting compensated for their work and to make sure they aren't missing anything the patient has mentioned.
Make health info easier to access and navigate across appointments.
A common theme arose from talking to the patients and providers. Patients were overwhelmed trying to keep track of all their health information, this was made worse for patients with chronic conditions who must go to the doctor more frequently (which means more doctor's notes, more medications, and treatment plans) and across multiple doctors.
Providers talked about how modernized digital EMR systems allowed them to input more information about their patients during their appointment. Unfortunately, this meant that doctors had more and more tasks relating to information maintenance. These tasks were things they were not compensated for as they did not directly relate to the care of the patient.
From here, I saw a more specific problem my team could tackle: the modernizing of healthcare record systems has led to a collective inability to manage all of the information in a meaningful and effective way.
We established 5 primary goals we wanted to accomplish through our design. These goals focused on enhancing communication between doctors and patients as well as helping patients understand their own health information with minimal effort.
Patients can create modules where they can add notes, messages, tests from across their providers to create packages of health info that makes sense to them.
Save health information that is typically not made for looking back at into modules in order to fuel your health insights.
Prioritize how accessible your health information is and surface pieces of information that are important for you.
Timeline breaks up key information from EMRs into a historical record - users can access medical information directly this way.
Integrate different timelines by selecting multiple single views into one to get more holistic picture of healthy journey touchpoints.
Access relevant medical information directly from timeline by selecting specific elements.
Take actions like scheduling follow-up appointments directly on the timeline through app suggestions.
Ultimately, my team chose to refine our Health Module concept based on a few key considerations.
1. Our subject matter experts and patients showed a lot of interest in the module, citing its novelty and potential usefulness as its major benefits.
2. We saw an opportunity to refine the health module and continue solving for this health information problem by flipping the script on traditional EMRs by giving patients more direct autonomy and control over their own health information.
We designed our platform so that users could create new health modules easily on the main page. Users freely can decide module’s icon and name. Also, documents can be added when creating the module.
We tried to provide users comprehensive view related to their health. The homepage includes crucial infomation the users need such as calendar, documents, modules, and pinned modules.
Based on our interviews with patients, we learned that conversation with doctors plays important role for them. Therefore, we designed that users can add messages with doctors in modules easily.
After refining our health module designs, we tested our designs with patients who we interviewed during the beginning part of our research.
Some of the product improvements we identified through testing directly with users.
Less steps to take certain key actions like creating a module
Make key actions easier to identify on screen (i.e. hover not the only state where action is accessible)
Ability to drag documents around in module
Ability to share individual items from module as opposed to entire module
Add method of sharing within module page
Add way to attach personal notes when sharing modules
Make individual page layouts more distinct so they don’t blend into each other
Change icon to share icon
More color so the text doesn’t look so overwhelming
Some of the product improvements we identified through testing directly with users.
Our testing participants were confused about the module’s categories. Therefore, we created categories for modules that allows users to fuller control over how they'd like to organize and label their health modules. We also expanded the space by reducing calendar space. Also, the calendar and document space are changed based on users’ feedback.
Previously, adding a message to module feature shows up when users hover over on the message. We learned that it's not that intuitive to users because they often didn't realize the option existed until they accidentally would hover over a message. Because it was a priority for us that users be aware that they can also add non-traditional pieces of information such as messages into their modules we added a visible button for each message and improved the feature so that multiple messages in a conversation can be added at once.
Modules are customizable collections of health information. They can be organized themselves into larger groupings (i.e. Diagnoses, Personal tracking, etc.) Modules can also be pinned and each can contain a mix of documents like doctor’s notes, patient notes, test results, and medication notes.
Modules can be grouped together and adding groups and individual modules are easily accessible through the homepage
Recently uploaded docs, notes, and test results can be quickly viewed through this section of the dashboard
Access a calendar with medication updates and appointment history as well as upcoming appointments
New modules and module groups can be easily created at the home. Based on the usability test feedback, documents and appointments can be selected when creating a new module.
Pin specific items from module in a pinned area. Accessing Edit mode allows users to drag and reorder items within the module
Patients can share specific information from a module with doctors, therapist, or caregivers.
Modules are customizable collections of health information. They can be organized themselves into larger groupings (i.e. Diagnoses, Personal tracking, etc.) Modules can also be pinned and each can contain a mix of documents like doctor’s notes, patient notes, test results, and medication notes.
Considering the convenience of patients, especially when visiting their doctor in person or writing notes outside, we created a mobile version based on our desktop version.
Providers can view and manage their patient communications through the admin view. Admins can upload documents or write notes to specific patient profiles.
How does our final design translate into the design goals we set out to meet? At the center of our design, modules make health information accessible and personalizable to patients, allowing them to see their own health information in ways that make sense to them and tell a clear health journey story. The ability to save and access multiple forms of communication often forgotten by existing EMR systems such as instant messaging allow health nuggets through these conversations to be preserved and acted upon.
What I learned from this project journey.
I made what I thought was a very detailed research plan - but as things are apt to go, I found as I was conducting research that the things I was learning revealed gaps in my knowledge. For example, as I was talking to patients I realized I needed to talk to industry experts, and as I was talking to industry experts I realized I needed to talk to doctors as well.
I felt tempted in many instances to make quick conclusions and move on but I let the threads I was seeing pull me to other places - from patients to chronic patients to experts to doctors.
Side Tangent (bear with me 🐻) —
My thesis advisor always uses this analogy when describing research that it “should flow like water”.
I think that’s really the approach I was trying to take here. Each of these stakeholders really provided an important and insightful part of the puzzle when exploring the healthcare ecosystem. While the place I ended up in was very different from what I initially expected I felt it was a much more honest investigation into those who would eventually be using our service.
My team’s client was very excited about augmenting our product using artificial intelligence. However, a key finding from our talks and evaluation with users showed that patients and providers didn’t trust these systems to make automated health decisions for them. By taking our client on the journey with me, I was able to help them understand where the patients and doctors were coming from.
