Digitalising outpatient care
@HVS
Timeline: Summer 2020 - Summer 2023
Company: Hôpital du Valais
Team: 1 UX/UI designer, 1 PO, 10-15 developers
Responsabilities:
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User research (user needs and pain points, user workflows, service mapping / interviews, field observations, surveys)
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Stakeholder alignment (workshops, presentations)
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UI design (low-fi, high-fi mockups, clickable prototypes, design system)- UI des
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User testing (prototypes validation, usability testing)
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Requirements specifications (epics, stories,...)
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Strategy, planning and prioritisation support for PO
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Change managements coaching with users
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Field support with solution roll-out and user training
PROBLEM & CONTEXT - EMPATHISE & DEFINE
~9 min read
​SCOPE
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Business goal: remove paper in the majority of the outpatient care workflows and centralise all patient data to ensure no information loss.
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User goal: increase collaboration between doctors, nurses and administrative staff, get an efficient system reducing data entry times and complexity, accelerating the production of reports based on entered data, accessing quickly multiple informations of interests and searching easily through the patient medical history.
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Technical constraints: develop a stand-alone application based on modern web programming languages (Angular, NodeJs) and data standards (FHIR, HL7) relying on a micro-service architecture and running in a containerised environment. Ensure the developed application is compatible with the existing clinical information system. Structure input data when possible.
How might we digitalise outpatient care with an efficient, collaborative, reliable and pleasurable tool and adapt its supporting processes and workflows ?
PROCESS - IDEATE, PROTOTYPE & TEST
UX RESEARCH PROCESS
1. Identifying the users
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Doctors
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Nurses
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Therapists
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Administrative staff
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Patient
2. Learning about user needs, current pain points and workflows
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User interviews
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Field observations
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User surveys
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Co-creation workshops
3. Learning about the existing digital ecosystem of the hospital
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Technical interviews
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Collaborative work with developers
4. Learning about the business intents and underlying strategy
In total we identified more than 110 user needs across 4 different profiles (doctors, nurses, administrative staff, patient). Here are a few examples.
UI DESIGN PROCESS
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Paper prototyping
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Competitive benchmarking
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Low-fi mockups, information architecture
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High-fi mockups, visual design, interaction design
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Technical review of designs with developers
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Interactive and clickable prototypes
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User testing
Deliverables:
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High-fidelity clickable prototypes
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User testing reports
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Functional and non-functional requirements
Usability testing
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Users were given specific scenarii with fictive patient data to test different features
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Several key metrics were measured (time on tasks, # of clicks, # of errors,...)
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Follow-up interviews were conducted to better understand user behaviours
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Design changes were classified with an effort/impact matrix to help prioritise the next steps
FHIR
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FHIR (Fast Healthcare Interoperability Resources) is a data standard for electronic health records.
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The advantage of using FHIR lies in the links that can be made between the data and with the fact that it promotes an architecture where the information is stored once and modified dynamically in terms of content and references.
IMPLEMENT & DELIVER
Method:
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MVP definition, story mapping and cost estimates
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Feature prioritisation and roadmap definition
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Development
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Testing
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Delivery and validation through a 6 months pilot with selected medical department
Deliverables:
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Design styleguide/design system
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End-user ready product/service
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PRODUCT MODULES
Follow-up notes
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Overview of all the patient consultation history with a feed of notes chronologically ordered
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Different types of note designed for doctors and nurses in which they can write down what has been discussed during the consultation, the care performed, the vital signs measured,...
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Possibility to generate a consultation report or a work incapacity certificate based on a written note
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Filtering and searching functionalities to quickly find specific information
Diagnostics & problems
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Overview of all the medical conditions and diseases of the patient
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Collaborative list to share information easily and strengthen teamwork between doctors
Medication
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Overview of all medication taken by/prescribed for the patient
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Possibility to prescribe new medication, check drug interactions and generate a recipe
Medical documents
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Overview of all the consultation reports, examination reports, scanned documents, letters,... of the patient
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Possibility to visualise and print documents
Laboratory
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Easy access to the patient's lab results
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Quick way to make a new test prescription
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Possibility to subscribe in order to be notified for new lab results for the patient
Radiology
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Easy access to the patient's radiology results
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Quick way to make a new radiology examination prescription
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Possibility to subscribe in order to be notified for new lab results for the patient
Allergy
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Overview of all the patient’s allergies
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Possibility to manage the allergies (add, delete, invalidate)
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Sidebar module to have quick access to the patient's allergies and fill up new ones very fast
Split screen
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Ability to display and work in 2 modules simultaneously
Notification
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Overview of all the notifications for new lab results, radiology reports,... for all patients for which the user has subscribed
OUTCOMES
Key metrics
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Less user support and no major incidents during the exploitation phase of the product leading to the interruption of the service (2 minor incidents during the first 6 months)
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Less user training on how to use the system
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High user satisfaction
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Reduced use of paper and complete removal in some departments
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No information or patient data loss
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Behaviour change and user outcomes
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Increased collaboration between nurses and doctors
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Some doctors started making consultation reports themselves instead of having administrative staff do it for them
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Better overview of patient data and reduced time spent searching information leading to better care for the patient
Business outcomes
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Family doctors getting information faster than before due to the ease and speed of generating reports based on input data
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Increase of adoption in a voice-recognition technology by some doctors facilitating the input of data
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Standardisation of some processes between doctors and higher efficiency overall
Technical outcomes
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Setup of a modern and robust micro-service architecture running in a containerised environment
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FHIR data standards applied to all patient data
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Modern and efficient front-end/back-end application available as a foundation to build rapidly new features and applications for future use cases to extend the capabilities of the clinical information system
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Secure authentication framework integrated
LAST THOUGHTS & LEARNINGS
Collaboration between design and development
I learned that the sooner the developers give feedback on the design, the better the outcome for everyone. Co-creating together is essential to ensure I design a reasonable and technically sound product.
I also learned to adapt the design on-the-go while developers are working. It is only when the development starts that we realise the challenges and changes that have to be made to some parts of the initial design. Being able to make compromise and rapidly find new solutions is very important.
Standardisation vs customisation
Different user needs and different workflows require customisation in the product. However when developing a new tool, you want to start small and increase the complexity based on real user feedback after use of the product ideally. I had to find ways to anticipate and deliver customisation at scales in a simple and standardised fashion.
Technical architecture influences on design
The data and the relationship between the data have a huge influence on the system performance and capabilities. I have learned how important it is to progress simultaneously on the UX/UI design as well as the technical architecture definition of the system.
Finding the sweet spot between aesthetically pleasing, low cost and highy functional
A beautiful UI is always important for users and designers. However sometimes, the cost and functional aspects take priority over the aesthetics.
Modularity: App level rules vs module level rules
I did struggle finding the right approach between applying the same base rules in all modules of the applications and deviating from those standards to make some actions more efficient. A usable product has consistent rules and standards and that makes it easy to learn and to use. But sometimes you need to beak the rules you made too.
Feature prioritisation
I found it sometimes difficult to prioritise the development of some features over others. In most cases we tried to ask users for their opinions but we still had to make some choices. This is where having a diverse team with different backgrounds and perspectives helps as well as making sure that everyone can share his/her opinions and feel being listened to.
Thanks for reading.