Improving patient care through improved treatment tracking and collaboration tools

Kaiser eChart is an electronic medical recorded (EMR) system that was designed to improve patient care by providing clinicians with state-of-the-art tools to view a patient's medical history, record patient visit notes and track diagnosis and treatment plans. Additionally, Kaiser eChart was designed to improve diagnosis and treatment coding during patient visits, resulting increased revenues from proper insurance billing.

Opportunity:

Empirical's key focus was to provide a user experience that naturally supported the way in which clinicians interacted with patients while also providing them with new tools that created opportunities for efficiencies. By leveraging a methodology that combined the discovery of strategic opportunities for the business as well as a thorough understanding of the end-user needs, we could ensure that the goals for the project were met.

Empirical's user experience design opportunities:

Determine the essential clinician needs via contextual research in the clinical environment

Create an EMR application that organizes tasks into a mental model that clinicians can easily understand

Provide clinicians with easy access to a patient's medical record and a simplified approach to recording notes

Simplify process for determining appropriate diagnosis/treatment codes required for diagnosis and billing

Unify clinician tasks into a single application that delivers improved functionality, efficiency and usability

Provide the opportunity for clinicians to personalize the eChart to meet the need of their specialty

Approach:

Stakeholder Interviews

Empirical conducted a series of interviews with key stakeholders (physicians, adminstrators, support etc.) to uncover the primary business opportunities and stategic goasl that would serve as the basis for the requirements for the new EMR system at Kaiser.  We designed a discussion guide that included the ranking of the goals and features of the proposed EMR system. Later this ranking data was used to prioritize feature requirements.

Task Analysis

While we were conducting stakeholder interviews, Empirical was also spearheading contextual inquiry with clinicians in an effort to discover the user needs the eChart needed to support. By observing first hand in a clinical setting the processess supporting patient treatment at Kaiser, we were able to identify the essential tasks and workflows that would need to be supported by the eChart system - if the system was to be widely accepted and successful.

IA and Interaction Design

Once the business opportunity and user needs had been identified, our next task was to focus on the challenge of designing an easy-to-use EMR applciation. Using an "agile" approach, we created a series of low fidelity application concepts (wireframes)and reviewed them with key stakeholders and user groups - quickly incorporating the feedback in a rapid design iteration. This early user feedback is an essental tool we use to help ensure that the design is satisfying the established requirements and definining a overall structure and interaction conceptual model that resonates with the target audience - the clinicians.

UI Design and Development

After the overall application site structure, navigation, taxonomy (nomenclature) and interaction of the eChart was designed, Empirical went to work of designing the visual treatment for the user interface and built a series of interactive prototypes. Prototypes for patient scheduling, medical history summaries and patient visit notes were quickly developed and reviewed with user groups both in formal user testing environments as well as in a contextual clinical setting. As with other phases, this feedback was quickly incorporated into design updates.

Empirical was also responsible for building the front-end templates for the final user interface. These templates were dynamically generated from Java code components using WC3 strict dhtml.

Usability Testing and Validation

To ensure that the clinician's needs were being supported by our design efforts, Empirical planned various user evaluation sessions. These sessions ranged from quick testing of paper prototypes to full blow user validation prior to the initial release of the application. By performing this validation early and often during the design phases of the project, we were able to make necessary improvements prior to development - where the cost of such changes had little impact.

Solution:

Electronic medical record systems like Kaiser's eChart hold the promise of transforming the efficacy of health care for both clinicians and patients. This can be measured in improved access to patient's medical histories and the ease in which those records can be updated and shared. eChart creates an opportunity to improve diagnosis and treatments, improved communication between specialists and primary care physicans, and improved opportunities for preventative health care at Kaiser. Also, the customization features provided by eChart have given the clinicians the ability customize the way they work - creating increased efficiency and reducing the time spent on tasks not directly connected to the treatment of patients. Lastly, the ease in which physicians can select and document the diagnosis codes required for appropriate reimbursement within eChart, have both physicians and business leaders at Kaiser Permanente smiling.