Fresenius is a premier healthcare company focused on delivering the highest quality of care to people with renal conditions. They have 2400+ dialysis clinics in the US with over 190000 patients. The current system they use requires their physicians to navigate in and out of numerous softwares just to get through the day. This cross-platform inefficiency slows down their workflow causing them to waste valuable time.
Compass is an app that streamlines the daily workflow of nephrologists, while allowing them to spend time on what matters the most: providing quality patient care. With Compass, physicians can see the list of scheduled patients for the shift/day, detailed patient charts and lab reports, take quick notes during each check-up and manage prescriptions.
In order to avoid delays during the process, we defined the goals for each week before kicking off the project. The timeline was divided into 4 sprints. Each sprint included a review session with the stakeholders. The feedback was then incorporated into the next sprint. The first 2 sprints were devoted to ideation and wireframing. The following sprints were for iterations, visual design, and prototyping. We made sure to include user testing in our design process not just in the end but also at the beginning to validate our direction.
Before we start thinking of solutions, it was crucial for us to understand what exactly were we trying to solve. There was one big problem to begin with - we were going to design for a field none of us were familiar with. Sure, we read all the research that was handed down to us. We exploited google in the best way possible. We did our own secondary research. But was that going to be enough? Of course not. We hadn't got a chance to talk to the people who were going to use this app. And so, our team traveled to the client site to get a first-hand, extensive understanding of their business needs followed by a comprehensive 3-day design sprint to explore potential innovative solutions.
Day 1: The first day was spent listening, consuming and asking LOTS of questions about the day-to-day life of the physicians. Throughout the day, each of us was noting down "How might we..." questions. By framing a problem as a question, we train our brain to look for meaningful and relevant solutions rather than focus on the problem. For example, one problem statement we came across was "The note-taking process is cumbersome". This was framed as "How might we make the note-taking process easy and efficient?" See how the question already makes us look for solutions? By the end of our 8-hour workshop with the client, we cumulatively had about a 100 how-might-we questions. A few examples:
Day 2: The second day was spent analyzing and synthesizing all the questions we came up with. We used affinity mapping to club the questions that were trying to solve the same problem. This helped us gather different perceptions and solutions for each problem. After the categorization, we asked the clients to mark the questions/categories that they felt were most important for us to focus on. We encouraged them to add their own how-might-we questions to the board. By the end of the exercise, we had the 4 categories they wanted us to primarily focus on - Patient list, patient info, notes, and orders.
Day 3: The third day was used to ideate and brainstorm solutions. We picked one category (Example: patient list) and set a timer for 10 min. We jotted down as many ideas as we could. The clients were encouraged to do this exercise with us. At the end of 10 min, we all presented our ideas to the team. We repeated this method for all the categories we finalized on day 2. In the end, we all put up our sketches/notes on the wall and proceeded to mark the ones in which we saw potential. This helped us discard ideas that were unfeasible or seemingly "cool" but not useful to the client. We also had to consistently keep in mind the timeline to ensure that we prioritize and finish what we take on.
The primary goal of the research was to understand the day-to-day tasks of the physicians and identify the pain-points in their journey. To further aid us in our research, the client provided us with in-depth journey maps and user personas which helped us identify our focus points.
After gathering all our insights from the kickoff sprint and the research, we set out to first and foremost, identify what problems we will be solving.
Systems are not integrated: Multiple systems need to be accessed during office visits and dialysis clinic rounds to find labs, data on a patient, medication lists, etc. The systems not being integrated can cause duplicate work for the physicians.
Missing important information: Crucial information like care alerts, prescriptions, and transplant status are hard to find. It is critical for the physician to not overlook this so they can follow through on updates and avoid miscommunication. The consequences of oversight can be lethal.
Time-consuming data entry: The process of completing notes after patient visits is cumbersome and inefficient.
Poor Navigation: There are a lot of clicks needed in the current system for the nephrologists to complete their day-to-day tasks.
No real-time information: Once the patient begins the dialysis treatment, there is no information in the system. This can cause the physician to accidentally skip a patient and lose out on billing and the ability to provide good patient care.
At this point, we were exploring a lot of features and it was important for us to lay down a foundation. Most importantly, the development team would start working on the framework of the application soon. This meant it was time to chart out the information architecture. Once we had that in place, it was easier for us to visualize the structure and think of possible solutions for the future scope.
Due to the specialized nature of our targeted users for Compass, it was paramount we engage with them early in our process to gain a clear understanding of their clinic workflow, along with their level of literacy in mobile app technology. By weekly reviews with the stakeholders and simple task-based tests with physicians, we were able to see individual habits on general navigation, gesture knowledge, and priority of information hierarchy. By using Lookback and Invision, we set up our user test and gathered their feedback.
For example, when designing the patient list screens, we got very valuable insights by asking one question:
"What patient info is used to decide who to visit next when rounding?"
We got to know that just the patient name and demographics do not suffice. Nor does the order of their scheduled appointments. The physicians prioritize by the patient's treatment attendance and time remaining in the treatment session.
An efficient way to sort and filter through their patients.
An intuitive way to categorize and consume the patient details.
A quick and efficient way to quickly create a note. This particularly enables collaboration between physicians and cuts down on duplicate work.
One place to review all the orders and sign them in bulk with just two taps.
We had a few more ideas that were successfully discussed, validated and tested but could not be added to MVP due to time and contract restrictions. Few of those being:
- Adding a new patient
- Attaching a quick note (Non-medical) to the patient
Once we nailed the features and flow for mobile, I took upon the task to define the direction for tablet with regular feedback from the team. A cross-platform, integrated solution was paramount for a seamless and successful physician experience across all touch points. Most of these physicians already use tablets to access the other applications they currently use. Sometimes, they need to use the computer in the patient's room to log into certain softwares. The biggest convenience they get with a tablet is to multitask and not be location restricted.
" Found this to be a great timesaver. "
- Dr. Adam Protain, Adventist Health, Portland
" We've gone as far as we can with traditional research. Now we have technology in our pockets that lets us go even further. "
- Dr. Helen Link Egger, Duke University Medical Center
" Brilliant. "
- Dr.Peter Manring, Bronson Healthcare
Feedback delays due to busy schedules of the physicians: Our timelines were tight and getting regular check-ins with nephrologists wasn't easy. There were quite a few times when the feedback was delivered later than the expected date which meant that we couldn't incorporate that in time. Since we were working on multiple platforms, we needed the designs to be locked down for iPhone before starting the tablet design. Unfortunately, there was a lot of back and forth which led us to a state where we were tackling too many problems.
Remote testing: The physicians we were designing for were located all over the US. It was difficult to arrange for real-time testing sessions. We used lookback to video record the tests but most physicians forgot to speak-out their thoughts. We lost the opportunity to ask them contextual questions based on the test.
Rules and regulations: There are quite a few rules and regulations associated with the process of a patient visit. It was challenging to design something innovative while fulfilling those requirements.