Optimal Vision Care Prototype

A small step in the right direction for problem list reconciliation.

Client

Department of Defense

Role

UI Engineer

  • User Research
  • UX Design
  • UI Design

Project Overview

The Optimal Vision Care Prototype was a year-long contract to investigate, design, and develop novel solutions to problems had with (then) modern electronic health records.

Depicted below is a slice of the entire project, a sprint focusing on the problem list.

The Challenge

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The Problem List is a... problem

The feelings associated with problem lists in EHRs is fairly unanimous across practices, clinical disciplines and even with different software: They're a problem. A problem list often gets out of control with duplicated diagnoses and problems, and problems associated with a specific diagnosis getting lost in the shuffle.
But this wasn't apparent or something I an the team even wanted to focus on, initially.
After hearing the dreaded problem list mentioned during meetings with our clinical SMEs once or twice, I did some research of my own and discovered the depth and ubiquitousness of the issue. I proceeded to bring it up during meetings, and started to hear first hand stories about just how much a problem the problem list can be.

Discovery and Exploration


"Problem lists are the problem of all EMRs - no one does a good job of presenting them."

- Health Informatics Expert

A prototype to get started

The first prototype for a solution to the problem list was by an emergency physician. She passionately exclaimed, over a Skype call, that there must be a way to group diagnoses, and she also made a wonderful little prototype of her idea with Microsoft Paint.

From there, I designed a handful of prototypes to get the current mess of medical information into a manageable, helpful, consolidated list.

Taking it a step further

Working backwards from the prototype our SME made, a consolidated list, the next step was to explore ways to begin with a flat list of diagnoses and arrive here.

In a few clicks, the physician could view the details of a diagnosis, view it in context of other diagnoses on the list, and decide how to consolidate them (secondary to, related to, subset to, etc).

Revision and Testing

"Something that lets you somehow update the problem list in a user friendly way that takes like 5 seconds."

- Emergency Physician

Direct manipulation

While these prototypes provided all the functionality to create hierarchy in the problem list that our SME imagined, it required a lot of attention.
Instead of requiring the users to click or tap a button, figure out a new window, click or tap again to close/enter their changes, I thought that making the problem list editable directly would work better. Dragging problems on top of one another to create a relationship became the crux of the design.

Similar to or secondary to...

Another hindrance to speed was the amount of choices available when relating two problems. I consolidated the choices to "similar to" for duplicates and closely related problems, and "secondary to" for problems that were results of or symptoms of others.

Refinement

"We sometimes see quiescent inflammation that becomes active, then back to quiescent and back to active."

- Opthalmologist

Last time seen active

Our SME explained that the timing of these recurrences often provides clues to a need for changing management strategies.
Based on this insight, I thought that the list could be sorted better to provide more context at first look. When problems were last seen as active as a sorting mechanism combined with problems tagged by their status (putative, active, quiescent, and resolved) gives the provider lots of timing context at a glance.

A closer look

To give the problem more context, a user can open an Info window about a problem, revealing the it's complete history (labs, referrals, notes, etc.), which they can scrub through using an activity pic-list that displays and links to times of low or heightened activity levels.

The diagnoses would be linked with worksets that include tests/studies/referrals that might be commonly associated with that diagnosis. This would save a lot of time and potentially a someone's life if something is overlooked.

Formative Feedback

"This is a great way to provide a sub-structure to the overall list, a great feature to reduce clutter.

- Neuro-ophthalmologist

I like the tools used to better represent the clinical picture."

- Ophthalmologist

With this quantitative and qualitative data, the project moved into the summative testing phase.

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