Optimal Vision Care Prototype

The OVCP was a contract funded by the Department of Defense to research novel solutions to problems physiicians were having with modern EHRs. The purpose of the contract was to research these issues, document our designs, and collect quantitative and qualitative feedback from care providers to establish requirements for the next generation of medical software in the military.

This page is case study of the two-week spring focused on the problem list - which was only disocverd to be a significant problem only after it came up several times while documenting diagnoses in preceeding sprits

My Role

UI Engineer

Client

Department of Defense

Timeline

2 weeks

Tools Used

Adobe XD, Apple Keynote, ProtoPie

Discovery


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

- Health Informatics Expert

Physician as designer

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).

Prototype by an ER physician depicting how they imagined a low-touch problem reconciliation could look

Prototyping


"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.


Hick's Law

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.

Space Space Space Space Space Space Space Space Space Space
Click-through prototype

Click above to view. This was presented to the clinical SMEs to get qualitative and quantitative feedback, shown below, on the clinical effectivenes of the design

Refinement

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

- Opthalmologist

When was it last 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.

What's the history of the problem?

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.

Click to above view prototype

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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