Overview

Brief

The project served as my Springboard Capstone. EMRs are packed with many necessary features. Leading EMRs have complicated interfaces which give a sense of being robust. Further, physicians find it hard to unlearn ways of writing notes, even if the process is repetitive.

Project

Emerald EMR was designed to make writing notes and navigating essential pages in electronic medical records and to have "fewer clicks" than its competitors.

Tool Used

‍Adobe XD

Duration

6 months

Role

Researcher & Designer

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History of EMRs

In 2009, the administration provided support to physicians and hospitals to implement electronic medical records. Many decided to opt in, thinking the $44,000 was “free money,” but in reality, the costs of implementation as well as ongoing learning and maintenance proved to be more expensive than they thought. Ten years later, many in my personal network were struggled adjusting to them with some leaving practicing altogether or, along with a new generation of medical professionals, find it a necessary hassle in practicing medicine. I researched to understand what remained the issue.

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Desk Research

Pervasive issues related to EMRs were:‍

Time

Also felt by patients, physicians spend almost half their time at work using an EMR.‍

Burnout

Percentage of EMR use correlates with burnout.‍

Retirement

Those who struggled retired earlier than otherwise planned.

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Problem Statement

EMRs take too much time to learn and use. This disadvantages those with disabilities most.

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Solution?

Though I completed thorough desk research, I wanted a better understanding of how EMR users experience the product. I reached out to nine medical professionals in my personal network to learn what their stresses were.

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Interviews

Most of my interviewees had experience with Epic, some used AllScripts (or Sunrise), and one used Cerner. I wanted the full picture about their interactions with their EMR, regardless of their accessibility needs.

Some questions I asked were:

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Ease of use

• How would you describe your training for your EMR?
• How do you feel about the EMR you use most regularly?
• Which EMR would you recommend to a colleague?
• What do you use an EMR most for?
• Can you describe the workflow?
• What are more complex tasks you need to perform a task which require an EMR? 
• How long does this process take?

Features

• What are essential features for you?
• If you could add a feature, what would it be?
• If you could remove a feature, which would it be?

Disability

• What are your thoughts on the speech to text function?
• What disability functions are you aware of in your EMR?

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Research Synthesis

I organized my research notes into affinity maps, user stories, and a persona.

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Clean the interface

The key takeaway from the interviews was the need for less information on screen. Other interviews suggest the same as they described repetitive tasks and a drawn-out process to writing notes.

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Exploring accessibility

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There were various opportunities noted when it came to improving or creating accessibility functions. One of primary interest were adjustments to the speech to text transcription function which is currently a popular (but expensive) add-on.

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Pivoting

Ideations for accessibility functions (like voice to text transcription improvements) seemed out of reach. Based on the resources I had, I found it was most feasible to work on general design issues that may benefit everyone.

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User Stories

User stories helped identify useful paths to move forward with: 

• I would like to search cancer diagnoses by diagnostic codes so I can pull up presets faster.
• I would like to customize presets so I can streamline my workflow.
• I would like to add note templates so I can customize my workflow.

Reflecting on the insights, the design problems in my scope were:

• Notes take too long to write.
• There are too many “clicks” in modern EMRs.
• There are too many features on the screen.

Persona

Drawing from the main issues my persona, Dr. Oh Oncologist, had, I decided to look for ways which would pointedly solve her troubles with an EMR which affected her home life.

Clear frustrations include:

• there's too much clicking
• the system is too repetitive
• there are too many windows on the screen

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Refined Problem Statement

Common EMRs have too many (sometimes repetitive) features on the screen which affects the speed of writing notes.

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Solution

Improve the EMR interface to make it simple and straightforward. No more unnecessary, repetitive, or hidden features.

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Implementation & Testing

From site maps to user testing, I saw my ideas and features change over several iterations.

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Information Architecture

The site map covered everything I thought was essential for an EMR's use. Drawing this up gave me a foundation for the sketches I created thereafter.

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Guerilla Testing

Notes tab and the interface shows a blank note to fill in. This feature is for those times a few ideas need to be jotted or for any impression which may not warrant a formal template to fill out. During my guerrilla testing, participants found this a useful idea.

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Designs

The idea did not hold well during the first round of testing.

• It blocked the rest of the notes page, giving the impression this was the most important task when visiting a notes page.
• I seemed to have misunderstood what one physician had said, “The most important thing about being in medicine is note-writing.” The conversation itself covered how long it took to write a note, but I could have better understood that writing a note can entail reviewing older notes first.
• “Note-writing” may encompass actions ranging from adding onto another note, referencing, and perhaps much more that I did not think to look into.

"Instant Note" feature iteration

Below:

1) Wireframe of the Instant Note feature

2) First Design of the Instant Note feature

The first design interface was also considered "boring." It was intuitive enough, but improving the color scheme couldn't hurt.

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Re-visiting the site map

The overall idea of simplicity was lost on my users. I thought to change the layout from deep to flat.

High Fidelity

In my final iteration, I removed the feature.

A different idea for making the note writing experience faster was to add a plus sign on the page. Clicking on this would mean adding a new note. I added the option to select a previously used customized note (pre-set) or a template from Emerald.

It was recommended to remove "pre-set" and "template" and only keep the plus sign. The plus sign is intuitive enough and made the other options - so after clicking the plus sign, a user is then prompted to choose which kind of note they want to move forward with. Users found this intuitive and it fit their demand for personalizing their notes.

Overall improvements

Medical professionals who tested the EMR found two key improvements in this prototype than in their current systems. The note writing feature and the interface was considered more intuitive and fun to use.

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Prototype

Check out the final design prototype below.

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