Workflow1

Project details

A project management system made at a healthcare startup in conjunction with the Oncology Nursing Society and a prominent hospital. Patients are given a responsive web application to report medication adherence and side effects. Nurses are given a dashboard tool to create instructions and receive reports. This project made it to pilot testing stage. For this example, I will focus on one aspect: creating and receiving personalized medication schedules.

What I did

• Extensive research, shadowing and interviewing of patients and nurses

• Created all initial sketches, wireframes and prototypes

• Worked with in-house and outsourced developers by delivering specs

• Performed extensive QA

• Worked with graphic designer to add aesthetic layer

Tools used

• Omnigraffle

• Axure

• Photoshop

• Plan IO

Lars Lindahl, UX Designer, Workflow Example

(c) Lars Lindahl 2015do not distribute without Lars Lindahl’s permission

The Challenge

For example, a patient with advanced breast cancer may receive treatment with tablets of lapatinib and capecitabine.

She needs to take the lapatinib once a day, 1 hour before a meal or 1 hour after a meal, while the capecitabine should be taken twice daily, with food or within 30 minutes after eating.

1) Medication schedules for patients can be very complex especially in regards to meal times.

2) Nurses use paper to explain to patients how to take their medications. This is inefficient.

Identifying the Pain Points

• Urgency of fasting restrictions is not emphasized

• Too much reliance on patients to adhere

• Patient lifestyles now revolve around medications

• Nurses always need to look up these protocols

• Dosage changes are difficult to communicate

Discovered through research, shadowing, interviewing

Sketching Initial User Interactions

Patient Alerted

Initial Interactivity

Dosage Changed

Medication Added

Medication RemovedFull Schedule

Updated

Read Only Materials Updated

Usage History Stored

Make Your Own To-Do List

InteractiveData Stored

Patient Created Medication &Dosage Selected

Patient Interface Created

registration…?

Initial Set Up

Welcome Screen

Interactions Expanded

Adherence Responses

Data Stored

alerts?daily reports

Side Effect Reported

Data Stored

alerts?

Question Asked

Data Stored

alerts?

Dosage Changed

App Updated

alerts?

Materials Sent

App Updated

alerts?

Adherence Adjustments

Data Stored

alerts?

Staff Patient

Lars L

indahl

Approved Solution, part 1

Fasting protocols for each medication are digitally stored in centralized system maintained by the hospital

Specify fasting requirements

Create a medication type

Create a dosage type

Specify frequency of usage

Specify times of usage

Specify strengths of usage

Store dosage types

Create additional dosage types

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For each patient, nurses will retrieve and input traditional meal times. Appropriate medication times will then be generated from this data.

Attach medication type with patient

entity

Attach stored dosage type with patient

entity

Unique usage times are computed & recommended

Select usage times

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Confirm start date17

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Patients can view their daily schedules with both meal times and medication times clearly indicated.

Select usage times

Recipient receives customized scheduling

Select new usage times

Recipient receives customized scheduling

Recipient receives alerts revolving around this schedule

Recipient receives alerts revolving around this schedule

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Confirm start date17

if changing schedule

Lars L

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Comparative Analysis Example - MangoHealth

Mango initially provides food instructions but they are buried within larger education material

There is no mention of food when patient is pinged to take medication

Authoring Dosing Protocols (Structure)

Indicate whether [Bundle] should be taken with or without food

With Without With or Without

The patient should take [Bundle] at least:

1 hour before eating

or and

hour after eating

2 hours before eating hours after eating

How to TakeFasting Instructions

List the dosage types below:

Name this typeStandard Dosage or

Indicate the number of doses per day for Standard Dosage:

twoone three four

Indicate the dosage strength for Standard Dosage

800 mg

Indicate the time each dose should be taken for Standard Dosage:

First Dose:

Second Dose:

when you wake upsometime in the morningsometime in the afternoonsometime in the eveningbefore you go to bed6am - 12pm12pm - 6pm7pm - 12am

Indicate the Time On / Time Off schedule for Standard Dosage:

none

Days On Days Off0 0

Add This Dosage Type

The following prototype was used to get feedback from nurses —>

Lars L

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http://vvo36m.axshare.com

Selecting Patient Lifestyle Times & Medications

First Name Last Name

Date of Birth

MM/DD/YYYY

EHR ID

###

General Patient Info

Patient Lifestyle Info

Breakfast

Lunch

Dinner

Wakes Up

Goes to Sleep

5am6am7am8amother

9pm10pm11pmother

5am6am7am8am9amother

11am12pm1pmother

5pm6pm7pm8pmother

Select Medication

Select one or more medications

Medication Medication Medication Medication




Select Times

most common:

browse all

Lars L

indahl

Applying Appropriate Medication Times

select Zytiga times:

select Prednisone dose 1 time:

10 am 11 am

With Zytiga, the patient can not eat at least 2 hours before a meal and 1 hour after a meal. The patient should take 1 time some time in the morning

With Prednisone, the patient must take with food 2 times sometime in the AM & sometime in the PM

select Prednisone dose 3 time:

With Prednisone, the patient must take with food 2 times sometime in the AM & sometime in the PM

Dose Timeline

Breakfast

Lunch

Dinner

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1

7

Zytiga

Prednisone 1

Prednisone 2

9 am

7 am

7 pm

new time

new time

new time

1 pm2 pm3 pm4 pm5 pm6 pm 8 pm9 pm10 pm11 pm12 am

recommended:

recommended:

recommended:

The Start Date for Votrient has not been set

But you can start preparing now:

Set a Time to Take the Drug

Read About How to Take This Drug

Votrient must be taken on an empty stomach . It must be taken either one hour before eating or two hours after eating

You will take this drug every day at

Set a Time

Time Unkown

Important

When do you normally eat breakfast?

8

When do you normally eat lunch?

1

When do you normally eat dinner?

7

Next

B

L

D

select a time to take Votrient

7am 10am

12pm 3pm

4pm 5pm

6pm 9pm

10pm 11pm

V

Confirm

If “Anytime” is Selected by Care Team

B

L

D


7am 10am

V

Confirm

If “Sometime in the AM” is Selected by Care Team

B

L

D

Did you take Votrient?

Y N

Today’sSchedule

menu menu

Change Default Times

Change Only Today’s Times

When doe you eat breakfast today?

8

When doe you eat lunch today?

1

When doe you eat dinner today?

9

Next

B

L

D


7am 10am

12pm 3pm

4pm 5pm

6pm 7pm

8pm 11pmV

Confirm

change

/record as an exception

Lars L

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Applying Appropriate Medication Times - Iterations

Drug 1

Drug 2

Schedule

Profile

Add Plan

Bundle2

Concifrm Changes

[Bundle1][start date]

First Dose: Sometime in the morning

no time selected

Second Dose: Sometime in the evening

no time selected



another time



no time selected

no time selected

7:00 AM

8:00 AM

9:00 AM

10:00 AM

11:00 AM

another time

another time 12:00 PM

12:00 PM

1:00 PM

2:00 PM

3:00 PM

4:00 PM

5:00 PM

6:00 PM

7:00 PM

8:00 PM

9:00 PM

10:00 PM



12:00 PM

does not exceed past sleep time (10pm)

does not include recommended times

8 amwakes up

1 pm

11 pm

eats breakfast

eats lunch

eats dinner

goes to bed

11 amZytiga Dose

6 pmPrednisone Dose #2

9 amPrednisone Dose #1

Zytiga DoseMust be taken without food. Do not eat 2 hours before taking and 1 hour after taking

Recommended times for this patient:

11 am 12 pm 8 pm 9 pm

Prednisone Dose #1Must be taken with food

9 am 1 pm 6 pm

Prednisone Dose #2Must be taken with food

9am 1 pm 6 pm

select different time



10 pm 11 pm



John’s Day Schedule

Lars L

indahl

Patient Portal Interface (Initial Sketches)

9 pm

8 pm

7 pm

6 pm

5 pm

4 pm

3 pm

2 pm

1 pm

12 pm

11 am

10 am

8 am

9 am

7 am Good morning

Take drug 1

Take drug 2

Do not eat

Do not eat

Do not eat

Lunch time

Breakfast time

Dinner time

Take drug 1

[Day][Month] [Day #]

Drug 1 Drug 2

STATUS Home Instructions Side Effects EducationCalendar

view full calendar

7:00 AM - 10:00 AMDo not eat for three hours

Did you take this yet?

I did Remind Me No I can’t

9:00 AM - Heads up! Take 2 medications at this time

Ok to eat10:00 AM

Zytigatake 4 tablet

Lars L

indahl

Patient Portal Interface (Iterations)

medications tracking

reportsymptoms

appointments more

STATUS

home

8:33 AM

7:00 AM

Do Not Eat For the Next 2 Hours

8:00 AM

Do Not Eat For the Next Hour

Take 4 Tablets of Zytiga

9:00 AM

TIME RIGHT NOW

8:33 AM

3:30 PM

Symptom Review with Nurse Taylor

Your Schedule for Today

6:30 PM

Take 2 Tablets of Prednisone

show instructions

show instructions


reportsymptoms

appointments more

STATUS

home

Today

8:33 AM

10:00 AM

8:00 AM

7:00 AM


Do Not Eat For Next 2 Hours

Do Not Eat For Next 1 Hour

Do Not Eat For Next 1 Hour

MAY 1, 2014

How To Take These Medications

Time Right Now

5:00 PM


How To Take These Medications



9:00 AM

Lars L

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iOS provider info / time / battery indicator returns in this screen

Up next event follows same logic as previous wireframe design

timer counting down time between event time and internal iOS time. Appears as hh:mm:ss

Only show this message if up next Medication is Zytiga. See Plan IO spreadsheet for eating instructions for each medication (eat.xslx)

Tapping this button opens menu as shown in final page of this document

Swipe Medication name to the left to reveal full instructions (see next page of this document)

Example if only one event is up next In this case, it is 11:00 AM Zytiga. also could include: 7:00 PM Prednisone & 11:00 PM MS Contin

Tap this link to open flow seen in page 3 of this document

Static text for single medication

Annotations Examples - Patient Portal


reportsymptoms

appointments morehome

Great Job So Far Today!

September 22, 2014


What’s Next

[Time]

[Action]

Full Schedule

[status]

What’s Next

10:30 PM

Take 1Tablet of Prednisone

Full Schedule

7:00 AM

Do Not Eat For the Next 2 Hours


9:00 AM 9:0


Great work!

Don’t take this dose yet

8:00 AM

Do Not Eat For the Next Hour

Take 1 Tabletof MS Contin

10:30 AM

Take 1 Tablet of MS Contin

12:30 PM

medications tracking appointments morehome

reportsymptomsGreat Job So Far Today!

Home Screen on Landing Home Screen in Action (Example)

1 - The home screen (seen when first opening app & also accessible from first icon in the footer) lists the schedule for the day

2 - Each card represents an action for the patient. See Google app’s card structure for similar layout here . Action names / times / statuses / icons / types are all listed in the spreadsheet for both Patient A & B.

3 - The “Your Schedule for Today” display shrinks and sticks to header when the user slides down to see full list. It returns to larger display when sliding back up to the top.

4 - The event that shows up in the “What’s Next” section is determined by the upcoming event based off of the internal clock in the phone. If the internal clock is past the events listed, include statement “All done for the day :)” instead of a card like such:

Great work!

Great work!

10:30 PM

What’s Next

All done for the day :)

Full Schedule

5 - If multiple events occur at the same time, show event marked PRIMARY in spreadsheet first and show glimpse that there is another card to its right. Swiping to the left reveals that card and swiping back right reveals the original primary card.

6 - Actions marked “Additional Instructions” in the Type column of the spreadsheet should be more condensed cards. They should be half the height of a normal action card.

7 - Actions have different statuses & color icons depending on if they have occurred after or before the internal clock time.

Take 1 tablet of MS Contin

11:00 AM

You missed this dose. Please only take your normal dose tomorrow

x


12:30 PM

Don’t Take This Dose Yet


12:30 PM

Great work!

Example of Rows 6 & 14 of Spreadsheetif action is BEFORE the internal clock

Example of Row 6 of Spreadsheetif action is AFTER the internal clock

Example of Row 14 of Spreadsheetif action is AFTER the internal clock

shrinking header sticks to top

slid

e to

scr

oll

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s Lindah

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Demo

Setting Patient Timeshttp://recordit.co/zgBTeDMZvS

Lars L

indahl

Demo

http://recordit.co/UzqXNbuh2yPatient Portal - Version 1.0

Lars L

indahl

Thank You!

Contact Info

Lars [email protected]