CLINICIAN DESKTOP
on behalf of EDIMS, LLC

 

THE CHALLENGE
EDIMS, a small privately-held company was a leader in decision support for Hospital Emergency Department (ED) clinicians throughout the Northeastern United States. Their underlying technology was good, but their user experience was outdated and, for some key interactions, overly-complicated. In the life-or-death environment of the ED seconds really count.

THE DESIGN OBJECTIVE
What would a ground-up redesign of the EDIMS user experience look like if we prioritized ease-of-use, configurability and the speed of key workflows, including physician and nurse charting, patient triage and assignment of billing codes?

Patient dashboard view of the Clinician Desktop

From the design documentation for patient chart panel.

Representative page from the design documentation I created for EDIMS Clinician Desktop. This was years before Sketch & Figma would revolutionize the way we document design.

DESIGN PROCESS

Platform: Client-server application for Windows computers.

Identifying the Problems
The environment of the ER disrupts much of the received wisdom about usability (such as data density and readability conventions) while rendering other aspects — like guidelines around color blindness – even more important. It was an environment I had to experience to understand.

Over a year, I conducted dozens of in-ER observations, usability tests & staff interviews to learn how they worked under life-and-death pressure. Observations helped me understand what was valuable and what was outdated in the existing application.

The old EDIMS system in the ER

 

Forming Design Hypotheses
I started sketching design hypotheses and creating flow diagrams to memorialize the processes I was seeing. It was a time of continually vetting assumptions with clinical personnel and making adjustments.

Learning Whom I Was Designing For
Additionally, I created a “Persona Board” where I encouraged staff to come by and talk about their role. I collected input about their responsibilities, key questions that symbolized their job functions, and daily activities. I began assembling the personas and leaving them posted around my desk. Soon my workspace was home to frequent, informal discussions about the emerging designs. My interview subjects became my collaborators.

Sketch of a nurse charting interaction that came from a design workshop.

Persona worksheets that hung by my desk. Clinical co-workers were invited to read and append notes when they walked by.

Emergency clinicians are used to consuming large amounts of information very quickly. It became clear that information levels which would overwhelm the average person were necessary in this environment. The key would be to surface the most important data, facilitate quicker location of key information, and better navigation into and out of patient documentation details.

Structuring Ideas
With all the inputs, ideas came easily. The challenge was figuring out which ones were truly worth pursuing and which should be placed on a someday/maybe list. These were not decisions I could make on my own. I used sketches, mixed-fidelity wireframes and flow diagrams to “audition” features for evaluation. Scope continued to evolve into the design phase, but regular stakeholder communication kept the project focused on clinician needs, regulatory obligations and patient care.

I sketched, storyboarded and diagrammed as concepts came together.

Design & Documentation
I moved forward with use cases and detailed wireframes. With a system as intricate and mission-critical as patient documentation, I needed to go beyond simple annotated wireframes. I created a 100+ page UI specification document, describing the expected function and behavior of each component. 

As I was designing and documenting, the UI development team was building out modules to support usability testing. Each week I would have clinical staff try out aspects of the system—either in prototype or simply using “paper prototyping” with wireframes. I could use this essential input to feed revisions and track down “sticky” spots.

Wireframe of a nurse charting module

Use case with integrated diagram

EDIMS Clinician Desktop
The final system was an enormous step forward in patient documentation for EDIMS and met with significant clinician enthusiasm. Chief among the new features: clinical charting for doctors and nurses was combined with the patient grid; the system was aware of the clinician user and saved their preferred screen arrangements; and live filtering allowed immediate access to desired patient.

TOOLS & METHODS

  • Ethnographic research including numerous hospital observation visits

  • Use case creation & flow diagrams to enable consensus

  • Subject Matter Expert (SME) interviews with ER doctors, Nurses, and non-clinical staff

  • Facilitated In-person collaborative workshops with clinicians to evaluate ideas and priorities

  • Rapid prototyping with paper & pen, illustrator and code (in partnership with development team)

  • Design artifacts created in OmniGraffle, Illustrator and InDesign.

  • Functional & Design Specification documentation created in InDesign

  • Usability testing done in person

THINGS I LEARNED

  • Designing for desktop applications has more constraints than for the web. When that software needs to run on off-the-shelf hardware within an institution like a hospital, you had best ensure your code is optimized.

  • The best product doesn’t always win. Despite being overwhelmingly preferred by clinicians I interviewed, EDIMS would regularly lose bids in favor of rivals that provided poorer experiences — but were enterprise-wide solutions.

OUTCOMES

  • The new system was greeted with tremendous clinician enthusiasm.

  • Significant improvements in Time on Task for key workflows.

  • Discovery of important workflow “hacks” customers were using that opened up new business opportunities.