Developing a electronic health record system for a network of over 40 outpatient clinics, pharmacies, and diagnostic centers
Electronic Health Records
Developing a electronic health record system for a network of over 40 clinics, pharmacies, and laboratories.
Program
Role
Methods
Center of Integrative & Development Studies
Senior
Research Analyst
Workshops, contextual analysis, workflow analysis, prototyping, usability testing, survey
Tools
Miro, Figma, Qualtrics
Timeline
6 months to MVP
Recurring evaluation
The challenge.
The research strategy.
My team and I spearheaded a transformative pilot initiative, transitioning public and private service providers from traditional analog systems (i.e., paper-based) to digital platforms. Our clients wanted to consolidate outpatient, pharmacy, laboratory, and satellite clinic services and their respective referral networks into a cohesive system.
Our goal was to develop a web-based electronic health records system to synchronize services across a complex network of outpatient facilities.
Our development of the prototype and functional beta version was driven by a multi-phased generative research initiative, involving stakeholder workshops, contextual inquiries, and a workflow analysis.
Participatory Workshops
We crafted 'How Might We' white-boarding sessions to probe into ways patients can be registered efficiently, records can be streamlined, and collaboration across departments can be supported.
Workflow Analysis
Workflows in facilities that include an in-house laboratory and pharmacy are often intricate. To understand these complexities, we charted the average patient journeys from intake to discharge.
Artifact Collection
Contextual Inquiry
We conducted participant observation sessions across the network of facilities to observe operations and identify pain points.
Our approach involved the collection of artifacts, such as patient intake forms, paper charts, billing statements, and prescriptions.
Understanding user insights.
I distilled critical feedback and suggestions across the spectrum of care—from first contact to ongoing care management. Insights from our generative research initiatives were instrumental in shaping the initial prototype.
From insights to design solutions.
In a span of six months, our team advanced from ideation to the implementation of a functional EHR system.
This was achieved through iterative UX design practices -- involving wireframe development, low-fidelity prototype creation and refinement, and a phased deployment of the minimum viable product at an urban pilot site.
Pain Point
Issue 1: Lengthy wait-times for patient intake and triaging.
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In-network facilities experienced extended patient wait-times.
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Lengthy registration processes required upon intake and the presence of duplicate records.
Design Intervention
Feature 1: Integrated Digital Registration System
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Documents patient's insurance and social welfare data.
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Tags patients' coverage eligibility.
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Prevents duplicate registrations.
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Automates patient queue.
Pain Point
Issue 2: Fragmentation in patient data sources.
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Healthcare providers expressed difficulties sourcing and updating past patient records.
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Administrators noted the lack of quality of care monitoring mechanisms.
Design Intervention
Feature 2: Consolidated Patient Chart
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Streamlines patient record management with a click-to-edit feature for charts, medical histories, diagnostics, and medication details
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Predictively tags ICD codes on patient charts to monitor quality of care indices.
Pain Point
Issue 3: Punctuated patient journeys & in-network workflows.
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Workflows between providers, laboratories, and pharmacies experienced considerable operational fragmentation, leaving the onus of care navigation upon patients themselves.
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Patients expressed difficulties recalling and reporting diagnoses to each provider upon referral.
Design Intervention
Feature 3: Built-in Referral and Coordination System
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Centralizes referral management.
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Provides multiple access points for lab requests/prescriptions.
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Restricts patient information access to relevant providers only.
Pain Point
Issue 4: Frequent stock-outs and manual inventory tracking.
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Pharmacies frequently experienced stock-outs due to manual inventory tracking.
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In-network providers in facilities with local pharmacies were often uninformed about medicine availability.
Design Intervention
Feature 4: Built-in Inventory Tracking System
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Integrates drug formulary for automated tagging.
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Generates pre-filled medical certificates.
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Consolidates available drug lists within the facility.
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Alerts for stock-outs of medications.
Pain Point
Issue 5: Lengthy claims processing & billing bottlenecks.
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In-network facilities' manual generation of facility reports led to prolonged processing times for claims and heightened the risk of documentation errors.
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Administrative teams noted patient bottlenecks at billing, attributing them to the necessity of manually verifying procedures performed.
Design Intervention
Feature 5: Automated Coverage Monitoring
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Automatically stores data from consults/SOAP charts.
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Transforms patient data into printable reports.
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Captures key health outcome indicators.
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Generates financial and patient expenditure reports.
Note: All names outlined on these prototypes were made by researchers and do not reflect the real identities of patients serviced in the pilot sites.
Evaluating the product.
Tangible achievements.
Following the development of a functional prototype, we engaged in research to evaluate our EHR product. Our methods included conducting in-depth interviews with providers, moderating usability testing sessions with test users, and administrating surveys for patients and providers upon pilot launch.
Usability Testing
We facilitated 5 moderated sessions with a physician, triage nurse, records manager, pharmacist, and laboratory technician.
In-Depth Interviews
Semi-structured interviews with system administrators and implementors were conducted throughout roll-out to assess the compatibility of the product with inter- and intra-facility workflows.
Patient Satisfaction Surveys
Health Provider Satisfaction Surveys
Exit surveys were administered to a minimum of 200 patients to assess their satisfaction towards wait-times, registration procedures, and care coordination
All healthcare providers and administrators who had used the pilot EHR were surveyed across all 40 pilot sites. In total, insights from 128 initial users were obtained for analysis.
Our EHR product transformed and synchronized healthcare delivery across a network of 40+ primary care facilities, 7 laboratories, and 4 pharmacies. Other key outcomes included:
20 Minute
Reduction average wait times for patients in the urban cohort.
95%
User satisfaction among early adopters of the EHR system.
40%
Increase in patient satisfaction across facilities.
100%
Automation of general public health reports across sites.
System Strengths
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Healthcare providers found the SOAP interface to be uncomplicated and easy to use. There was appreciation for the ease of reviewing patient history, including previous consultations and findings.
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The capability for laboratory and pharmacy staff to update patient records, which physicians could then access remotely, expedited patient turnover.
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Physicians valued the automated generation of prescriptions and lab requests, reducing manual input.
Areas for Improvement
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Users with limited technological proficiency faced challenges operating system hardware, such as trackpads, mice, and keyboards.
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There was a need to reconcile the actual number of patients in the queue with the listed number, addressing discrepancies from no-shows.
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Users suggested the implementation of an appointment scheduling system.
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A feature to indicate whether a patient had been seen by a provider upon chart access was proposed.
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Laboratory technicians advocated for enhanced EHR compatibility with diagnostic equipment to facilitate better interoperability.