MOSAIC PCN (Primary Care Network)
Digitizing Patient Records
With An Automated Form Builder Application
Role: Lead UX Researcher (sole)
Impact: Informed the design and development of a form builder application that populated a cloud-based patient information database, allowing patient records and data from forms to be automated, stored, accessed, and used for medical research and improved healthcare across Mosaic PCN clinics in Canada. This form builder application was expanded upon and considered to be a core template for future products.
Business Need: Digitize and streamline the cumbersome hardcopy patient information workflow for Mosaic PCN clinics via a form builder application, thereby increasing efficiency and assisting in the continuity of patient care. Additionally, allow physicians to view and track records for informational consistency, diagnosis, and screening of changes in patient status.
Deliverables: Write the functional requirements document for the form builder application; design the information architecture; create use cases, process/task flows, diagrams, and design the lo-fi mock ups.
Note: Details limited due to NDA.
Research Objectives
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Identify where typical information gaps to a "patient's story" occur
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Connect and automate the pieces of the story within a comprehensive, user friendly workflow pertaining to the form builder application, with the relevant user experience for each target user group
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Within the form builder application, identify opportunities and key information that assist healthcare professionals in providing accurate, timely, and effective care for their patients
Methodology
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9 x 1-hour interviews with users representing each of the three target user groups/roles (Mosaic Administrator, Physician, Patient)
The following whiteboard images convey their processes, which were then transcribed into digital diagrams.
Analysis
Subsequently, analysis began with the development of personas and user stories. There were three primary user roles with distinct needs and uses within the larger digitized process that was to be implemented.
1. Mosaic Administrator (MOA)
User Story: “As an administrative assistant for Mosaic PCN, I can select a form from the Mosaic application on a tablet so that I can hand it to a patient to fill out.”
Permissions: They have the ability to access View, Edit, Patient View, Save, and Submit. They may or may not have permission to access the Form Builder (to create forms).
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The person who tends the front desk of the Mosaic PCN clinic
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There may be several different people in this role per clinic
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This role can span across numerous clinics
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They are responsible for the initial face-to-face interactions when a patient arrives at the clinic, which includes managing the retrieving/selecting, submitting, collecting, and saving of forms
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They are responsible for forms being correctly filled out and saved to the database
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If a patient fills out a form incorrectly, it is the MOA’s responsibility to return the form back to them and have it filled out correctly
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They may or may not be responsible for creating new forms
2. Patient
User Story: “As a patient with Mosaic PCN, I can fill-out a form on the tablet so that the attending physician can view it prior to seeing me.”
Permissions: They have the ability to access Patient View.
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The person who has an appointment at a Mosaic PCN clinic, along with an attending physician
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They will be required to fill out one or more forms correctly
3. Physician
User Story: “As a Mosaic PCN physician, I can create a new form in the Mosaic Form Builder app so that we can have the most relevant, digital forms available for our clinic.”
Permissions: They have the ability to create new forms through the Form Builder and can access View, Edit, Patient View, Save, and Submit.
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The primary person who has access to the Form Builder component with the ability to create a new form, edit, and save new form templates
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The person who primarily views the completed forms patients fill out and the MOA saves
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They primarily view these forms prior to seeing a patient, though may at any other time
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They also analyze the content in the patient records in order to inform patient diagnosis and improve patient care
These user profiles corresponded to permissions categories and identifying their related access and functionalities. These included:
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View: this permission allows the user to view a form, whether it is empty, partially filled-out, or complete
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Patient View: this permission allows the user to edit (fill-out) a form on the tablet device
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Edit: this permission allows the user to edit the input contents of a form
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Save: this permission allows the user to save changes made to the input of a form, which further allows a user to select it again for editing
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Submit: this permission allows the user to save a filled-out form, which subsequently allows for viewing but not editing
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Form Builder: this permission allows the user to access the Form Builder component of the application, along with the ability to create form templates, retrieve and edit existing form templates, and save form templates to be used in the primary form management (Dashboard) component of the Mosaic PCN application
Accessibility
Because the Mosaic PCN target audience for the filling out of forms in the tablet interface is highly varied and must be user-friendly for people who may have a variety of disabilities or impediments, accessibility is paramount. These limitations may relate to level of experience with technology (particularly with touch-screen interfaces), visual/cognitive ability, motor skills, or reading skills.
Core accessibility and design principles included:
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The Back Button as a safeguard
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Scroll ability vs. clicking into multiple additional pages
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5th grade reading level
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Touch targets at minimum 44 x 44 pixels
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Allow users to zoom in or increase font (responsive and flexible layout)
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Provide simple, clear, and constructive error/feedback messages
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Keyboard functionality for all elements (in the use case they are accessing the form on a laptop or desktop prior to arriving at the clinic)
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Generous spacing between items (apply the 4-point spacing system)
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Wizard assistant (guided step-by-step taskflow or workflow)
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Icons along with text in the design of buttons
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Interactive elements are not towards the edge of the screen
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High colour contrast
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Colours should be used conservatively
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Blue and green tones are avoided
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Using more than one cue to highlight important information
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Usable focus states, making them look different from the elements around them
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Labels and instructions for each form field and input
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Useful alternative text connected to images and other non-text content
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Well-defined hierarchy of content (and visually clear)
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Larger touch targets (e.g., calls to action), to include larger font sizes
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Clear confirmation of target capture
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Relevant graphics and no animation
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Icons should be simple and meaningful
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Irrelevant information is avoided on the screen
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Information is concentrated mainly in the centre
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Screen layout, navigation, and terminology are simple, clear, and consistent
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No timer or auto screen lock; there is ample time to read information
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The demand on working memory is reduced by supporting recognition rather than recall
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Minimal number of questions (10 or less)
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Fewer choices/answer selections to questions
Here are just a few of the lo-fidelity wireframes I designed for the form builder application.
Key Insights
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Time consuming process: the time it typically took for patients to fill out forms when they arrived at the clinic often led to delays for physicians, administrators, and subsequent patients being seen.
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Resolution: the application needed to have the ability for forms and messages to be emailed to patients prior to their arrival at the clinic.
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Most patients experienced some degree of stress, anxiety, or frustration when filling out the hard copy form at the clinic. Being unclear on what the questions were asking added to their stress. All of the above resulted in either incomplete forms, untrue responses to the questions, illegible answers, or incoherent answers.
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Resolution: simplify the language of the form (to 5th grade reading level); ask only necessary questions; provide Wizard guide to walk patients through every step; provide clear explanations for questions and terms; make the design language of the forms engaging, friendly, and empathetic.
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Because answers on patient forms were often incomplete, illegible, untrue, or incoherent, that data was unreliable, leading to big information gaps in the 'patient's story', and possible patient care oversights and misdiagnoses. If the physician only has access to what the patient has written, physicians and nurses rely on patient interactions to discern what is occurring; they subsequently rely on what notes were added in order to gain a picture of the patient's story.
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Resolution: convey notes and data from the forms in a way for physicians to easily see a patient's history (or, "story"), allowing them to more easily make patient-related decisions and diagnose.
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Business Impact
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Cost Savings: 30% savings in administrative costs due to reduced manual data entry, which minimized errors and the need for rework
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Patient Satisfaction: 70% of patients preferred digital forms, leading to higher satisfaction rates
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Efficiency Gains: allowing patients to complete forms in advance reduced wait times by 26% and increased patient retention by 30%
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Accuracy Improvements: the digital forms reduced errors by 35%, leading to better patient care, patient safety, and compliance