Dialysis Note
Making it easier for doctors to access and document patient information using Electronic Health Records. Senior Honors Thesis in Design at UC Davis.
Timeline
October 2022 – June 2023
Tools
Figma, FigJam
Team
Laura Yien – UX Researcher and Designer
Bill Mead and Dr. James Housefield – Faculty Advisors
01. INTRO
Problem
Doctors and healthcare workers use Electronic Health Record (EHR) software systems to access and document patient information. Many of these systems are difficult to use, causing healthcare workers to spend extra time on documentation instead of patient care. Poorly designed EHR systems are among the leading causes of burnout among doctors.
Goal
Empower healthcare workers to efficiently navigate electronic health record systems, freeing them to focus on patient care.
Solution
While problems with EHR have been documented in the medical field, there has been little exploration of tangible design solutions. Through this project, I investigated how to improve the usability of EHR interfaces through user interface/user experience (UX/UI) design. I designed my own version of EHR called Dialysis Note based on interviews I had with doctors, nurses, and social workers who work at dialysis clinics and specialize in caring for patients with kidney diseases.
02. RESEARCH
Defining Scope
In the early stages of this project, I considered pursuing other topics, but ultimately, I decided to focus on EHR systems after speaking with a Design Thinking Consultant at UC Davis Health. She suggested that I focus on improving EHR systems because there had been little focus on improving the user experience for healthcare workers. Many doctors and nurses had voiced their frustrations and problems with these systems, but there had been little exploration of tangible design solutions. I chose to focus on EHR systems because there was the biggest opportunity to design something new and meaningful.
Epic EHR, used at UC Davis
I focused my project on nephrology, which is a field that specializes in kidney care and diseases. My aunt is a nephrologist who works at UC Davis Health and other dialysis clinics in Sacramento. She regularly spoke about her frustrations with EHR systems and the extra time to documentation costs her normal work hours. When our family gathered on New Years Eve last year, she was still on her computer inputting notes and updating patient charts. After witnessing how inefficiencies with EHR were impacting not only her work, but also her personal life, I was inspired to focus on her speciality.
Conducting Interviews
I interviewed healthcare professionals in Sacramento who used EHR in dialysis clinics and specialized in kidney care. I interviewed 5 doctors, 3 nurses, and 1 social worker. During the interviews, I asked my participants about their role, pain points using EHR software, and features that they would like to see in an ideal EHR system. Prior to conducting these interviews, my project was approved by the Institutional Review Board at UC Davis, which assures all academic research is conducted ethically.
Interview Findings
01 Inefficient EHR Charting
Doctors do not take notes on the computer in real time because it takes too long. Some doctors take handwritten notes and others do not even take notes while they visit patients solely relying on their memory. They spend extra time afterwards inputting notes into the EHR
02 Impersonalized Systems
Current dialysis EHR doesn’t automatically recognize when each doctor is logged in. There are several steps for them to find their patient info. They need to navigate through multiple windows and drop down menus to find the correct charts and patients.
03 Need for Templates
Doctors, nurses, and social workers need chart templates to document efficiently, but the template creation process is difficult.
04 Confusing Feature Names
Buttons for key features have labels that make it difficult to understand their purpose. For example, to save a note to sign it later doctors have to click on a “Lock” button, which was confusing for many of them.
05 Infrastructure Needs Funding
Buttons for key features have labels that make it difficult to understand their purpose. For example, to save a note to sign it later doctors have to click on a “Lock” button, which was confusing for many of them.
03. DESIGN PROCESS
Sketches
After identifying these key findings, I started sketching solutions. I also decided to focus on designing for nephrologists (doctors) specifically instead of nurses and social workers who had different workflows. I knew that I was not going to be able to redesign an entire EHR system, so I narrowed down my focus to three main features.
Flow 1: Home Page
How might we make it easier to view and access patient information?
Flow 2: Patient Chart
How might we make it more efficient to input patient information?
Flow 3: Templates
How might we make it easier to create and use templates?
Low Fidelity
From there, I translated my sketches onto Figma as low-fidelity wireframes.
Design System
Next, I developed the design system and branding for Dialysis Note. I wanted the designs to be clean and easy to understand so I used a minimal color palette and readable sans serif font. I made an interactive prototype for the home page, chart, and patient search user flows.
Undergraduate Research Conference
On April 28, 2023, midway through my project, I presented my mid-fidelity prototype and progress at the Undergraduate Research Conference at UC Davis. My biggest takeaway was learning how to communicate my project to different audiences. I explained my project differently depending on my audience’s familiarity with design and healthcare fields.
User Testing
After the Undergraduate Research Conference, I conducted usability testing with the mid fidelity prototype. Afterwards, I made changes based on feedback.
Changed toggle labels for shifts and locations to match clinic workflow
Added a "More History" button to access more information
Added a way to link templates to default notes
Created an individual patient page with all relevant information.
04. FINAL DESIGNS
05. TAKEAWAYS
Project Implications
Throughout the research and design process, it was clear that most issues regarding EHR can be mitigated through a human-centered design approach – designing for the needs of the people who use the software. As one doctor explained to me, EHR systems and the entire documentation process has been designed for needs of insurance companies who use the information to determine cost and reimbursement for treatment. There has been little focus on the needs of the people who use these systems every day. Ultimately, by improving their experience and efficiency with EHR, doctors and nurses can be freed to spend more time and energy caring for patients. Improving EHR systems can not only increase the efficiency of documentation, but the quality of patient care.
Next Steps
Some next steps for this project would be to conduct usability testing on the final prototype with more doctors and dialysis clinic workers. Additionally, while I focused on the patient encounter chart, I would like to also explore how Dialysis Note would work with other templates and charts. Thinking further, I would be interested in exploring how design patterns used in Dialysis Note could be applied to EMR systems in different medical specialties.
Reflections
The most challenging aspect of this project was not the designing but navigating the academic system. I had never worked on an honors project before, so I learned how to be proactive in reaching out to professors and academic advisors for help writing my proposal, abstract for the research conference, and application for the Institutional Review Board. I also took initiative when reaching out to healthcare workers to be interviewed. I learned how to advocate for myself and my project to make sure I was meeting all department requirements and deadlines. I was responsible for all aspects of my project, and I had to be proactive to ensure I could complete it.