PatientSite Redesign

The purpose of this project was to create a redesign proposal for Beth Israel Deaconess Medical Center. My focus for the project was to develop a mobile app version of their patient portal, called PatientSite.

Proposal

While I state that I will focus my work on patient scheduling and medical records, this would later change as user testing began to show trends of different needs than what I had initially anticipated. Instead of a section for records, which patients said they preferred to view on their computers, I opted for medical billing. This design change later became a major positive focus point among testers.

Beth-Israel Patient Portal UX Redesign

Focus Of The Redesign
For this project, I will focus on reducing the number of no-show patients. This is to address the problem of time and money being lost on patients who either have forgotten to show up for their scheduled appointment, or decided that they no longer wanted to come in but were unable to give notice. In order to approach this problem, I will look at and address the following features of patient portals: scheduling and patient information.
Who Are The Users Of This Product?
- Chronic Patients, Parents of Patients, or Elderly
- Research showed no true age centroid, majority of users were 40+
- Largest number of adopters and repeat users ranged from 40-49
- Gender skews towards female
What Are These Users Looking To Do/Accomplish?
- Check Doctor’s notes from previous visit
- Schedule future appointments
- Communicate with their provider
- View both medical and billing records.
How will this product be a vehicle to help them achieve their goals?
- Scheduling
  Patients have lives too. Making the scheduling system to be visual allows the patients to see what days and times are still open. Allowing the patient to choose their appointment at their own leisure (given that it isn’t urgent) may prove to have a positive effect on reducing no-shows. The product will then save the date to their calendar, regardless of website or mobile, in order to ensure that the patient can check their appointment time even when they’re logged out. Furthermore, every time the patient logs in they will clearly see at the top of the page that they have an appointment scheduled for some date, with the option to change or cancel it.
- Personal Information
  Patients will want to access their medical and records and maintain any current medications that they have. Having this information presented in a clear and concise fashion, and without overloading the patient, will be necessary for this to function properly. The users will want to sort through this information in ways that make sense to them, and not in a way a doctor would see it.
- Communication
  Being able to view at a glance who their providers are will be something that users will want to do. I suggest having a shortlist of their most contacted providers which should provide a level of convenience to the patient. From that list they can then decide who they wish to contact, or if they wish to contact someone else they can view a more expansive directory.
How big will the User Population be? How Often will they utilize this portal?
- Hundreds of thousands of users.
- Most will access the portal on an infrequent basis; only a few, chronic, patients will access the portal regularly.
- The most likely time period that a patient will access the portal is after an appointment.
What are the economics of this product?
The selling point of this product is a reduction in lost costs due to appointment no-shows. My approach is to offer a flexible scheduling system as well as regular reminders, or push notifications. Additional features of this product that would further increase its value to Beth Israel would be ones that can create a reduction in redundant communications between the patient and their provider.
What is the competition like?
As shown in the client’s presentation, the competition (Epic) does have an updated UI appearance. The navigation architecture was logically planned out. Their scheduling system was all visual and had a relatively large size, making it easy on those with visual impairments to schedule an appointment. However they also missed a few key features that patients wanted. For example, their lab work was all presented together with no way to sort through them or to show only specific kinds of labs. It also put all patient reports in the same section, adding visual clutter to an already information dense page.
What is needed for this project to succeed?
The portal must provide a patient an effective way by which to gauge their status of their account. Before a patient will perform any action, they will almost always want to know what has happened while they were away or if anything new is coming up that they need to know about. This information should convey some information about their most recent visit to Beth-Israel. This may include a brief overview of what was done, why, and perhaps a few outstanding doctor’s notes that they should particularly pay attention to.

It must also have a robust scheduling system that also can remind the patient of upcoming appointments and be easy to use. A patient that schedules an appointment that is weeks, or even months, away should not be burdened with remembering that date. The app should remind the patient of their upcoming appointment as the date draws closer. The app may even suggest to them that they can change the date if it is no longer convenient.
What hardware will the users utilize to interact with this product?
The majority of the users currently visit the site through their mobile devices. Users that will access the site/app will be using an iOS or Android as their operating system. Most users will have their mobile devices up to date, however the site/app should accommodate older versions of those operating systems.
A fair portion of users will still access the website on their home computers. The majority of users will be on a PC, running Microsoft Windows, with some running Linux or operating off of an OSX computer.

Personas

User Stories

I developed these stories to help me better understand the viewpoint of our patients. They eventually took on a life of their own as I began to test my designs with real users.

Melissa's User Stories

Short Stories

When I schedule an appointment, it automatically saves the date to my phone’s calendar.
When I go through my records, it automatically shows me my newest records regardless of what I was searching for last time.

Expanded Story 1

Melissa prides herself on being where she needs to be, when she needs to be. Not a moment too soon or late. While kids can throw a wrench in that at times, Melissa found that using her phone’s planner for her medical schedule is a life saver. She knows that she needs to take another blood test before next Tuesday, so she needs to make an appointment with the doctor. She heads over to her computer and logs into PatientSite. On the side of her screen she quickly spots the calendar icon and clicks on it in order to view her appointments.

The calendar, remembering Melissa’s previous setting, is setup to show only two weeks at a time. It shows Melissa that there are a few openings Thursday morning, or one opening on Friday at 4:30 PM. Melissa checks the calendar on her phone to see if she has anything to do on Thursday and sees that she has a spare bit of time. Clicking on the 9:25 AM slot, she then clicks on the Reserve Appointment button. The site automatically pushes the date and time to her phone’s calendar once it verifies the appointment. This quality of life feature saves her from spending time on manually updating her phone’s calendar. Logging out, Melissa is now fully updated and gathers her things before heading out to pick up her son.

Expanded Story 2

After a long day at work, and a particularly bad day with her kidneys, Melissa finally managed to get home. She gets through the front door, tosses her keys into the bowl and crashes onto the couch.

Melissa enjoys the brief moment of peace and quiet when she gets the feeling as though she has forgotten something. Her eyes slam open as she remembers that her test results came in today. She slowly gets off the couch and heads over to the computer and logs into her PatientSite. Going over to the records page of her account, she is finds that her records are still sorted by test type. She remembered that she was trying to find a particular test result last time she was online. However, despite this, Melissa doesn’t have to change any of her current search settings as the site realizes that a new record was added and asks her if she would like to view it. Clicking accept, the site then downloads the test results and displays them for her to see. Not having to really spend much of her precious energy searching for the result, she gets comfortable in her chair and begins reading.

Michael's User Stories

Short Stories

I can send the data gathered by my sleep monitor through my phone, to my doctor.
Viewing my schedule and managing my appointments doesn’t consume my time and can be easily viewed at a glance.

Expanded Story 1

Michael tries to spend most of his days operating like a normal human being. His sleep apnea was particularly bad last night and wasn’t able to sleep much. He groggily decides that he’s done torturing himself for one night and gets out of bed before the crack of dawn. After he takes the sleep monitor straps off of his wrists and chest, he goes over to and picks up his phone from the charger.

The machine lives next to Michael’s bed, but connects with his phone’s bluetooth receiver. He scans through the graph and sees what he already knows; he had a bad night of sleep. He knows the doctor will want to see the data so he goes over to his records on the PatientSite App. There, he sees a short list of his most recent documents and a button to upload new records onto the system. Pressing on it takes brings up a screen of the most recent files on his phone. He chooses the freshly pulled sleep machine data and presses upload. The phone goes back to the previous screen except it now has the latest entry from that morning; slightly greyed out as it uploads and makes itself available.

Later that the day, Michael heads in to meet his doctor. The Doctor logs into his account on the computer and pulls up the charts and graphs that Michael had uploaded that morning.

Expanded Story 2

Between class, homework, internship, doctor visits, and so on, Michael doesn’t really have much time to spare. He was just about to finish talking with his mother when she reminded him that he had to reschedule his appointment from this week over to the next. Apparently they were all going somewhere or doing something, Michael wasn’t particularly sure or interested for that matter.

The moment he got off the phone with his mom, he pulled up the PatientSite App. He presses the calendar on the bottom corner of the app to pull up his calendar with his appointments. Glancing over them, he finds the appointment for this week, selects it, and drags it down into the next week. He drops the appointment on a blank calendar day, indicating that there are time openings for that day with his doctor. Once he lets go of the appointment a list of times pops up that Michael can select from. He chooses a evening time, hits confirm and without so much as having spent a minute, he’s done rescheduling his appointment.

Initial Mockup

In the beginning, my intention with the mockup was to make something that would feel familiar to mobile app users. I focused on creating a design that would hold simplicity at its core, all while being mindful of design trends that are currently widespread. After testing this design I found that while users were easily able to navigate through the app, they were both confused and overwhelmed by the layout of buttons. The feedback I received indicated that I needed to rethink which actions should be emphasized.

The medical records section of the app was eventually removed from my design as the users preferred viewing that information on their PCs.

The Breakthrough

This was the "aha!" moment. While I was busy working on making the Medical Records section more usable, one of my test volunteers began discussing how confusing all of their medical finances were to them. There was no easy way to look at what was being charged and why, no indication of how their insurance factored into everything, and no way to get just a general overview of their financial status.

I scrapped the Medical Records in lieu of the Billing Info section. The initial mockup shows that this section would provide an "at a glance" view of a patient's medical payments, account history, their statements, and so on. The approach here was to give the patients a little bit of everything so that they could get their bearings. Just like before, this feature became more refined through testing; eventually it evolved to have a tighter focus on the information displayed.

Final Mockup

After a series of user tests, as well as peer reviews, this became the final version of my mockup design. With a greater emphasis on allowing users to interact with the app in the way they want to, the final user test showed the greatest response. The app offered tiered information structure, providing more information the deeper a user went into the app. This was to create a level of flexibility in how much data the user had to process at any given moment.

The most notable changes to the scheduling section of the app was the inclusion of a separate "list view." This decision, driven by test feedback, was made to accommodate patients that had several appointments to keep track of. Viewing that much information on the original calendar was uninformative and unhelpful to them. Furthermore, I changed a few interactions

However the biggest success was found in the Billing Record section of the app. By offering a quick overview of where patient expenses were coming from, how their insurance factored in, and what their resulting bill was, received positive from chronic patients. The option for a patient to see their statement in detail was also developed with the intent to reduce patient calls to the hospital; based on feedback from a previous clinic manager.

Lessons Learned

Feedback is paramount. Having an open communication line to users = refined product scope.
Always iterate. If you think that you got it, make it even better.
Being open to change allows the natural changes to happen faster.
Collaboration can be the greatest tool.
Don't focus on colors early on. It distracts from getting the functionality right.