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EMX Systems

Designing a medical record exchange system with providers in mind.

Project Overview


Summary

EMX Systems is a healthcare technology company based in Michigan developing a health information exchange platform to improve medical record exchange between healthcare providers who use different electronic medical records (EMR) systems. The most popular EMR solutions, which store electronic patient records, cannot communicate to access each others records. Our client is developing software that supplements a provider’s existing EMR to make record exchange possible. Their platform includes an intranet web application, EMX Portal, for providers to securely access patient records from any other provider regardless of the originating EMR.

As part of UMSI Design Clinic, I, along with four other designers, were tasked with designing EMX Systems to fit healthcare providers’ workflows. We applied a user-centered design process to understand the needs of medical professionals and used a parallel prototyping process that involved our entire team at every step. A interactive prototype ready for development was delivered to the client with detailed UI specifications.

My role

I contributed during each step of our research and design process. I interviewed two physicians, contributed to interview analysis, wrote content for the personas, and developed our user journey. During the prototyping phase, I was responsible for designing the dashboard and the individual record screen. I also lead the development of a UI component library in Sketch to improve our team’s prototyping speed.

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The Challenge


Our client, an retired medical doctor, believes that current electronic medical record (EMR) solutions, which store digital patient records, are not designed for healthcare providers’ needs. Many doctors have at least one complaint about their EMR. Solutions are often are selected based on the needs of the hospital administration, such as the ability to bill patients more efficiently.

Our client believes that a more provider-friendly system can be created. His new company, EMX Systems, aims to supplement existing EMRs by providing fast, secure patient data access at the point of care. Fundamentally, he challenged our team to solve the following problem for the EMX portal application:

How can a healthcare record system be designed to better fit care providers’ needs?

Our Approach


EMX Project Timeline

We used a user-centered design approach where users were involved at every step of the process. We conducted user research to identify problems, ideated to come up with multiple solutions, created a prototype based on our best idea, and validated our idea using usability tests. Based on test results, we iterated on our prototype. For this project, we completed four design iteration cycles.

Design Overview


Design Overview Design Overview 2

User Research


Contextual Inquiry

In order to understand how healthcare providers used patient records, we conducted 9 interviews with care providers. Our interviewees group included a combination of doctors, nurses, and medical students.

We used a contextual inquiry approach to interviews, in which we visited interviewees at their office to ask questions about their EMR usage experiences, followed by observing them interacting with their EMR*. Each member of the our group was responsible for conducting 1-2 interviews. Afterwards, we synthesized our interview data by building an affinity diagram to organize our notes and synthesize our findings.

*Interviewees demonstrated with their own medical data or used data from patients who signed HIPAA waivers for this project.

affinity map

Based on our affinity diagram, we learned the following for our interviews:

Survey

After our team gather in-depth stories of provider’s EMR experiences via interviews, we wanted to learn more about what types of patient information were most important. Our team designed a survey on EMR usage which was taken by 20 medical professionals in the University of Michigan hospital system.

Based on our survey, we learned that:

Personas + User Journey

Based on our interviews, our team constructed three personas representing distinct groups in our audience. During our prototyping phase, they were valuable in reminding our team of the distant ways different types of providers used EMRs.

personas

We also created an user journey, to document our team’s understanding how providers accessed patient data and the pain points they encounter doing so.

user journey

Ideation


Our team used a parallel design approach to coming up with design solutions. Each designer on our team created rough wireframes for multiple ideas and then pitched each idea to the team for feedback and critique. Afterwards, we reviewed all ideas that were pitched and created one collaborative wireframe using our individual ideas as references.

sketching in a group
whiteboard sketches on paper

Design Solution


Design Features

Dashboard: A running timeline of the patient’s history

When providers meet patients, especially for the first time, they want to know the medical history of that patient. This will involve asking patients directly, but patients can miss details that are important to making a diagnosis. What can done so that providers check that they are getting the full picture of a patient’s history?

The dashboard is designed to allow healthcare providers to see a patient history at a glance. Information is organized as in a combined feed and seperated by record type.

EMX Dashboard

Design Rationale


Dashboard Customization: Increase the level of personalization for each specific doctor’s practice

Different providers see different information as important. It would be futile for our team to attempt to select what type of records should appear on the dashboard since any decision we make would not acommedate many of our users. How might we accommodate different needs for different providers?

Dashboard customization gives EMX system the flexibility for users adjust the dashboard catagories to fit an individual provider’s workflow while still maintaining a clear information hierarchy that makes the page easy to skim.

EMX Customization

Design Rationale


Save for later: Keeping track of patient information

Providers typically look at multiple different types of documents making a diagnosis. In most EMR systems, this means multiple searches through the patient’s data to find all the documents they need. How might our system be designed so that providers can keep track of multiple documents at once?

Our save for later feature allows providers to mark documents they find important so that they can quickly refer back to several documents very quickly. This will save them the effort of having to repeat a search for a document simply to view it again.

EMX save for later

Design Rationale


Results filtering: more powerful searching for providers

We learned from interviews that providers will often use their EMR’s search feature to find documents that they dont immediately find. However, search can return too many results, which the provider when has to go through to find what they are looking for. How can we make searching faster for providers?

EMX filtering

Design Rationale

Design Iteration


Our team completed four design cycles in which we built a prototype, got feedback from our users, and modified the prototype based on feedback. At each iteration, features were adjusted or changed based on what we learned from our users.

Refining the Dashboard Design

Through usability testing, we learned that doctors want to look multiple records of different types before making a diagnosis. Our dashboard design evolved so that providers can preview multiple types of records can be presented on EMX’s dashboard.

Dashboard iteration

Language Differences

In our first prototypes, we used the word “history” to label the patient’s full visit history. During user testing, this term was confusing our users due to it having a different meaning in the context of healthcare. One user remarked, “When I see the word history, I think of the history of this patient’s [current] diagnosis.” We changed this labeling to stay “Encounter history” to clarify the confusion.

language changes

Adjusting for limitations

Viewing labs results is a common reason for a provider to access their EMR. For that reason, our initial designs displayed content from lab results records in the dashboard to save an extra click to view them. This was changed after learning that lab results can very long or scanned into a EMR as an image. In both cases, information would be difficult to pull, so our design was changed to reflect this technical limitation.

changing for limitions

Deliverables


UI Pattern Library

We developed a color and typographic guide during our last iteration cycle to improve the consistency of our final mockup screens and to create unified visual system for EMX Systems. At the end of the project, the library was given to the client as deliverable to aid with development.

UI Page 1 UI Page 2

Interaction Map

A interaction map was also included with deliverables. We focused on making making the map as thorough as possible to document the user flow for EMX’s developers.

Click to here to view a hi-resolution version (PDF)

interaction map

Interactive Prototype

The final version of our interactive prototype on InVision was included with our deliverables. A link to the prototype can be provided upon request.

Outcomes


We delivered a full InVision prototype of our project to our client, detailed UI specifications, and an interaction map documenting the information architecture. After some minor visual tweeks, our client was extremely satisfied with our work and plans to incorporate our design into the development of their product.

What our client had to say:

The result is an excellent implementation that we can build on the EMX service platform, well done. The specifications certainly help, making our bootstrap implementation quite natural. I’ll be building out a demo ready version of your design and hope to use to as an example of how providers and designers can come together to build great products that have a real-world impact. Your teams’ insight will certainly help us meet that goal.

Jason,
Lead Developer for EMX Systems

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