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We Have To Wean Doctors Off Paper. But How?

Here’s how a group of Silicon Valley designers reconciled a minimalist design with the labyrinthine health-care system.

We Have To Wean Doctors Off Paper. But How?

“Will this help save lives?” is not a question commonly overheard among Silicon Valley design teams.

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The question underscores the oddity of working in health IT, where the product is never just the product. For every decision on the design of a new feature, there is a host of implications for the doctor, the patient, and the tangled health-care ecosystem. The product might be too streamlined, depriving doctors of functionality or information that can save lives. The product might not be streamlined enough, obscuring crucial data or forcing the doctor to spend more time with the technology than the patient.

Silicon Valley is driven by simplicity and innovation. Its revolutionary conceptual models reimagine existing technology and create completely new user behaviors. Designers here have a huge influence on how a user will interact with these products. In health IT, this also means a huge responsibility to help, not hinder, the doctor’s efforts to deliver better care. Making things simpler can help. But simplicity means fewer choices–and eliminating choices for a doctor requires much more caution than eliminating choices for a consumer. We’ve crafted a few principles to follow for designing the electronic medical record (EMR) systems of the futures.

Design should be intuitive and human-centric

Doctors are people, too. They also appreciate simplicity, in spite of the complexity of the health-care sector. Designers should use the principles of good design to give doctors an intuitive EMR system that can be learned in minutes. This requires an alternative approach to the health-care-centric model of legacy systems. Only a designer’s intuition can produce the most efficient EMR possible–which also requires crucial, potentially risky decisions about how a doctor will use our product.

Let’s take, for example, the decision to include a list of most frequently prescribed medications in an e-prescribing module. This saves the time, of course. But does it also influence behavior by encouraging a doctor not to prescribe different medications? Will a doctor sometimes choose one of these frequently prescribed drugs instead of spending the time to search for a new, potentially more appropriate medication? What if something is missing or gets in the doctor’s way? Designers must continuously ask how the clinical workflow is impacted by simpler features, reordered data, or rearranged design elements.

Size up your biggest competitor: Pen and paper

Paper, without a doubt, remains the biggest competitor in the EHR sector. It’s also a blank slate, where each doctor can have a totally different workflow. It works for your neighborhood doctor and the nation’s top brain surgeons alike–and its inherent problems (poor handwriting, difficulty of retrieving records) are easy for doctors to overlook.

When thinking about ease of use, then, paper is a great point of comparison. If an EHR isn’t easy to adopt, doctors will quickly get frustrated and return to familiar paper. If it isn’t flexible, it will be impractical for many specialties and doctors with unique workflows. Taking this into account, we found that pre-populated and editable templates can help doctors to easily start recording patient visits within minutes of adopting a system.

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Don’t just translate–reexamine and redefine

Don’t limit future design with what’s already been done. Look at the doctor’s essential need and see how new technology can meet it better than any prior alternative.

Instead of just “translating” paper charts, for example, chart notes should automatically fill-in preexisting prescription information and past medical history. Providers should be able to instantly send chart-note information in fax referrals to their colleagues. Keeping the doctor’s basic need in mind, it’s easy to see that prescribing and making referrals are essential to a patient-visit workflow. But they can only be combined this efficiently on a digital platform. These little features add up to big time savings over paper.

Added little features can also waste time with unnecessary clicks and increased cognitive load. Many EMR systems will illustrate a practical gestalt of the health-care system itself: highly complex and powerful but cluttered, inefficient, expensive, and even unnavigable–in other words, a gargantuan-one-size-fits-all trying to be too much for too many people.
You can’t be everything to everyone, but you can be useful and usable to all your own users by understanding their basic needs. You don’t need a needlessly complex system if you understand exactly what these needs are.

Listen to Your Most Valuable Player: The User

Naturally, users are the best source for understanding needs. Team designs can be based on expertise and intuition as designers, but every phase in the process–sketching, wireframing, prototyping–should involve continuous feedback from users. From administrators to nurses and doctors, different users can provide unique insights into usability limitations–as both medical professionals and ordinary people.
This allows you to discover, organically, how a doctor’s needs and workflow can inform the intuitive design process. You understand the need from a doctor’s perspective while developing the solution from a designer’s perspective.

User feedback was instrumental in the redesign of Practice Fusion’s e-prescribing workflow. Built fast in the early days of our product, users found it took too long, requiring six screens of input to produce one simple outcome. On task-based software like ours, we realized, doctors don’t want to spend all their time clicking through screens when they should be attending to patients. Six screens are excessive when the alternative is a single scrawl on a blue prescription pad.

So we cut back and used time-saving predictive technology. Two separate pages for searching for and adding medication were combined into one. Medication instructions for specific medications and patients, preferred pharmacies, and confirmation screens were all prepopulated to be even quicker than paper. In total, six screens were reduced to two.

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It may sound dramatic to say that design decisions like this could be a matter of life or death. But as long as we keep redefining the technology they use, doctors will continue to gain new tools to save lives. We keep finding simpler ways to achieve the same results, so doctors can spend more time with patients. And as keen-eyed Silicon Valley designers working together with vocal doctors, we continue to remake the health-care system.

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Written by Practice Fusion’s Kramer Weydt, Lindsay Garlock, and Jesse Germinario.

[Image: TakeStockPhotography and natu via Shutterstock]