Electronic Health Records - Prescription Ordering Prototype

UX Challenge

I was hired as a User Interface Designer for a contract project through Partners HealthCare and the Brigham and Women’s Hospital Center for Patient Safety Research. The project set out to reimagine the Computerized Prescriber Order Entry (CPOE) process, and help to reduce medical errors by optimizing prescriber workflows and enhancing patient comprehension. The hypothesis of the project was that surfacing a medication’s indication, or reason for use, to a higher level of visibility on both the prescription’s label and in the medication ordering process would allow patients and doctors to feel more confident about consuming and ordering the drug. This is a change from the current reality in some of the leading Electronic Health Record (ERH) products.

Design Process & Solution

This project involved a 3-year effort, which is documented on the Agency for Healthcare Research and Quality website. During the first year, a group of UX Researchers, Physicians, and Pharmacists held 6 different discussion panels involving a variety of key stakeholders in the medical community. The goal was to discuss the critical issues facing the industry when it comes to prescribing medications.

I started my work during Year 2 of the project, which focused on leveraging human-centered design activities to design a working prototype proposing a new CPOE workflow. Following is a summary of my process for designing the prototype.

Initial Research

Before starting my prototype, I reviewed the panel discussion recordings from Year 1 of the project, and completed literature reviews to better understand the domain. I also worked closely with a User Researcher and team of medical practitioners to brainstorm key requirements. Using these inputs, I documented ideas on how to satisfy the requirements. I also did a competitive review of how other EHR products on the market (e.g. EPIC and Cerner) approached prescriber order entry and how these workflows could be improved.

Brainstorming & Sketching

After I had gotten my head around the requirements and competitive landscape, I did some brainstorming and sketching to see how the features could start to come together in an interface that would ultimately test the hypothesis of the project. Throughout this early phase, I had ample meetings with other stakeholders on the team to clarify questions and ensure that I was on the right track as I worked towards developing a medium-fidelity prototype that we could test with real medical providers.

Early Mockups

I quickly jumped into Axure to do some higher-level interactive ideations that I could share with the project team for more concrete feedback. Using the expert resources in this group, I continued to ideate and add new features as we solidified the use cases that we wanted to build into the prototype. The goal during this phase was to ensure that we were working towards a final product that would successfully test whether or not surfacing drug indications as the organizing principle in prescription ordering software provided a more error-prone mental model for prescribers. The images below illustrate how the prototype evolved throughout the user-centered design process.

Formative User Research

At various checkpoints throughout the project, we held review sessions with groups of medical practitioners around the greater Boston area. This included some participatory design sessions to help inform the early drafts of the prototype, as well as more structured task-based testing using later iterations of the design. The images below show artifacts that nurses and doctors created during some of our participatory design sessions. These were useful opportunities to ensure that the prototype design was on the right track, and that we were building something that would actually address pain-points of our target users.

Interactive Prototype

At the completion of the project, I built a medium-fidelity interactive prototype in Axure that satisfied a variety of prescribing scenarios with different levels of complexity. The screenshots below capture some of the key interfaces that we wanted to test. Note that the organizing principle along the left-hand side of the application is the patient’s medical problem, i.e. the indication for prescribing a medication. This is the key concept that we wanted to test with the prototype.

Usability Testing

After I had finished my time on this project, a team of UX Researchers used my prototype for formal usability testing. The findings of this study were published in The Journal of the American Medical Association. The study found a statistically significant reduction in both user clicks and user error when completing tasks on my prototype, versus two commercial prescribing systems currently on the market. This validated the hypothesis that making the indication of a medication more prominent in the prescription ordering process is a beneficial direction for EHR companies to consider in their future product design decisions.