Research & strategy driving changes to a medical assessment

Organizational Context

A design team was established at Inovalon in the spring of 2018, with me being hired as a UX Strategist and Researcher soon after. Inovalon has historically relied on client feedback (the buyer) to drive what products are built and many times has not received direct feedback from end-users (largely doctors, nurse practitioners, and other clinicians). The design team was asked to support the effort of understanding the end user experience in the summer of 2019.

Project Background

ePASS is a clinical assessment tool used by providers to submit information pulled from a medical assessment. Each “SOAP Note” completed provides patient information to help clinicians identify and treat gaps in care. The SOAP notes completed also means revenue for Inovalon, our health plan clients, and direct cash incentive to providers. Our design team was engaged to learn ways to increase SOAP note completion by understanding the experience of the end user.

My Role

As the only design person supporting the ePASS product and clinical teams, I led all initial discussions to identify the needs of the project, organized and trained product team members on user interviews and research activities. My research also led to first of its kind workshop at Inovalon, which I facilitated, leading to additional ideas and workstreams. I have continued to support the ePASS team in helping them prioritize projects and helped them redesign the product’s user registration process.

Research

ePASS is an assessment tool that has existed for over a decade. The Product team has always seen their users as doctors and clinicians completing the assessment while seeing their patients. However, when I interviewed over 20 users from 5 states and Puerto Rico, I learned that only one clinician discussed starting and completing an assessment without support help.

While clinicians and providers signed off on SOAP notes, as required by law, it was support staff that did the majority of the ePASS assessment data entry. In fact, in some instances, our health plan clients were hiring support staff just to complete ePASS assessments for various provider offices. ePASS users could be supporting 5 doctors in one office or supporting 400 offices and thousands of doctors.

For larger provider offices, CMOs (Chief Medical Officers) were not going to “burden” providers with another tool to use, he continued:

There is only so much I can burden my docs with…[providers told him]…we will hang you if you make us do this.

When asking another CMO if his doctors would use ePASS, he said that it was “not likely to occur” and continued:

All primary care providers regardless where they are at, we’ve got too much on our plate…we are already finishing charts, doing work at home, there is just not time for providers to do this type of work.”

Insights

After synthesizing the recorded data, I created the following insights:

• There are small UI Changes that can improve the experience and speed up completion of the assessment

  • An improved search as user were observed using Google and other sites to find ICD health codes

  • Removing unnecessary content such as blood pressure readings for left and right arm as many times clinicians would not note for both

  • Changing treatment and placement of buttons that users were unable to find (e.g. many didn’t see the button to add medications)

• The primary persona is not the clinician, it is the support person or “practice manager” handling the majority of the data entry in the assessment

  • While clinicians submit assessments, it is largely a practice manager or coder who is completing the data entry and the clinician is merely reviewing for accuracy and submitting

• The primary persona or “practice manager” has substantial challenges getting sign off from their clinicians and tracking which assessments have been completed

  • From various spreadsheets to notepads, tracking assessment completion was the biggest challenge for ePASS users. A close second to that, and related, were there attempts to get clinicians sign off

• Interoperability with an EHR (electronic health record) system would increase assessment completion

It has long been known organizationally that if ePASS can be integrated with a EHR system, that would support assessment completion. This was confirmed in the research when CMOs and providers spoke to duplicate data entry and needing to work in multiple systems.

The full research summary can be found here. With the insights from the research in hand, the product leadership asked the design team to facilitate a workshop to bring out ideas and help prioritize the work.

Ideation & Prioritization Workshop

The workshop success criteria was to collaboratively ideate and create baseline plans for ePASS business and design decisions to drive increases in SOAP note completions. The research drove the guiding questions, which were:

• How might we create more transparency around SOAP note submission and tracking?

• How might we make it easier for those supporting providers to create accounts?

I collaborated with my design team colleagues and planned the majority of the workshop through MURAL and our remote calls.

I framed the workshop with the guiding questions and shared some of the research. We then broke the individuals up in teams for ideation using a creative matrix. We used enablers to stir creativity like “what would Elon Musk do?”

We then prioritized ideas through an importance difficulty matrix. Later, we broke the teams down smaller to create concept presentations for the ideas prioritized.

A summary of the ideation workshop can be found here. After the workshop, my role was to support the implementation of the UI changes and facilitate next steps to build on these concepts.

Redesign driven by research

I redesigned screens based on the research and the we tested with users to validate the changes would improve their workflow. Updates were made to the assessment and the landing page which included: