Pre-Visit Prep
Pre-Visit Prep: Helping doctors prepare for patient visits
Company: athenahealth
The problem: How do we best allow clinicians to prepare for patient visits?
The solution: Give users early access to exam documentation so they can queue up orders, add templates, and get up to speed on the patient
The team: product manager, scrum team developers
My role: discovery research, UX design, validative research, design strategy, project management, stakeholder management
Research methods: shadowing, contextual inquiry, interviews, surveys, resonance testing
Design methods: ideation workshop, low fidelity concepting, prototyping
Collaboration methods: scrum ceremonies, UX critique, cross-functional design reviews, readouts to leadership
The Opportunity
Athenahealth’s cloud-based electronic medical record (EMR) software limited providers and their staff to documenting in the exam only once the patient had checked in. To better prepare for visits, customers checked-in patients before they arrived (disrupting check-in workflows) or were forced to document heavily while in the room with the patient.
This was one of the biggest complaints of clients across athenahealth’s userbase with 481 accounts posting prep-related feedback on our client feedback message board. These 481 accounts represent $422 million in yearly revenue.
The Users
Providers (MDs, DOs, NPs, PAs, etc) want to…
- document as efficiently as possible
- create a plan of care for a patient
- get up to speed on a patient before seeing them
- delegate tasks to their staff
- know which patient visits to prepare for
Provider staff (MAs, RNs, etc) want to…
- document as efficiently as possible
- support providers
- ensure patient record is complete
Discovery research
To understand how clients prepare for patient visits today, I observed two different client sites and interviewed 9 providers and staff to understand:
How do clients define prep?
Who is performing encounter prep?
When are people prepping?
What are people prepping?
How are providers using their prep during the exam?
What workarounds are happening currently?
In what scenarios does prep differ?
How does prep vary across size and specialty?
I learned that the goal of prep is to identify gaps in care and create a plan to address those gaps in the visit
The ultimate goal is to reduce time getting up to speed or documenting while they’re with the patient. In turn, this increases facetime with the patient so they can provide the best care possible.
Design
After ideating with my scrum team, I landed on a straightforward solution to prep: Just give providers and their staff access to the exam before the patient’s there. The main thing that providers want to do during prep are:
Add templates
Add orders/labs/vaccines
Pull forward last encounter
Edit/remove parts of last encounter
Pre-populate templates and note fields
Early access to the exam allows them to do all these things, all while getting up to speed on the patient story through viewing the chart. This also allows the provider to delegate to their staff, further lifting the load from the provider.
Validation
The concept of early access to the exam was a huge hit with clients. After scoring well and garnering praise, the scrum team began implementing Pre-Visit Prep.
Note and synthesis spreadsheet from user interviews
Success Metrics
After Pre-Visit Prep entered alpha in October 2019, ~20% of patient encounters in the alpha were prepped. This is to be expected since not every visit can be prepped (e.g. a sick visit, a patient who’s likely to no-show, or a visit with no agenda).
During alpha/beta, prep scored high on user satisfaction surveys and become an instrumental part in our clients’ workflows.
The most exciting impact that Pre-Visit Prep had was that for encounters that had been prepped, providers saved ~66 seconds per encounter. That rolls up to about 3 hours of time saved per week.
Pre-Visit Prep was released as generally available to all of athenahealth’s users in June 2020. We continue to see a reduction in time spent documenting for clients who prep.
Takeaways
This project was a great learning experience for me since it was the first project I led from discovery to implementation. I learned to take advantage of my internal subject matter experts as much as possible when users are difficult to recruit.
This was also a good example of a simple solution being the best option. Not only did we satisfy clients due to the UI’s familiarity, but we also developed the MVP in less than three months, which allowed the team to develop extra phases of high-value additions like the idea of a note to different staff members and a prep status indicator.
