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How user experience design transforms prescription writing for the better

Editor’s Note: This blog series provides readers an inside look at how members of our user experience team approach new projects. As they go through the design process for a specific solution, they’ll share how they use science and a rigorous process to create a better experience for our users. This is the first post in a four-part series.

Health IT software development can have two distinct results for clinicians: make life easier or add to existing burden. The difference between these two outcomes can seem arbitrary. Sometimes the smallest design decisions affect the user experience in big ways.

But are these distinct outcomes random, or is there a way to get to a better result?

Why cause and effect are critical

As clinicians, we study cause and effect all the time and follow strict processes to determine correlation. For example, handwashing reduces the transmission of bacteria to our patients. We study the effects of medical interventions to see what works best in treating diseases. As user experience (UX) professionals, we also have a proven process called User-Centered Design (UCD) that leads to positive user experiences.

Working with an outdated prescription writer

The Allscripts User Experience team was asked recently by the development team to redesign the Rx Writer (prescription writer) module in Allscripts Sunrise™ to make it easier to use.

When we evaluated the existing product, it was easy to see that an earlier team tried to accomplish several different – sometimes conflicting – priorities:

  • “I need to do all of my work in one place.”
  • “I need to see relevant details without leaving the screen.”
  • “I need to search in a couple of different ways.”
  • “I need all this functionality — don’t take anything away.”

In addition to these user requirements, we also had regulatory and interoperability requirements to support. These requirements continued to change after the product was released, and that required more information and functionality to be added to the module. This resulted in a screen with a long toolbar, additional buttons, tabs, a lot of fields, small text and a ton of information all on one screen.

Understanding areas for improvement

While the team met all the criteria requested, the end product had a high cognitive load for the users. Writing prescriptions in the existing Rx Writer is not as satisfying for our users as we would like.

In redesigning this functionality, we applied the UCD process to create a design that reduces the cognitive load for the clinicians and helps them in their work.

Following the process

This blog series walks you through the four steps of the UCD process and explains how we applied it to the new Rx Writer designs. The first step in the process is to understand product users and their workflows, typically done by creating user profiles.

Allscripts has existing profiles for Physicians, Nurse Practitioners, Physician Assistants and other prescribers. For the Rx Writer project, we wanted to supplement these with a better understanding of how providers create prescriptions.

The interviews

To accomplish this task, we interviewed six clinicians with both inpatient and outpatient experience prescribing medications.

In the interviews we asked these clinicians to describe their current prescribing workflows in addition to their ideal prescribing scenario. We were not looking for features but wanted to identify “helper” concepts to ensure what we built enhanced their experience and reduced the burden of prescribing.

For example, one user said, “I want to search by Problem, class or drug—make it easy to proceed from there (one click and done is preferred in most cases).”  This guided us in our design for searching medications. Users identified many items that included creating an easy-to-use dose calculator (“Keeps me from making a mistake”) and integrating with the Assessment and Plan of the note (“Works better within my workflow”). Not all the items identified in these initial interviews can be accomplished right away, but the exercise helped us know what would bring immediate value to our clinicians and how to prioritize the rest moving forward.

We also asked what would make the project succeed or fail to give us measures that we can use as we continue the design process. We now know what the users expect with this experience (ex: “Easy to navigate”) and what will add burden to their day (ex: “Doesn’t feel fluid or efficient”). Knowing these expectations will drive the design process.

From the interviews, we established some high-level themes that are important to clinicians when they are prescribing:

  • Manage difficult types of medications (liquids, inhalers, compound medications, etc.) gracefully.
  • Provide help for safe and efficient prescribing (dose calculators, max dose notifications, guided dosing based on problem, etc.).
  • Incorporate Clinical Decision Support and alerts to be seamless and helpful allowing me to fix things right away.
  • Make finding and selecting medications easy and flexible. If possible, support one-click ordering for common medications.
  • Bring me the information I need to make decisions such as relevant lab results, last five blood pressure readings, allergies, problems, etc.
Lessons learned

We established what is important to the user when searching for medications, completing the medication form, and submitting medications. We incorporated these lessons learned into the designs as we moved forward.

In the next blog post, I will cover step two of the UCD process: Usability metrics.

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