MedBuzz

Scope

November 2021

An efficient pill reminder app for medical workers

UX Research
UI Design

Preface

Despite the recent advancements in smartphone-based clinical communications solutions, the collaboration technology provided to physicians and nurses has lagged far behind, even though ready access to information can be a matter of life and death. This is one of the projects focused on smartphone-based solutions for the nursing community.

Design Flow

The ascend

Scenario

A hospital nurse has just visited a patient and needs to give him medication. The patient has not taken the medication before but needs to take the medication 4 more times in the next 48 hours. The patient is currently taking 3 other medications. One medication is for a chronic condition, and the other two medications were first given when the patient arrived at the facility.

From the scenario, the nurse needs to keep track of:

How many medicines the patient has already taken and how many do they have to take.
The exact time with which the patient should take the medicine.
The severity or priority is given to each medicine.

For this exercise:
• Focus only on the profile of a single patient.
• The nurse should have access to basic patient information.
• The user should have the ability to enter a medication taken, and also learn what medication has already been given to the patient.

Your design solution should handle at least the following:
• Patient identifiers
• Doctor identifiers
• Medication details

A patient is expected to take, on average, 3 to 8 types of medication.

Analysis of the problem statement

Inpatient nursing:
Inpatient nursing refers to medical care provided to patients who require observation by clinicians, physicians, or other medical professionals. These may be patients who need to stay in a medical facility or for a longer-term stay.

Solution requirements

Profile of single patient.
Information about the patient.
Access information on medication charts and schedules.
Information regarding the doctor, who treats the patient.
Details about the medication.

Fixing the stakeholders

Even though there are several stakeholders in a hospital (Doctors, Emergency staff, Chefs, Health care workers, Sweepers, Ambulance drivers, etc), the primary focus for this design task will be that of a Nurse. The digital application design will be exclusively catered to nursing staff.

Fixing the Medium

Many hospitals use several smart devices like PC, Laptops, Tablets/pads, Mobile phones, etc. But based on the factor of portability, two of the digital devices can be considered.

Smartphone
Tablet/pads

From the data pulled from Google Analytics’ Benchmarking feature, globally 68.1% of all website visits in 2020 came from mobile devices, an increase from 63.3% in 2019. Desktops drove 28.9% of visits, while 3.1% of visitors came from tablets.

The below statistics shows the worldwide and Indian market share between desktop vs mobile vs tablet.

This data gives light on the number of smartphone users compared to tablet users. Factors like faster adaptability, learning curve, etc give the smartphone an edge over tablets, even though screen size and visibility are more to tablets.

Thus, the design will be focussing on a smartphone. Assuming that most of the people are experienced in using a smartphone than a tablet and also due to the fact that mobile phones are much cheaper than tablets.

Secondary Research

Do smartphone solutions work for hospital staff (here nurse)?
(Based on the article by Hamshy Raveendran who leads Product Management and Go-to-Market for Samsung's B2B Mobile division.)

Many hospital leaders have admitted to the fact that in many ways healthcare has been left behind. Over a decade from the HITECH Act, many physicians and nurses still rely on clipboards, printed records, desktop terminals, and even old-fashioned pagers to access patient information and stay connected.
Despite recent advancements in smartphone-based clinical communications solutions, the collaboration technology provided to physicians and nurses has lagged far behind, even though ready access to information can be a matter of life and death.
In a study published by the Journal of Hospital Administration, 85 percent of doctors said smartphones made their clinical communications easier, 79 percent found medical smartphone apps helpful, and nearly 68 percent said these tools didn't require any training. And that was before COVID-19 pushed healthcare's digital revolution forward by a decade.

A smartphone deployment is an ideal choice for streamlining clinical communications.
Clinical communications are a critical issue for nurses, which makes it a critical issue for hospitals. Many hospitals are already struggling with nursing shortages, and the U.S. Department of Health and Human Services projects shortages of more than 10,000 RNs in four U.S. states by 2030. 5 Many hospitals have been forced to recruit nurses from abroad or pay higher salaries for temporary nurses, just to maintain adequate staffing.

By saddling nurses with inadequate communications tools, hospitals increase on-the-job stress and the likelihood of staff burnout, which can increase turnover. In a 2018 study of more than 50,000 U.S. nurses, nearly 10 percent reported leaving their current employer. The top reason for quitting — reported by 31.5 percent — was burnout, which was more prevalent among hospital workers than other types of nurses.
Burnout-related turnover could be a bigger problem in 2021 and beyond, as a result of the pandemic. In 2020, 93 percent of healthcare workers reported feeling stressed, and 76 percent reported exhaustion and burnout, according to Mental Health America. Meanwhile, an American Nursing Association survey found that 51 percent of nurses were overwhelmed, and only 36 percent felt “like my work has meaning.”

Today, forward-thinking leaders are focusing just as much on the employee experience as the patient experience. That means providing nurses with the tools and resources they need to do their jobs efficiently, so they can spend more time helping patients.

Benefits of Smartphone technology in medical fields

Improve collaboration

The nursing staffs often work on a shift basis. When the patient is being monitored on 48 hr basis, usually two nurses take up the charge. It is of top priority to have good communication and collaboration between these two parties. Unlike the traditional way in which the data is stored in physically written records, which can have issues like handwriting recognition etc. But through a smartphone, the patient's data is continuously monitored and also it resolves any readability issues.

Increase the productivity of nursing staffs
Reduce medical errors
Provide better documentation

The next step would be to know the current practices that nurses would follow when they have to track the medicinal records of the patient. This step is important because it validates the research that has already been done and also gives more insights into the work culture of nurses.

Primary Research

Interview
A couple of interviews were conducted with nursing staff to know more about their work life and the current practices they use when they have to track the medicinal pills of the patient.

Transcript

Q. Who prescribes the medicine and how is it being recorded?
A. The Doctor prescribes the medicine. Details like the dosage, the time interval between the medicines, etc will be given by the doctor itself. He records this in a Case Sheet and gives this to us. We then strictly follow what the doctor has written in the Case Sheet.

Q. What all are being recorded in the Case sheet?
A. Each patient has a different Case sheet and it includes the patient’s name, their diseases, lab results, details about prescribed medicines, etc. It also acts as a charting sheet where we record all medicines that we have given to the patient, what all medicines are left for them to take, condition of patients- like their temperature, etc. It also includes the doctor’s order sheet and nurse’s response sheet.

Q. Can you throw some light on Doctor’s order sheet and the Nurse’s response sheet?
A. Doctor’s orders like the medicine name, the dosage, the time intervals between the medicines, etc are recorded in one column of a case sheet, which we typically call a doctor’s order sheet. For example, the doctor may order 6 hourly dosages for injection and we nurses must give the patient an injection between 6 hours of intervals. And we track these in the nurse’s response sheet.

Q. What happens to the Case sheet once the patient gets discharged?
A. The entire case sheet will be filed and gets transferred to the medical record library.

Q. How many patients should a nurse attend to in an average day? Also, do you work on a shift basis?
A. Since I work in a government hospital, on an average day 3 nurses must check on around 20 patients. Yes, I work on a shift basis.

Q. Do you find it difficult to manage multiple patients and their case sheets?
A. Yes, it is difficult, but it’s part of your job. Remembering each of their case sheets can be tricky thus we have to constantly monitor the case sheets so that we don’t miss on anything. For example, the medication timings of the patient.

Q. What is your take on a medication tracking app?
A. I like this idea. If the app can give timely alerts to nurse, then it would be great.

Q. If we are creating an app to keep track of the medication, which device will you be comfortable using the app? a smartphone or tablet?
A. I have never used a tablet in my life. Therefore, I will be happy with using the app on my smartphone.

Q. Since you people work on a shift basis, how do you guys communicate with each other about a particular patient?
A. The communication happens with the help of a case sheet and report book. We record every inference on the report book so that the nurse that comes next will have a clear-cut idea of the patient’s current situation. Also, we chart most of the patient’s activity, like the medicines taken, etc on the case sheet. Also, before leaving the duty, we give “handover” to the next duty nurse. (Which is actually a verbal conversation on patient status, things to take care of, etc) Thus, everything runs smoothly.

Q. What are all specifics the doctor mentions when he prescribes the medicine?
A. The doctor specifies the name of medicine, its dosage, and the time intervals with which the medicines have to be administered to the patient.

Q. What is your thought about digitalizing the traditional recording process?
A. I think it’s a great idea. I believe the change is already here as more and more hospitals are moving towards digitalization.

Q. If there are any negative remarks on the traditional pen and paper recording system, could you shed some light on it?
A. One of the factors is that the traditional system uses paper and sometimes you will need more than one paper to record everything thus making it slightly bulky. Also, if your hospital is not managed well, you can even run out of paper. Another aspect is the readability of different handwriting styles.

Insights from the Interview

The nursing community is ready to embrace the digital medium.
Ideally, the entire case sheet should be converted into a digital platform but based on the design requirement of the task, only medication tracking will be implemented.
The doctors normally prescribe medicines on an hourly basis (e.g. 6 hourly) and the nurses have to chart them according to time intervals.
Communication between the nursing staff is the key.
While prescribing medicine, the doctor specifies the name, dose, and time intervals with which it should be administered.
Nurses often carry around large paper works.
Understanding different handwriting can get tricky.
Nurses work with multiple patients are remembering each of their case sheet details is difficult, thus constant monitoring is required.

User Persona

User Journey and Storyboarding

For an experienced nurse like Annie, the main frustration happens when she has to look up again and again onto the case sheet, just because of the fact that no alerts are there to aid her. But a newcomer nurse like Helen also feels anxious during the handover sessions.

Market Study

With respect to the problem statement, most of the frustrations can be solved through meaningful design. But before going into the solution phase, it is necessary to understand what is out there in the market hence the market study.

Even though there are hospitals that have dedicated apps for their staff and customers, features like medicine reminders are either absent or sidelined as a feature. In either case, making inferences from these apps may not benefit while designing an app exclusive to medicine reminding. Therefore, it is essential to explore more independent apps which are focused on a medicine reminder. It is to be noted that these apps are designed for all the users in mind and are not specific to nurses.

Medisafe

MediSafe is a user-friendly mobile app that offers a number of features that make prescription management easy. The app is described as a “virtual pillbox” that sends users personalized reminders to take their medications as directed. Notifications also include drug interaction warnings, so users know if they should not take their medications with certain drugs, foods, or beverages.

The app is also ideal for caregivers. There is the feature of a dependent that lets users add prescriptions for multiple people, such as children or elderly patients. Users can also use the app to send a notification to a caregiver if they forget to take their medication.

MediSafe also helps users feel confident that they won’t run out of their medications, thanks to refill reminders. Users can import their prescriptions from major pharmacy chains or add their medications manually.

2. MyTherapy pill Reminder

MyTherapy is an ad-free pill reminder and medication tracker. It also has features like a pill tracker, mood tracker, and a health journal, e.g. with a weight tracker. The app also has a feature where the user receives a beautiful picture of the day as motivation to take your medicine.

3. Dose Cast

Dose Cast is a paid app. The app has the ability to set notifications for taking medications, enter customized dosages, take notes on individual medications, and smart silencing, so notifications are not sent while users are sleeping.

Solution Phase

Scenario 1:
Designing a smartphone solution that is integrated into the hospital systems.

Once a patient reaches the hospital, he/she receives a hospital patient card with a unique id associated with it.
Every activity of the patient will be recorded as data and will be available for the hospital.
Personal details consulted doctors, lab results, medicines, bills, etc are the data that the hospital holds.
It is to be noted that every member of the hospital has a unique id, which is also synced with the hospital.
Leveraging this data, a smartphone app can be designed such that the nurses can log inside the app with their unique id and they can easily get the details of their patient by inputting their patient id. (Through this, the manual effort to type every detail of the patient is resolved).
Since the details of doctor and patient are important to the design, it would be logical to adopt a system that can easily give all these results with ease.

Scenario 2:
Designing a smartphone solution that is independent of the hospital systems.

This app will act as a universal app that can be used by nurses as well as ordinary users.
The app needs manual input from the user to record the details about the patients as well as their doctors.

Scenario 3:
Designing a smart wearable device that can give timely alerts to the nurses. This can be done with a help of a smartwatch or a unique customized product. Though all of the solutions can be developed into a working prototype, Scenario 1 stands above all. The reasons for the same are recorded below.

The problem statement clearly describes the user to be a nurse and it doesn't make sense to make it open to all users.
Connecting with the hospital data will make the onboarding process faster and the user will only need to provide minimum input.
From the research conducted, it is observed that most of the user demographics hold a smartphone and are well versed with it. Thus, as a quick and reliable solution, mobile phones can be used instead of any other wearable device.
Wearable devices also require a learning curve and they are also expensive, which could be a potential red flag from a business perspective.

Thus selecting scenario1

Designing

Low Fidelity- paper prototype

Adding patient

Adding medicine

Doctor Identifier, reports, and case sheets

Information Architecture

Low fidelity- digital prototype

Adding patients

Adding medicine

Visual Identity

Mood board

Colour palette and Font

High Fidelity Prototype

1. Onboarding: User flow

MedBuzz lets users log in with the help of their hospital id card.
Simply scan the id card through the scanner or type out the id number.
Once MedBuzz gets your identification, it quickly sets up a user profile.
The user can either edit the info or simply confirm it.
On the same page, the user can set up a 4-digit pin code for easy access.

2. Adding Patient Details: User flow

Users can easily add patients from the “view patients” page.
The user can add a patient simply by scanning the patient’s hospital id card, or by typing id number.
There is also a provision for manual entry if there is any discrepancy.
By clicking continue, the user moves to the “patient details” page, where the user can see patients' biodata, their test reports, Case sheets, and the medicines that they are currently taking.
By further scrolling, the user can simply press the “Add patient” button to add the user to their watchlist. Also, if the user wants to add a new medicine on the same go, then they can do that by simply pressing the “add medication” button.

3. Adding Medicines: User flow

Users can add medicines from the “Patient Detail” Page or directly from the “alert” page. Both of the cases have a similar flow
By pressing the “Add medication” button, the user moves to a page where they can enter the details of medication like the name, form of med, the strength of med.
Users can also categorize the med into Chronic or Acute. This results in a colour change in the medication tile. Thus it becomes easy for the user to identify it from the rest of the medicines.
The user also has the ability to set the schedule of the pill.
By entering the starting date and end date they can fix the schedule, or if the schedule is endless. simply put the end date as “Endless”.
Or they can manually press the day button to lock that particular date. Also, they have the ability to lock dates by intervals.
After the end of it, by simply pressing the” ADD” button, new medication gets added to the medication list.
All the upcoming alerts can be seen on the alert page according to their scheduled time. Medications for chronic diseases are given a separate colour.

4. Doctor identifier, reports, and case sheets: User flow

While viewing the patient details, the user could clearly see the consulting doctor of that particular patient.
Also, on the “patient detail” page, Reports and Results as well as case sheet can be seen.
By clicking the Reports and Results card, the user can see all the lab reports and results of that particular person. Since this app is in sync with the hospital data, the results appear as soon as they get published. The page also lets the user know the pending reports.
The case sheet of each person is included on this page, through which doctors' orders, nurses' “handovers” etc can be seen.
Also in the case sheet, the user can see what all medications have already been taken up by the patient.
There is also an option to add new Case sheets by scanning them.

5. Medication alerts and swipes to finish feature: User flow

After successfully administering a medication to the patient, the user can easily use the swipe function to complete the task.
This swipes action records the medicine as “already taken medicine” and updates it in the case sheet. Therefore, when other uses check the medication history, they can see it as already taken.

Full Flow