Case Study
Less Clicks, More Care: A world-class EHR application redesign

>>Less Clicks, More Care: A world-class EHR application redesign

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Abstract

When Health eTools sought to create a next-generation version of their student electronic health record (EHR) platform to be the fastest, friendliest EHR tool available to school nurses, they turned to SDLC. Specifically, they wanted SDLC Partners to redesign their application and refine their product requirements to provide a clear scope for the development teams. Additionally, it would be SDLC’s responsibility to ensure our design was successfully implemented by the developers.

We followed our double-diamond human-centered design (HCD) process (see Figure 1) to re-design the application. The team traveled all over Pennsylvania to observe working nurses in their schools to better understand the users’ goals and pain points with the existing application.

SDLC’s Double Diamond Design Process

Figure 1: SDLC Partners’ double-diamond human-centered design process

An interdisciplinary team, consisting of a user experience (UX) designer, a user interface (UI) developer, and a business analyst, collaboratively interpreted the data and developed conceptual models of the users and additional data they needed to collect. Design ideas were shared daily with an on-site nursing subject matter expert, and periodically with a set of “nurse ambassadors.” The best of these ideas were codified into a specification that was shared with the offshore development team.

About the Client:

Health eTools provides a next-generation electronic medical record (EMR) system for more than 500 schools. Health eTools is an EMR system designed specifically for school nurses, that works in conjunction with a school district’s existing student information system to help school nurses confidentially track, manage, and report on the health of their student population.

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The Challenge

People, job varies

School nurses are busy and their job varies by hour, child, and medical issue. Some school nurses see upwards of 30 students in an hour. Many children come to them for issues that would be typically handled in an urgent care clinic. Frequently, a school nurse is the only medical professional to handle these issues so they must be confident, have access to reliable information, and be able to work accurately and quickly.

School nurses manage a variety of medication, illness, and injury needs throughout the day. They need a system that allows them to fully trust digital technologies rather than rely on paper-based tools that require hours of data entry, and also supports balance between compliance requirements and seamless workflow.

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The Solution

SDLC Partners gathered first-hand observations of the work activities of school nurses, including how they interact with students, as well as the Health eTools EHR. Our technique is based on a master-apprentice model of learning, observing, and asking questions of the user as if she or he is the master craftsman and we, the apprentices.

Our ethnographic interviews yielded the following patterns and several revealing conclusions:

  • The pace of walk-ins can be frantic, making immediate data entry difficult.
  • Nurses work away from the desktop much of the time, requiring a tool that can work on the fly.
  • Features that cause a nurse to question themselves bogs down productivity and causes unnecessary distractions.
  • Features need to more closely fit the flow, speed, and location of care interactions.

An interdisciplinary team, consisting of a UX designer, a UI developer, and a business analyst, collaboratively interpreted the data and developed conceptual models of the users and additional data they needed to collect.

We developed two personas that represent the population of school nurses we encountered. These personas provided us with a precise way of thinking and communicating about how users behave, how they think, what they wish to accomplish, and why. Our primary persona, “Belinda,” (see Figure 2), is an emotional communicator who tries to validate every child who comes into her office. Our secondary persona, “Ryo,” (see Figure 3), is an experienced clinician who does everything by-the-book. When designing the system, we continually asked ourselves, “How would Belinda want to interact with the system?” or “Will this help Ryo capture all the details?”

Figure 2 Primary School Nurse Persona “Belinda”

Figure 3 Secondary School Nurse Persona “Ryo”

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The Results

Less Clicks. More Care.

The primary goal of the redesign was the elimination of UI excise.

SDLC Partners collaborated with Health eTools and their client users to leverage human-centered design techniques that are meeting the needs expressed by school nurses using the system.

Together, we helped advance Health eTools to be the fastest, friendliest school EMR on the market. In fact, a school nurse cited saving about one hour at the end of every day and 16 hours at the end of the year when she tabulates data reporting.

“Health eTools has eliminated the days of using pen and paper to tabulate the SHARRs report data.

I love the documentation in Health eTools.  I can review student visits with parents and doctors to help diagnose problems or identify concerns. Health eTools makes immunization compliance a cinch. All the information is at my fingertips. “

Lisa J. Miller, RN, CSN, BS, MS
Greater Johnstown Elementary School

With a new CDC-compliant Immunization Tracker, a Guardian / Parent portal, and single sign-in for both Health eTools and an SIS, nurses can spend less time clicking and more time caring for their students. In addition, nurses will be able to satisfy state-mandated reporting requirements and generate powerful reports to keep their students healthy and in school.

The technology was enhanced and tailored to meet the compliance, efficiency, and professional requirements of busy school nurses.

Health eTools had a specific product where they wanted to enhance the user experience while further differentiating it in the market. Our work with them will enable them to compete in more states and serve more school nurses and students.

Investing in Human-Centered Design, as an integral part of an organization’s enterprise software product development process, greatly increases project success by reducing rework and increasing end-product adoption. Our process is based on teachings from Carnegie Mellon University’s Human-Computer Interaction Institute where our Human-Centered Design practice leader, Jonathan H. Brown, is a graduate of their master’s program. CMU’s program is the most published school for Human-Centered Design in the world.

SDLC Partners can help you get it right for your customers the first time…every time.

If you would like to learn more about how Health eTools is streamlining workflow and making care easier for school nurses with the help of SDLC Partners, contact us at 412.251.0848 or online.

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“With ever-growing customer demands and market competition, it has become paramount that we improve our delivery lifecycle and SDLC has ensured that
we have done that.”

Casi Johnson, Chief Operations Officer/Innovations Leader, M3 Accounting + Analytics

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