EMR FOR PETS - A UX CASE STUDY

🗓️2021

Electronic medical records for pets. Build a better experience for healthcare providers and pet keepers by strengthen their relation. Eliminate the use of third-party apps for tracking pets welfare and sharing data with the vet. Monitoring health, sharing details and making all part of the medical records is possible.

PROJECT OVERVIEW

CHALLENGE

Statistics show that more than half of population globally own a pet. However, tracking welfare and health state electronically is a challenge. The struggle in the healthcare community persists, for both sides, veterinarians and pet keepers.
On one hand, health providers are still required to fill out paper forms when medical encounters are taking place and to understand health evolution from physical records.
On the other hand, pet keepers have a hard time recording, sharing and making part of medical records their tracking notes about pet’s health. Also, accessing medical records from personal devices is not yet a default possibility.

OBJECTIVES AND PROPOSAL

Design a digital product that solves the scattered state of pet medical records by bringing all pet care vital records to one place in order to simplify care for both veterinarians and owners.
To do that, I have to design a digital experience that:

ensure that vets focuses only on providing medical care to pets, and do not have to worry about logging the findings and recommendations
sources official records directly from the vet and provides the keepers online access to the pet's vitals. The caretakers have guidance for following doctor’s orders accordingly, receive alerts when vaccines and checkups are due, and can even mark events and share them with physicians, all being part of pet’s medical records.

Outcome: Remove the need of third-party products for both sides (vets and keepers), all features being available and sharable in one place.

TOOLS

Sketch,
Figma for prototyping,
Pages and Notes - Apple ecosystem apps for taking notes after interviews, writing takeaways after reading online surveys and any other idea I had during the design process

ROLE

Research, UX - self directed

Framework - DESIGN THINKING PROCESS

Chose user-centered approach to problem-solving for taking on this challenge.

01. Empathize

Understand who the users are and the challenges they are facing.

RESEARCH

Start with the basics by doing foundational research to figure out what the users need and how to address those needs with the digital product I intend to design. Questions I considered during foundational research:

What should I build?
What categories of users do I identify?
What are the user’s problems?
How can I solve those problems?
Am I aware of my own biases, and am I able to filter them as I do research?
Done qualitative research during designing phase also, to be able to build a solution upon feedback and gather facts to support my decisions.

RESEARCH GOALS

Get familiar with the veterinary medical industry
Understand how veterinarians conduct a medical checkup and how they log findings
Understand how keepers keep track of their pet’s health evolution
Understand the experience both vets and caretakers currently have and discover pain points
Identify gaps in sharing pet’s medical records between vet and keeper and transform them into opportunities
Identify competitors and evaluate strengths and weaknesses

Since there are two categories of users for the digital product I intend to design, I split the foundational research based on this.

SECONDARY RESEARCH - veterinarian perspective: online articles, research publications, reports and statistics

Patterns and takeaways identified

While EHRs are widely used nowadays by veterinarians, rates of satisfaction with these systems are actually decreasing. This statement is sustained by the survey results published by American EHR Partners and AMA which shows that EHRs fail to offer improvements on productivity and costs. The questions from the survey revealed that 72% of physicians thought their EHR system's ability to decrease workload was inefficient.
Unintuitive flows and heavy features confused practitioners and thus generated longer period of time to overcome challenges, complete daily tasks and learn the EHR system features.
Christine Sinsky, MD, VP of Professional Satisfaction for the American Medical Association stated that “over half of US physicians are currently experiencing signs of burnout” the driver being EHRs which leads to career dissatisfaction.
According to a survey done a few years ago in Massachusetts on veterinary medical practices, findings showed that 63% were using a mix of both electronic and paper-based records with only 34% of that reporting satisfaction and only 17% had switched completely to EVHRs. This suggests that electronic health record systems weren’t meeting their needs.
Interoperability is also a known issue and even sharing data is not very helpful considering different terminologies and abbreviations used. This suggests the lack of a standardized system used widely.

PRIMARY RESEARCH - pet owner perspective: user interviews (foundational research) and usability studies (after ideation phase)

Although having biases is normal, I remained open minded throughout the entire process in order to overcome them and to prevent them from affecting my work.

Before starting to build anything, I’ve chosen interviews as a foundational research method. I've done one-on-one interviews with 4 friends that own pets (3 man and a woman between the ages of 25 and 55), who I interviewed via Zoom and FaceTime. My goal was to gather qualitative data by asking open-ended questions that require participants to explain their answers by providing more details.

While developing the product, I have conducted usability studies (which is the most common method used to conduct design research) with the same 4 participants to see if its development was on the right track and what adjustments needed to be done. I’ve conducted the usability testing online via Zoom.

Patterns and takeaways identified after initial interviews

Caretakers can not rely on any software tool to monitor their pets's welfare and struggle to make records about pet’s health state.
The purpose of the tool should be beyond a reminder, especially the ones set up manually.
When a treatment plan has to be followed, the instructions must be clear. Users sometimes are confused and overwhelmed by details like medication, dosage, duration of treatment.
When vaccination plans are followed, keepers feel misled regarding when they are due. They think a roadmap would be helpful, alongside with reminders.
Users are concern about monitoring progress in case of a surgery or any kind of event/condition the pet has. They want to share the info gathered with the vet making him aware. Also, they would fell less stressed if they would know that the notes are part of the medical records and linked to the event.
For owners with pets that suffer from chronic diseases, monitoring them is mandatory. Thus, logging symptoms, drug shots, dosages and frequency is a requirement. Register such information makes visible health evolution and should be part of pet’s medical history. But doing so within third parties apps is demanding and unable to make it part of official medical records. Is just logged information with no background details.
Owners often feel stressed about the certificates, or any kind of notes the vets does in the pets medical files that stand as proof of health. If they are not in handy for situations where they have to present them, like at boarding kennel, they feel overwhelmed and frustrated.
Receiving the invoices from the veterinary clinic into an electronic format would please users because the need for keeping both paper evidence and photos or scans of those is eliminated. Moreover, submitting claims to insurance company the keeper is registered at would be done effortlessly with no additional requirements.

To summarize the findings in a more visual way, I have created empathy maps, personas and user stories based on interview takeaways.

EMPATHY MAPS

PERSONAS

USER STORIES

02. Define

Based on research findings, I build up the connection between pain points and problem statements. Based on this, it was clear for me what my design will address.
Designing with usability in mind for both sides, veterinarians and caretakers is a must. I considered this requirement every step of the way.
Based on my research (veterinarian standpoint) and my takeaways after interviews (keepers standpoint), I have learned that for both sides the pain points fall into categories of Product (quality issues with existing products on the market) and Process (related to user’s journey with existing digital products).
Identifying the pain points helped me find potential problems that I can address and my design solution can solve.
After summarizing the pain points, I’ve recap the facts I know about the users needs so that I am able to write the problem statements accurately, providing a clear description of them. This way I framed the insights to help me move forward with my design process and jump into ideation phase.

PAIN POINTS

PROBLEM STATEMENTS

I gathered all point views from the personas I have created, and for the problem statement I have grouped them all together into an aggregated form for keeper Ellen.

03. Ideate

Come up with as many design solution until I decided upon the best one.
In this phase of the design process I have created User Flows, paper and digital Wireframes and the Site Map.
This being mainly a UX Case Study, I did not invest time into creating mockups, and kept things at high-fidelity wireframes level. Those I have explained in a section below.

IMPROVE THE EXPERIENCE FOR EVERYONE. AIMING FOR INCLUSIVE DESIGN

While framing the solution, three main questions acted as guidelines in my design strategy:

How can I design for everyone taking into account there are two sides of the matter?
What contexts need to be regarded?
What stands as the flawless experience?

Early on, it was of value to understand the diverse factors that may influence the experience for both Veterinary and Caretaker.

04. Prototype and Test

Try out the functionality I had in mind in ideation phase to get a feel for what the product will look like and how it will be experienced by users.

With this final step described from the design process, I will now continue with explaining step-by-step the product and providing rationale for every decision I've made.

Display information. Form categories. Build connections between them

I started by putting the information in order, with the aim of finding the easiest way to comprehend it.

HEALTH RECORD: every pet patient has one that highlights the medical encounters, events and care received over time. All gained information summarizes the vaccines and medical tests done, meds taken and treatments received. It allows healthcare providers to ensure informed care.

MEDICAL HISTORY: represents suitable information gained by the vet from health records when examining a pet, with the aim of putting a correct diagnosis and providing medical care.

PHYSICAL EXAMINATION: a direct examination of the patient done by the vet. Clinical signs are noticed if appropriate, and the care provided, diagnosis and treatment are logged and stored as part of the health records.

DIAGNOSIS and TREATMENT plan: possible to be made by health professionals based on information gathered from Medical History, together with the Physical Examination’s conclusions.

A common meaning is that the health care provided is documented and all steps are connected.

FROM AMBIGUOUS FLOWS TO INTUITIVE ACTIONS

The baseline for my idea is simple: minimal requirements (for both veterinarians, and caretakers) for documenting the care provided to the pet. Enable the veterinary to focus on patient and transform vet’s recommendations into actions for caretakers to follow accordingly.

This means the Outcome = Treatment Plan & Recommendations the veterinary generates when filling out encounter’s details is converted into a comprehensible Input = Actions to be taken by the keeper. Moreover, these are stored as part of health records.

In addition, the keepers have at their disposal more options when logged into the account. No need for third-party softwares to benefit from more features like managing invoices or tracking drug dosages.

My solution is designed with care and consideration for ill pets also, who need tracking of medication, drug doses, meals, hydration and activities.

Suitable Architecture - inspiring confidence when engaging

With these benchmarks in mind, I considered the checkup sheet filled out by the vet at each encounter to be the starting point of generating all engagement, actions, scenarios in the app. It stands as the core of the app, meaning the layout is shaped by the output veterinarian generates with each encounter taking place. All the other possible actions are secondary.

Therefore, the challenge stood into the way I designed the checkup sheet, with consideration for the user flow to be easy and intuitive.

With consideration of information grouping above, here are the sections:

CURRENT HEALTH STATE visible at a glance. It emphasizes key health indicators valid at the time being.

MEDICAL HISTORY available for deeper understanding of past medical events. An easy way of browsing past medical findings, so takeaways are comprehensible and unchallenging to be found.

MEDICAL ENCOUNTER concluded with the health assessment and recommendations provided by the vet. Point of generating future actions.

With the risk of repeating myself, I will point out again that each Medical Encounter stands as an input for Health Records and is the main pathway for generating future actions within the app. This process has a predefined format since the beginnings of time, but my vision stands with the way I designed the functionalities and patterns of the flows. My design solution relies on the manner in which medical data is gathered, stored and how the app engages with the user and anticipate actions.

Teach by Example

From this point further, I will provide the rationale behind every decision considering a distinct scenario and its possible outcomes: keeper John has a scheduled appointment at the veterinary clinic for his American Akita named Onni for a routine physical checkup.

Current Health State and Medical History

First section displays the briefs about pet’s health status. This approach anticipated vet’s interest into Medical History, Current Health State and any concern worth mentioned.

Same data about pet’s health state displayed from keeper’s perspective making the basics being accessible.

If deeper understanding is required, a link for accessing Medical History is available. Being read-only, the way data is displayed is identical for both sides, veterinarian and keeper.

Benefits of the way this section is designed:

key health indicators easy noticeable, mindfully displayed
enable vet to provide informed care with ease
improves the quality of the initial part of medical encounter when vet gathers facts for establishing basics
carefree for the keeper for not having to reply on his memory to provide some crucial fact. All is documented in the app

Reason for Encounter

This section follows to mark the grounds for the appointment.
The name for the visit is automatically inherited from the scheduling the keeper made. So, no action required from the vet. If anything worth mentioning, vet can select Yes radio button and a new section is available for logging details.

This part of the encounter influences the diagnosis (a later section) meaning information provided in here will stand as proof for health assessment.

Vital Signs and Initial Observations

Moving forward, elementary health indicators are recorded with minimal effort from vet side. Each category has predefined indicators according to medical practices. I grouped this info together, as it stands as prerequisites for the encounter.

vet requirements are anticipated
Vital Signs section has a Past Statistics button displaying a graph of the evolution over time of the registered data at each checkup
section Initial Observations has a special part dedicated to any event the keeper may have registered from his profile and linked it to the appointment when scheduled it
worry free for the caretaker not having to rely on his memory to point out something if case

Physical Evaluation

As expected, a structured examination of patient’s general appearance is in order. Considering this is done in a predefined and systematic way, meaning by inspecting body parts, I grouped the data into six categories.

Health Assessment

After recording the observations, vet proceeds to the most important part of the encounter, health assessment followed by the recommendations.

HOW: only actions to be taken based on available data already filled out into the sections above. So, no further data required to be logged by the vet.

Benefit: although this process is no mystery to anyone and each medical visit, human or pet, ends with findings and recommendations, it is usually done on the same dull manner that implies only logged data as free text. Storing information with no engagement, no interaction, no anticipating next steps based on findings and doctor’s orders is nothing but boring and hard to browse. The approach I present does the exact opposite of the things I just listed.

External Parasites

Health assessment starts with a common fact which is whether or not pet has external parasites. If no, good for him, if yes then a typeahead control is available for registering it, alongside with proof.

Medical Diagnosis

Three scenarios are available, and one of the three is selected by default based on previous data filled out:

Case 1 - Pet is Healthy

If no parasites were selected above and no issue raised in reason for encounter section, then by default first option is selected, with the possibility for the vet to change it if case.

Case 2 - Assumption Needs to be Confirmed

If an issue was raised at reason for encounter, but no external parasites are present, then the middle option stands for default option. Then the disease or condition assumption should be named while the symptoms and signs faced are fetched from RFE section - already recorded by the vet. Obviously, input is editable in case additional data needs to be logged.

Case 3 - Follow-up Visit or Pet has a Condition

As title states, this option is ticked off by default, if one of two scenarios happens. Otherwise, it can only be selected by the vet, regardless of data logged at previous sections.

Follow-up Visit (default)

When the medical encounter is a follow-up and patient comes back with test results to obtain a medical opinion. Thus, the veterinary can put a diagnosis and register the symptoms in case of any.
If it’s not the case, and tests are just a routine formality, then vet can change option and tick off the option which states that pet is healthy (option 1).

Pet has external parasites (default)

When external parasites are confirmed and logged a section above. Thus, the Condition is already filled out and Symptoms are taken from RFE section with possibility of adding more.
Note: if case, other condition(s) can be registered based on clinical signs, alongside the external parasites.

Vet considers so (selected)

This option can be chosen by the vet when filling up the checkup sheet for conditions like skin allergies, for example. No external parasites present, but issue raised at RFE section and, therefore based on clinical signs vet can put a diagnosis (so middle option not needed). Symptoms are taken from RFE section and condition is filled by the vet using the typeahead control.

No matter what scenario is in question, two things happen by default easing the veterinarian’s job:

the facts that stand as confirmation for condition are already filled up: medical tests or clinical signs, depending on the case

the current encounter is automatically set as reference with possibility of browsing medical history and select prior medical visits, treatments or medical tests to stand as supporting material

Risk Factors and Overall Care

The next point in assessment section is designed especially for when pet needs surgery and there are concerns that need mentioning. If it is the case and medical tests are required to be done before surgery, then in the next section appropriate action can be taken.

A final section in the health assessment category is related to the care level the keeper is providing, noticeable in pet’s overall health. The welfare of the pet is reviewed and evaluated by the vet and conclusions are not linked to the medical findings from the ongoing encounter.

Recommendations

Following Health Assessment, Recommendations are given according to findings as a final step in the medical encounter.
Benefits of the way it is designed:

according to doctor’s orders, the keeper is guided how to fulfill the indications. Any option selected by vet as recommendation, will trigger an engagement needed to be accomplished by the keeper

each instruction or step completed by the keeper, stands as proof and analytics can be seen by the vet. This way he is sure the keeper is following them accordingly

removes the overthinking vet does when providing recommendations. No worries about how he puts his words, he relies on the app to make keeper understand what he has to do

removes the same concerns regarding misunderstanding doctor’s orders from keeper side also

moreover, based on how this section is designed, vet can rely on the app to be his support and help not to forget to provide all recommendations

Possible Triggered Scenarios

Considering these actions are triggered automatically, I thought about three types of next visits (main engagement with suitable linked actions as secondary), regardless of which kind the current one is:

a.FOLLOW-UP visit

triggered for Medical Tests category entirely, regardless of which options are selected

triggered for only a part of Treatment category specific for acute conditions only. Therefore, prescribed medication that cure short-termed conditions (less than three months) like flu, itch, parasites require a follow-up so veterinary can check on health development

Therefore, follow-up encounters are required and set up automatically when medical investigations or treatments are essential for the vet to establish a suitable diagnosis.

b.ROUTINE PHYSICAL checkup as a common practice for keeping welfare

triggered for the other part of Treatment category specific for chronic conditions only. Therefore, prescribed medication essential for conditions that are long-lasting in its effects, demand more medical attention. Thus periodic checkups will occur more frequently. In this case, on pet's profile in the Active State of health his disease and treatment are displayed

triggered when no Medical Tests are recommended or when no treatment for acute condition is prescribed. Thus, over the counter medication can be advised to be taken (benefits keeper to know which vitamin should buy and information is stored in medical history to keep record of it) or vaccination plan is selected along with boosts shoots if pet is in his early stages of life

c.SPECIALIZED consultation done by a veterinary specialist when pet needs further attention

triggered for Medical Referrals category entirely, regardless of which options are selected. Therefore, referrals stand for last category of recommendations veterinary can propose. Services are grouped by veterinary specialties

One note here: all medical procedures which implies Surgery, regardless of the speciality, have different actions trigged compared to the rest of the items from Medical Referral. A surgery or a delivery for females is a special life event and should have different approach. Thus, if a surgery is recommended, the current visit will be automatically set as reference to the surgery sheet, and the surgery event will automatically have a follow-up checkup been set. After the follow-up, possibilities for the next visit are exactly the same as presented so far.

Upcoming visit already filled out

Upcoming Medical Visit is the last section on the checkup sheet which is already filled out based on above selections from Recommendations section. After veterinary saves changes from the checkup sheet, the scenarios for the keeper will be set accordingly.

Appraisal required

Routine check-up

Specialized care needed

Recommendations turned into Actions

All recommendations given by the veterinary in the encounter are turned into actions to be done for the keeper. As pointed out earlier, app does not only serve the purpose of storing data, but also generates a specific behavior based on selections made and encourage engagement.

Tracking medication.

Manage all documents regarding bills issued for the services provided. Share them with insurance company. Take proper actions related to future appointments.

Final Thoughts and Takeaways

This challenge I've put myself up to was a fruitful adventure into research, UX and brought a lot of takeaways about interactions with users to gather feedback and inputs in regards to your product. As Next steps into this project, I think a proper UI will be appropriate and further usability testing will come in handy for sure.

Some key takeaways:

Create a well-organized project plan. With so many issues to consider, a good strategy will prioritize on what’s needed for the MVP and keep track of backlogs.

A well done Competitive Audit helps in understanding your place better. Know what are your requests and take advantage of the weak spots in the market to improve your solution.

Understand tradeoffs in decision-making. Knowing when and why to use a particular tool or research strategy is part of the critical-thinking needed to successfully deliver.

General references

Besides the links already specified in the text, here are others sources from where I gathered data.

Developed by Victor Baba