Patient Engagement Advisors and EffectiveUI

Please tell us about how you created an enterprise or business solution that keeps usability at its core while still effectively meeting business needs.: 
 
PEA provides Transition of Care, Outpatient Service Development, and Industrial and Business Health Services for large integrated healthcare systems nationally that desire to extend the commitment of care for patients, employees, employers and consumers beyond the hospital walls. 
 
One example of the business challenges health systems have related to a successful patient ‘transition’ to home is:
•97% of the patients leave a hospital with a prescription in hand and have the intent to go to a third party pharmacy to have it fulfilled
•26% of patient never pick up or take their first medications
•24% of patients readmit because they are not compliant / adherent with their medications
•CMS (Medicare / Medicaid) and commercial payers now economically penalize health systems for patient readmissions – costing them approximately $25,000 per incident.
 
One of the ways PEA helps hospitals better engage with patients is through the implementation of an on-site pharmacy and Transition Specialist (Pharmacy Technicians) who are deployed throughout all of the acute care floors/units and respective clinics and outpatient service areas.  The Transition Specialists who are tasked to serve each and every patient who is discharged from the hospital use PEA’s Patient Navigation System (PNS), an iPad application that includes two applications to help better manage the patient post discharge requirements (e.g. discharge medications). Countdown to Discharge helps track patient status and specific complex workflows (eligibility, permission processes, method of payments) so that PEA Transition Specialist can track patients throughout their time in the hospital, and the Basket and Point-of-Sale application helps PEA employees order patients’ prescriptions and necessary supplies (nutrition and related product requirements) via the in-hospital retail pharmacy and coordinate post discharge referrals before being discharged. This system helps to ensure patients are getting the post-treatment care they need, and reduces the likelihood they will return to the hospital with problems.
 
PEA enlisted EffectiveUI to help redesign its system. Because the activity of filling prescriptions is highly regulated, and there are many different layers involved in the process (including signatures, verifications, etc.), PEA wanted to create one application that effectively addressed all of the specific needs of its Transition Specialists who work to engage with patients before they are discharged to help them fill their pharmacy, nutrition, and related clinical requirements.
 
In order to keep the prescriptions in-house, and to help increase patient post-care success, PEA employees have a short window within which they can meet with patients after a procedure and before their prescriptions are automatically sent to the pharmacy they designated upon admission. The new PNS applications needed to ensure a clear picture of when patients are ready to fill prescriptions and order supplies, as well as conduct a smooth transaction that follows the required steps needed to fill prescriptions in a timely manner.
 
EffectiveUI conducted ethnographic research to help inform the design and workflow for the application. They conducted a thin heuristic evaluation, and then shadowed the PEA employees meeting with patients to observe the process and to understand where improvements could be made to the system.
 
The C2D piece of the application, which ties in with the hospital’s secure patient records, needed only some slight adjustments; while the Basket and POS application was set for a complete redesign – both from a workflow standpoint as well as visual design – with a goal of making the process easier for both the PEA Transition Specialist and the patient or their proxy given the context of their environment and state of mind. The research and evaluation had made clear that the most important piece of this redesign was getting the workflow right. A clear understanding of the entire domain and all of the architectural considerations that allow for payments and other fulfillment was critical – it all had to work together seamlessly.
 
Another important factor was accounting for multiple information types (e.g. patient information, financial data, demographic data and pharmacy / prescription, and physician orders) on an iPad screen. Starting with the interaction model and manifesting in the screen layout, the team designed a system for presenting more relevant information and at each step of the workflow to facilitate greater efficiencies and accuracies.
 
In the redesign, language was made consistent across the applications, and the complex layers of prescription fulfillment were combined to make the process more streamlined. For example, when filling certain classes of prescription drugs, several signatures are needed. The app now allows patients to sign the iPad only once, applying it to multiple needs and records. The new system also allows for easier payment transactions, such as split payments due to HSA/FSA cards and what they will cover.
 
The Countdown to Discharge and Basket / Point of Sale application is deployed pervasively throughout PEA’s customer base. The updates to the Countdown to Discharge are deployed everywhere, while the Basket and POS version is still in beta, and will be deployed to over 100 Transition Specialist in approximately a dozen health systems using the Patient Navigation System (iPads) in the next 90 day (timeframe).