Alere Consult

Designing care plans to improve patient outcomes

Alere Consult
When: 2013
My role: Design Lead
The team: My Design Manager, Product Manager, Front-End Developer

Coordinating care for patients with chronic conditions is difficult. All clinicians–primary care physicians, care coordinators, and telecoaching nurses–use different software programs that don’t talk to each other. This leads to redundant data entry and wasted time with patients. I was excited to join Alere Accountable Solutions to solve exactly this problem. We wanted to improve patient outcomes by sharing important patient data with clinicians and helping patients live in their own homes.

Creating a Shared Experience for Clinicians

The main product we built was Alere Consult, a health information exchange. We aggregated patient records from disparate sources (clinics, hospitals, specialty care) and present clinicians with a single view of the patient’s history. With our product, clinicians could see information like clinical notes, medications, lab data, and diagnoses even if it wasn’t written by a provider in their network.

Patient history in a single, longitudinal view regardless of where they received the care

To build on this powerful product, we also tackled problems that account for a large proportion of healthcare spend–caring for patients with chronic diseases. After diagnosing a patient or hospitalization, we wanted to create an environment where patients could continue living from home and still have clinicians monitoring their health. Our connected devices, like blood glucose meters, pulse oximeters, blood pressure monitors, and weight scales could send vitals directly into a patient’s chart.

The devices connected to a hub (the one I’m holding), which relayed vitals to our patient charts (right)

Turning Care Plans into a Usable Feature

One of our customers (a hospital network) was looking to roll out Alere Consult for all their clinicians, but needed to be able to document care plans. I set out to understand how clinicians use care plans in the context of patient visits. Engaging our top doctor users, I found that patients set goals for themselves. Clinicians tie those goals to the patient’s clinical problems and set interventions to help patients reach those goals.

Looking at competitor platforms, I knew that their interfaces seemed cumbersome to fill out, even as I had a few doctors show me how they used it. I wanted to see how clinicians filled out care plans in the context of a patient encounter. I realized I could engage Alere’s telecoaching division to help me perform this research. Telecoaching nurses talk to patients over the phone most of the day and one of their primary roles is to create care plans. I organized a two-day research study to observe these nurses with my boss.

Care plans in competitor platforms were structured in an unnatural way

Our immediate learning was that the competitor platforms structured care plans in an unnatural way compared to the typical conversation structure between a nurse and patient. I flipped the design on its head and provided a simple way to enter and review information for follow-up encounters.

Showing a rough prototype to the nurses on day 2 helped validate our design direction.

Improving our design to match how clinicians talk with patients

Quantitative Goal Tracking

Many goals involved tracking vitals, weight, and other quantitative measures. Knowing that we collect many of these measures with our connected devices, I took the initial designs further. I created a few components that would help clinicians visualize the patient’s progress toward their goal. For qualitative goals, I designed a way for clinicians to assign progress measures based on their conversations with the patients.

Observing the telecoaching nurses, I often found them using clunky interaction design to get the answers they needed

Explorations with quantitatively tracking goals

Understanding What Was Worth Pursuing

The research we did over the two days of shadowing telecoaching nurses helped us understand their environment and a few trends.

Reference materials for various health conditions were pinned up (left and center) in every nurses cubicle along with numbers and addresses for the call center (right)

I listened to 7 patient calls and plotted the topics covered to discover trends.

Visualizing patient calls helped improve our design to match the structure of telecoaching calls

In bringing the learnings back to our teams, we also sketched out a typical day of a telecoaching nurse.

A typical day for a telecoaching nurse

Digesting the experience, we determined there were three problems that were worth addressing:

  1. Scheduling calls with patients—Telecoaching nurses spent most of their day figuring out who to call. Many patients were not available, even for their scheduled calls. Time zone math and the old system added to the problem.
  2. Reducing the need for reference materials—Without being overbearing, nurses wanted some light scripts or relevant checklists based on the patient they were talking to. This would eliminate the need to find the right post-it note or reference tacked to the wall.
  3. Simplifying medication reviews—Patients didn’t always have their medications on hand. If they did, figuring out what adjustments their physician(s) made since the last call was nearly impossible. Sometimes telecoaching nurses asked patients to mail their medication list to update their records!

As our team designed the medications feature later, our research played heavily into reviewing and making adjustments to existing medications. The first two problems were slated for later.

Using care plans as a pivotal project, we improved upon our competitor’s designs and used the research from the project to address adjacent problems. I also had a couple of important takeaways:

  • Observing clinical situations led to a better and faster understanding of the problem.
  • There was no substitute for having the nursing team participate in design of the feature. Rather than toiling over minutia, I got the big-picture design problems solved first.
  • Using competitor products in research is a completely valid way to test different solutions.