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SI 501: Client Report Katie Kondek, Ran Tao, Hsin-Yen Tu, Steven Scharrer, Kritika Versha


CONTENTS

Executive Summary Executive Summary

Client Overview Project Overview

Data Collection 01

Findings

02 Short-Term Recommendations 03 Long-Term Recommendations

This report documents the research and contextual interviews conducted for SI 501 at the University of Michigan’s School of Information. Over the semester our team has been working to diagnose problems and breakdowns in the information work-flow of Brairwood Family Medicine. These breakdowns, many of them centering around the records management software MiChart, are discussed in detail on pages 2-6. Recommendations, based on a thorough analysis of these findings can be found on pages 6-9. Client Overview

Conclusion

contextual interview Contextual Interviews are one-onone interviews conducted in the user’s workspace that focus on observations of ongoing work (see the box, How many interviewers: one or two?). Conducting a thorough Contextual Inquiry interview is more than observing and recording the user’s current tasks. You want and need to discuss what is happening in the moment with the user.

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Over the course of the semester our team has been working with Briarwood Family Medicine. Briarwood is part of the University of Michigan Health System and provides a wide range outpatient medical services. Briarwood, like all of the constituent parts of the University Health System has adopted the use of MiChart, a software aimed to standardize process across health services. Project Overview Our overall goal for this project was to deliver salient recommendations to our client. It became evident after our first meeting that we would need to focus on MiChart, the way MiChart is used and the impact on the medical professionals who use MiChart.


interpretation session

Data Collection

We refer to this session as an interpretation, but your organization

Data was collected by interviewing, shadowing, and documenting empirical findings. Our team was able to conduct five interviews over the course of the semester. We spoke with the healthcare staff whom check patients in and out, the call service staff, medical assistants, and doctors.

may call it a download, brain dump, or debrief. During the interpretation session, you will share your interview experience with the rest of the team and interpret the data, capturing the key

After our data was collected our group conducted interpretation sessions of the interviews. An interpretation session is a debriefing of sorts. The team members conducting relay their findings to the team as group. In doing this we are able to generate additional questions, flag points of interest for further investigation and start to generate insights.

issues and doing any work models

Once enough data was collected our group began to diagram and model our findings, and then consolidate those diagrams in order to see things a big picture. The diagrams were a helpful tool used to put things in context and see how the information works in sequence, which actions trigger additional actions, and most importantly; to help source breakdowns, or things that aren’t working for the user or in the system.

affinity diagram

you have chosen to capture. As a rule, plan on your interpretation session lasting approximately the same amount of time as the Contextual Interview.

The affinity diagram organizes the individual interpretation session, or affinity, notesinto a wall-sized, hierarchical diagram grouping the data into key issues under labels that reveal the customer’s needs. The affinity shows in one place the common issues,themes, and scope of the customer problems and needs.

After constructing our consolidated diagrams, we were able to move build an affinity diagram. An affinity diagram is hierarchical diagram that the documents all users, insights, and breakdowns across an entire system, in this case MiChart, and helps organizes the data into key issues. The key issues identify common, core problems form the basis for recommendations, which can be found on pages 6-9.

The affinity acts as the voice of the customer and the issues it reveals become the basis for user requirements.

Terms listed as defined by Rapid Contextual Design: A How-to Guide to Key Techniques for User-centered Design. Holtzblatt, Karen, Jessamyn Burns. Wendell, and Shelley Wood in San Francisco: Elsevier/ Morgan Kaufmann, 2005. Print.

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FIndings

01

MiChart is not always user friendly. There are several tasks that can no longer be accomplished in MiChart that the old system, CareWeb easily did. There are several processes that are redundant. When tracking patients through MiChart, there are several steps that a staff member must do once in MiChart and physically do again. For example, in MiChart there are dots on the screen that let other users in MiChart know what stage the patient is at. There are also markers in the medical assistant’s office space that they manually switch. Sometimes, they forget to do this and potentially cause confusion. It also takes up time to go back to the office to switch the dots. Doing essentially the same task twice wastes significant time that could be spent actually with patients. There is also an issue with check-in. When patients arrive, the desk staff must check in the patient to two appointments, one ten minute appointment and one longer block of time with the doctor. The issue is not with two appointments, these ensure Check in staff goes through the same procedures for both. MiChart should allow for the check-in staff to check a patient into both appointments at the same time. While this wouldn’t minimize significant time, it could add up throughout a day. There is also ambiguity when scheduling referrals. Some patients are told by doctors at other clinics that they could get into Briarwood Family Medicine’s internal medicine department in a few weeks when the reality is actually a few months. Patients call very confused and it would be easier for clients to know ahead of time what the wait looked like. There are also sever3


al ways for referrals to potentially show up in MiChart, perhaps in a way so that the referring doctor could see the wait times for each clinic. MiChart can be somewhat redundant in many ways, repeating tasks both within the system and physically. If MiChart is to be successful in eliminating redundancy and dedicating more time to patients, some of these redundancies should be eliminated in the phsical realm and just updated in MiChart. MiChart also does not handle paperwork very well. During one of our observations, a client came in to ask for signed paperwork. The paperwork had been filed at the front desk, however, there was not doctor signature on it. The staff member had to get up from the desk and find the doctor for the signature, which took about 7-10 minutes. Because this sort of interaction occurs daily, it should be a standardized process in MiChart. If MiChart can track patients, it should be able to track paperwork. While the patient was not stressed in this situation, it could pose a problem if a patient needed this during a particular busy check in time at the clinic.

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MiChart should also be able to better track x-rays and other lab test results. Currently there is not an easy way to track client results or any sort of paperwork in MiChart. This should be easily accomplished and would save a significant amount of time if there was a means for MiChart to track the process of not only paperwork for clients, but also for all existing paperwork. Tracking paperwork should be easy to do in MiChart, and doctors and other staff should be able to indicate when they have signed off on something then placed it in the correct area for client pick up.

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There is also a lot of paperwork in general at most doctors offices. While the paperless office seems to be a myth, the amount of paperwork generated per patient per visit is somewhat significant. In another scenario, paperwork printed that the client did not need or want during both the check in and check out processes. It should be relatively simple for the staff member working at the desk to ask a client whether or not they would like the printout of the visit summary or the medication check. These papers print out every single time a patient checks in, and not only is it an incredible waste of paper, but just more paper in the office that needs to be shredded considering the patient information on it.

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There are too many ways to do things in MiChart. Our team found that the procedures for MiChart tasks are not standardized. The multitude of means to accomplish tasks in MiChart impede full utilization of MiChart’s potential. Several means of accomplishing tasks distracted some staff and some felt that it was difficult to teach others. This does not mean that MiChart’s various ways to complete a specific function should be eliminated. MiChart’s flexibility regarding performance is still important, however, if the procedure is standardized it could benefit most of the novice users. Those novice users who do not have much experience with MiChart are more easily able to memorize and operate just one procedure. Given that, we could increase the speed of the process and decrease the possibility of making errors.

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Training in MiChart is inconsistent or insufficient Our team noticed users worked within MiChart differently to accomplish the same tasks. On one hand,


this showcases the customizable characteristics of MiChart, while on the other hand, this also presents the hurdle regarding work efficiency. The variety of uses within MiChart leads to miscommunication between staff, which decreased efficiency as well as effectiveness in work. Standardized processes and sufficient training are needed to create a common ground of communication when using MiChart. Standardized training will not only facilitate MiChart competency for staff, but also ease communicational tension between different employees. Using MiChart is or Can be a lengthy process Our team found that processes of operating certain functions are too lengthy. This design might be intended to decrease possible errors and clarify the progress, however, it also led to a decrease of working speed. This lengthy process results in a worse situation, especially when combined with a sudden burst of patients. Furthermore, lengthy process occupy too much cognitive resources, and impede staffs’ ability to multitask, which also lead to decrease of the efficiency.

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Short-Term Recommendations (Within 3 Months)

01

Training. With the busy schedule that staff at Briarwood Family Medicine center have, the difficulty of understanding and working in MiChart needs to be resolved. Creating an online forum where employees can post their doubts and have someone resolve their queries. Employees can make a list of queries they currently face when using MiChart. There could be discussions and hands-on training sessions scheduled accordingly. If several different times are offered, staff members 6


will have the flexibility of the Briarwood Family Center where their queries could be resolved.

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MiChart needs a standardized procedure for using certain functions. This procedure should be simple and easily memorized. This standardized procedure will facilitate communication between employees encountering difficulties in MiChart. Furthermore, it makes the transition of work between employees easy, and also aids communication between employees and the technology department. Organize paperwork (IE if finished put it in the box) Organizing paperwork might also be helpful in the short term. Simply creating files to categorize paperwork used at the check in desk into finished and unfinished files will assist employees. Employees will not need to read through all paperwork to note which items need further processing and can take care of paperwork in downtime. Long-Term Recommendations (6 months – 1 year)

01

Find a means to track paperwork.To quicken the checkin process during rush hours, patients can be handed a print-form to fill in details. At check-in counter, important details from the submitted form can be verified, scanned and uploaded using a new functionality which can be introduced in MiChart. This can ease the task of typing in detail of patient into MiChart at the Check-in counter and thus speed up the patient workflow process.

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Find a means to eliminate physical and MC redundancies. Elimination of redundant functionality in MiChart gives an opportunity to introduce functions in MiChart which can be used to synchronize records’ (e.g. lab reports) accessibility from other departments which are


currently not accessible for staff but are useful to them. Briarwood staff also do several tasks both in MiChart and physically. One example of this are the dots in MiChart and in the MA office. A suggestion to eliminate some of this work is to eliminate the physical redundancy and elect to do this task only in MiChart. Usability testing. Asking for monthly feedback from employees to assess the current condition of MiChart could be helpful in further standardizing MiChart. Furthermore, sampling users from diverse backgrounds with different responsibilities regarding the health care, will help refine MiChart in ways that fit both the novice users and expert users. Finally, usability testing is essential before launching new functions. Customize for each user. In addition to standardizing the procedure within MiChart, it is also helpful to include the flexibility of MiChart. For example, during our interview process, we realized that certain tabs of MiChart were never used by the employees in particular roles. Such tabs can be eliminated for that particular employee role. By applying this flexibility, it creates expert users more familiar to MiChart and increases working speed. Hovering label in MiChart. A hovering label can be introduced in MiChart for various tabs to help the employees who use it to understand its content in a better way. Novice users could easily understand the procedure of operating certain functions by using this feature. Moreover, this feature could be turned off after the user is familiar enough with MiChart. In this way, it will not be a distraction once users master MiChart.

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Group related practices. IE Group the items for Checkin, Group items for check out The interface of MiChart can be refined by grouping similar information together, or distribute the display into a few tabs to categorize the information. For example, tasks related to check in process could be set onto the top left of the screen. By doing so, users will have a better acknowledge about where to find the function they need, and it could increase the efficiency of the work. Best Practices.Since there are multiple ways to perform a task, the best practices in MiChart can be identified through discussion for each staff role and noted. Standardize the procedure to use MiChart:

a

Handbook. All the best practices identified and noted can be handed to the employees for reference in form of a handbook.

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Further Training: A quick training-quiz can be made mandatory every six months or so for every employee who uses MiChart to make him aware of the best practices to be followed while using MiChart. Another way to do this is to utilize online training and demonstrate for users how best to accomplish certain tasks. In conclusion, we would like to thank Briarwood Family Medicine for their wonderful cooperation. We believe that some changes to the MiChart system can result in significant improvements, and additional training will make the work flow more efficient. We hope what that our recommendations will be of some assistance. Thank you again for your long lasting cooperation! 9


SI 501: Client Report