Patient
Care Team
Control
Understanding Physicians, Nurses & Asthma Patients
- Interviews – AstraZeneca Medical Science Liaisons, Nurse Practitioners, Physicians about asthma, and patients.
- Research – Medical journals and articles.
- Patient – I am also an Asthma Patient. I have been using 1 control inhaler, and 1 rescue inhaler since the age of 12.
Diagnosis Can Be Difficult
Suspected Asthma Patients should have their diagnoses confirmed with spirometry.
Primary Care often prescribes asthma medications without a spirometer test.
COPD and Asthma are sometimes misdiagnosed by primary care physicians.
Chest pain, tightness, or difficulty breathing are symptoms that can be related to other diseases like allergies, anxiety, or heart conditions.
Misdiagnoses in a patient population could be over 33 percent nation wide.
Getting Control
Once Asthma has been diagnosed, getting control with the proper medications can be difficult. Patients will be prescribed different brands of medication or have the delivery system changed throughout their treatment.
“Rescue Inhalers” relieve an exacerbation (Asthma Attack), but are very commonly referred to by the generic name “Albuterol”. On the inhaler, the “Brand Name” is usually the most prominent. Some brands do not show “Albuterol” unless the canister is pulled out of the dispenser and the fine print can be read. When a pharmacy switches between brands it can cause patients to mix up their Control and Rescue inhalers.
Can we show patients what their current “Rescue” and “Control” Inhalers look like?
Can we remind patients to take complex medications like Prednisone correctly?
Education
Improper Inhaler use is a common problem. Methods for teaching patients how to use inhalers are inconsistent. Patients who have been using inhalers for years forget how to properly use them or take shortcuts.
Can we remind them how to use their medication between visits?
Adherence
One doctor told a story of a patient he watched from his office window empty his inhaler into the air in the parking lot before coming into the office. He filled out the Asthma Control Questionnaire as if he had been taking his medication. Then showed the doctor the empty inhaler as proof he had been taking the medication.
The doctor felt his motivation was that the patient didn’t want to disappoint him.
Environmental Factors
Asthma symptoms and the risk of exacerbations goes up when the Air Quality is poor.
- Smog – Particles in the air are harder to expel.
- High Humidity – Airways restrict even more. Traps contaminants in the air.
- Cold Temperatures
- Sudden Weather Changes
- Allergens – Pollen, grasses, trees, dust, and mold.
How can we help patients answer the question; “Can I go across town tonight to see my son’s soccer game outside?”
Can we show them how to protect themselves from Environmental Factors?
Maintaining A Higher Level of Good
One Physician told us about a patient who started off barely able to get out of bed. Her “Level of Good” was so low that she would comment on how she had such a “Good Day” when she did the dishes.
During her next visit, she was complaining about how “Bad” her day was because it took her so long to check out of the grocery store and to get her hair done. Her new “Level of Good” had been raised so high because she was leading an active lifestyle again.
A higher level of good can also be a danger point in the patient’s progress because when they feel better they will go off their medications and begin to regress back.
Can we show the patient that they are doing better and how they got there?
Can we give physicians the ability to positively influence patient behaviors that lead to a higher level of good?
Drive Communication Between Patients & Care Team
Asthma Control Questionnaire (ACQ) every 1 to 6 months before an office visit. Often the patients do not fill out the ACQ accurately about how they are taking their medications.
Can we ask the patients how they are doing with more personalized messages at certain points in time?
Can we alert the Care Team if certain answers are given or certain criteria set by the Care Team is not met?
Can the Disease Platform learn what messages work the best at what time to keep patients at a Higher Level of Good?
Electronic Medical Records, Apps & Dashboards
Visited 5 private practices in the San Francisco East Bay Area:
- 4 of the practices review and fill out patient charts on paper. The review of medical data via printouts.
- 1 Used a computer with EPIC Medical Records.
- None used a smart device to chart or review patient records.
- They all did data entry into their EMR at the end of the day.
Engaging with our partnered Healthcare Networks we saw EMR systems with…
- Dashboards that are hard to read.
- Do not offer any level of customization.
- Patient apps like Epic’s My Chart not being used.
- EMR Modules for Asthma not being activated.
The main reasons why these apps or dashboards were not being utilized was…
- Extra cost to the EMR provider for module and app usage.
- Lack of dedicated IT who can implement and maintain apps and dashboards for their systems.
Asked our partners about Propeller Health…
- The cost was too high.
- Not believing patients will use and maintain a BT device sensor.
- Wasn’t trusting the findings and not willing to take the budget out to see.
- Looking for a tailored experience directly in their existing EMR.
Return on Investment
AstraZeneca
Healthcare Network Access
A way to form new program partnerships and new representative contacts.
Reputation
If we create patient programs that are not based on AstraZeneca medication it will show that we care about all patients regardless of what they are prescribed.
Value-Based Care
Insurance providers reward Healthcare providers for the quality of the patient care they deliver instead of the number of tests and health care services they provide.
The patient data that is coming into the disease platform can help prove that our medications are providing better care to specific patient populations by measuring patient outcomes such as medication adherence, increase in symptom-free days and a reduction in emergency room visits.
New Prescriptions
Can we provide representatives new and meaningful data to discuss with Physicians?
Because we have shown we care will physicians prescribe AstraZeneca medications first?
New clinical research populations
Can we form new partnerships for research and development?
Disease Platform Data (deidentified)
Specific Patient Populations
Improve Upon Claims Data – Not just a single point in time.
Discovery of New Treatments
Discovery of New Markets
Refills – A better understanding of what happens leading up to prescriptions not being refilled.
Healthcare Networks & Private Practices
Free Patient Apps, EMR Dashboards & Support
The cost of having IT develop or to pay for Apps and EMR modules from the leading EMR provider in the industry Epic is extremely expensive.
Propeller Health has the most traction with a sensor that goes onto the patient’s inhaler, a patient app reporting data to a machine learning platform but cost the Health Care provider or Payer between Customers pay a monthly charge of about $15 to $25 to sign up their patients. That data does not go into their existing EMR Dashboard.
Free EMR Integration and Support
A number of our partners deployed their EMRs in different ways across their HealthCare network.
Example Healthcare Network –
1. Pulmonary Practice could be treating patients who have developed Asthmatic Bronchitis. IT has Epic EMR deployed on a specific server type with specific dashboard modules activated.
2. Allergy Practice treating Asthma related to allergic reactions. Different IT group has deployed Epic another server type and does not have any dashboard modules activated.
Stakeholder Presentation
Presentation to our stakeholders what the product will do and how we can leverage existing Disease Platform Apps and Dashboards. Audio stitched together from the presentation.
Working Prototype & Dashboard in 3 Weeks
Leveraging Existing Apps
Disease Platform Apps – The desired feature set closely resembled other Disease Platform apps, so I was able to pull Components and Widgets from our Framework.
Partner Asthma App & Care Team Dashboard – Edge has been in use at Geisinger Healthcare Network for over a year. The team collected quantitative data on how the app was performing in their patient population. The dashboard is in use by their Care Team and qualitative has been collected around its functionality.
Patient Mobile Dashboard – I referenced Apple Health’s Dashboard Architecture. We used Disease Platform Framework InfoGraphics Widgets.
Prototype Information Architecture
Full Breath Prototype inherited organizational structures from the other apps that were designed to monitor data coming into the app from devices. Not have the patient input data or see their history.
Platform Design Guidelines
Geared towards internal and external applications that are AstraZeneca “Branded Experiences.”
Elements, Components, and Widgets in the Sketch Libraries relate back to the Framework.
Allowing for experiences to be rebranded and reconfigured into Partner Branded experiences (“Unbranded Experiences”), or for reuse in new experiences.
This design system defines:
- Naming Conventions
- Colors
- Primary, Secondary, Accent…
- Typography
- H1, H2, H3…
- Icons
- small1, small2, medium1…
- UI Component
- Elements
- Sizes
- UI Widgets
- Screen Layout
- Multiples of 4
- Margins
- Columns
- Actions
- Copy
- Design Specs
- How to create.
- Where to post.
- How to create assets.
- Asset Repo
- Jira
- Zeplin
Color Guide Derived From Framework
Component Design
Design Components to be responsive and flexible using our Framework Elements.
Test the Container (Screen) interactions, and readability with our Framework Grays.
Can I Help Code the Styling?
If I am able to find the Components in the Framework Directory and help with styling, then we have built a successful component.
End of Week 2
Working React Native iOS App sending data to the Web-Based Dashboard.
- Record an Asthma Attack
- Bug – Can pick a future date.
- Add Medications
- Record Peakflow
- Asthma Control Test
- Insights being populated
- Air Quality service built pulling from AccuWeather.
Play Video
Prototype Usability Testing
Usability Plan – Created by our team’s UX Researcher.
Interviews Recorded – App screen gestures and audio was recorded.
Task Accomplishment Notes – As he interviewed each patient’s performance per task was recorded and scored from; Frustrated, Useable, Enjoyable
Task Score Cards – Each task gets a score based on Jakob Nielsen’s 10 Usability Heuristics.
Post Testing Discussion…
Why – Why did each score end up the way it did good or bad?
Possible Solutions – Quick notes how we could fix the problem or improve the task.
System Usability Scale – Filled out by each patient at the end of the session. SUS Calc
Partner Patient Population Philadelphia
| Day 1 | Day 2 |
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30 - 45 min. each |
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Care Team Dashboard
I played the role of the Care Team member making sure data was coming into the Dashboard and returning messages from the patients.
iOS Symptom Tracking A B Test
A - Categorial List
Symptoms → 🔙
Triggers → 🔙
Medications → 🔙
Results – Useable
Categories – Too much in and out of the categories looking for what they wanted.
List Ordering – The ordering of the list by “most used” or perceived “importance” was a mistake. What is important to one patient is not important to another. This caused the patients to pause because their first instinct is to go alphabetically.
Missing Symptoms & Triggers – We are missing items from our list, like Tightness of Chest.
B - Categorial Carousel
Symptoms ⟷ Triggers ⟷ Medications
- Should we have the patient slow down and answer each category, one at a time?
- Does slowing them down result in more accurate data?
- Disease Platform Heart App showed this approach could work.
Results – Frustrating
Unknown Categories – Cannot see all the categories at once so the patient keeps flipping back and forth.
List Limits – Limits the number of options in each category, it would turn in a scrolling list inside a card.
Alphabetical Flat List?
There are too many symptoms and triggers to choose from.
Patients are telling us they would tend to track the same ones over and over.
An alphabetically ordered flat list might cause them to pause at first, but once they learn the list they would simply scroll down pick symptoms, triggers, and medications to track.
Listening & Making Changes
Because the prototype was so rough I had the design files open and began to work on glaring issues.
I communicated the changes I wanted to the front-end lead. Because of our front end framework was in place he was able to easily push new builds to the development branch.
In between patients, I woudl discuss the changes with the UX researcher.
I we agreed the changes were an aprovement and not effect testing he we would update the patient device and be ready for the next patient.
Add & Adjust Wording
Great way to tune an app for a specific patient population or health care network by using the terms the patient’s doctors use.
Add Generic Name – Some patient populations refer to their “Rescue Inhaler” as “Albuterol” (the generic name). On the fly, we were able to add the generic name to our Medication Entry Card Component and test to see if we were solving that disconnect.
Adjust Color & Contrast
Component and Widget is crafted with opacities, and the icons are .svg from the platform library. I able to have the front end lead change the color of the icons, the typography, the backplates of the components or the background of the app in we are having contrast or readability or issues.
Adding & Reordering Lists Items
The Symptoms list was really lacking items patients were looking for and ordering them by importance was not working out. At the end of the first day the UX Researcher and myself regrouped at the hotel and redid the symptoms list. We realized we forgot Chest Tightness!
Patient History All Wrong
The most radical changes I began to make was on the Patient History-Info screen in the design files only. I began to rearrange the chart info and order of which we were presenting the symptoms and medication tracking data to the user but nothing was working.
I began to pull some of the patients after their testing session and presented these new designs in Sketch.
Showing charts and data to a patient causes them study.
Nothing was working… we need to simply tell them their data with real words!
Re-Empathize
Usability Data
System Usability Scale
- Average of all Score Sheets
- Individual Score Sheets
Heuristics Task Cards
- Average of all Score Cards Per Task
- Individual Task Cards
Moderator Notes
- Users performance and where they got stuck in each task.
Patient Recording
- Patient Video – Focused on their face.
- Patient & Moderator Voice
- App Gesture
Heuristic Task Cards
Task Cards with averaged results across all the users with meaning quotes from users.
Add the Why?
I lead a post testing workshop where the researcher, product manager and myself discuss why each Heuristic category scored the way it did.
Add Possible Solutions
I lead the way on trying to brainstorm possible solutions and get the first ideas right into the card.
Avg SUS Score - 80
Why was the Average SUS Score so high when the individual app tasks scored so low?
Novelty
The patient population is part of a health care network with no main app and the patient portal is extremely out of date. The main feature that pushed the score up was the Air Quality feature. None of the patients knew that daily air pollutants and allergy data were out there.
Redesign
iOS Major Fixes
Information architecture
Redo around
Insights Screen
- 30 Days of Data – Just show the history of the last 30 days.
- Remane – “Highlights”
- Move – to Home Screen
- Separate “Highlights” – Tap goes into the highlight’s details.
- Words – “Highlights” must show the patient their data with words!
- Charts – Don’t make the patient think! Charts could be appropriate for “Highlight” details
- Research – What is the most important data to show without drawing a correlation.
Peakflow Screen
- Slider Widget – Value hitbox and slider interactions are not smooth.
- Information Page – Why and how to take a peak flow measurement.
Home Screen
- Air Quality – Extremely important! All patients were wowed with the ability to see the air quality no one had thought to look up air quality, they use a regular weather report.
- Symptom History has to be next to environmental factors
- 30 Day Countdown – Show the user that they need to get their doctor 30 days of good data.
Asthma Symptom Tracking
- A Test – Usable
- In & Out.
- Tags – Record Screen populating with “Tags” of Symptoms, Triggers, and Medications is hard to understand what was added.
- Remove Tags – Mis-tap removes “Tags” on accident.
- B Test – Completely unusable and stopped testing after 3rd patient.
- Flat List Creation – A long scrolling list not hiding options behind categories. Will patients learn the list tap what they need and get in and out of the app?
Asthma Attack
- Asthma Symptoms – The patient’s idea of what an Asthma Attack is was different than designed. The design records and “Attack” with different levels of severity. The patients look at asthma-like symptoms that change in levels of severity Asthma Attack is the highest level to them. Had the idea that patients only needed to record during an asthma attack. Not true need them to record daily anytime they want to record they are feeling bad or the end of the day to get that 30 days of good data.
Medication
- Has to pull from the EMR or the Pharmacy to auto-populate the medication and instructions.
- Has proper naming for Generics and which medications are for rescue and for maintenance.
On the Way!
Rebranding for Partners
Results So Far
The Future