Evolving the Patient Encounter
building a competitive edge through user-centered design
Strategic opportunities for future-thinking design
Product design teams are faced with the challenge – and the opportunity – of balancing competing priorities and timelines in the quest to improve customer experience. As a design leader, my job is to simultaneously address the short-term needs of our roadmap while also envisioning the future of our products.
At Practice Fusion, I engage my team in these aspirational, future-thinking projects while finding strategic opportunities where we can make these new experiences a reality. In 2019, I identified the patient encounter evolution program as a key strategic initiative that would enable us to take a huge leap forward in the capabilities of our platform and compete more effectively with the increasing number of low-cost EHRs proliferating in the space.
Challenge
Redesign the central feature in our product to allow clinicians and staff to move through the patient visit with ease, focus, and efficiency.
Outcome
Modern, clean and efficient design with a steadily increasing adoption rate (27% in Q1 2022); delivery of key customer request for customization; fully updated services framework to support more robust feature development.
What is the patient encounter?
In an electronic health record (EHR) system, the patient encounter is the nucleus of the application; it’s the central location for documenting everything that happens during a patient visit. The Practice Fusion patient encounter is used an average of 65,000 times a day. Many different people in the healthcare practice interact with the encounter, from the front desk staff who check the patient in, to the nurse who takes a patient’s vitals, to the clinician who evaluates the patient’s needs and creates a plan for care.
The opportunity
Original patient encounter design
Healthcare providers don’t want the computer to get in the way of face-to-face time with their patients. Unfortunately, documenting patient visits in an EHR requires a lot of time in front of a screen. This administrative burden is one of the leading causes of clinician burnout. Researchers have found a direct connection between burnout and poor usability in EHRs. Too many clicks, inefficient workflows, and repetitive data entry drag healthcare providers down. Building an EHR that is designed with physicians’ experiences as a core component of the design process is critical to making a difference in this experience of burnout.
Over the years, Practice Fusion customers have provided feedback on a wide range of issues with the encounter, including concerns with perceived data density and legibility and a lack of customization. By investing in this part of the product, Practice Fusion would be able to address important customer concerns and create a stronger foundation for the robust, innovative patient care capabilities that our customers are seeking.
Our approach
The patient encounter hadn’t been touched since 2014. Tackling this critical area of the product required careful planning; iterative design, user research, and development; and the voice of our customers in every step of the process. Over the course of this multi-year, many-phased program, my role was to lead the overall initiative in partnership with the VP of Engineering.
In 2019, we began the process of evolving the Practice Fusion patient encounter by focusing on this key problem:
How can we improve the encounter experience by allowing clinicians and staff to move through the patient visit with ease, focus, and efficiency?
We focused on these measures of success:
Reduce the number of clicks required to accomplish key tasks
Address the most pressing usability issues voiced by our customers
Increase level of satisfaction with the patient encounter over time through the delivery of consistent improvements & more robust features
Phase 1: Journey mapping & generative research
Together, our lead UX researcher, lead product designer, customer support representative, and myself partnered on a long-term generative research study to develop a comprehensive user journey map focused on these key roles in the practice: front desk, nurse, and healthcare provider. Through interviews with over 30 customers, we established a clear understanding of the workflows, pain points, and opportunities throughout the patient visit as it relates to the encounter note. A clear set of principles emerged from the research to guide the design:
Allow customers to reference patient data while also adding new data to the encounter
Bring more actions to the surface instead of hiding them behind clicks (i.e., fewer modals, more inline editing)
Streamline and organize the sections of the encounter to map closely to the flow of the patient visit
Phase 2: Design iteration & concept testing
Informed by the research insights, our lead product designer, Grace, iterated on a new framework for the encounter utilizing the many new components and patterns we had developed for the EHR in the years since the encounter was first designed. Each iteration of the design was tested with customers to validate assumptions and ensure the new encounter organization and structure was in line with their expectations. We also reviewed the designs internally on a regular basis, vetting them with staff clinicians, regulatory experts, engineering leads, and customer-facing teams to get their expertise. Through the testing process, we refined the navigation elements for the encounter note, the hierarchy for the note sections, editing patterns, and the functionality of the left-hand data reference panel.
Early design iterations
Final design
The final encounter design utilized a new pattern of a collapsible left-hand panel with a tabbed navigation that contains the different sections of information a clinician may need to reference during a patient visit. We used inline editing wherever possible to bring as many actions as we could to the surface. We also organized the overall note into a logical hierarchy based on user feedback and our own clinical team’s input and built a two-column view for large viewports. To ease our customers into the experience, we offered the ability to easily turn on and off the new encounter so they can learn on their own time. The resulting design allows for a more efficient and streamlined patient charting workflow.
Phase 3: Development (and more design & research)
Grace and I were both embedded with the product development team for the duration of implementation process. We worked very closely with the program manager, and the front end, services, and QA engineers to plan the phases of work, groom stories, and test for design quality. Over the course of more than a year, we collaborated with the team to problem-solve issues on a daily basis and work towards the delivery of the first phase of changes to our customers: a new framework, look and feel, and organization of the patient encounter.
In parallel with the development work, Grace was also designing the next phase of improvements: encounter customization. We tested these designs with customers and our internal teams in the same iterative manner as the first phase of work. As soon as the first phase was implemented and tested, the development team immediately took up the customization work while I worked with the program manager and UX researcher to pave the way for releasing the updates to our customers.
Encounter note customization settings
Phase 4: Training and education
The new encounter would be a massive change for our customers, so it was critical that we help them ease into the new experience and provide them with outlets to share their feedback. To achieve those goals, we:
Provided customers with the ability to easily turn on and off the new encounter experience so they could learn how to use it on their own time.
Added a survey link in the encounter for easy access to share feedback with us.
Delivered a series of live webinars over the course of 6 months where we demonstrated the encounter and answered questions from customers.
Created multiple step-by-step in-product walkthroughs to highlight important features and functionality.
Produced tutorial videos that underscored information shared in education articles, blogs, webinars, and other communications.
Data helps us learn and grow
Delivering the new patient encounter to our customers has been a tremendously challenging process. Change is always hard. While new customers seem to love the new encounter, customers who have used Practice Fusion for many years have been frustrated and overwhelmed with it.
Through data and analytics, we’ve been able to stay close to our customers’ experience of the encounter over the past 8 months since its first release. Through the strong collaborative leadership of myself, the VP of engineering, and the VP of program management, and the dedication of the lead UX researcher and product designer, we have regularly responded to feedback and adapted in real-time to support our practices through this change.
The in-product survey has helped us keep close tabs on the day-to-day experience of the encounter. With over 2,000 customer responses, survey feedback and satisfaction ratings have helped us make UX refinements, identify bugs, and identify future areas of investment.
Our analytics platform, Mixpanel, has allowed us to constantly evaluate the utilization rates of the new encounter and measure the impact of educational initiatives; product marketing in the EHR; and other customer communications like emails and blog posts. We use these reports to help us understand the health of the feature and identify opportunities to encourage greater overall adoption.
Mistakes = information
From the outset, we approached this program as one of our most ambitious experiments ever. We used the data we had to make the best choices we could at every step. We’ve treated our “mistakes” as information, helping us to evolve the feature and make it better over time. However, receiving customer feedback on this kind of scale can be quite a blow; for every positive comment, there’s usually a dozen negative ones following quickly behind. This process has demanded that we remain strong, steadfast, and connected as a team, always seeking to ensure that everyone feels like we are all in the evaluative process together. We have worked together to problem-solve and prioritize improvements, and we adapt constantly
Through the incredibly close collaboration between design and engineering teams, we were able to deliver on one of the most complex features our team has ever worked on. I have been able to engage in this initiative as both a design leader and a partner in the hands-on work of getting things done. This dual role allowed me to help guide decision-making and strategy while supporting the lead designer in managing the intense demands of design process, creating a system to make feedback actionable, and helping the team to feel supported and empowered.