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Epic \ Trauma Badge Scanning

Epic / Trauma Badge Scanning

 

An efficient screen for clinicians and staff to document their presence in a trauma.

 
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Context

Company:

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Time Frame: 2 months

Team: Individual, with input from engineering

Key Contributions: design lead, research lead, wireframes, high fidelity mockups, usability testing, user interviews, communication with stakeholders

 

Documentation in an emergency

The Problem

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Documenting the events that occur in the emergency room during a trauma is necessary for liability and practical reasons, but it can be quite difficult to prioritize while saving a life. A scribe is typically present in the trauma room to complete this task, but accurately identifying and listing all the people who come in and out of the room is hard, especially if he does not know everyone's names.

I asked…

How can we utilize badge scanning technology to streamline documenting trauma staff arrivals and departures?

To handle hardware constraints, the badge scanning application lives on a touchscreen computer monitor and serves multiple beds and patients, but still automates and streamlines as many steps as possible, out of respect for the rushed clinicians who are there to save a life.

 

How do traumas work?

Research Goals

Epic is the leading electronic health records system in the United States, and is used to store 54% of American patients' health records. By collecting this data in one data system, hospital systems are able to easily calculate charges, share information between departments and hospitals, and review charts quickly. Clinicians are thus tasked to document everything that happens to a patient in Epic, including the events of an emergency trauma.

This project had a small scope. Badge scanning technology was easy to implement, so the project was given a limited amount of resources for the release. My task was to decide how the screens would work. At first, I was given a vision concept created by another designer to garner excitement at a company conference.

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Though I have spent at least 500 hours in emergency rooms and have witnessed a few traumas, I needed to take a step back from these mockups and consider what I still needed to know to create something usable. I went into the project asking:

1. What are existing systems doing? 

The easiest way to identify requirements and needs was to do a variation of a competitive assessment where we spoke to our customers who had developed their own badge scanning systems to connect into Epic. Viewing those screens and having those conversations revealed that I was on the right track with my ideas and that this was something our clients would realistically want to use.

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2. What are the edge cases? How complex could this get?

It was crucial to understand the ecosystem of a trauma bay. I had questions like:

  • Could a physician be attending to two patients at once?

  • Could there be two patients assigned to one bed in the system?

  • Could the staff arrive to the room before the patient arrives and has a patient record created?

  • Does every organization track staff departures, or only arrivals?

3. Is asking a clinician to scan his badge on his way into the room a reasonable request?

I feared that giving clinicians a new task when racing to a trauma room would receive a severely negative reaction. Initial interviews with administrator-nurses revealed that many of the edge cases listed above did exist, it also revealed a great deal of excitement about the project. We received no dramatic outrage about the idea, so I decided early that this concept was possible, as long as I continued to push for making it as simple as possible.

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Evaluating my assumptions

Usability Test + Requirement Gathering

I took the screens I was given, made a few updates with my suspicions around edge cases, and conducted a usability test along with an interview. These were remote calls with trauma nurses at 6 different hospitals across the country, many of whom also held some administrative responsibilities. We talked through their workflows and identified potential barriers to implementation at their particular organizations.

My insights centered around a) visibility and control and b) flexibility vs. simplicity. For each area, I proposed relevant solutions and shared some whiteboard ideas with the engineers.

 

Visibility and Control

The whole concept of using a screen for a badge scanning solution was worth challenging. Why couldn’t they just tap their badge and move on? I explored this in my interviews, and learned that they actually wanted more visibility and control to prevent errors. I even added an optional extra step — an “Accept” button after the user scans — because they felt uncomfortable scanning without confirming the information and completing the interaction manually.

Flexibility and Simplicity

My interviews revealed a need for the flexibility to handle multiple beds and patients on one workstation, but my SUS (system usability scale) scores revealed that the product seemed overly complex.

I felt after the interviews that these biggest priorities competed with one another. By making it possible to choose from multiple patients when scanning, it was more complex to just scan and go instead of interacting with the screen.

Flexibility: I needed to make it possible to support multiple trauma patients and beds on one workstation, because it was not feasible space- or cost-wise at most hospitals to introduce a new workstation next to every trauma bed.


Simplicity: I also needed to make the system feel less complex, because participants were already complaining that the cognitive load to swipe into a trauma was too high. I proposed defaulting the expected patient and clinician role to mitigate time spent reviewing the screen.

In most cases, there will only be one trauma patient in an ER at once. When that is not the case, given that teams tend to all go to one room at once, we can choose the most recently selected patient by default (unless that clinician already marked him- or herself as arrived to the patient the system wants to select). Thus, it becomes a matter of glancing at the screen to confirm that the right patient was selected, rather than scrolling around to find the room or complaint that you are running toward.

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In just a few quick steps…

High Fidelity Designs

From the whiteboard drawings, I created high fidelity mockups that I used for a second round of usability testing, this time with trauma physicians, who are typically more critical and strapped for time. The feedback was positive enough that we proceeded to release the feature in 2018.

The final experience lived on a touchscreen monitor paired with a badge scanner. It begins with a starting splash screen, which, upon badge scan, leads to the automatic selection of the most likely patient you are here to see (based on the logic outlined above), followed by an auto-save after ten seconds. This allows the clinician to either tap and move on quickly or have the control to select a different patient.

The home screen is on display always. When someone taps a valid badge, the patient options appear.

After 10 seconds, or upon tapping "Accept Now", the screen returns to the first home screen.

 

Reflections

I wish it could have been simpler. The wish for a scan without the need for screen interactions while walking through the door seemed like one that could be granted, but in the end constraints of the functionality and hardware prevented me from getting there. In the future, I imagine RFID location tracking to make this possible without even having to think about it. However, this requires hospitals to make hardware purchases that were unlikely, and this project allowed the code to be put into place for future enhancements.

I had left Epic for graduate school by the time this feature was released, so I do not know how it was received. Things sometimes move slowly in healthcare, so it may be some time before many clients purchase and implement the monitor workstations needed to host this feature. I also suspect, as with adding any technology interaction to an ER workflow, that while this could be a big win for the scribe nurses and hospital administration, it will be unpopular for other trauma clinicians, so I hope location-tracking RFID badges make it onto Epic's road map soon.

I am self-motivated by my empathy to make things happen. As a whole, I absolutely loved working on this project. Focusing on efficiency and ease of use in a high stakes environment while considering many logistical factors was a very engaging challenge for me, and my conversations with trauma nurses and physicians motivated and inspired me. I was very proud of my defaulting solution, because it was simple and effective, and would not have happened if I had not dedicated myself to making simplicity happen.