Professionals ‘Timeline’ feature - User research & usability testing with clinicians

Background

We worked with a wide range of clinicians across different organisations to create a new ‘Timeline’ feature for professionals on the patient’s summary page. The timeline’s purpose was to show a clear visual representation of activity in the patient’s record, so that a clinician looking at it for the first time can get an idea of the patient’s health activity.

We started by running a workshop with stakeholders to gather their requirements so we could create some initial designs.

Once we had the design ready, we met with clinicians across various specialties to gather any further requirements and feedback.

User research findings:

GP feedback

• Found graphics more telling of the patient's overall health rather than just text - felt a visual overview was extremely helpful at a glance.

• Wanted to easily see how conditions were being controlled - with things such as:

• Trend of bloods - key lab data

• Risks - foot or kidney disease etc

• Commented that each of the above will be different depending on condition - so clear flags and easy steps to get to further information was useful with an easy pathway to the trend information.. without scrolling if possible)

• First impression of design: Felt it was clear that it's a timeline and that you it was obvious you can use slider to change the date range

• Wanted hyperlinks to information to be made more obvious

• Concerned on how it might look with a huge amount of data

• Wanted different colours for hospital vs primary care to get a sense of where care is coming from

• Wanted to see key risks & alerts (i.e patient is frail / social care are involved etc)

• Wanted to see what teams the patients are under

• Wanted to see upcoming appointments too, including hospital appointments, realtime hospital updates,

• Wanted a clear view of management of patients such as trend lines

Emergency Dept Feedback

• Was interested in seeing the latest consultation - (felt it was important to know what is current)

• Wanted to see who other care providers for the patient are

• Felt it was good to be able to dive into encounters as would not fit all details on timeline

• Less interested in allergies - good to see but not necessary on front screen

• Recent investigations - felt this was less important

• Felt they needed to see data sources to reflect content and level of that content

• Felt it was important to see a list of carers to help with discharge decisions - idea of care package being provided (do they get personal care or is it only just meals on wheels, what level of housing do they have etc)

• Would like to see end of life care plan on PKB Joint assessment framework assessment for elderly would also be useful

Discharge team feedback

• Data items they wanted to see on the summary page alongside the timeline:

  • Contact details

  • GP – name, address, contact number, CCG patient lives in, borough patient lives in)

  • Next of kin – name, address, contact number

  • Social care details (Care home / Hospice / sheltered accommodation/ Social care manager / Social care worker / Community nurse / District nurse/ Care packages

Cardiology feedback

• Team wanted a list of care-plans for all professionals to access - a shared document that GPs and social care could also input into.

• For Heart Failure patients, they are interested in seeing patients measurements & symptom tracking. They stated that one of the most important items to view is symptoms and to understand what's bothering the patient the most ie. severe symptoms.

• They wanted to see a less cluttered summary page,diagnoses, allergies, drugs, measurements Blood results and imaging less important.

• Their priority was to get a very clear impression from the first look of the timeline page.

• Initial design feedback: (As a physician not necessarily a cardiologist) Felt the view was very useful, symptoms would be prioritised for their team and then medications and drug changes, Felt that diagnoses, Upcoming & past appointments would be useful. Felt test results would be better on another screen.

• They were also interested in seeing social care data - particularly those with chronic diseases and their management.

Usability testing findings:

Once we had incorporated feedback from the user research sessions and had updated the design, we ran some usability testing sessions with different specialty teams to gather final feedback and make final changes based on the outcome:

Session 1 (Mental Health team)

Feedback from sessions addressed:

1. We fixed the timeline legend icon on smaller screens so it's easier to expand (previously the word was not hyperlinked - just the icon)

Session 2 (Endocrinology team)

General Feedback:

1. Felt the design was very exciting & useful.

2. Said that in renal, they have around 900 patients that attend 3 times a week for dialysis - this will really flood the timeline so using a filter to remove certain types of events (inpatients for example) would be extremely helpful.

Feedback from sessions addressed:

1. Felt the wording ‘Edit sharing’ wasn't intuitive & that ‘Edit access’ would be much better so we changed it.

2. Agreed to review filters for timelines once it has been used by clinicians in live sessions to check which filters would be most useful.

Session 3 (Trauma & Orthopaedics team + patient)

General feedback

1. Felt it was a good tool & liked the look & feel.

2. Said it would be more usable for Trauma & orthopaedics if you could filter by specialty. For orthopaedics professionals - nearly all other items are irrelevant and they will be interested in seeing items relating to their specialty only.

3. Agreed to review filters for timelines once it has been used by clinicians in live sessions to check which filters would be most useful.

Session 4 (Paediatrics)

General feedback:

1. Much clearer than the previous summary page. Brilliant, looks really good, intuitive & easy to navigate

2. Showing days with measurements / symptoms also very helpful and like that clicking on these take you to the section to see them in detail

3. The banner should contain the GP details (Dr, Practice name & area)

4. The banner should contain a field for school name and area if paediatric - this can indicate a number of things to clinicians. Having telephone numbers etc for both isn’t essential as these can be researched separately

Feedback from sessions addressed:

1. Also felt the wording ‘Edit sharing’ wasn't intuitive & that ‘Edit access’ would be much better so we changed it.

2. Team will review where to record GP information.

Session 5 (Rheumatology team)

General Feedback

1. Prefers original summary screen with information listed

Final design