Goal: Discover the patient experience and use of digital technology at the Heart Failure Clinic and Inpatient Unit at a hospital in Northwest Baltimore. Ideate solutions or opportunities for technology adoption across the continuum of care. Ideally, this work could be extrapolated to generally understand the patient experience with chronic disease.
Role: Design Lead and Project Manager. I was the only designer on this project, but my team included other strategy and clinical research staff with whom I lead strategy for project goals and planning, research discovery, facilitation, and analysis.
Time: 5 months (August 2017-January 2018)
Location: Baltimore, LifeBridge Hospital
Why this Project?
I jumped at the opportunity to work on healthcare innovation. My personal health journey has been a struggle, to say the least. It was exciting to be in a clinical setting where I got on-the-ground learnings directly from patients and clinicians.
Lessons Learned from the Project:
•Researching a vulnerable population requires extreme caution for ethical approaches to design. Mainly, protecting patient confidentiality was the primary concern, so no private or identifiable information was collected during research. Secondly, removing bias from our process like not including quantitative data that could include racist skews or ensuring that our questions were at a third grade reading level and comprehensible to all our patients.
•Limiting factor: we could only talk to patients that arrived to the clinic. An entire population of patients is left out of this analysis simply because they could not show up. Despite having invited over 30 patients and confirmed 8 of them the day before the group interview, only 1 patient and spouse showed up. The other patients did not show up because they were too ill or did not have transportation. Furthermore, scheduling focus groups with this population was challenging because most patients only used phones (some cell phones), rather than email or electronic/digital methods.
What Patients Need
What is the patient experience with Heart Failure and what digital technologies do they use to manage their medications and condition?
Many Heart Failure patients in Baltimore City are from vulnerable populations– zip codes that have life expectancy 10 years younger than the national average and almost a 20 year gap between poor and rich neighborhoods in Baltimore — they suffer from poverty and lack of resources like transportation, access to healthcare, low literacy and e-literacy rates, and access to healthy food. How does this affect their experience?
Between November 2017 and January 2018, interviews and observation:
•17 patients with various classes of Heart Failure
•4 patient family members
•50 total hours spent in contextual inquiry, interviews, and focus group.
I created10 patient personas based on aggregated details from interviews, observation, and quantitative and qualitative data analysis from workflow development and various patient experience survey and regional health data. The personas had many categories, especially focusing on:
•Heart Failure class
•Digital technology use
•Readmissions to hospital
Patient Experience Map
Major themes emerged based on patient needs, grouped in 3 segments: Patient Engagement, Gaps in Care, and Communication across the continuum of care. We focused the journey mostly on the patient actions and feelings, though provided physician experience insight for a more well-rounded understanding of the communication between both end-users.
•Pre-Diagnosis: Early identification of patients with HF; digital health education.
•Diagnosis and Treatment: Secure communications among Care Team and directly with patients to coordinate care (texting, emailing, voice-to-voice); easier referral and auto-enrollment; EMR decision making; open appointment scheduling; ride-sharing apps; e-prescribe apps.
•Management: Remote monitoring with 24/7 access; secure communications with patient; open appointment scheduling; ride-sharing apps; medication management and virtual therapy; auto-reminders for medications.
Major User Takeaways
•Use of technology and e-literacy ranged from full distrust of any tools to competent smartphone and tablet users. Patients’ use of technology usually depended on 2 main factors: age and family or caregiver support.
•Younger patients (35–60 years) were more likely to feel comfortable using smartphones, tablets, or computers, especially relating to their medical information and managing their disease.
•Older patients (65 years and older) were less likely to trust technology or be willing to use the tool as a way to manage their disease.
•There were some exceptions to this rule in the older group; however, the majority of older respondents said that they were only comfortable with speaking over the phone or had a flip phone.
•Most patients had a younger family member helping them with care (a child or younger sibling), and those caregivers utilized smartphone, tablets, or computers.
•Less than half of the family caregivers mentioned using applications to manage care; almost all caregivers agreed that digital tools would improve the caregiving experience.
•The younger patient group affirmed that they would be willing to adopt various digital technologies, like phone or tablet applications, to improve medication adherence and treatment management. All patients agreed that they would like more options for interacting with the care team.