Primary roles: Team Research Lead and Project Manager

Design contribution: Comments feature and mobile

Outcomes: Our sponsor is pursuing funding to develop our application. 

Harborview hospital commissioned a digital transformation of the paper-based Plan of the Day tool with the goal of improving coordinated care actions for our graduate capstone project. Tobin Valenstein, Irene Yuan, and I are working with the ICU at Harborview to design a system for improved collaboration among ICU care providers.

The Plan of the Day (PoD) is an action plan summarizing the patient's care and necessary steps to be taken over the next 24 hours. It also contains a checklist section of common concerns shared across ICU patients. The plan is generated by a resident during morning rounds and then handed off to the patient’s nurse, where it lives at the nurse’s workstation on wheels (WoW). After this handoff the PoD becomes an information dead end. We have an opportunity to improve the usefulness of the PoD by digitally designing it where it can be accessed by several devices in the ICU.

As the research lead for this project I went through HIPAA training, conducted expert interviews with attendings (supervisory physicians in the ICU) and led the literature review for white papers on checklists, collaboration, and technology integration in ICUs. I also led our efforts to conduct over 25 hours of observations in the ICU shadowing residents on rounds.

Our observations and literature review formed the foundation from which we began designing interfaces that amplified the collaborative potential of the Plan of the Day. I developed user flow diagrams and concept maps highlighting the usage of the existing PoD. Our team then began sketching environments the PoD could live in from interactive whiteboards to mobile devices. 

We also conducted two sessions of participatory design activities with residents (a card sort and quick paper prototype), to inform iterations of our initial design work. 

We explored several different interface designs including web, mobile, digital notebooks, tablets, and monitors throughout the process.

After confirming with our sponsor that our understanding of ICU workflow was sound we began sketching interfaces that highlighted different features the Plan of the Day is based on summarizing care and listing actionable items.

While we worked on sketching we interviewed IT workers at Harborview to better understand data protocol and retrieval methods. 

I led the initial mock up for the mobile interface to get ready for usability testing. I also wrote the usability test protocol and participant consent forms. 

We tested our design by creating a simulated rounding session and tested on six residents. They confirmed the ability to quickly update a patient's care plan and communicate with other providers was a desired feature. 

We refined our design based on user feedback to attach discreet events to goals all belonging to one plan heading. Our final design concept is called Arc, inspired by our goal to help providers track changes to care plans throughout the arc of the day.