A Mobile App and User Experience Success Story
By Clarissa Goetz, SAP User Experience, and Thilo Berndt, Mobile Applications, SAP AG – May 31, 2012
SAP Electronic Medical Record
SAP Electronic Medical Record (EMR) is a natively built mobile application that gives healthcare professionals instant access to the electronic medical patient records available in a hospital. Using SAP EMR, physicians can view relevant patient information on their iPads at the point of care – such as a patient's bed – during a ward round. Physicians can get an instant clinical overview as well as browse detailed findings, charts, images, progress notes, cumulative lab results, coded diagnoses, and procedure information.
SAP EMR currently supports Apple and Android devices – and backend integration to Siemens i.s.h.med - and includes interfaces to other backends, including PACS (Picture Archiving and Communication System) and other clinical systems.
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Figures 1-2: Screens of the SAP Electronic Medical Record (EMR) app from the Mobile for Healthcare product area
Project Background
Communicating with patients and discussing a patient's progress with other medical staff are two significant elements of a hospital doctor's daily work. Information about the patient's health is central to this interaction and is an essential prerequisite for any medical decision.
The SAP Electronic Medical Record team recognized that, in hospitals particularly, healthcare is mobile by nature and that lives can be saved if hospital doctors and other health staff have ready access to relevant and up-to-date information whenever and wherever they need it. They therefore set out to make this critical step in the clinical health process safer, easier, and more effective.
To ensure an optimum result first time, and because healthcare – more than any other industry – is about technology AND people, experts from the User Experience team at SAP were involved throughout the project lifecycle. Their job was to help conduct end user research and design a user interface that embraces current interaction patterns and provides optimum support for the target end users: hospital physicians who attend patients in hospital wards.
The project's mission was to create a mobile electronic medical record application with an easy-to-use, intuitive UI that would provide doctors with relevant, up-to-date patient information to make their work easier and enhance doctor-patient interaction – while at the same time ensuring the confidentiality of the patient data.
Version 1 of SAP Electronic Medical Record focused on the provision of read-only capabilities for an Apple iPad mobile device. Additional objectives were to keep complexity to a minimum and achieve a fast go-to-market.
What Were the Major Challenges?
According to the product owner, the main challenge for the team throughout the project was to put its accumulated knowledge aside and take the end-user input as its guiding source of information. Although the team members had a great deal of health industry expertise, they were unsure about which parts were relevant for this particular mobile usage case. Fortunately, the user researchers delivered “just what the doctor ordered”: By helping the team conduct end-user research, they generated a wealth of user-validated and relevant input directly from the users' workplace. Together with the product owner and experts from development, industry solution management, and consulting, the user researchers visited hospitals to talk to doctors and observe them on their daily ward rounds: This is, after all, where the bulk of interaction between patients and doctors takes place.
One difficulty that user research projects sometimes face – getting the right customers and end users interested – was not an issue in this project. The hospitals and doctors were more than ready to participate in user research if it would help define an innovative and mobile solution that would eliminate some of their problems and give them ready access to patient information. Granted, the prospect of getting their hands on an Apple iPad during the test and pilot phase also helped push up the participation rate! However, while access to target end users was no problem, there were other challenges that had to be met.
Personal health is a highly delicate and emotional topic, and conducting end-user research in a hospital setting called for an enormous degree of sensitivity on the part of the project team. To participate in ward rounds, the SAP team had to obtain permission not only from the hospital administration and the target users (the doctors), but also from the patients who were to be visited on the ward round. Also, very strict confidentiality requirements had to be adhered to, which included the SAP team participating in a training course on medical confidentiality. The main research challenge, however, was methodological: In a conventional research setting, researchers guide the end user through a more or less structured conversation at the user's place of work, while the other research participants observe and take notes. In this case, however, the SAP project team was not allowed to speak or ask questions while on the ward round. All questions had to be noted down and asked later during face-to-face interviews with the doctors.
Hospital ward rounds During a ward round, a group of doctors and nurses visit patients at their hospital beds to discuss the patients' health status and medication or to explain their medical history to the unit's head physician. The ward round is a very important part of the interaction between healthcare professionals and their patients, because it may result in a decision on the next course of action, such as a change in medication or the need for a special check or examination. Currently, healthcare professionals primarily use printed patient records on their ward rounds. Some hospital units may have a laptop mounted on the ward trolley to enable staff to refer to electronic medical data during the round. In other units, doctors rely solely on paper records, which causes difficulties if, for example, the hospital's central X-ray unit decides to produce X-rays as online documents instead of printouts. If an essential piece of information, such as an X-ray, is not on hand for a particular patient, this can prevent the doctor from making the best possible health decision – a potentially dangerous and, at the very least, disconcerting situation for hospital staff and patients alike. (As one doctor put it, "It's like driving a car with the windshield covered up.") |
Developing mobile applications for hospital doctors means embracing a completely new interaction paradigm – it's not simply a question of presenting backend data on a smaller screen. The task of designing and developing a health application for the iPad required a team of designers and developers who were well versed in working with mobile devices: not only because a number of limitations posed by the backend application had to be compensated for, but also because of the highly specific imaging and documentation requirements in the healthcare domain.
With the help of the user researchers, the project team conducted several rounds of customer site visits:
- End user research initially captured the doctors‘ work context, tasks, needs, and pain points.
- In formative usability tests , the team observed doctors using the first prototype and collected their feedback. To ensure objective feedback, this research was conducted at different hospitals.
- In an additional research step, an observation and diary study was conducted in which the first version of SAP Electronic Medical Record was implemented and tested in a live environment.
The site visits followed roughly the same pattern: The SAP team joined doctors and nurses on their ward rounds, taking handwritten notes and interviewing the doctors afterwards. Back in the office , the project team analyzed, investigated, and consolidated the data they had gathered. In this way, they were able to brainstorm about different solutions and validate creative design and implementation ideas. The results of these workshops were fed into the user story map, task flows, and design mockups, enabling the team to continually increase their domain knowledge and understanding of the end user. Once the team members were confident that they could design a product that would meet the users' needs, they agreed on the scope and froze the user story map for version 1 of SAP Electronic Medical Record. Other findings are awaiting the start of development in February 2012, as part of the version 2 backlog that is slated for availability at the end of Q2 2012.
Timeframe of the project:
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