Focus
Project status
Collaborators
Erik Lang, MS
Philynn Hepschmidt, MS.Ed
Christine VanZandbergen, MPH, MS PA-C
Michael George, MD
Chadwick Johr, MD
Anupama Shahane, MD
Peter Merkel, MD
Larry Shulman, MD
Peter Gabriel, MD, MSE
Innovation leads
Opportunity
The electronic health record (EHR) is repeatedly cited as a national driver of administrative burden and burnout.
In 2018, in partnership with the EHR Transformation Team, Information Services, and the Office of the Chief Medical Information Officer, we launched a Your Big Idea Innovation Tournament to crowdsource EHR pain points and solution suggestions from Penn Medicine's frontline staff. More than 30 percent of participants described pain points related to documentation and data aggregation in the EHR.
That same year, the Department of Medicine's annual climate survey revealed "excessive Epic burden" as a significant issue across all divisions. In interviews with clinicians, it became evident that gathering the necessary clinical data to prepare for patient visits, a process known as chart prep, was causing a considerable burden. Individuals we spoke with identified information overload issues, poor data usability, countless clicks, and excessive scrolling as contributing to their cognitive load.
Intervention
Focus streamlines chart prep by pulling relevant information into a single view, reducing the number of clicks needed for clinicians to find information and interpret a clinical picture of the patient.
The application, developed in partnership with clinical champions from the Division of Rheumatology, enables clinicians to quickly catch up on what patients have done since their last visit, whether that be visits with other specialties, lab tests, medication changes, or new imaging studies. And smart previews of clinical notes, developed in collaboration with Penn Medicine's Data Science Team, give providers a shortcut to the assessment and plan without the need to open reports one by one. Telephone encounters between visits can also be tagged with a dot phrase for easy access for the next visit, which introduces an element of dynamic charting to reduce repetitive work in the future. Finally, specialty-specific data groupings for labs and medications allow providers to focus on critical information and reduce clutter.
Impact
Focus reduces the burden of chart prep for providers.
During a two-month pilot with 18 providers in the Division of Rheumatology, Focus was utilized over 380 times, with 61 percent of users returning multiple times. Focus users required 44 percent fewer clicks to complete chart prep, and the most frequent users during the pilot demonstrated cognitive burden rating improvements by 18 points.
After multiple iterations, we achieved a system usability score of 86.7, and Focus received a Net Promoter Score of +34, with providers raving, "I'm prepping my notes and using Focus! I like it quite a bit" and "Focus is open on my left monitor. Epic is open on my right. Fantastic!"
The team is currently exploring how Focus can be leveraged to facilitate care coordination for additional groups. Thanks to its ability to collect and display tailored clinical data Focus also serves as a practical tool for testing new EHR applications quickly.
Innovation Methods
Show me
Show me
Show me
Instead of relying on a verbal recount of experience, ask users to show you how they use a product or service. What people say they do is often quite different than what they do.
Observing users in action will help you understand the spectrum of experiences users can have with the same product or service.
Surveys, interviews, questionnaires, and focus groups don’t tell you what you need to know. Prompting users to show instead of tell often reveals what others have missed.
Show me
We conducted several hours of contextual inquiry, watching providers run chart prep before ambulatory visits.
We observed providers searching and gathering the same data elements across all patients, inefficiencies due to extraneous encounter listings and inadequate filters, and volumes of telephone encounters burying actionable messages. We also identified the importance of designing for trust and transparency to reduce the anxiety among clinicians that they might 'miss something.'
Fake front end
Fake front end
Fake front end
Fake front end
Our earliest prototypes were simple Word documents. We compiled the clinical data Focus would aggregate and shared it with rheumatology providers to elicit insights into exactly what was required for chart review.
We also facilitated card sorting exercises to inform subsequent digital mockups to test interactivity and user interface requirements before creating a working version of the web application.
Eye of the beholder
Ask users to wear a GoPro, keep a diary, or snap photos throughout their day. Artifacts like these will help you understand their first-person perspective.
Eye of the beholder
Eye of the beholder
When the COVID-19 pandemic hit, we had to conduct research and development remotely. As we scaled the application to new divisions, we asked clinicians to share their screens while conducting chart review and note prep.
The insights we gathered from these observations enabled us to improve Focus further, making it even more effective for users.