Empowering healthcare providers to make life-sustaining treatment decisions with patients and their legal decision-makers.
Click the below image to access the interactive prototype.
Problem & Solution
Healthcare providers across the United States have been completing the POLST, Physician Orders for Life-Sustaining Treatment, on paper since 1995. In more recent years, an editable PDF version was developed, but no technically advanced solutions currently exist in managing the POLST form.
Below are some of the major difficulties in managing a paper or PDF version of the POLST:
- having to remember to print, carry, sign, and return the form to clerical staff
- EMR image files instead of captured patient data
- poor retrievability in times of medical crisis
- physical misplacement and damage
- required scanning to digitize
Our solution transformed the POLST into an efficient smartphone application MVP to save providers, patients, and their loved ones time and effort when completing, modifying, and retrieving life-or-death treatment decisions.
Role & Responsibilities
I acted as the Project Lead, with a focus on research, for the POLST app. After inviting the clients for a consult, I recruited and accepted eight designers to join the team.
The designers participated in varying roles, ranging from user research and designers to branding specialists. My main purpose was to set project deadlines and coordinate client meetings at the expected intervals.
Additionally, I was responsible for planning, overseeing, executing, synthesizing, and presenting both low and high fidelity validation findings as we continued to define the MVP.
Near the end of the project, I assisted with designing high-fidelity mockups, including stepping in when one team member required additional support to meet our deadline. With the help of yet another team member, we prototyped and hotspotted over 300 screens for both Android and iOS.
We determined that there are no known competitors to the POLST app at this time.
Although the State of New Jersey recently launched an online initiative to educate residents about downloading and completing the form with informational videos, there are no advanced technological solutions to capture and store the patient’s wishes.
Jobs to Be Done
We created job stories focusing on the needs and expectations from the primary healthcare providers who administer the POLST.
Additionally, we considered patient and legal decision-maker needs for a view-only option of the incomplete and completed POLST forms. We took into account feedback from the client and their colleagues’ experiences in completing the form with aging and critically ill patients.
Task Flows and Low Fidelity Wireframing
Once we had a better understanding of our users and audience, we developed a rudimentary task flow focusing on the physician, as we had determined that the same flow would occur for both the physician assistant and nurse practitioner due to practicing abilities (i.e., their signatures suffice and don’t require a sign-off from the physician).
Our assumptions and continued feedback from the client allowed us to develop low-fidelity wireframes with Balsamiq to use for basic user testing to validate some of our hypotheses, such as:
- data collection points must 100% match the POLST form
- all records must be retrievable and modifiable
- users will need to manage practitioner teams
The forms section was developed by two of our team members, each who developed different form concepts, one being “accordion” style and the other with a top navigation and button selections. Ultimately the client requested we continue with the first concept, which closely reflects folding and unfolding the paper form itself.
Users & Audience
Primary users of the POLST app are physicians, physician assistants, nurse practitioners, and clerical staff who manage medical practices.
Secondary users include patients and their legal decision-makers who need to access a view-only copy of the incomplete or completed POLST form.
To stay within the constraints of the MVP, the user flow for the patient and their decision-makers were restricted to an email invitation to create an app login, ability view the POLST, and log out.
Any corrections or modifications to the POLST would have to be communicated to the provider during an office visit, by phone, or via the provider’s HIPAA-compliant online patient portal.
We anticipate that the app will continue to be built out from the MVP to accommodate patient and legal decision-maker editing capabilities.
Usability Testing & Interviews
Usability testers and interviewees were recruited through the client and design team.
In order to validate our hypotheses and gain feedback directly applicable to the MVP, we prioritized testing with medical professionals who had experience with the POLST form.
During low-fidelity testing with the InVision prototype, we discovered the following:
- physicians are most often the final signatory
- most providers will print the POLST versus email
- some users had difficult reading the chosen font and size
Later in high-fidelity prototype testing, we learned:
- onboarding was perceived as clear and easy to complete
- users were hoping for more guidance in educating their patient about the POLST
- the majority of first-time users were able to navigate through the application features with minimal error or confusion
Deliverables for the POLST project included:
- a competitive analysis report
- validated clickable prototypes for both Android and iOS
- research findings for both low-fidelity and high-fidelity usability testing
- a style guide
- all source files transmitted via Sketch and Zeplin
Scope & Constraints
In order to focus on developing an MVP, we had to tighten the scope of the project.
The client initially requested that we design for both iOS and Android smartphones and tablets. After discussing with the client the 4-6 week timeline, we were able to agree to focus solely on smartphone designs.
Additionally, the client had requested that we design for a new user flow for patients and legal decisionmakers to be able to request and make modifications to the POLST. After another discussion about timelines, we were able to maintain the original plan for the MVP.
Our main goal was to maintain the fidelity of the POLST form itself, as emphasized by the client. One large exception of the process is that we did not include the second (back) page of the POLST, which comprises educational explanations for both providers and patients.
Due to user feedback that they wanted more support with patient education, we encouraged the client to explore more robust options beyond linking to web content in each section of the POLST.
The intent was that healthcare providers would reference their mental models of the paper / PDF form in order to efficiently and effectively capture all patient data for later retrieval or modification.
Outcomes & Lessons Learned
We designed a zero-to-one smartphone application with one user stating, “It’s user-friendly. It’s easy. It doesn’t take a lot of steps to get done what you need to get done. I went through it pretty quickly and this is my first time.”
The application is now in development with anticipated release first in the State of California. Healthcare providers in the state will now be empowered to efficiently and effectively complete POLST documentation with their patients and legal decision-makers, eliminating the need for paper and PDF forms that require scanning and uploading.
The POLST database will be searchable by all assigned providers, in contrast to the problematic storage of images. During user testing we learned that most providers had expected a tablet or web app version, which will most likely be the next step for the product design.
In reflecting upon my role and contributions to the MVP, I expanded my knowledge of both design and my professional skills. I learned that defining the boundaries of an MVP earlier in the design process can be beneficial for both clients and the design team.
From a personal perspective, I observed my continued growth in a design leadership role, including efficient distribution of labor, maintaining motivation and morale, and effective communication with a team who has a diverse set of individual needs and expectations.