Overview > Projects > Product Design - 2022

eSMART

Product Design - 2022

When hospitals need to create and maintain medical records for their patients, they use a third-party solution called an “EHR.” As of 2024, Epic owned 42.3% of this market. IMO Health offers integrated data service solutions for EHRs. Think of them like aftermarket upgrades to your car. In 2021, IMO’s Epic upgrade, eSMART, enabled doctors to “clean” a patient’s records of outdated or redundant diagnoses. So why weren’t doctors using it? This is the story of how I re-imagined that powerful tool and solved its adoption issues.

cleaning the clutter: what esmart was intended to do

But often a PL gets so long as to be unwieldy. Some problems are “LAPSED,” as in longer relevant to your current state of health. For example, a broken leg that healed seven years ago isn’t affecting you now. Others are DUPLICATIVE. For example, three different doctors may have diagnosed your same case of colitis three separate times. Still other problems are RELATED. If a chronic condition worsens, for example, from stage 2 to stage 3, there’s no need for two entries.

Everyone in the United States who has ever seen a doctor has what’s known in the healthcare industry as a “Problem List” — or “PL.” It is a record of every medical problem you have ever been diagnosed with; from halitosis to heart disease. Your PL will follow you around from one doctor to the next and grow in length the longer you live. And your doctor will reference your PL to get an understanding of your overall health each time you visit.

EHRs like Epic are not set up to organize and categorize a patient’s Problem List in ways that enable doctors to identify these three kinds of clutter.

But IMO Health is.

Can’t this kind of “cleanup” just be automated? Absolutely not! Each change to a patient’s Problem List requires a doctor’s professional judgment. In the healthcare biz, a patient’s PL is sacrosanct. Just as HIPAA laws prevent your PL from being shared with unauthorized people or organizations, professional convention prohibits computer algorithms from changing it without oversight.

Enter, eSMART. This add-on to Epic will look at any given patient’s Problem List and sort each problem into useful categories. In this way, eSMART can call out the clutter, make recommendations, and afford the attending physician options for “cleaning” it. Old problems can be archived. Duplicate problems can be deleted. And related problems can be aggregated.

Why weren’t doctors using eSMART?

the old version

Despite IMO’s best intentions, eSMART was definitely NOT flying off the shelves. It suffered from woefully low adoption. Doctors would get an invitation to try it, and take a look. But metrics revealed docs would launch it once, poke at it, and never open it again.

But why? There were an array of reasons so many well-intended IMO products struggled. Most can be traced to organizational, structural, and strategic decisions common to growth-state companies. As I write in a separate case study about a different IMO project, Engineering’s outsized influence on matters of both product management and design engendered a tendency to build first, ask questions later.

But eSMART was also wildly unusable.

Heuristic Highlights

Indeed, there was so much agreement as to the need for a complete UX overhaul, I was never asked for a formalized heuristic evaluation. The following are from my notes.

Inevident self-evidence

Pretend for a moment you are a busy doctor. You’ve been told there may be problems on your patient’s list that don’t belong there. And you’re told there’s an app that can help. You open up this app and see this UI (left). Now … GO! Tick ... tick … tick. What do you mean you don’t know what to do next? It’s all right there! This product fails the first rule of usability: Don’t Make Me Think!

Poor “posture”

As Alan Cooper has described, Web applications take one of two “postures.” “Sovereign” and “Transient.” Epic and eSMART are perfect examples of both, respectively. Of transient apps, Cooper writes “the UI should be obvious and helpful, presenting its controls clearly and boldly with no possibility of confusion or mistakes.” Quick, in this UI (left) what is the meaning of the checkmark icons?

“Mystery-Meat” icons

The UX crime of “Mystery Meat Navigation” is usually committed by an over-reliance on the communicative value of icons. So, while the trashcan icon in this UI (left) probably means ‘Delete,’ what about the arrow icon? Even a doctor wouldn’t guess it meant ‘Resolve and move to patient history’ on the first try. Which would be a shame, as this was the crucial function it represented.

Thrown down the inkwell

When comparing the amount of “ink” NEEDED to represent data in a grid or chart, to that amount actually USED, Edward Tufte himself recommends the smallest delta possible. And accepted design theory cautions against using lines and boxes to group related content when negative space and proximity would suffice. This UI (left) flouts both of these design principles.

UX Design I rendered for this project

My role during this project was Lead UX Designer.

Designing in the Paleolithic Era of UX

The year 2005 was a different time. Described in Information Architecture for the Web and Beyond (O’Reilly, 2015), as a time when “many companies employed a one-step process called ‘Code HTML.’ Everyone wanted to jump right in and build the site. People had no patience for research or strategy.”

Such was the context in our industry for my team on-site at Humana HQ in Louisville, Kentucky. The client expected to see results immediately and sketches or diagrams wouldn’t do. Which meant the user interface I was designing and prototyping would come to drive every major decision about the product’s ultimate capability.

result

This project was a huge success, earning our team an award from Humana and my employer repeat business. Here's how we did it.

Information Architecture …

Where do I begin? Have you ever peered over your doctor’s shoulder as he or she enter notes from your visit? Have you glimpsed the pitiless, crammed-in, overwhelming excuse for a user experience these diligent professionals grapple with daily? AI and ambient technology may help with data entry nowadays, but doctors will always need to review, analyze, compare, and edit medical records and, as of 2024, little has changed. This is the story of how I insisted on being part of the solution — not the problem.

Visual Design (and Theme) …

Everyone involved in this project agreed that the metaphor I chose early on to unify the overall concept was crucial. What does it look like when people are invited to coordinate their voices? How can we describe it in a way anyone could relate to?

A choral performance, I thought. Led by a conductor, of course. Which informed every creative decision I made about the application’s logo, tag-line, and decorative imagery.

One Humana, One Voice.