Problem Statement ----------------------------------------------------------------

In the chaotic emergency care environment, patients are being admitted haphazardly and staff members must make snap judgement about patient treatment. Doctors, nurses and other members of the hospital staff need an efficient way to keep track of patients coming into and going out of the medical care units. They also need to keep track of patient medical status, interventions performed, and note which members of the staff are responsible for which patients. A common medium for information management in this fast-paced environment is a simple marker and white board, which doctors and nurses share to keep track of this large and complex network of information.
While the whiteboard does score high on the efficiency and learnability scale, it is a dismally unsafe and prone to all kinds of error including lapses, mistakes, poor form, smudging, etc. For an institution whose goal it is to provide care, the dismal safety score of the whiteboard merits a revamped user interface design.
Several institutions employ existing medical information management platforms, but clinical staff often describe these tools as "cumbersome", "inefficient" and "annoying", and often simply use the white boards instead.

User Analysis ------------------------------------------------------------------------

Target Users Classes

Doctors
- Perform diagnosis
- Prescribe medications and treatments
Nurses
- Interact more personally with patients
- Keep record of patient health status
- Administer medication
Hospital staff
- Need to track the procedures performed on patients for billing purposes,
- Contacting family members.
Paramedics
- Need to inform the hospital of incoming patients and provide information on health status.

Target User Goals

Doctors, Nurses and Parademics:
- Need to manage patient information cleanly, and safely without negatively impacting their operational efficiently
- Want to Prioritize care to the most needy patients
- Want to be able to easily access the content in the system
- Would like to update patients status as quickly as possible
Hospital staff:
- Track the procedures performed on patients for billing purposes
- Contacting family members
- Minimize hospital costs and maximize patient throughput
- Would like to be updated about patient status as quickly as possible
Paramedics:
- Record and send information on patients to the hospital as early as possible to ensure that the caregivers are ready to receive and provide immediate treatment.

Target User Obstacles

Doctors, Nurses and Parademics:
- Very little time or dedication to learning new interface designs.
- Existing platform is highly error prone, and can be difficult to discern
- Existing platform is cumbersome and information is not easily transmitted. This can lead to a latency issue where information is not updated frequently enough.
Hospital Staff:
- Have difficulty understanding "Jargon" of the clinical staff, and layout of the information on the white boards
- Are not informed of updates in status without rechecking the board, which is itself prone to latency issues.
Paramedics:
- No efficient way to communicate or send information collected in the ambulance to the hospital.

Task Analysis-------------------------------------------------------------

Task 1: Checking Patients In

Where is the task performed?
What is the environment like?
What are the time or resource constraints?
Who else is involved in the task?
Why is the task being done?**
What does the user need to know or have before doing the task?**
How often is the task performed?**
How is the task learned?**
What can go wrong?

Task 2: Adjusting Patient Information

Where is the task performed?
What is the environment like?
What are the time or resource constraints?
Who else is involved in the task?
Why is the task being done?**
What does the user need to know or have before doing the task?**
How often is the task performed?**
How is the task learned?**
What can go wrong?

Task 2: Checking Patients Out

Where is the task performed?
What is the environment like?
What are the time or resource constraints?
Who else is involved in the task?
Why is the task being done?
What does the user need to know or have before doing the task?
How often is the task performed?
How is the task learned?
What can go wrong?

Interviews -----------------------------------------------------------------------------

Interview 1: Doctor 1

Dr. X is a young radiologist who often works in ICU. As he has very good IT skills (MIT CS level), we thought it would be a great idea to have his feedback on the current platform used for information management. He described his work in the ICU saying "Patients in ICU can stay for a few hours up to a few weeks. The goal of the hospital employees is basically first to keep patients alive, and second, if they succeed, to treat them." Dr X. then explained how the patient's data are handled by the hospital employees. "The medical information on each patient is currently stored in two different places: a file folder (paper) containing the main general information on the patient, such as the patient's medical history, physicians' observations, his age, etc. A whiteboard (A3) on which is indicated which drugs the patient has received in the ICU, and at what time he received it. The whiteboard also contains key information on the patient that everybody should know, typically allergies and main diagnosis.We asked him who used this information. He replied physicians, nurses as well as unlicensed assistive personnel need access to them. For example when unlicensed assistive personnel give a meal to a patient, they should know if the latter is allergic to it.We then inquired what goals and needs he has which are not addressed by the current solution (file folder + whiteboard). Here are the key points of his answer:

Patients with intricate medical records are difficult to handle as the whiteboard only have enough space for if a few main medical information (as the whiteboard's primary purpose is to keep track of drug administration)
it's impossible to collect data for medical research
papers can be lost/altered, and are inconvenient to move (in case the patient needs to be moved)
many measurements are done on the patient, displayed in real-time on-screen, but needs to be manually written on the whiteboard, and never make it to the patient's file folder.
since information on the whiteboard aren't recorded in the patient's file folder, if one day another physician needs to give a drug to the patient that he had received during previous ICU period, the physician will not know how the patient had reacted to it.
Interesting remark on the last point: "For forensic purposes it could be interesting. But otherwise it's not useful very often. I guess maybe when something's wrong and strange with the patient it can be helpful to browse the detailed history (or for research purposes), but globally I don't think it happens often: 2-3 days after it's been measured most likely it won't ever be needed again. Otherwise, when a parameter needs to be monitored, again it's copied into the patient's file. All this is probably quite patient-dependent: probably the web interface should be able to adapt to different cases. Like, "pinning" a parameter of interest so that it's more visible for a specific patient (eg temperature for a patient with a severe infection vs blood pressure for one after myocardial infarction)"

Addendum after interview: "I thought about something: another interesting information to have on the whiteboard would be upcoming appointments: I'm thinking mainly about radiological exams: it can be interesting/useful to know that at hour X a radiologist (that's not actually a radiologist but a "manip radio" but I don't know the English term) is coming to do an X-ray to the patient, or that the patient will be moved to the scanner or something. I don't think patients move that much once installed in ICU, but still when they do it's good to have as much people as possible aware of it."

Key points: TODO

Interview 2: Doctor 2

Dr Y. is a young ICU physician. As ICU is a broad topic we focused on how patient's information is handled.

He described 5 different types of information containers (everything is on paper except the first one):

administrative information (everything non-medical, e.g. age/sex/address/…)
basic medical information: upon the patient's arrival to the ICU, a physician interviews the patient (provided that the patient is able to talk) and write a medical summary of 1 or 2 pages containing anything could be interesting to treat the patient. This synopsis follows a conventional format. It will be kept within the service, even after the patient has left.
the nurse folder, where nurses write down precise technical information such as given drugs ( quantity / time ) as well as key measures on the patient such as blood pressure or ECG.
Nurse whiteboard: data measurements (blood pressure/ECG/…), drugs, key events
Paramedic whiteboard: Sumary of the previous examinations of the patientIn addition to those five sources of information, they can be some computer applications designed for specific type of information such as medical images, but those applications aren't interconnected.Dr Y. then enumerated his most important needs:* easy, rapid access to any information pertaining to the patient* reliability of the information, e.g. not having the wrong file (this seems obvious but it does cost many lives annually)* having one information container instead of the myriads of information sources he currently has to deal with. We must be in mind that physicians/nurses/paramedics often have to react very quickly in the ICU. Also, it's not the job of physicians/nurses/paramedics to rewrite information in different folder. They should better use their time to help the patients.The goal is simple: saving the patient's life, while providing correct work conditions for the hospital's employees.