athenahealth Presurgical Evaluation
A workflow that streamlines the pre-op journey for staff and patients.
Overview
Hospitals are forced to cancel surgeries for a myriad of preventable reasons – the patient didn’t follow directions, no anesthesia evaluation, or the patient chart is not up to date. Cancelled surgeries result in loss of revenue, wasted surgeon time, and extra work for front desk staff.
By digitizing the entire pre-op experience, we set out to create a comprehensive workflow to reduce cancellations, enhance patient care, and improve efficiency within the pre-surgical department.
My roles
For this project I was the lead designer and assumed the roles of:
User Researcher
Facilitator
Design Strategist
UX Designer
Interaction Designer
Deliverables
Summary of user research from 3 hospital visits
Journey map
Audit of current workflow, pain points and opportunities
Blueprint for future vision
Designs for first iteration
Future vision
Project specifications
Duration: 9 months
Tools used:
Sketch
Axure
SurveyMonkey
Jira
Asana
Understanding
I started out my research by understanding the limits in our current system. Only the most basic visit type was supported, which I call a “1 to 1” – a patient visits the hospital for 1 service in 1 department. This is too limited. Patients come to the hospital to visit many departments for many services, sometimes over many days.
I created this graph to show the gaps in athena’s software. The grey squares are unsupported visit types, such as physical therapy, infusion therapy, and surgery.
Journey mapping
To understand users’ needs, I visited 3 hospitals to shadow staff and observe current processes and pain points (I even watched a surgery!). Additionally, I conducted foundational research by speaking to internal subject matter experts.
I created a journey map to illustrate a patient’s experience from consultation all the way through post-operative care. An important insight is the significant number of individuals involved in preparing a patient for surgery. The process is also non-linear, with many steps happening concurrently.
Blueprint
My first step in creating this new workflow was to define our goals and guiding principles. I developed a blueprint to communicate with internal stakeholders, outlining what our team would tackle in Q1 and introducing our future vision. In the following slides, I’ve pulled out some key artifacts that illustrate the current pre-surgical workflow and how my envisioned improvements will enhance it.
Current Workflow
User Story
Beth the OR Scheduler receives a surgery order. Either as a faxed document or electronically in athenaNet.
She sends the e-order to 1 department and paper copies to the other relevant departments.
Beth closes the order and navigates to the OR schedule.
She finds the patient in athenaNet and selects a time from the OR schedule.
She enters the details from the order into the booking page and submits the order.
Scheduling the order automatically creates a surgery visit.
Pain points
Pain points
Beth cannot send an order to multiple departments at once. She sends paper copies which create paper workflows.
Beth cannot access an electronic order from the OR schedule.
Once Beth begins scheduling, she must complete the task. If she navigates away, she will have to start over.
Beth must re-enter all the information from the booking sheet manually.
Creating a PSE visit is a completely separate workflow.
PSE and surgery visits are not connected.
PSE visit information is not accessible from the OR schedule.
Optimal workflow
Opportunities
Surgery order flows directly into the OR Scheduler.
Booking page is already populated with order information.
The scheduler can see orders that need to be scheduled, double booked time slots, and pending surgeries.
Relevant and pertinent information is available during scheduling and booking.
Beth can send the order to multiple departments.
A request for a PSE visit creates a visit inside the surgery visit case and an appointment tickler.
Once the PSE visit is scheduled, scheduling details flow back to the OR schedule.
First iteration
Our first iteration focused on creating a specific ‘visit type’ for pre-surgical visits and ensuring PSE information flowed between systems and departments.
OR Schedule
In-progress surgeries
Pertinent clinical info on the OR schedule
Booking
Indicate a PSE visit
Appointment tickler for PSE visit
Pertinent clinical info available during booking
Visit
1 case supports multiple visits
Add PSE visit(s) to a surgery case
Individual check-ins for each visit
PSE with multiple outpatient departments
Schedule from the Visit Timeline and classic scheduling
View and manage all visits from the Visit Timeline
Future Vision
My future vision is an all-encompassing tracking center for schedulers, nurses, pre-op staff, anesthesiologists, and surgeons.
On the left side is a worklist for pre-op staff for surgeries that are scheduled but not completed.
The center work space will toggle between an individual patient’s pre-surgical needs and the OR schedule.
The right side will be a expandable section to take actions such as ordering tests or medications.
Lessons Learned
Pre-op work is detective work
Since many hospitals still rely on paper workflows, and different EHR systems often struggle to share information between each other, nurses and administrative staff often find themselves needing to track down and piece together every patient’s clinical history. Having a patient’s full clinical history is imperative for determining if they are healthy enough to undergo anesthesia.
A cancelled surgery is delayed patient care
Surgeries are scheduled months in advance, with surgeons fully booked at any given time. A canceled surgery is an additional future booking, wasted surgeon time, and lost revenue for the hospital.
Nonlinear with many specialized roles
The OR scheduler, scheduler, pre-op nurse, and anesthesiologist – these roles are specialized and unique. Each has its own goals and prepares for the patient and surgery simultaneously. It's crucial to consider the workflows of each of these roles in this design.