INTRODUCTION
What happens to patients after they are discharged from the hospital? Studies suggest the majority of patients do not follow instructions, lose them or get lost in the technical jargon. Can a smartphone application fix this problem?
Yes.
With a team of four graduate students from San Jose State University’s Human Factors and Ergonomics program, we sought to conceptualize, develop, prototype and validate an application that will do the following: Keep them from being readmitted to the hospital, understand and follow a regimen of healthy eating, proper medication use and daily exercises, and remember their progress for meaningful dialogue with their physicians.
CONTEXTUAL INQUIRY AND USER REQUIREMENTS
Through contextual inquiry, we interviewed several patients who relived their experiences being discharge from a hospital. Interviewees commonly reported not remembering where they left their instructions and not having a reliable way to track and remember symptoms that may signal a serious condition developing.
Based on this feedback, requirements were developed. They included: A medication manager that would prompt and track proper medication use, a calendar with reminders and notifications for appointments and medication, a diary for logging daily symptoms and notes for the doctor to review and a diet and exercise guide.
The greatest feature of this application would be the ability to push patient discharge instructions to this application for a tailored experience, unique to their individual needs.
DESIGN APPROACH
Rapid paper prototyping kicked off our creative juices. Through discussion and multiple prototype variations, we came to agree on workflows, icon choice and usage and the overall navigational structure.
USABILITY PRINCIPLES
Accessibility: Careful consideration of user demographics, typically the elderly population with visual decrements, guided design choices for larger button and font sizes in addition to higher contrasts. Simplicity was key in both design and language.
Reduce cognitive load: When considering the user’s context in the home with frequent interruptions, a simple navigation was chosen. This included simple forward, back and return to main menu interactions through few screen layers.
Knowledge in the world vs. knowledge in the head: Similar to the principle of designing for memorability, good design also provides pertinent information to the user instead of relying on their knowledge. Interfaces hold useful, need-to-know information to guide users to the appropriate actions. This is seen in the diet/exercise section of our application.
Instead of having patients read, decipher and remember long discharge instructions, users can get started immediately with video, pictures and simplified instruction. Most importantly, this approach breaks down exercises into manageable daily activities and engages the user in an interactive way.
Memory: Easy to use interfaces do not rely on flawed human memory for successful interaction. Instead, good design understands the fallibility of memory and incorporates prompts and reminders for task completion. As shown in our contextual inquiry, users struggle with remembering what is in their discharge instructions let alone where they placed it.
The area that requires the most memory assistance resides in the medication manager section. Here, users are provided everything they need to know for proper and safe medication use.
The diary also supports memory by tracking and recording symptoms, measurements and notes on a daily basis. The save feature allows the user to access a history that can be shared with the doctor for a more informed, productive discussion involving appropriateness of medication or other regimens. Visual graphics of heart rate, glucose levels or blood pressure over time show a pattern of improvement or decline in relation to target rates.
Feedback: A cornerstone of good interaction design, feedback provides effective communication with the user and is paramount for ease of use. When users log entries and hit ‘save’, the interface tells the user it has been saved. Through subtle color changes, buttons indicate that they have been pressed.
