This personal eHealth application is the way to a better hospital experience
Graduation project: "A better hospital experience for pregnant women with a medical indication using a personal eHealth application."
Digitalisation in healthcare is developing and at Hike One we’re very interested in this evolution. With our user-centered mindset we’re especially interested in how the personal and human touch, that is so essential in physical healthcare, could also be obtained in digital healthcare (eHealth). This challenge was the starting point of the graduation project of Hélène Schmitz. To dive into this she focused on a specific case: the hospital experience of pregnant women with a medical indication. Several colleagues at Hike One experienced that this process could be supported better, and that a more personal eHealth application might be useful for this. This led to the following research question:
How can the hospital experience for pregnant women with a medical indication be improved by a personal eHealth application?
Research
A medical indication during pregnancy
In order to answer the research question an understanding of medical indications is necessary. Women get a medical indication during pregnancy if they have a high risk on complications or already have complications. There are a lot of different reasons to get this medical indication and it can occur at any point in time. Examples are gestational diabetes, high blood pressure, expecting twins, or a baby in breech. Having a medical indication means needing a strong observation of a gynaecologist. This results in being not, or no longer, under supervision of the midwife. And changing from an intimate obstetric practice, to a big clinical hospital for check-ups and possible other appointments. Even though this hospital process is different for everyone due to the type of medical indication and the seriousness of the situation, they all have to go through it.
Hospital experiences
Having more knowledge of medical indications, it was time to figure out how the hospital process is experienced by these women. Research, consisting of desk research, observing forum reactions, and interviews, showed that these experiences are varied. Both positive and negative experiences are often influenced by the hospital they’re visiting, how the care is organised and what doctor is in front of them. Unfortunately eHealth can’t do anything about that, so investigation was done on what problems actually occur because of that.
By talking to women that have been in this situation, it became clear that there are a lot of similar issues despite of the different medical indications. One of the striking insights was that these women often have to deal with a lot of different appointments and doctors. Almost every appointment is with another doctor. They’re not sure if all these different doctors know everything about their situation, or how and who to contact. This makes them very insecure. Annoyance also occurs when the women are told, for example, an appointment with a specialist will be made, but then they have no clue when they will hear more about it. A better insight in their appointments, what and who they can expect could be very useful.
Another common problem is that these women often experience a rushed gynaecologist in their appointments, instead of a midwife who has time for a more personal talk. Women indicate that they miss the intimate atmosphere at the hospital. Because of the rush, women also experience they can’t ask all the questions they want, and they’re often sent home with a generic folder. They have to browse through the whole folder to find the answer they were looking for, which is indicated as very impersonal and annoying. This also results in searching online for answers but not being sure if it’s reliable.
eHealth
After having collected valuable insights on the possibilities for improving the hospital experience, additional research on eHealth itself was needed. Different types and risks of eHealth have been investigated, and several eHealth applications were analysed to see what could be learned from them. An example risk for eHealth is: a low motivation to use an eHealth application, because they don’t know the benefits of using it, or hesitate due to privacy issues. It also occurs that they don’t use it because they don’t know how to use it. This could be because of a lack of skills or a bad usability.
Looking at various eHealth applications it was noticed that they are often designed very business-like. The style is very medical and not warm and caring at all. Besides, the usability is often not great. For example, web applications are not responsive and can therefore not be used on mobile phones. Moreover, the navigation is often difficult, because the applications have too many features. There’s a lot more research to write about. But according to these insights it was important to come up with something that has a clear purpose. To make it safe and easy to use. And consists of a good combination of a serious and reliable, but also a warm and personal feeling.
Guiding Principles
In order to create a valuable concept, the gathered insights were translated to some guiding principles:
- Be relevant in all different situations
Regardless of the specific medical indication, the pregnant woman should always be able to benefit from the solution. - Create insight in appointments and doctors
More overview should be provided in the maze of appointments and doctors. - Offer reliable information tailored to the users’ needs
Currently given information is often not focused on the personal situation or is not offered at the right time. Information must therefore be offered from reliable sources, in a dosed manner and at the right time. - Radiate a personal feeling
The touch of personality that’s experienced with the midwife but being missed with the gynaecologist should be digitally radiated to eliminate that feeling of being a number. - Keep it simple
eHealth should be as simple as possible so it’s easy to use for everyone. - Be accessible always and everywhere
In this era, in which everyone is constantly online, the offered information, data and features should always and everywhere be accessible. - Be safe and reliable
Keeping personal data protected has the highest priority. The environment in which information is provided must be safe. Reliability must also be radiated so that users dare to share their personal data.
An iterative process
With the Guiding Principles in mind, a brainstorm session with several colleagues was held to come up with ideas for a concept. Eventually a virtual assistant, that helps women in a personal manner with their questions about appointments and medical information, seemed like a good idea. Working in three iterations, each consisting of researching, concepting, prototyping and testing, improved the concept, visuals and features. Using the insights from the tests and additional research on Conversational UI’s, chatbots interaction and personalisation, and persuasive design, the final concept emerged: Janna, the virtual pregnancy assistant.
About Janna
Janna is a virtual assistant that helps pregnant women with a medical indication by offering reliable and personal information about everything they need to know. She is a smart chatbot that is always and everywhere accessible via a mobile app. She can help pregnant women with questions about appointments, their healthcare team, medical information, information meetings and contact information.
For example, Janna can tell them when their next appointment is, give them specific information about the risks of gestational diabetes, or provide them the phone number of a specific department of the hospital. All users have to do is just type their question to Janna, or use Janna’s tips and hints to start a conversation. Next to that Janna is also capable of sending them reminders of important occasions. Context awareness makes Janna able to ask the pregnant woman to write a review after seeing a doctor. Janna’s friendly character and tone of voice should help users in asking her for help, and seeing Janna as a safe place they can fall back on.
How is this possible?
Personal information of users
To realise Janna’s functionality, the application needs access to users’ personal and medical information. Therefore the application is linked to the Electronic Patient File (EPD in Dutch), which means it can (for now) only be used by hospitals that have an EPD for their patients. Most of these accounts are safe, since they are linked with DigiD.
Artificial Intelligence
Another important factor to make this concept possible is Artificial Intelligence. Different forms of Artificial Intelligence are used in this concept, for example Natural Language processing and Machine Learning. Natural Language Processing makes it possible for Janna to understand human language and answer back in human language. Machine Learning helps Janna to learn from her users’ input and output. With machine learning she is able to recognise patterns in conversations, which helps her answering more and more questions over time.
Testing the concept
The concept has been tested multiple times within three iterations. The tests consisted of moderated user tests, and were done with several women who experienced a pregnancy with medical indication recently. The first tests showed that the conversational user interface was very new to the user group. So in further iterations a more clear introduction of the chatbot was added, to help first users get to know the interface better. Other features, such as logging into multiple hospitals to have all appointments together in one place, were made due to users’ feedback.
The women that tested the application were overall very positive about the concept. Having all this information in one place is awesome, it would really help them to be more prepared and worry less during the process. They think Janna is looking very friendly and it’s a nice character to have a chat with. To make the concept really perfect, users would also like to have a summary of their appointments or recommendations of their doctors.
Our learnings and the future of this concept
This project showed us a bunch of interesting insights on the possibilities of eHealth: how it could give users a more personal feeling even though it’s a digital channel, and how this could help improve hospital experiences. Although it’s now designed for pregnant women with a medical indication, the features used in this application also show a lot of potential for other user groups (that also experience a maze of appointments and doctors or have to deal with a lot of information).
The concept is a fresh new touch on the eHealth applications we know nowadays. However, more research is necessary to realise this concept. For example, technical specialists must be consulted to find out what Janna is really capable of, how smart she is and how fast she learns. Last but not least, we want to cooperate with hospitals to expand the application to its full potential.
Hélène Schmitz
Graduate Intern at Hike One
