Let’s talk healthcare design: Tony Threatt

The best design problems are the tricky ones.

And they don’t get much trickier than implementing electronic health records in a 1000 bed hospital.

That’s exactly what Tony Threatt’s mission is at the moment.

We caught up with him to hear about what his role as a Senior UX designer at Vanderbilt University Medical Center (VUMC) entails, and how a strong design process can smooth the transition to EHR.

How did you get to your current role?

While studying for my PhD, I took a course on product design with a wonderful professor — Joel Greenstein. I had been familiar with IDEO and the Stanford Design School (d.school) and it was the first time I was taught a systematic design process even though I was trained in design by two architecture programs. The design process that I was taught was never explicit — we designed in whatever ways worked for us but it was never really defined with methods and milestones called out.

After taking his first course I was hooked and the following semester I took a second course (and later an independent study) from Dr. Greenstein. I also had an opportunity to work with Matt McEvoy, an anesthesiologist, at the Medical University of South Carolina.

We used a human-centered design process to build and evaluate an iPad app for perioperative code teams. This experience combined with my dissertation thesis which was redirected to a hospital context really propelled me into product design in healthcare. I later took a human factors post-doc at VUMC with Dr. Matt Weinger and Dr. Anne Miller in the Center for Research in Systems Safety and from there the rest is history.

What does your workspace look like?

Currently we have a really nice office with an area for individual desk space and a collaboration area that includes whiteboards and a really small conference table. We think very visually in our small UX group (team of two) so I really pushed to have whiteboards on all of the available wall space in our collaboration area.

That area has been referred to as the ‘Beautiful Mind Space’ and they are usually covered with wireframe storyboards. Our space will change in the near future — our organization is in the midst of a organizational change including our workspaces changing to a more open concept — however, we will carry the qualities of this space forward as our space is redesigned.

What projects are you (and your colleagues?) working on at the moment?

Implementing Electronic Health Records

VUMC is in the process of implementing Epic (vendor EHR) and it is the sole focus for the organization. As a UX designer we are augmenting that project by providing research and evaluation services. The implementation is a huge project so we’re picking strategic areas to get involved. Because Epic will provide the majority of our foundation, our team is looking towards the edges of the EHR using human-centered design to innovate with healthcare technology.

Mobile patient portal

Another project that we’re working on right now is developing our patient portal on Android and iOS. This has been a great project for our team. I consider it a ‘discrete development project’ — because we know the functionality that is needed for the apps so we’re using this opportunity to learn how to develop in these two platforms.

Design Sprints for informatics research

Finally, we are an academic medical center so I have started to run design sprints with our medical colleagues interested in informatics research by helping them to create informatics tools using human-centered design and the GV sprint methodology. It’s been fascinating to see how the mindset of my research colleagues and their products are positively changed due to rapid human-centered design.

Also, when you think about the length of a research grant and the timelines associated with it — using this process to quickly create a prototype incredibly speeds up the process and allows for more research cycles. In one instance creating a diabetes dashboard and in less than two weeks, we have been able to go through two cycles to understand and define the problem, design, wireframe, prototype, and test a solution with real end users. That’s pretty impressive.

Are there any common misconceptions/myths about what you do at the hospital?

I believe there is plenty of misconceptions about design beyond my organization. However, here’s some context about my organization. It is technology first and has been for a long time, meaning, while we had some internal design consultants, HealthIT did not have an in house designer (me) until October 2014 after designing, building, and maintaining its own EHR for 20 years. So, I’ve had my work cut out for me.

I think the biggest misconception is that design comes at the end — as if we’re whitewashing the picket fence. I fight against this mindset everyday. I think that most designers agree that design adds business value. I want to make sure that we’re building the right product at the right time in the right way; as well as, reduction of potential patient safety errors, reduction of time on task, or reduction of development time. In my first year, we were able to show our benefit to the organization by creating a product and organization style guide and pattern library and were able to bring on an additional UX designer, Andy Meagher, which has been awesome.

You’ve been working on an Electronic Health Records project for your hospital. As a UX designer, how has your role impacted that team?

As the first person in a true design role I’ve had numerous opportunities to have impact on our EHR. Documentation, ordering, e-prescription, and our patient portal are few areas.

One specific project that had a measured effect in the clinic was our redesign for the clinical decision support (CDS) alerting mechanism within our e-prescription software for drug-drug, drug-allergy, pregnacy, etc interactions. This project included participation from all stakeholders and design at every step. In this project our team conducted user research, a summative usability test, determined areas for software improvement, designed a new CDS bar, conducted iterative formative testing, helped our development team implement a solution, and developed a metric/reporting framework. A project of this scale does not happen all the time — there are pieces of design thinking here and there in other projects — and that is why I think this one was so successful.

Another activity that was successful that I lead was an introduction to design thinking workshop. Similar to the one developed by the d.school. We had 70 people sign-up (out of 300) and another 10 show up on the day of the workshop. It was awesome to see my colleagues interact with folks they haven’t interacted with before, go through the design process that they don’t use in their everyday work, and really commit to the event. It was pretty impressive. The biggest issue we had following the event was making sure that folks could translate the skills they learned into practice. We did not have something specific so we have had a little difficulty but otherwise it was a great event.

As far as challenges are concerned — I think about this a lot. I’d love to be using full blown design thinking, human-centered design, methodologies with every team that I work with. However, that’s not the case. We have glimpses here and there — the e-prescription CDS bar is one. What I find is that most folks simply return to what they know and how they have always solved the problem. I struggle with this because I believe that human-centered design blows away any other methodology or mindset. So, the challenges that I face are:

• How do I engage folks in human-centered design in as many ways as possible?
• How do I increase our human-centered design literacy?
• How do I allow myself to be okay when we’re not practicing human-centered design on every project with every team?
• How do I change that for the next project and the next team?
• How do I use some of the design thinking mindsets when I cannot use them all?

How have you adapted your design approach for a healthcare environment?

I can’t say that I have adapted my design approach to healthcare. Design is the same no matter the context — understand the user’s needs, define the real problem you’re trying to solve, design solutions, and test with end users.

What is different and what I have found more difficult in healthcare is understanding the hierarchical organinzational structure and understanding who you need to influence to create the most impact. However, I think that anyone trying to make an impact in their organzation has to figure out the structure. So conducting internal empathy has been something that I did not estimate correctly.

What’s the best advice you could give to a designer starting their first healthcare project?

Listen. I would probably say this to any designer entering a new context but you need to conduct a “listening tour”. You need to understand your stakeholders, what their desired business outcomes are, and who can you identify as allies on the project. Once you do the pre-work, make sure to observe your end users and don’t get frustrated if you cannot do every step in the design process as you intended. Roll with the punches.

And finally, what’s coming up for you that you’re excited about

My friend Emily and I are working with two non-profits, The Urban Green Lab and the Nashville Innovation Project, and are using design thinking methodologies to help them with their projects. It’s awesome to use design thinking with folks who are not familiar with the process and who are passionate about social causes.

In Nashville we have a design thinking meet-up the first Thursday of each month and I’m always excited about that morning. It’s truly one of the most inspiring mornings all month because you have a group of people who haven’t worked together jam on a problem for an hour and leave refreshed and ready to tackle whatever challenges that lie ahead. It’s also the best way I’ve found to network because the group goes through an experience together eliminating any interpersonal barriers.

Personally, the other thing I am excited about is a 10 year anniversary trip my wife and I are taking in October to Boston. I’ve been a few times and my wife has never been so I’m really excited to see the sights with her and have some time to celebrate our life together.

Questions from James Turner and answers by Tony Threatt who’s a UX Designer at Vanderbilt University Medical Center in Nashville, Tennessee

DesigningHealth.care tells stories from designers working on the front lines of healthcare transformation. Want to take part? Drop us an email at hello@jamesturner.co.uk.