ENTvision

 

2017

Yiyi Gao (Research, interface, video)

Rex Sae-Lim (Research, interface, video)

Madeline Helland (Research, illustrations)

ENTvision is a mobile application that allows doctors to clearly explain illnesses and diagnosis through an interactive 3D model. The conversation and visual communication during the visit are recorded for patients to access after they leave.

Our goal is to increase patients’ trust for doctors’ diagnosis, allowing patients to have a better understanding of their symptoms, illnesses and treatments. Ultimately, this reduces cases of patient unnecessarily demanding referrals to specialists, as well as cases of self-abuse from not following treatments.

Hunt Statement

We researched how patients and primary care doctors communicate during a clinic session. We aim to design a visual communication mobile application that allows for more efficient communication between patients and primary care doctors. Our goal is to help improve the patient’s understanding of diagnosis and give them assistance and resources for when they leave the appointment.

Literature Review

http://www.enttoday.org/article/how-to-prevent-medical-diagnostic-errors/ 

ENT patient visit overview

https://www.medscape.com/public/about

Medical image library that aims to help doctors make more accurate diagnosis. It is designed to fit into the clinician's workflow, it provides fast, informed decision-making while in the clinic session.

https://www.visualdx.com/how-it-works

Visual DX - medical image library that aims to help doctors make more accurate diagnosis. It is designed to fit into the clinician's workflow, it provides fast, informed decision-making while in the clinic session.

http://www.improvediagnosis.org/page/AbouDiagnosticError

Both the following website and article gave us a better understanding for diagnostic error and the issues and conversations surrounding it. They discuss prevalence and offer suggestions for how to improve/prevent it from happening.

Research Findings

Based on our research, we created flow models for each interviewee and the information they provided.

Research Findings Summary:

• The problem occurs in the lack of trust/communication between patients and UC/PCPs.

• Patients see a problem in the diagnosis, because they don’t trust the credentials of the UC doctors. Therefore, patients want to know information gaining at UC is credible and accurate.  Problem 1, (no good measure though)

• If there’s already good connections between specialists and doctors, maybe connect ENT doctors to the follow up, not really referrals, but an area in between, reduce unnecessary referrals, make doctor's background visible

• UC/PCPs see problems with liability of patients in following treatment procedures, and they want to know that patients are following the treatment prescribed. Problem 2, follow up of patients is not the same

• Possible solution

Reassurance is needed for both doctors and patients. Patients want to hear from ENT specialists as reassurance to the UC/PCPs’ diagnosis. UC/PCPs want to consult objective view from ENT specialists to have more guidance and confidence.

Concept Generation

Idea I : Progress Dashboard

Progress Dashboard can keep track of patients and increases transparency if patients were not following treatments. However, this solution does not truly strengthen the trust between students and family care doctors.

Idea II : Videos with specialists talking about diagnosis and procedure

This idea would be an attempt to validate family doctors' credibility for patients but is not directly related to family doctors themselves. The idea is weak and irrelevant to the core problem (lack of trust).

Idea III : Standard Algorithm published by ENT

Standard algorithms published by ENT specialists of UM health care already exist. This idea is repetitive to the tools that are already "in stock".

Idea IV : Communication function with ENT specialists

Since some doctors already have connections with ENT specialists, it is a good idea to have this function for them so the communication is standardized on a platform. However, the motivation behind this project is to reduce false and late referrals to specialists that adds stress to the specialists' side. 

Idea V : Curb-side consult

Initially, we thought this was a good idea. However, we later found out that Mi-chart has its own built-in curb-side consult function. 

Navigation Flow

Wireframes and Developments

Adding Interactivity

Usability Testing

Findings from usability testing with students:

• Confused with info screen - more indication of what to do

• Zoom occurs too fast - more screens to show gradual change

• Works on iconography for tools on diagram page - some unclear 

• Words are too medical in the app, especially in the patient portal

• Would like ability to add typed notes to diagram

• Adjust language in application to be more understandable

• Add faded diagram in the thumbnail of a recording

 

Findings from usability testing with family care doctors:

• Add comparison photos for normal vs. infected/affected ENT areas

• Don’t require drawing - have it make sense if just talk and zoom

Summary: After assessing feedback taking into account of users' background knowledge, we decided to proceed with the following changes to our design.​​

• Modify iconography and logos for better feedforward

• Add faded diagram thumbnail for existing diagrams

• Add comparison photos for normal vs. infected/affected ENT areas

Design Specification

We looked at the three primary principles of Apple Human Interface Guidelines and considered them when developing our own interface design.

 

Clarity

 

We want the interface and the navigation to be simple and straightforward. We used icons that are clearly related to their functions and have good feedforward for users. The icons and tabs were kept simple, and unnecessary adornments were reduced. We increased the font size and changed the text color based on feedback from usability testing, and the interactive elements were highlighted to better suggest interactivity.

 

Deference

 

In this medical app, we want to reduce the anxiety and confusion of the users. We want to keep the interface light and simple, and we avoided gradient and drop shadows that may create illusions of realistic objects. During our interface development, we replaced the 3D diagram with more user-friendly colors to reduce the potential discomfort for users. We kept the layout clean while emphasizing the key features, allowing for easier user experiences.

 

Depth

 

Throughout our mockup design iteration, we aimed to improve the visual hierarchy and user understanding of the interaction. In the video thumbnail and the recording page, we used transparency and blurring the background to show the hierarchy of different contents on the same page. We used different typeface and font size to differentiate the main title and the content for each page.

By keeping a consistent layout, we want to show a depth of content as the navigation flows. When the user opens the homepage, they will see a simple layout of information. As they further interact with the 3D diagram, we created more “rewarding” moments when they zoom in, click on the interactive areas and see the pop-up window with illness and treatment information.

The patient’s and the doctor’s portal have a slightly different layout and function, but each tab behaves the same way for keeping the integrity of the entire app.

Mockup Iterations

First Iteration           Second Iteration       Third Iteration           Final Mockup

Reflection

 

Strength:

 

ENTvision's overall design is well developed following concrete steps starting with research. The research processes and findings tie closely to the design as well as the stakeholder's motivations.

 

We researched into existing medical websites and applications to make sure we are not designing an ENT related app that already exist.

 

Iconography is clear, and overall visual elements are user-friendly. The mockups are very detailed and well executed.

 

Weakness:

 

We only conducted primary research with clinicians; we want this app to be beneficial for both doctors and patients, but we lacked insights from the patient’s side.

 

As for the design, though usability testing was conducted, it would be desirable if there was another round of think aloud after the final iterations of mockups for us to improve on the visual design and interaction.

 

Our conclusion to use iPhones came from our interviews with the doctors. All interviewees said they carry their phone and use it as a documentation tool. The hope is to make the app more smartphone-friendly due to the small screen size. In the future, ENTvision can be a mobile and web-based platform, so doctors have the choice to use different platforms.

 

 

Moving Forward:

 

There are more problems within the urgent care practice, but we were not able to talk to enough urgent care clinicians. If we want to expand this project to urgent care, we will need more demographic research about the people who go to urgent cares more often, and we need to consider if smart phone application would still be suitable for them.