Lippincott DocuCare

Immerses nursing students in an Electronic Health Record (EHR) trainer that simulates realistic patient-care scenarios.

A picture of the Lippincott DocuCare's redesign Medication Administration Record (MAR) page.

Project Overview

Problem

DocuCare’s Electronic Health Record (EHR) did not align with real-world EHRs used by practicing nurses, and instructors experienced friction evaluating student case scenario assignments.

Process

Designed the DocuCare experience in batches while bencmarking real-world EHRs such as Epic and Cerner. Validated EHR with instructors and practicing nurses to validate its realism to prepare nursing students.

Impact

DocuCare’s new EHR trainer simulated a more realistic clinical experience that improved nursing student confidence post-graduation. The new assignment evaluation interface allowed instructors to quickly view changes made by the student, while also maintaining the option to view within the EHR.

“The transition from education to patient care continues to be a big hurdle for new nurses entering the workforce and the health systems that hire them. Having clinical-like application tools available to nursing students will help build their clinical judgment and reflect a more true-to-practice experience that can minimize these growing pains. The essential goal of documentation is safe, effective patient care delivery and clinician-patient communication. Students that use DocuCare gain exposure to these skills during their education, making them more practice-ready and more attractive to employers, while supporting curriculum needs.”

— Julie Stegman, Vice President, Wolters Kluwer Health Learning & Practice

I helped migrate Wolter Kluwer's DocuCare to their Phoenix platform, and improve the EHR trainer to provide realistic training for nursing students.

Wolters Kluwer was migrating DocuCare to the Phoenix platform to better align it with their other related products. As a part of this effort, they wanted to improve the experience using the Electronic Health Record (EHR) so it better aligned with real-world EHRs in use.

I collaborated closely with the product owner, and UX design director to define the areas for UX priority, and divide the requirements into batches. With my role as the primary designer, I was responsible for assisting in conceptualization, leading in design refinement, delivering design specifications, and preparing Product Backlog Items (PBIs) for final hand-off.

My Role:
Primary Designer

The Team:
UX Design Director
UX Designer (me)
UX Researcher
Product Owner

Timeline:
Nov 2021 – May 2022

Problem

DocuCare's Electronic Health Record (EHR) did not align with real-world EHRs used by practicing nurses, and instructors experienced friction evaluating student case scenario assignments.

Instructors specifically provided feedback that the way DocuCare administers medical orders and tracks them in its Medication Administration Record (MAR) does not align with their expectation based on their previous experience using real-world EHRs. 

A picture of the original Medication Administration Record (MAR) page in DocuCare.

Batches of Work for the Project

Batch 1

Establish base class functionality

Redesign the base DocuCare functionality for the Phoenix platform. This includes navigation, class management, assignment flows, and case libraries.

Batch 2

Improve EHR training experience

Taking a look at what is currently available in the DocuCare EHR trainer, and align it closely to real-world EHRs.

Batch 3

Improve Instructor evaluation

Instructors needed an easier way to view EHR changes made by students during their simulated assignments.

Process

Weekly design sprints and check-ins with the product owner kept us aligned as I worked through completing user stories.

Much of the work in batch 1 was focused on using existing patterns used by other Wolters Kluwer nursing products available on the Phoenix platform. UX design work was heavily focused on the assignment flows, and interacting with course content such as the DocuCare case library. Notable pain points we planned to solve were around microcopy for actions as well as visual hierarchy. As the team grew confident with the direction of the designs, I prepared a prototype to validate in moderated usability tests.

A picture of a FigJam board exploring menu design and language for DocuCare's case library actions.

Batch 1 usability tests revealed instructors needed additional help to unclutter their case lists.

While drop downs were available in the designs to filter case libraries by category, tag, and ownership, instructors still found the view to be overwhelming by default. To alleviate the cognitive load when arriving to the case library, I suggested using accordions for organizing the cases by category. This way the instructor can progressively disclose based on the specific case scenario they plan to assign for their nursing students.

A picture comparing the original design of the DocuCare case library before testing, and the design afterwards that addressed instructor feedback.

Moving into batch 2 designs for the EHR trainer, I spent time thoroughly researching the major EHRs used in the medical industry such as Epic and Cerner.

It was difficult to find much up-to-date references on the complete experience Epic and Cerner’s EHRs since it deals with sensitive health information. Though difficult, it wasn’t impossible to find instruction videos for order administration and sheduling medications via the MAR page. Some of the sources I referenced were old instructional YouTube videos, written documentation of order administration, and an obscure instructor presentation of a Jeopardy game covering the MAR table for Epic. These findings were later used in discovery sessions with instructors to get feedback on the state of DocuCare at the time and how it aligned with the experiences we found with Epic and Cerner. This allowed us to get more clarification on expected functionality and how these interfaces were to be used.

A picture of the presentation used in discovery sessions where instructors were interviewed about the state of DocuCare and how it compared to real-world EHRs based on my findings.

The Orders and MAR page went through an extensive redesign to align with instructor expectations based on their previous nursing experience.

Instructors indicated that the DocuCare orders page need more clarity around dosage to be administered, as well as the frequency at which it should be administered to the patient. It was also stated that it was difficult to scan the table to see the status of orders in comparison to the Epic EHR. The DocuCare MAR page was also said to have an unexpected structure since the typical experience using an EHR is viewing medications on a timeline to better track the timing for administering medication for the day and upwards of a week for a patient. taking these findings from research, I began working on page layouts for the order and MAR pages to better align the scenarios presented by instructors.

A picture of DocuCare's redesigned order and MAR page.

With batch 3, we designed and tested the new instructor evaluation experience with the redesigned DocuCare EHR trainer to get feedback on both during moderated usability tests.

Making use of a linear prototype that I drafted up for testing, I worked with a UX researcher to define the narrative of the scenario I wanted the instructor to work through. The scenario was the instructor is going to grade a student’s assignment and verify the changes to the data in the DocuCare EHR. The first goal was to get feedback on the summary view that would provide a quick look at changes made to the data by the student. The second goal was to then get feedback on the EHR as a whole, but mostly focused on the order and MAR page when we had the instructor click into the trainer to view the data in the EHR. Feedback was generally positive about the new experience, and instructors were excited for the ability to be able to quickly parse through the data and switch between students effortlessly.

A picture of the DocuCare evaluation landing page before submitting evaluation and post-evaluation for commenting.

To assist the product owner, I documented 277 user stories and 519 acceptance criteria for the redesigned DocuCare experience.

This reduced the burden on the product owner, and helped me vet the designs to ensure they were not conflicting with earlier user stories for the original experience of DocuCare. I documented assumptions, conditions, and expected outcomes to ensure that UX, product, development, and QAs would be on the same page. As a final deliverable, the client recieved the research reports, the Product Backlog Items (PBIs) as a Google Sheet, and a Figma file with all the user flows that lined up with the different user stories or PBIs.

A picture of the Goolge Sheet populated with different product backlog items for the DocuCare experience.

Impact

DocuCare's new EHR trainer simulated a more realistic clinical experience that improved nursing student confidence post-graduation. The new assignment evaluation interface allowed instructors to quickly view changes made by the student, while also maintaining the option to view within the EHR.

Thorough benchmarking on EHRs, and speaking with experienced nurses allowed the team to create the best learning experience for nursing students without compromising the functionality tied to DocuCare’s case libraries.

Reflection

This was the first project at Openfield and one I’m still very proud of to this day. With my UX director, I was able to grow as a designer by honing my skills, and gain experience presenting and communicating with clients. I learned some lessons from this project that I’ve taken into other projects I’ve worked on, such as:

  • While it’s great to align with competitors or analogous products, it is still important to provide an accessible experience. Though the goal was to align with real-world EHRs, we still needed to avoid some of the pain points that came with them. Such as inaccessibility issues and the inherent cognitive load that comes with review medical data.
  • Sometimes it’s valuable to step back from the UI and evaluate the user experience. I worked through a lot of iterations on the MAR page to try and represent the data within the timeline. It wasn’t until I started using it in a prototype that I realized some things work in concept, but not in practice. It’s always good to validate your experience first and worry about the UI afterwards.