Key Concepts
Information Systems Analysis & Design, Interviews, Sketches, Use Cases, Process Flows, Risk Assessments, & Hi-Fidelity Mockups
Group Members
Mesfin Bekele
Calvin Korver
Yiran Juan
Lisa Koss
Date
Apr. - Jun. 2017
Instructor
Richard Sturman
Tools
Pencil, Visio, & Adobe XD
Role
UX Designer
Overview
I worked as a UX designer on a project for the University of Washington Medical Center (UWMC). We were tasked with improving UWMC's current process in evaluating providers by proposing a new, improved system that would replace their archaic paper system with a digitized automated system. Our final project report analyzes both the current state and our proposed future state to compare the risks and benefits of implementing a new system.
Mission Statement
We seek to improve the accuracy of the evaluation process to ensure that all of UWMC’s providers comply with mandated standards in a timely manner.
The Problem
The current UWMC Medical Credentialing Specialist, Madeline Sanabria, came to our INFO 380 class in seek of a solution to replace their old, archaic paper-based system that they currently use for evaluations for current providers and newly hired providers.
Our client, Madeline Sanabria, wanted a comprehensive analysis of the current evaluation system process within UWMC, with my team noting areas that could gain improvements in efficiency and automation which would lead to a proposed design of an information system solution. Our information systems solution will improve the effectiveness of sending evaluation forms, effectively streamline the client’s current process of handling and tracking provider evaluations, and easily provide generable reports to ensure compliance at all levels within and outside of the UWMC.
USER RESEARCH
What is the UWMC's evaluation process like right now?
UWMC's Medical Credentialing Specialist came to one of our lectures for an open interview session. During this session, my team learned all about the evaluation process from her point of view. We found out that there are two different types of evaluations: Focused Professional Practice Evaluations (FPPE) and Ongoing Professional Practice Evaluations (OPPE). OPPEs are bi-annual evaluations for providers that have been working for UWMC for some time while FPPEs for are newly hired providers or providers who request new privileges.
Her ultimate responsibility is to ensure that all evaluations are correctly sent out to the appropriate medical supervisors for them to fill out about the providers that they oversee, received back within the proper time frame, and comply with mandated standards. The evaluation process is a combination of an Excel Spreadsheet and paper forms so this process relies heavily on our client as she is the only one responsible for mailing evaluations, manually entering data in the spreadsheet, and tracking all status changes.
My team identified the aforementioned process flow in our initial concept overview below. We also included an initial idea into how our client could lessen her workload and error margin with the use of a database.
A concept overview of what UWMC's current process is like, but also includes an initial future state idea by my team. By including a database, the evaluation process would become automated. As a result, automatic error checking would reduce the time required to get an evaluation back while also eliminating the need to physically mail an evaluation.
From listening to the in-class interview session and from asking our own questions, we identified four key pain points:
- The Medical Credentialing Specialist has to manually add all fields to the Excel spreadsheet, which is prone to human error since they have to be updated whenever a change is identified
- All paper evaluation forms are stored in a physical file system, making it difficult to quickly compare data across all of the entities within UWMC
- Compliance with OMSA and other entities may be delayed if an evaluation is lost in the mail or incorrectly filed
- Very time consuming process overall since our client has to make updates manually at every step of the process for ~72-312 evaluations per month
Current State ANALYSIS
What is inefficient about the current state? The risks?
My team was then tasked with analyzing the current system used by UWMC to ensure that we understood the entire process before recommending any concrete changes.
As-Is Use Cases
In the current state, there is one primary actor and two stakeholders that participate at various stages in the evaluation process. The primary actor, the Medical Credentialing Specialist, is responsible for most steps, which include initiating, updating, and tracking evaluation statuses. Otherwise, a provider's supervisor is only responsible for filling out the paper evaluation once they receive it in the mail. The Office of Medical Staff Appoints (OMSA), one of the compliance agencies, is responsible for digitizing completed paper evaluations for safe-keeping.
A use case diagram that shows how the primary actor, our client, interacts with other stakeholders in UWMC's current evaluation process.
With only one designated person to maintain and access data related to the evaluation of health providers, unnecessary delays occur because all departmental supervisors as well as OMSA have to wait for our client to initiate any information requests. Not only that, but if a supervisor has any questions or concerns regarding a provider that they oversee, they have to wait for our client to email them back after obtaining the required data.
As-Is Process Flow
My team then took an in-depth look into UWMC's current evaluation process and wrote down all of the steps, noting any glaring deficiencies that could later be improved.
One tedious problem that we noticed in the information process flow is that in order to identify a provider's supervisor, a paper evaluation is mailed to that supervisor on record while our client waits for a response. If that supervisor has changed, without our client being aware of the change because it's not marked in her Excel spreadsheet, another paper evaluation has to be mailed, which wastes more valuable time.
A detailed look at all steps that both the primary actor and stakeholders are involved in as soon as an evaluation is initiated.
Even more so, if a mistake is made on a paper evaluation, but the supervisor doesn't catch it before mailing it back to the Medical Credentialing Specialist, this tedious process has to be restarted to correct any errors to ensure that all evaluations pass the mandated standards.
Our client also has to manually remind supervisors via email if they haven't filled out an evaluation within the three week deadline, forcing her to check the Excel Spreadsheet everyday to track all evaluations in progress.
Risk Assessment
The current state system has multiple risks that we have identified. These risks include mis-identification of departmental supervisors as well as improperly stored or lost data due to an ineffective paper based system and simple Excel spreadsheet. Additionally, there is inefficient communication between the supervisors and our client due to slow, manual tracking of evaluation statuses and there is also a risk of human error on the supervisor’s end while completing the evaluation.
The impact of the majority of these risks are fairly high, resulting in potential catastrophic failures with little that our client can currently do in effectively mitigating these impacts when they do occur.
Our team's risk assessment of the current system if the UWMC continues to use it.
Recommended Next Steps
After analyzing UWMC's current system, my team recommended the following next steps:
- UWMC's IT system needs to be updated to a centralized, relational database store, track, and retrieve the data gathered from evaluations; would automate the delivery and tracking of evaluations and allow more personnel to access the data based on permission privileges
- A web application with a user-friendly interface should also be implemented to streamline the current flow of information; evaluations would be completed via an online web form to automatize and digitize the process while maximizing security
Future State ANALYSIS
How can my team make UWMC's process more efficient while reducing the risk for error?
The future state of UWMC’s evaluation process aims to leave behind the out of date paper-based system and instead utilize a centralized relational database that allows data to be accessed easily and seamlessly. Our future state proposal sastifies the following requirements:
- To ensure documents are available 24/7 to comply with OMSA's regulations, we recommend using Amazon Web Services (AWS) and Amazon SES (email services) to provide high availability and reliability rates
- The web application will include a notification system to ensure supervisors are aware of upcoming evaluation deadlines while giving our client the ability to send custom messages as needed
- Using AWS and Amazon SES provide unlimited scalability as the evaluation database grows and only uses as much as the UWMC needs
- Using a database system will increase security as only users with the appropriate permissions will be able to access sensitive evaluation data, getting rid of the worry of a paper evaluation being lost or misplaced while DocuSign will verify the appropriate supervisor
Estimated Project timeline
Overall, we intend that this project will take six months to complete. We expect to have a fully-functional, cloud-based web application available for the client and other stakeholders to utilize by the end of this time period. Email and document integration will be completed by this time and the client will be able to phase-in the use of the new system.
Our estimated length to develop and implement our proposed system is six months.
To-Be Use Cases
In the future state, there would be one primary actor as well as three other stakeholders. With the new system, our client the Medical Credentialing Specialist would now only be responsible for adding new providers into the database, updating their privileges, and setting up what kinds of automatic notifications that she wants to remind supervisors of pending evaluations. She could generate reports to track evaluation statuses when she needs them, without have to manually read individual rows in an Excel Spreadsheet.
The Medical Director will now be able to check compliance report themselves, based on their database permissions, while supervisors will only have to fill out evaluations via the web without the need to manually mail the form back. OMSA will now just be able to search our database for a record of the digital evaluations, no longer needing to digitize the forms themselves.
With an automated system, the responsibilities of the Medical Credentialing Specialist have greatly diminished.
By dividing up the responsibilities across multiple users, our client's responsibilities are reduced greatly. As a result, she can respond to questions or concerns faster while staying on top of what evaluations haven't been completed yet almost instantly. Any extra time she has can be spent elsewhere, doing more valuable things instead of manually reading and updating an Excel Spreadsheet or mailing paper evaluations.
To-Be Process Flow
The processes that are new or have modified in the future state include: adding a provider to the database, setting up automatic notifications, completing evaluations, and verifying evaluation statuses.
For our future proposed process, the Medical Credentialing Specialist would first log onto the web application and add any providers to the database with the required details of the provider (such as name, role, privileges, and name of supervisor) that aren't yet added. From here, our client can automatically send FPPEs or OPPEs as needed to the appropriate supervisors, automatically sending them a notification that an evaluation is available to fill out. Supervisors would access their available evaluations also through the web application. By using a system like this, the time that both users spend on their evaluations are reduced drastically because the process is entirely online and automated.
The new process flow for initiating and completing an evaluation is much simpler and shorter.
With the use of an online web application, our client an also manually send notifications to supervisors when she sees fit, invoking immediate communication. With the use of automatic notifications as well, which are sent out automatically every six months for OPPEs or whenever a new provider or privilege is request for FPPEs, manual notifications ensure that supervisors are listening and are aware that they might have forgotten or missed an evaluation that is approraching its deadline. Instantaneous communication allows evaluations to be completed faster because issues or concerns can be remedied quicker since paper mail is no longer used.
Our client can choose to send out notifications manually if she wishes to remind a supervisor to complete their evaluations.
Risk Assessment
The future state system we have proposed does include some associated risks, but these risks have a comparatively lower probability of occurring than those identified in the current state. The risks that we have identified fall into the areas of: security, maintenance, software installation, training, and budget.
All of the following risks are in the area of “acceptable,” except for the financial risk, which solely relies on the client’s own determination for a proposed budget. Even if the severity of a risk impact is high, there will be proper prevention and mitigation methods put into place when our solution is implemented to reduce the severity and longevity of any impact experienced by UWMC to ensure the confidence within our proposed system.
The risks associated with our proposed future state are relatively low-risk compared to the risks we identified in the current state.
FUNCTIONAL DESIGN & High-Fidelity Mockups
With a simple web application system in mind and a tight deadline, my team and I spent around 15-20 minutes sketching before starting to mockup the design that we envisioned. The mockups below represent the ideas that we sketched, which achieve keeping the interface to a minimum with simple navigation.
Home & UI
The first priority of our web application is to meet our client’s need of a user-friendly interface. The un-friendliness of our client’s current Excel Spreadsheet system causes unnecessary frustration and increases the time spent having to sort through which evaluations need to be sent out. The design of our proposed web application adopts a minimalistic design that only places focus on the most important aspects of the Medical Credentialing Specialist’s job and automates all of the processes that no longer need manual input. The screen that welcomes our client to the application, after logging on with a valid UW NetID, is simplistic and gives four easy options to pick from: OPPEs, FPPEs, Generate Reports, and Administrative Tools.
A simple home dashboard gives our client the user-friendly interface that she's looking for since the navigation is simple, but descriptive.
Evaluation Tracking
To maintain compliance with OMSA and other regulatory organizations, our client needs to be able to ensure that all evaluations are completed on time. An easy way to track the statuses of both types of evaluation forms within our web application is through the generation of an easy to read bar graph report that compares side by side how many evaluations have been completed and how many have not been completed for each type of evaluation. Now, there is no need to manually search an Excel Spreadsheet, potentially missing evaluations that are close to their deadlines.
With each report that is generated, our client, OMSA, or another other user with the appropriate permissions, can hover to see exactly how many evaluations still need to be completed.
An in-application notification, seen in the top right, allows our client to send out notifications to supervisors and receive them once an evaluation is completed or if it's nearing a deadline. The notification system is critical when it comes to sending out FPPE forms as they are only mandatory with new providers or providers that are requesting additional privileges. The variability of when FPPEs are due increases the possibility of the Medical Credentialing Specialist making an error and potentially not sending the respective supervisor a reminder to complete the form.
Evaluation Forms
To completely automate the process flow for our client, we have streamlined both the OPPE and FPPE forms in digital form to remove all of the associated physical paperwork in the current system. Both the OPPE and FPPE forms are very similar, with minor changes on the top halves of both forms. All fields included on these forms are exactly the same as those found on the paper evaluation forms. By keeping the formats the same, supervisors will have no trouble getting used to the new system as there is nothing confusing or new to learn.
Reflection
Working to meet the expectations of an organization as big as the University of Washington Medical Center was a much different experience than it is working on an academic project. With real stakeholders and a client that was actively working with us, we got to discover first hand how to work with user needs from multiple different view points and positions within or outside the UWMC. It was interesting for our team to work and ideate together to satisfy the needs of multiple users, discussing the benefits and risks of certain designs in terms of every user who would use the system. We found that even though one design might benefit one user fully, it might introduce risks for another user so we had to consider the trade-offs for every design or development decision that we made.
Ideating, analyzing, and designing in a scope as big as this one was a valuable learning experience as I learned how important it is to consider the values of all users involved, no matter how big or small their role is.