Patient rounds application for Hospitalists and Physicians.

Hospitals lose millions of dollars each year in unrecorded patient encounters and other inefficiencies that occur during a physicians daily patient rounds.

We were asked to design a system for physicians to approach their rounds and record patient encounters and the resulting outcomes more efficiently. 

This tool needed to help hospitals keep better control of patient encounters and the resulting billings. 

It needed to allow for the easy reordering of the patients to be visited and create a record of the visit, all while offering a fast way to enter recommendations and notes for the next visiting physician.

Help a large medical software development company build a white labeledmobile first tool that would give physicians better options when they’re making their daily rounds, while also building a “single-source-of-truth” record for the medical facilities for which they work.

“This tool needed to record the patient encounter, the physician’s recommendations, discharges, and any handoff information other physicians would need when the patient appeared on their rounding lists.”

About the users

Each day, physicians decide the order in which they’ll see patients based on a variety of criteria. From room location to lab results timing to patient discharges to teaching opportunities, and more. Typically, prior to morning rounds, each institution issues a daily electronic document to each physician containing the names and locations of the patients they are to see that day. How physicians use this list to build their rounding lists can take many different forms.

We spoke to a broad cross-section of physicians to see how they manage their daily patient rounds and were surprised to see how analog the large percentage of solutions were.

On the more digital side, a few of the physicians we interviewed would send their morning rounds document as a PDF to their phones or tablets, visit each patient and then use a variety of other tools to record the encounter and document their recommendations. Needless to say there were myriad inefficiencies in multiple areas of each physician use case we saw.

Some were using an inexpensive phone app designed to allow the manual entering and checking off of patient encounters, but offered no integration with hospital billing (which IT probably wouldn’t have been happy about anyway). 

Interestingly, very few of the physicians we interviewed used the hospital-generated document as it was delivered to them.

“Other physicians would physically print out the list of patients and then cut the rows into strips with scissors. From there they would tape each strip onto another piece of paper to build the list in the order they wanted it.”

Physicians are one of the most challenging groups of users we’ve encountered when it comes to introducing new technologies and systems. They’re far too busy with patients to have to learn a whole new system or method of working. Anything that can be laid off to the back office, PA’s or nursing staff will be, but the tool we were to develop had to be used by the physicians themselves, so whatever we designed, it had to fit in with the world they were used to as smoothly and as intuitively as possible.

The thinking

Once we’d identified the various use cases we’d need to address, we started whiteboarding the different approaches we could take.

Our early goal was to try and completely revolutionize the way physicians worked so that every patient interaction made the very best use of the physicians limited time with them.

“The goal was admirable, but the reality proved to be much different. We quickly learned, after showing our working wireframes, that when it came to what physicians considered to be a tedious and unavoidable clerical task, they had no interest in anything revolutionary.”

What physicians needed was a tool that performed in a way that they already understood. It needed to be intuitive, powerful, and easy to use without getting in the way of their primary concern of helping patients. 

  • Create patient “strips” with high-level patient information that mimics the way existing daily rounds lists appear 
  • Allow these patient strips to be easily reorder-able
  • Allow physicians to quickly use these strips to mark patients as “seen” and “unseen”, drill down to order tests, create “to-do’s” , build comprehensive problem lists, increase levels of urgency and create notifications for other physicians and providers
  • Keep everything finger-friendly and intuitive
  • Be clear about when a patient encounter begins and ends

Here’s a portion of a typical patient rounds list:

We saw examples of physicians actually cutting these document into strips with scissors and then taping them together again in the order they wanted them.

Here’s how we fixed that issue: Draggable patient “Strips” that also allow physicians to record encounters (patient visits), communicate with other physicians, add patient issues, medications and general to do’s, which in turn all became the single source of truth for billing and patient records.

By taking the issue down to it’s essence. By REALLY listening to physicians and their back office staff we were able to replace an inefficient (but widely used) paper-based system with a tool that reflected the users existing experience, but was easier to use, more accurate, and increased the likelihood that hospitals could bill every patient encounter. 

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