Timeline:
June.2023 - Aug.2023
Internship Employer:
athenahealth
We want athenaOne's Clinical Inbox to help providers and administrators to proactively plan for time Out-of-Office and easily see who will be away and for how long.
My Role:
Product strategy
UX research
Concept Design
Deliverables:
Customer Feedback Analysis
Personas
User Interview Synthesis
Research Readouts
Solution Documentations
Annotated Concept
Our Team:
Jessie Stein(MBA intern)
Mentors:
Juhee Hans(UX mentor)
Josh Benedikt(product mentor)
What is Clinical Inbox
The Clinical Inbox is part of the athenaOne product, which built to make organizing patient visits easier for both clinicians and non-clinical staff. It helps them quickly and accurately document a large number of files.
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OUT-OF-OFFICE PROBLEM OVERVIEW
CURRENT SITUATION
In athenaOne's clinical inbox, physicians and other practice roles’ time Out-of-Office can disrupt the flow of work.
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In particular, inbox items continue to be assigned to Out-of-Office roles causing potential delays in addressing clinical tasks, such as urgent issues, patient cases, lab results, and prescription orders.
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Additionally, the backlog upon clinician's return hampers efficiency. Auto-closure scripts may be needed when overwhelmed by a large inbox.
Current Workflow & Workarounds for Out-of-Office Scenarios
STRATEGY FIT
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#39 on the Voice of Customers(VoC) ask list with 845 upvotes and 113 comments
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Represents $427 million in revenue
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Out of 316 clients on VoC lists:
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86 are Enterprise and 141 are Group
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PROBLEM
In athena, it is challenging to manage, coordinate and address work of clinicians and other users who are absent to ensure work is addressed timely.
The current gap is...
athenaOne currently do not have Out-of-Office functionality to support clinicians and other office roles when a provider goes Out-of-Office.
Our goal is...
Clinicians and supporting clinical roles can see which providers are currently out of office and for how long
Streamlining the process for covering roles who must temporarily take on additional work
Discover
What is the user landscape: customer feedback analysis
From the 113 comments we gathered from our customers surrounding the Out-of-Office problem, we want to analyze and sort those feedbacks based on certain goals.
GOAL
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Are there any known pain points and user needs after sorting out the customer feedback around the OOO problem space?
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What insights can we get out of the customer feedback? Are there any themes that emerged after grouping similar insights?
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Are there any identifiable pattern or persona?
PAIN POINTS & IDENTIFIED PATTERN
Customer feedback serves as an indirect reflection of user needs. Upon categorizing similar needs, I identified the emergence of three distinct user types. While not an exhaustive representation of all user perspectives, the analysis of 113 comments on Out-of-Office scenarios does provide insight into varying user behaviors among different user types.
The Worrier.
The OOO clinician
These clinicians constantly fret about whether their buckets items are routed correctly or whether their responsibilities will be piled up during their OOO time, leading them to anxiously check their inbox even during their OOO time.
The Ultimate Backup.
The covering clinician, MA, Staff
These clinicians take the responsbility of covering for others' work or delegating tasks to their peers. This often leads to frustrating extra work while certain clinicians are OOO.
The Domino Effecter.
The specialty clinician, nurses
These clinicians hold roles that are scarce or carry significant responsibilities. When they are OOO, a negative chain effect would ripple through their colleagues' work, causing disruptions and challenges to overcome.
More accurate comprehension: talk with internal teams + end users
7 Internal Teams Conversations
Product Knowledge
Patient Safety
Client Onboarding
athena Mobile
Voice of the Customer
Analytics
Practice Scheduling
GOAL
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Gain an initial understanding of athena’s functionality and the community of different product offerings that may have impacts to the Out-of-Office problem scope.
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Help us narrow in on how we wanted to focus our end user interviews.
11 Semi-structured User Interviews
5 Clinicians
4 Practice/Office Managers
2 Staff Members
GOAL
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Understand the dynamics surrounding the Out-of-Office scenarios experienced by
clinicians(before, during and after going out-of-office).
KEY RESEARCH QUESTIONS
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How do clinicians currently manage their work before, during, and after going OOO, including existing pain points or workarounds?
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What does OOO mean to clinicians? And how does each different type of leave influence work management in OOO scenarios?
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How do different types of practices impact the management of work for each clinician?
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What are the roles and responsibilities of various stakeholders involved in the handoff process, and how does their collaboration influence work management in OOO scenarios?
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How will some specific roles' OOO status influence work management ways inside the practice and outside the practice?
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What are the specific needs of clinicians regarding visibility/awareness and ownership of work items in OOO scenarios?
Dovetail Documentation
Define
What does Out-of-Office mean?
DEFINITION
After user interviews, we defined Out-of-Office as:
Healthcare providers are not physically or digitally present to attend to their clinical tasks due to various scenarios.
CHARACTERISTICS
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The frequency of going out of office varies.
The most common case is 1-2 week a time, and 2-3 times a year.
Part-time clinicians follow a certain routine to go OOO.
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The term of going out of office varies.
It could be half a day to several years, or even never come back.
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The predictability of going out of office varies.
Planned absence vs unplanned leave.
Examples
SURPRISING FACT
Clinicians could still be mindful of tasks even during their leave.
How do key players involved at each stage of OOO?
Key Players
Key jobs to be done at each stage of OOO
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Four categories of people at play to address OOO: OOO clinician, covering clinician(s), supporting staff, and office manager.
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There are many different practice roles involved if a clinician is going OOO, however, it is the clinician going OOO act as a starting point and who's impact is most felt.
Problem Breakdown
Findings Synthesis
We synthesize findings through two extended workshops.
GOAL
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Establish meaningful connections among the research findings.
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Generate and access hypotheses.
Whiteboard Workshops
Our discussion and interviews with different users led to takeaways that can be categorized into the following three themes:
Awareness & Visibility
PROVIDERS & CLINICAL STAFF SHOULD KNOW
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Who is going to be out
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For how long
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How will work be covered
Planning & Coverage
PROVIDERS & CLINICAL STAFF MUST PLAN
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When I am going to be out
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Who is going to cover for me
Managing Work Prioritization
PROVIDERS & CLINICAL STAFF COVERING OTHERS MUST DECIDE
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How will I prioritize
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What work to do when
Theme 1: Awareness & Visibility
SYNTHESIS 1
Awareness & Visibility needs to be organization-wide to see who is going to be out and who is covering
Who is in / who is out is difficult to track
Disruptions in workflows result from difficulty in tracking who is out and who is covering
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Practices create their own workarounds for tracking OOO
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No single way of managing coverage
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Administratively heavy to coordinate
"…[Presence indicators] in Jabber it shows people as green, yellow and gray. Yellow is in a meeting, green is active. So, we do cheat and use that to see if people are logged in. Sometimes we'll know if someone is working but not actually in the office..."
- Front Desk Triage Nurse Manager , Katharine Green
"…Have to remember who's the call provider for the day versus this is an office where they just want us to randomly assign things to the people that are working. It's not a high highly reliable workflow. And then we also get push back from providers about route configuring other providers buckets when they're off..."
- Front Desk Triage Nurse Manager , Katharine Green
SYNTHESIS 2
Awareness & Visibility should never be ambiguous in each touchpoint of responsibility transition
Theme 2: Planning & Coverage
What does PLANNING look like?
PATTERN 1
EXPLANATION
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Clinician going Out-of-Office takes ownership of preparing coverage.
OR
PATTERN 2
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Practice has processes in place to prepare for OOO.
EXPLANATION
What does COVERAGE look like?
Coverage looks like 1 person or team accountability dependent on practice size.
PATTERN 1
Large Practices
Coverage is often provided by a team of people with rotating shifts
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Rotating coverage can lead to a lack of continuity in patient care
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Use task assignment override functionality in athenaOne to create a shared inbox to manage coverage
PATTERN 2
Small Practices
Another clinician who know the patient well would cover for the absent clinician entirely
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Covering for a clinician entirely results in increased workload
SYNTHESIS 3
Planning & Coverage needs flexible team accountability and reduced manual effort in adjusting clinical operations
Time OOO is planned months in advance
Coverage is often provided by a team of people with rotating shifts
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Schedule freezing, appointment rescheduling and coordination with office staff to communicate coverage plans takes time and is labor intensive
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Covering for a clinician results in increased workload and imposes a burden when dealing with unfamiliar patients
"...I would say I plan probably minimum of three to four months ahead of time. Yeah. And a lot of them it's like six months just because, you know, rescheduling all those patients, it upsets them..."
- Physician, Kathy Rokavec
"…We pick one person a day to cover, we rotate it. And then I send an Outlook invite for the morning of coverage and say, please cover my inbox. I usually set it for 8:00 AM so it has a 15-minute alarm at 7:45 when everybody's logging in. I send a unique invite to each of those people for each day that I'm out [because sometimes people agree] but don't remember..."
- PA at Columbia Valley Community Health, Nick Collins-Feay
Theme 3: Managing Work Prioritization
SYNTHESIS 4
Work prioritization needs awareness into quickly gain context to accelerate work completion and catch up.
“My work first”
COVERAGE DURING OOO
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Different clinicians prioritize work flows differently, some with a "my work first" attitude, while adjusting for urgent incoming cases.
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It's difficult to manage all the work while handling other additional coverage work.
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Can't really get enough learning about others' patients, so it takes the covering clinician(s) more efforts to complete coverage work.
What are the urgent tasks
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Reviewing critical lab results, escalating deterioration of patient condition and notify staff members/on-call provider(s).
Identification of the “true” urgent tasks
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Clinicians often get alarm fatigue.
"...Unless it's urgent, I'm going to handle my stuff first and then I will try and keep up on who I'm covering for. I'm going to look at anything abnormal that comes in. If it’s a few days, I'm going to leave normals for when they're back..."
- Physician, Kathy Rokavec
"...When I'm covering, like on Monday, I had my inbox in list view organized by assigned to and then had three different users I was plucking through. I prioritize starting with anything marked urgent, orders, prescriptions, authorizations, patient cases, labs, imaging. If you're having a really slow day or feeling kind, I need follow-up, phone messages..."
- PA at Columbia Valley Community Health, Nick Collins-Feay
The returning clinicians need to quickly know the changes of certain work items status that handled
by the covering clinician
CATCH UP AFTER GOING OOO
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Currently returning clinicians start catching up even before their return, and it costs them extensive time to catch up, OR sometimes it's impossible to catch up.
"...I would just stop having fun about halfway through the vacation cuz I knew I had to go back Monday morning and all that work I had to take on, I had to go back in early. I would probably start Sunday night. It wasn't unusual for me to go into the office on the day I got back just to catch up on the, you know, again, back in the chart paper chart day. I mean there were piles so high you couldn't see me behind them literally..."
- Physician, Kathy Rokavec
Hypotheses & Ideas
At this point in our project, we have came up with 10+ hypotheses based on our previous research, however, because of time limitation, our team was able to concretely narrow in on the 2 main hypotheses we wanted to prioritize that have generated our MVP concepts.
Full List of Hypotheses
Entering Out-of-Office Information into athena
HYPOTHESES 1
Improving awareness and visibility of clinicians’ Out-of-Office status throughout a practice will ensure work is assigned to the correct clinician and allow for tasks to be completed in a quicker time frame.
MVP CONCEPT 1
PROBLEM SOLVED
Currently, athenaOne does not know if a user is Out-of-Office.
SOLUTION
Done by:
Clinicians or Administrators
What:
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Enter Out-of-Office information into athena
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Provide awareness and coverage to other workflows in different parts of athenaOne that get impacted by lacking OOO info
MVP CONCEPT 2
Manual Work Reassignment
PROBLEM SOLVED
Work gets delayed while staff members keep routing items to the OOO provider who is not attending to the tasks.
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Practices create workarounds for tracking OOO.
SOLUTION
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Ability for any user when assigning a task to someone, to be able to view "status"the of clinicians.
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Enable a color-coded indicator next to the name of the OOO provider.
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This will encourage a reassignment of a task to a provider who is not OOO.
HYPOTHESES 2
Automating inbox coverage display for a covering provider and clinical support staff will improve team accountability and increase work management efficiency.
MVP CONCEPT 3
Automating inbox display for coverage
Grid View
List View
PROBLEM SOLVED
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Clinicians find it irritating to flip back and forth from someone else's inbox to their own inbox.
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The covering clinician(s) may have low awareness of high-priority coverage work (i.e. urgent tasks)
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It can be challenging for the covering clinician(s) to distinguish their own work and the coverage work, which hinders work efficiency.
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Sometimes providers forget to cover for others – provides clear visibility into the responsibility to cover for someone else.
SOLUTION
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Enable covering provider to easily take over for who they’re assigned to by automatically adding the OOO provider’s inbox to their own.
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This will show up in both the list view and grid view (select "assigned by in list view)
We have generated more ideas; however, due to the brevity of the 10-week internship, it's impractical to implement each one.
However, we've thoroughly documented the complete list of user goals and ideas for future development.
USER GOALS
IDEAS
Theme 1: Awareness & Visibility
1. Easily access comprehensive clinician OOO info
across the practice.
All roles
MVP: Input Out-of-Office information into athenaOne.
Supporting staff, practice manager
2. Consider clinician availability when assigning tasks during OOO.
MVP: Improved manual work reassignment ability.
Theme 2: Planning & Coverage
The covering clinician(s)
3. Feel confident about taking on additional responsibilities.
4. Get better indication of responsibilities when a team covers for someone.
5. Clearly understand task responsibilities during absence.
MVP: Automate and enable the addition of an
Out-of-Office clinicians inbox to a covering clinicians' inbox.
Task status and history indicator.
Theme 3: Managing Work Prioritization
The covering clinician(s)
6. Effortlessly determine task priorities while covering for others.
Todo / in progress / review-ready board within quick overview section.
Supporting staff, practice manager
7. Equitably distribute tasks to balance work pressure and avoid delays
Automated workload visualization.
The OOO clinician
8.Easily learn the status of tasks when returning to work.
Summary of work completion during OOO.
Other Areas of Opportunitity
The visibility of OOO information should feed into other areas of care opportunities.
This would reduce patient care delays and provide efficient care team coordination.
* We only covered solutions inside of the clinical inbox that our work management vertical frequently dealing with. But out-of-office problem is not only a matter of internal work management, but it also influences future operations in other athena products.
athenaOne AS A WHOLE
Idea: "Hover over" ability in anywhere a clinician's name appears in athenaOne to show provider is OOO from any clinical workflows
SCHEDULING TEAM
Idea: Schedule blocking and rescheduling ability on the Calendar based on OOO information input in athenaOne
PATIENT COMMUNICATION TEAM
Idea: Auto-message display on patient portal that explain the “OUT” status of the clinician to patients
What I've learned
Try not to start solutioning on week 1. And then again on week 2. It won’t work!
Early on I got ahead of myself and wanted to dive right into solutioning. Thankfully for Juhee and Josh, they helped with course correction and brought us back to a clear process to follow starting from the beginning with problem understanding, research and discovery. As I continued to learn, the process evolved and the steps throughout made perfect sense.
Just because you have a schedule created does not mean it will happen exactly as you plan.
Week one we met together and developed our road map and schedule for the summer, and we thought this was exactly how it would be. Come to find out, we needed to make changes along the way that ultimately led us to spend extra time on parts of the process that needed it and overall deliver a better output.
💖Shoutout to my team for making this internship awesome and enjoyable!!!
Thanks for making it to the end!
✨
