Digital Neurology Exam
OSF Healthcare – June 2022 – January 2024
My Role
UX Design Intern – Interaction Design, Visual Design, Information Architecture, User Flows, Prototyping, Research, User Testing, Animation
Team
Dr. Christopher Zallek, MD, Project Supervisor
Timeline & Status
Overview
The Digital Neurology Exam (DNE) is an app for mobile and tablet that allows clinicians, nurses, and medical office assistants (MOAs) to record patients during their traditional neurology exam. Using motion capture technology, this tool generates objective numerical data to represent patient movements.
As the sole designer on this project, I was tasked with researching use cases for DNE technology, proposing methods for integrating captured data into clinician workflows, creating effective instructions for inexperienced medical office staff, and designing, prototyping, and testing the new DNE mobile application. Additionally, I created animated video material for promotional use.
My design and prototype for the DNE mobile application performed exceptionally well in user testing and was met with high praise from clinical staff.
Highlights
A complete, objective neurological history - at your fingertips.
Introducing the next big step in proactive healthcare.
Record patients with ease and accuracy.
No training - no problem.
Context
A New Age of healthcare innovation.
In 2020, OSF launched seven Innovation Labs to focus on solving complex, pressing issues in healthcare. Of those seven, the NeuroHealth Lab is charged with finding next-generation solutions to keep up with an increasing demand for neurological care while the shortage of neurologists and neuro-health experts continues to rise.
Eyes see so much, yet so little.
Very quickly, the lab team identified two core problems with the current neurology clinic workflow:
- The traditional neurology exam and its documentation process costs clinicians a large sum of time while yielding imprecise results.
- The analog nature of the traditional neurology exam results in low inter-rater reliability. Two clinicians observing the same patient may not assess their patients the same way, and their assessments may differ in meaning.
Record patients with ease and accuracy. No training: no problem.
PROLOGUE
The Digital Neurology Exam (DNE) is a new clinical tool being developed in the lab of neurologist Dr. Christopher Zallek at OSF Healthcare with the collaboration of engineers from the University of Illinois Urbana-Champaign (UIUC) and, more recently, myself. With the technology developed at UIUC, it is possible to generate numerical values for a wide variety of physical traits such as symmetry, velocity, and accuracy simply by taking a video of a person performing the actions done in a traditional neuro exam. In the past, neurologists have conducted the exam in a purely qualitative way, generating vague and unreliable results as each neurologist could make a different assessment of the exact same patient. By transforming the neuro exam process from a questionable, qualitative model into a standardized, quantitative one, the information provided by the DNE, if used correctly, could revolutionize neurology care.
THE PROBLEM
Introducing new tools into the healthcare environment is an arduous task. Clinicians already face high amounts of data overload and system fatigue, giving them a low desire to learn a new tool. It was clear from the beginning that, for the DNE to succeed, it would need to relieve the pressure of data instead of adding another number to check.
MY CHALLENGE
When I arrived, the DNE was akin to data without a display. I needed to find the best use cases for DNE information, and how to integrate that information into the clinicians’ workflow without disrupting other clinical functions. Most importantly, I needed to develop an understanding of the problems being faced by neurology clinicians on an everyday basis, and how the DNE could help to provide a solution.
GRAPH DEMO & FEEDBACK
To gather feedback on DNE use cases, I needed to develop a model that would display DNE information to users in a familiar, understandable formate. Upon seeing the DNE’s capabilities, I quickly prototyped an interactive graph which displayed DNE information alongside data from traditional neurology measuring tools. I then showed this to a group of 14 clinicians – some neurology residents, some advanced practice nurses, and some attending clinicians. In addition to the graph, I asked these clinicians a battery of questions about their day to day workflow and problems they face in their work.
Feedback to this graph was overwhelmingly positive, with almost every clinician stating that they would want this feature in their personal workflow. Fragmentation of information, a lack of information specificity, and the large amount of time needed to review patient charts were major pain points identified at this stage.
GRAPH DEMO & FEEDBACK
To gather feedback on DNE use cases, I needed to develop a model that would display DNE information to users in a familiar, understandable formate. Upon seeing the DNE’s capabilities, I quickly prototyped an interactive graph which displayed DNE information alongside data from traditional neurology measuring tools. I then showed this to a group of 14 clinicians – some neurology residents, some advanced practice nurses, and some attending clinicians. In addition to the graph, I asked these clinicians a battery of questions about their day to day workflow and problems they face in their work.
Feedback to this graph was overwhelmingly positive, with almost every clinician stating that they would want this feature in their personal workflow. Fragmentation of information, a lack of information specificity, and the large amount of time needed to review patient charts were major pain points identified at this stage.
USER PERSONAS
INTERFACE PROTOTYPE & FEEDBACK
Using the feedback gained from my first round of interviews, I developed a full prototype of an interface that took all of their pain points, wants, and needs into account. This was done in an attempt to assess what capabilities clinicians actually wanted, how they respond to viewing information in a graph-based format, and what features were seen as most useful.
Feedback on this prototype was highly positive and useful for future development. Three major points were taken away:
- 1. Clinicians like seeing all patient data at once.
- 2. Videos are highly useful tools for comparing patient data.
JOURNEY MAP
EPIC INTEGRATION
Now that the primary goals had been identified and the idealized prototype finished, it was time to show how the transition could be made to reach that ideal state. At this stage, I developed a prototype of DNE information being integrated into Epic’s pre-existing “flowsheet” feature. This prototype showcases that, with a little adaptation, we can begin to add DNE data into clinician workflows with minimal intrusion.
EPIC INTEGRATION
Now that the primary goals had been identified and the idealized prototype finished, it was time to show how the transition could be made to reach that ideal state. At this stage, I developed a prototype of DNE information being integrated into Epic’s pre-existing “flowsheet” feature. This prototype showcases that, with a little adaptation, we can begin to add DNE data into clinician workflows with minimal intrusion.
FUTURE WORK
This project is still under development! I am currently working on developing two concurrent user experiences. The first is to integrate the use of DNE recordings into the clinical admission process. I plan to do this by adding DNE recordings to the duties of medical office assistants (MOAs) to lighten the load of neurologists. This would not only benefit clinicians with useful information, but give neurologists more time to address each patient individually – time that is made all the more precious by the current neurologist shortage.
The second experience will involve an overhaul of the DNE application’s user interface. The current interface is a skeleton system that includes the functionality, but is difficult for newcomers to learn on the fly. I will be designing a new interface for the tool with the goal of enabling new users to easily pick up, learn, and effectively make use of the DNE.