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

1 year and 6 months, handed off for development.

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.

OSF Healthcare – NeuroHealth Lab Making Strides. Published April 20, 2022. Click for original article. 

Eyes only see so much.

Very quickly, the lab team identified two core problems with the current neurology clinic workflow:

Additionally, The events of the COVID 19 pandemic emphasized the great need for effective remote healthcare. The imprecision of neurological assessments is only exaggerated when attempting to treat patients through a screen – in the current state, detecting the slight physical changes that are indicative of neurological disease through a video call is highly unreliable.

We have the technology!

In 2021, the NeuroHealth Lab (alongside computer science engineers at the University of Illinois Urbana-Champaign) succeeded in creating a system that uses video to track and measure the movements of patients during their neurologic exam.

With this, it became possible to generate objective numerical data for patient exams to replace the subjective data standard currently being used.

Problem Space

On two fronts.

This project focused on two major user groups: Those who receive / consume the data, and those who capture it in the first place. Each case came with its own set of problems, challenges, and goals.

Problem #1

We didn't know how clinicians could use the data we collected.
Data without contextualization will cause more harm than good.

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While numerical data has the potential to help tremendously, information without context is just noise. Even though we now had the capacity to gather new kinds of patient data, we didn’t know what to do with it.

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However, we did know where it would go. The data collected by the DNE would end up being displayed in the hospital’s Electronic Medical Record (EMR) system – becoming a part of every neurologist’s regular workflow.

Challenge #1

Integrate DNE data into the clinical workflow. Successful integration should provide more actionable and accurate information to caregivers while lightening cognitive load and reducing patient assessment time.

Pain Points:

Cognitive Load

Resistance to New Functionality

Saving Time is the Ultimate Justification

Problem #2

The current tool is highly unfriendly to new users.
Training new users takes too much time and personnel resources.

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For this new tool to achieve widespread use, it needed to be highly beginner friendly. At the onset of this project, novices were unable to record patient data without extensive training. Multiple sessions of supervision and instruction from a trained neurologist were required for new users to competently, confidently, and reliably collect useful data. We quickly identified that the lack of a reliable and informative user interface was a major culprit in the DNE’s shortcomings.

Challenge #2

Design a mobile interface for the DNE that will enable any new user to instruct and record patients successfully on their first attempt.

Pain Points:

Limited Acquisition Time

No Experience

Sporadic Tool Use

Goal #2

Identify the best way for novices to learn how to administer a neurology exam on the fly.

Goal #3

Design a beginner-friendly user interface for the DNE mobile application that follows the identified guidelines.

Clinician Research

Understanding the current process.

To successfully integrate DNE information into the clinical workflow, I required a deep understanding of current workflow processes. Through a series of interviews and observations, I put together the following order of operations for a typical patient interaction, from symptom presentation to diagnosis and continued patient care:

1. Symptom

A patient reports possible neurological symptom to their Primary Care Physician (PCP).

2. Referral

PCP writes a referral letter for the patient and sends it to the triage center.

3. Triage

Referral is reviewed to verify the need for neurological care, and the type of neurology care needed. Patient is directed to the neurologist deemed most appropriate.

4. Evaluation

Neurologist reviews all patient medical information and conducts patient appointment. 

5. Continuity

Clinician decides on initial patient care plan, prescribing initial testing or medication if needed. Clinician continues to monitor patient over time.

Pain Points:

Cognitive Load

Resistance to New Functionality

Saving Time is the Ultimate Justification

Problem #2

The current tool is highly unfriendly to new users.
Training new users takes too much time and personnel resources.

Insert Image here

For this new tool to achieve widespread use, it needed to be highly beginner friendly. At the onset of this project, novices were unable to record patient data without extensive training. Multiple sessions of supervision and instruction from a trained neurologist were required for new users to competently, confidently, and reliably collect useful data. We quickly identified that the lack of a reliable and informative user interface was a major culprit in the DNE’s shortcomings.

Challenge #2

Design a mobile interface for the DNE that will enable any new user to instruct and record patients successfully on their first attempt.

Pain Points:

Limited Acquisition Time

No Experience

Sporadic Tool Use

Goal #2

Identify the best way for novices to learn how to administer a neurology exam on the fly.

Goal #3

Design a beginner-friendly user interface for the DNE mobile application that follows the identified guidelines.

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:

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.