Washington Healthcare Authority requested high-fidelity wireframes for ER physicians to easily diagnose Substance Use Disorder and prescribe life-saving medication so patients can start feeling better and taper off opioids in the hospital or at home.
I created round one wireframes, then conducted one-on-one interviews and usability testing with three ER physicians and implemented their feedback to prioritise information architecture, speed, and clarity. The project was then handed to a secondary designer to create additional wireframes while I provided feedback and direction.
Tragically, most nurses and doctors are unfamiliar with diagnosing and treating SUD effectively
Medications are more readily available, but physicians are unfamiliar with the precise dosing protocols
Physicians get less than 10 minutes of face time with a given patient
Time is of the essence! We needed to find an intuitive way for doctors to quickly find the correct Bup dosage for their patient
Gather resources and program updates for hospital admin and physicians to access during downtime
Provide patient-facing instructions for administering Bup at home, plus resources for staying safe in general
After round one of wireframes, I met with three Seattle-based physicians to hear more about their experience treating SUD, the environment and challenges of an emergency department, and any essential features that the website needs to be effective.
What do you value most in clinical support resources for treating SUD?
"Time. I spend about six minutes talking to a patient and then probably another five minutes updating the patient and then I have to move on. I spend a lot more time taking care of the patient because I have to coordinate care, put in orders, review orders, talk to other doctors, etcetera, but 10 minutes is my face time with the patient overall. And anything that makes me spend more time on the patient without actually improving the care is not going to be done."
How do you typically assess and diagnose SUD in your patients?
"The DSM-5 is actually a book that sort of helps assess and treat psychiatric disease. Opioid use disorder is included within that, which I think is also an interesting choice and says a lot about the way we approach substance use as a culture.
One of the criteria is that your opioid use leads to some sort of health risk or hazard or harm. If they're in the emergency department, that's happened, right? If they have other symptoms or other criteria for opioid use disorder, like they're using escalating doses or they have withdrawal when they don't use it, then that really puts them into more of a moderate category and they would be candidates then for Buprenorphine."
What are the biggest challenges you face in treating patients with SUD?
"As a pharmacist, I think there's a lot of confusion on the provider end as far as what you are legally allowed to do now—there's been some changes in the law as far as who can prescribe what and for how long. That's usually the biggest challenge. You know stigma is always a thing but I want to say that it's less stigma and more lack of knowledge."
We had the participants walk through a few tasks on the round one prototype which uncovered several places that could be optimized for speed and clarity, but all three participants were very excited about the value that the Scala NW website would bring to their experience treating SUD.
Physicians, pharmacists, hospital admins, and patients all need to visit the site for different reasons, so the homepage easily directs users to the content tailored for them.
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In the emergency room, physicians start with the built-in Clinical Opioid Withdrawal Scale calculator to get an idea of where the patient is at in withdrawal, and jump straight into getting the dosing protocol, complicating factors, and discharge instructions.
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Once home from the hospital with Buprenorphine, patients can't reach back out to the same doctor with questions, so the Treatment at Home page is paramount for instructions and information on self-administering safely.
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The forecasted impact of the Scala NW website is huge. It encompasses improved patient care, timely intervention, continuous medical education, patient empowerment, and overall efficiency in the Washington healthcare system. I'm really grateful to have been part of the process!
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