We use cookies on this site to improve our service, perform analytics, and remember website preferences. By using this site, you consent to these cookies. For more information visit our Privacy Policy
A digitally-enabled service model for team-based diabetes care
Researchers at OHSU wanted to enable a virtual team-based care model to allow clinicians to support their patients’ physical and mental wellness, motivation, and knowledge about how to manage their condition day-to-day. HHF was tasked with identifying the ways in which these clinicians would need to collaborate in practice, what it would be like for them to simultaneously support an individual patient, and to design the supporting workflows and digital tools.
Client
Artificial Intelligence for Medical Systems (AIMS) Lab & the Harold Schnitzer Diabetes Health Center at OHSU
Funded by
The Leona M. and Harry B. Helmsley Charitable Trust
Services
Contextual Interviews, Service Design, UX/UI Design, Usability Testing
Challenge
The DailyDose app, designed by HHF in collaboration with researchers at Oregon Health Sciences University (OHSU), is a tool that helps people with type 1 diabetes easily manage their condition by monitoring their insulin levels and providing recommendations for self-management along with features for setting health goals (read more about how we first designed the app here). In a previous case study, we described how we worked with DailyDose users to refine the app’s features using quantitative study data to guide our qualitative research into user needs. While modifications were made to the app’s interface to better support patients, our research process also uncovered the need for an innovative service model for team-based diabetes care in which diabetes educators, behavioural psychologists, and endocrinologists could collaborate with each other and with the patient to develop personalized care plans.
OHSU engaged HHF to design a comprehensive clinician dashboard to support the service model they had conceptualized, which would work alongside the DailyDose patient-facing app. For the dashboard to truly support various types of clinicians in delivering better care, we needed to understand their workflows, the data they need to see and document about their patients, and how the creation of a digital tool could optimize the conversations providers have with their patients to help them achieve their goals.
Process
Discovery
The research we conducted with DailyDose users helped the OHSU researchers to envision a service model that would improve the patient experience by supporting their self-management through a team-based care model. When interviewing patients about their behaviour and experiences managing their care both with the DailyDose app and on their own, we learned that people who have type 1 diabetes were sometimes overriding the app’s recommendations based on knowledge they gained about their health from their personal experience, or in response to exceptional circumstances.
The service model we developed with OHSU centres around the patient and their care team with technology (the DailyDose patient app and a clinician dashboard) supporting their interactions. We knew that for patients to work effectively with diabetes educators and endocrinologists in making positive changes towards better health, we had to centre the patient needs that we had uncovered through our research. The guiding principles of this model are:
- People who live with diabetes know their condition better than anyone else, and make self-management decisions within the context of their ever-changing lives
- There are many complicating factors in self-management that are not captured in the data reported by the app
- Only by understanding the individual and what they need to better self-manage can clinicians give appropriate advice and help make decisions
We knew that for patients to work effectively with diabetes educators and endocrinologists in making positive changes towards better health, we had to centre patient needs.
Our next task was to design the comprehensive clinician dashboard that would allow the care team to see patient data reported by the DailyDose app alongside the necessary context for understanding what influenced certain readings and why the patient responded to recommendations in a particular way. Because of the care team’s shared workflow, this dashboard would also need to enable seamless communication and collaboration between the various members of the team. We interviewed diabetes educators, behavioural psychologists, and endocrinologists who would typically work alongside a patient with type 1 diabetes to learn more about what they want to see in a clinician dashboard.
What We Discovered
Clinicians have different priorities. Endocrinologists wanted to see glucose levels, while diabetes educators and behavioural psychologists wanted to know behavioural influences and social aspects that affect diabetes management.
Busy and multitasking clinicians want to see all patient data in one graph and take notes in the dashboard without navigating away from the graphs. They also need to quickly understand how the algorithm works to safely adjust insulin recommendations.
There are many tasks that need to be completed during a patient visit which need to be prioritized. We need to make sure that this system supports clinical work but doesn’t distract from it.
Only Endocrinologists can make changes to insulin doses, but other clinicians can make recommendations that the endocrinologist can review. They need a workflow that simplifies collaboration and streamlines communication.
Design
Our challenge was to ensure the dashboard design would meet the needs of all members of the care team while being functional, visually pleasing, and easy to use. To achieve this, we had to reconcile where different types of clinicians had needs that were misaligned so that it would be easy for each of them to quickly see the most relevant information.
We built in communication tools that would enable the educators and psychologists to collaborate with the endocrinologists so that their clinical decisions could be made with an understanding of the challenges and motivations that influence how a person with type 1 diabetes manages their condition. This would help patients and clinicians to have better conversations and ensure that the goals they set together and the recommendations the patients see in the app were personalized and achievable.
After many iterations and feedback cycles, the core features we designed for the dashboard include:
Easy to interpret data
Comprehensive graphs present all the data reported by the patient’s app on one screen while still being easy to read. Hover effects help clinicians gain insights on specific data points and ensure that, whatever a clinician is trying to evaluate, the right pieces of information are on the screen at the same time.
Collaborative goal setting
DailyDose’s goal setting features support patients’ unique circumstances. Data and patient interactions can help educators and behavioural health specialists to quickly understand how close patients are to achieving their goals and what barriers might be getting in the way of their progress.
Smooth documentation
The notes section is on the same screen as the graphs so that clinicians do not need to open a new window or navigate away from the data they are viewing. The system allows for video and audio recording of a patient interaction for ease of use, and supports clinicians by automatically documenting any changes; clinicians only need to explain the rationale for their decisions to complete their notes.
Built-in safety measures
While the other clinicians on the care team can make small adjustments to recommended insulin doses in collaboration with the patient, this can only be done within a safety zone set by the endocrinologist.
Outcomes
The design of the comprehensive dashboard will allow clinicians to have more in-depth interactions with their patients and collaborate with each other to offer advice that is evidence-based and tailored to the individual’s needs, lifestyle, and preferences. This supports a model of care that respects the patient’s own knowledge about their condition and allows clinicians to work with them to build self-management plans that are truly patient-centred. The dashboard is currently in development and will soon be tested in real-life patient/clinician interactions with data gathered from the patient-facing app. Following testing, there is the opportunity for more iteration with the goal of scaling the DailyDose program to more users.
The patient-facing app allows patients to set goals for better self-management of their type 1 diabetes.