Tanya Sheremeta
Interactive Designer, Illustrator, and Animator
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Cardinal Health

 
 

 Better data means better patient outcomes. Cardinal is a personal microchip and companion app that ensures complete, accurate, and up-to-date medical data access.

 
 
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Cardinal
product thinking, ux/ui, motion


background:

In 2009 the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed with the intention of strengthening regulations surrounding the proper use of EHRs and the implementation of EHR systems. By 2014, adoption had advanced across the nation with 76% percent of nonfederal hospitals implementing a basic EHR system. While an improvement, it does not necessarily mean that the systems are being used properly, nor that patients or providers are enjoying a seamless experience. Unfortunately, hospitals and other medical facilities have struggled to standardize their EHR use and optimize data sharing across facilities resulting in negative patient outcomes.

read full research brief here

 
 

my role:
literature review
research (bibliography)
product thinking
copywriting
ux
storyboard
motion graphics

collaborator:
Kim White

tools: illustrator, indesign, photoshop, after effects

timeline: 6 weeks

 

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problem:

Electronic Health Records, EHRs are not standardized. Patient records across hospitals, clinics, doctor's offices, rehab facilities, occupational facilities, and nursing homes are not transmitted consistently and patient matching is a serious issue. Our current medical system provides few incentives for physicians and other caregivers to coordinate care across facilities and service settings.

Even within one facility a patient’s EHR may be incorrect or mismatched with other patients. For instance, a hospital system in Houston has nearly 250,000 cases in which patients share the same first and last names; of these, there are 70,000 instances of two or more patients sharing a first name, last name, and date of birth. One out of every five patients may not be matched to their records at a location where the patient has already been seen by a medical practitioner.

Medicines are the most common treatment used in elder health care and can significantly improve health outcomes when used appropriately. However, adverse drug reactions and medication errors can impact recovery or even be fatal. Effective data storage and exchange is vital to protect patients from receiving incorrect care.

 
 

Failure to correctly match a patient to their medical records can result in higher costs due to repeat testing, duplicate procedures, unnecessary procedures, delays in care, drug interactions, exposure to allergens, and adverse events like relapse or death.

 

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solution:

We know that many people with chronic conditions face challenges due to poor coordination between healthcare providers. Cardinal is a health tracking product that supports an implanted microchip and helps patients manage their biometrics and provides immediate access to medical data. High-quality care and appropriate services are necessary to ensure patients maintain autonomy in the face of disease progression.

A patient will always be identifiable even if they are unconscious or under duress. A simple scan can tell what you’re allergic to, what antibiotics you’ve been prescribed in the past, what medicines you’re on now, and a wealth of other information that can be taken into account when you need medical attention.

 
 

By aggregating patient data, medical records, and medication schedules, we can help patients on their wellness journey by significantly improving their health metrics and interactions with healthcare providers.

 

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Research and Key Inquiries:

 

 
 

focusing on patients:

Patients navigating care for chronic disease routinely interface with multiple medical providers across many care settings. Seniors, in particular, are more likely to have severe chronic conditions and suffer from frequent seasonal illnesses. Elderly patients experience adverse drug reactions and medication errors more than any other patient population.

It is estimated that 750 older people (age 65 and older) are hospitalized due to adverse drug events from one or more medications every day. Nearly two thirds of these hospitalizations are due to unintentional overdoses because clinicians and patients lacked critical information about current medication schedules. Patient matching and consistent transmittal of medical data are vital to protecting this population.

 

Patients overwhelmingly prefer the use of a unique identifier for record matching that is not a number or password since these need to be remembered or brought to a health care facility. When a patient is undergoing a medical emergency, it is difficult to share this kind of data with a medical professional.

 
 

identifying key features:

Based on our research, we were able to validate our concepts and identify key features to aid us in designing for patients. Comprehensive data aggregation is necessary for complete patient care, but this interface must also be accessible, intuitive, reliable, and trustworthy for the product to be embraced by users.

see whiteboarding the MoSCoW

As a jump off point we examined an Rx worksheet developed by the NIH (National Institute of Health) for patients who take multiple medications and OTCs (over the counter drugs) to track their intake and potential drug interactions. Patients are advised to bring a completed and updated copy of this form to every doctor appointment. This medication adherence model is ineffective, not accessible, and arduous to keep updated. It also places the onus of identifying drug interactions on the shoulders of patients.

Medication nonadherence is a complex, and costly problem that contributes to poor treatment outcomes and consumes resources. Cardinal influences patient behavior by proactively using reminders, counseling, reinforcement, education, and dosage simplification to help patients by lifting barriers associated with medication information complexity, interactions, and provider communication.

see Rx worksheet here

competitors:

It is well documented that medical alerts are lifesavers if first responders can be made aware of them. However, most medical alert wearables are ineffectual. Current wearables contain little actionable information and there is no protocol in place in any municipality for first responders to scan jewelry. Many of the wearables on the market do not look like alert devices or are overly decorative so are easily overlooked. In an emergency situation, patients are often stripped of their jewelry and clothing and a wearable must be worn at all times to be effective.

see competitor SWOT here

We identified a series of limitations and feature gaps left open by our competitors and incorporated those specifics with the needs determined by our research and interviews.

see Cardinal SWOT here

stakeholder interviews:

I also took the opportunity to reach out to my own care team and ask my physicians how they experience patient matching discrepancies. My providers were very open about their concerns for patient safety and were very forthcoming about issues with updating EMRs and transmitting medical data across facilities.

 

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is the human body a suitable place for a microchip?

This is no longer a hypothetical discussion. Treating and enhancing the human body with microchips is commonplace in restorative medicine. Complex computing devices are routinely implanted in the human body everyday: sensory neural prosthesis- the most ubiquitous being cochlear implants, visual prosthesis like ASRs- artificial silicon retina, pacemakers, insulin pumps, and deep brain stimulators (treats several neurological disorders ie.Parkinson’s). These devices are designed to restore lost functionality and improve the lives of patients.


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identifying the user:

Based on our research and outlining of needful key features, we were able to begin developing user stories to aid us in designing the interface. It was important to us to situate our user not just as a patient, or as a person who’s illness was self-defining, but as a whole, complex person. Our user, Nancy, primarily wants to feel empowered and in control of her health and quality of life experience.  Her husband’s rapid decline and their subsequent confusion trying to navigate the healthcare system, has prompted her to be proactive with her own health. She is also motivated to retain her autonomy and to not feel as if she is overburdening her daughter. She is overwhelmed by new medication schedule following a new diagnosis. She thinks that medical alert jewelry is for old people, but is still concerned that in an emergency situation she may not be cognizant enough to share medication tracker card.

 
 

“Do not regret growing older, it is a privilege denied to many.”

 
 

Outcome:

 

 
 

the user experience:

Cardinal ensures complete, accurate, and up-to-date medical data access to improve safety, reduce costs, and better coordinate care for people who see multiple medical professionals. After implantation in a clinical setting, the chip is paired with the HIPPA compliant app. In app, users can log health metrics, participate in wellness challenges, and set up medication reminders. Patients link charts using a portal like MyChart or they can send requests for EHRs directly to providers. By law, providers have 30 days to respond. Patients can access medical records conveniently, message pharmacists/ doctors, and include designated family or caretakers as part of the complete care team. A scan in a healthcare setting can relay a wealth of medical data to encourage high-quality, coordinated care and appropriate services assisting patients and their providers with disease management.

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Marketing

 

 
 

the video:

As part of our content strategy I created a video advertisement to educate people about the product. We wanted to inform about current issues in our healthcare system, but without using scare tactics. We wanted to center the user as their own health advocate within their whole care team.

see storyboards here

the brand:

The brand voice is compassionate and empowering. The name Cardinal was chosen to situate all our needs for proper care as a fundamental right. We created infographic elements with a warm and approachable tone. The Cardinal color palette uses warm and cool color relationships with the focus of adding a human touch to the oftentimes clinical healthcare space.

see branding guidelines here

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The App

 

 
 
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wireframing:

Kim took the lead on initial sketching. After she spent some time reviewing and iterating, we moved to the whiteboard to work through a few key task flow solutions and the onboarding experience. The key here was to design, review and iterate until we had a smooth user experience. We knew our user demographic would prefer using a tablet over a smartphone and we utilized iOS guidelines to create a functional, high contrast, stand out UI. Initially we built out in vertical mode, but after our first round of user testing we learned that people prefer horizontal. In order to collect better data in our second round of testing, Kim built out our next iteration in horizontal mode.



 
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prototype:

Our primary focus was to design a UI that easy to navigate, so all patients are comfortable using it. We designed for people with low vision and limited motor skills by utilizing touch screens, larger form fields, text, buttons and higher color contrast. Our design methodology was to focus on intuitive, easy to navigate screens, a simple and clean look with large icons and typography and to avoid splitting tasks across multiple screens. We wanted to introduce product features gradually to avoid cognitive overload. We also allow users to activate dynamic type options within the app in order to increase legibility. To ensure our design was accessible to colorblind users we tested using the Stark Colorblind Simulator.

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user testing:

We tested our solutions on several people in different demographics. We assigned them a task flow to add a new medication to their profile with the "Photo Identify Pill” feature.  We requested they walk us through their thoughts as they stepped through the task. Through their feedback, we were able to inform further changes, iterations and clarified issues.


 
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Final Features