Medical Prescription Redesign: UX Case Study
A prescription, often abbreviated as ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient.
In India, every day hundreds of doctors write millions of prescriptions for different patients. Those prescriptions contain information ranging from medication, vital measurements, prescribed tests to suggestions provided by the doctors. It’s a single piece of paper that has the ability to save every patient’s life.
The human body experiences a powerful gravitational pull in the direction of hope. That is why the patient’s hopes are the physician’s secret weapon. They are the hidden ingredients in any prescription.
In India mostly, there is a huge trend of handwritten medical prescriptions. Mostly the doctors who are working in government. hospitals or private clinics prefer to write handwritten prescriptions. The trend of handwritten prescriptions hasn’t improved enough for the past two decades. Though some doctors and hospitals are shifting towards digital / computer-generated prescriptions the handwritten prescription is still a huge concern.
Why redesign a prescription?
Medical prescriptions are used by different people like Doctors, Pharmacists, Radiologists, and Patients. Doctors always reiterate through a prescription to check important vitals, instructions, prescribed drugs. Pharmacists use perceptions to sort the medicines and write easy to read instructions for the patients. Patients use prescriptions to compare their vitals, check important instructions and medicine (some patients also do that). One can easily get an idea about the importance of this paper but due to bad formatting, congested and unclear handwriting makes it very difficult for patients to read the prescriptions. Even due to that, the pharmacists are also unable to read the names or instructions given on the prescription.
The problem is more severe in developing and underdeveloped countries where the medical system isn’t fully developed/digitized. You can click here to read more about prescription errors. A recent study showcases some data about the errors that occur due to the prescription error in Nepal.
Backend Story:
My elder sister is expecting a baby so, I went with her for a quick check-up. The consulting doctor is a famous gynecologist with more than three decades of experience. The doctor did a check-up and wrote a prescription contains different tests, vitals, precautions, instructions, and medicine. The very next day I went to a medical shop to brought medicine for her the pharmacist was not able to read the names of the two medicines properly. Anyhow, I was able to buy all the medicines from different shops.
After 1/2 days my sister lost a medicine packet which contained the written instruction for the medicine. She deliberately checked her doctor’s prescription to find out the instructions but was not able to do so because of the heavy use of the medical terms as well as the poor congested writing format.
Every day millions of people face the same issues. Despite having a good educational background, they are unable to digest basic information from the prescription. This huge social problem hooked me to redesign the existing medical prescription format to improve the interaction and decrease the errors.
Why I am redesigning physical prescriptions?
A developing or underdeveloped country like India or Nepal doesn’t have highly digitized systems, especially in the healthcare industry. Though nowadays a lot of booming startups are trying to provide online healthcare facilities and multiple hospital chains have introduced digital or printed prescription systems but still, the number is very less. A huge chunk of the population still interacts with the traditional pen & paper method of writing a prescription. The majority of the doctors still prescribe handwritten prescriptions. So, the interaction between humans and paper is the main point where I have to work on. That’s why I wanted to redesign a physical prescription rather than a digital one.
My role and responsibilities:
This is a personal project so, I am responsible for user research, secondary study, usability testing, and designing.
I have talked to 12 doctors, 7 pharmacists, and 18 patients to find out their pain points and provide a feasible solution to them.
Design Process:
Throughout the project, I have used Human-centred-Design principles to improve the interaction between Doctors, Pharmacists, Patients, and Physical prescriptions. I have also used several user research methods to find out their exact problem. Here is a high-level overview of the steps👇
I have divided my research into different phases to cover all the boundary cases and personas. A prescription can be used by a doctor, pharmacist, pathologist, radiologist, and patients. We have different kinds of people with different educational backgrounds and expertise. So, I have to spend a significant amount of time to know about the different sections and terminologies used in a medical prescription. Then I initiated an ethnographic study on two doctors who have different expertise. One is a gynecologist and another is a dermatologist.
In the next phase, I went to different medical shops and performed ethnographic study to figured out how patients buy medicine from the shops, what are their problems, how a pharmacist scan a prescription etc. I have discuss more on this process in the research section.
From my study, I can conclude that there is mainly their part and a couple of subparts present in a medical prescription 👇
(1) Header Part (2) Main Body (3) Footer Part
(1) Header Part: Doctors use this part of their prescription to highlight their name, address, registration name, hospital name, phone number, and a couple of other details.
(2) Main Body: Main body is the part that contains the main information regarding the disease, important vitals, instructions, recommended pathological and radiological tests, name of the medicines, and other required details. This part can be divided into a couple of other subparts i.e. Vitals, Symptoms, Diagrams, Recommendations, Tests, Tables, and Medicine.
(3) Footer Part: This is the last part of a medical prescription which contains the general instructions about licensing, drug recommendations, and address.
Let’s discuss more the problems🔍:
A single mistake in prescription can create a life and death situation for the patients. So, a prescription should be highly accurate and easily readable. For returning patients, a doctor always has to check the vital, previous diagnosis, prescribed medicines. Even if a patient has more than 2/3 prescription then sometimes the doctor also has totally them to prescribe further medicines. Some doctors also have to scan other prescriptions referred by different doctors. We all have experienced the poor handwriting of medical prescriptions, but this is not the only problem. The poor formatting and unstructured composition can make a prescription unreadable. A patient with less or no medical knowledge couldn’t understand prescriptions. The cognitive load is very high for patients. Even sometimes pharmacists cannot digest the prescription properly.
Study analysis of quality of prescriptions was done by comparison with a standard format and dividing them into four groups as poor, fair, good, and excellent depending upon the score obtained. The results showed that 12 (2%), 155 (31%), 335 (67%), and 0 (0%) prescriptions belonged to groups A, B, C, and D respectively. In all the prescriptions, 19 parameters were checked for presence or absence.
Patients mostly use the prescription to recheck the medicines given by the pharmacy ( the rampant increment in fake medical shops is a root cause behind medication error), check about the doses, instructions given by the doctors, and about the tests. But it’s almost impossible for a common patient to understand the congested and unstructured writing pattern.
I have designed a survey to get feedback on what people think about a medical prescription. I have attached two different prescriptions and a couple of other questions about educational background and experience. You can find out the survey result below👇
Research & Insights🕵️:
Research is the most vital part of any design process. This is also true for the prescription redesigning process. I have done extensive ethnographic research on 4 Indian pharmacies and 7 doctor chambers to find out the behavior of the patients, doctors, and pharmacists.
I have gathered a huge chunk of quantitative and qualitative data from my ethnographic research.
Ethnographic Study on Pharmacy, Doctors & Patients:
I have performed this research in both urban and rural areas of India where I observed almost 10 pharmacists. I have also observed 30 patients while they are buying their medicines. 18 of them had completed their higher secondary education, 8 of them had completed their secondary education and 4 of them had completed their 4th standard. Out of seven doctors, one is a gynecologist, two are dermatologists, four are general physicians.
The most insight that I got from the research is the different reading patterns of prescription. A pharmacist mostly focuses on a specific part of a prescription while a doctor focused on a broader area.
A pharmacist is always looking for the Doctor’s name, specialization, starting sequence of the medicine name, doses, and medicine instructions. Almost every time I found that people ask the pharmacists for the medicine instructions. Even they ask multiple times for the instructions as they had the fear of forgotten the instructions.
Half of the time I noticed that some of the family members came to the pharmacy to get the medicines and they ask to write down the instruction in the medicine packets.
A couple of times I found that the pharmacist was not able to understand the handwriting of the doctor so, he consulted with his colleagues for better clarity. Also in some cases, a pharmacist needs to put extra effort to find out the instructions properly.
Gynecologists mainly maintain the record of the vitals date/week/month wise. Dermatologists mainly use a part in their prescriptions to write about reactions of medicines.
A patient/ common people always start scanning the prescription from the left side, then they go for the right side, and at the end, they scan from top to bottom. A doctor always keeps their focus on the top part of the left side and the right part whereas pharmacies only care about the top header part and mainly the right part.
Usability testing with doctor’s prescription:
I had performed usability testing on 10 different people using a couple of prescriptions that I had managed from different doctors. My goal is to measure the error rate, the time needed to find out the details, and eye-tracking. Most of the participants can read basic English words i.e. day, morning, afternoon, and have minimal education (class 4- Secondary).
I had jotted down multiple tasks that I want them to perform to evaluate their performance. The goal of the testing is to — (a) Find out the usability issues faced by sample users (b) validate my assumptions and review insights about their thought processes.
Success Metrics — (a) Ease of use (b) Engagement and satisfaction ( c) time need to finish a specific task (d) Error occurs.
Quantitative Analysis:
I asked the 10 participants to perform 7 different tasks. Which involves tasks like finding the name of the doctor, blood pressure, what was the first instruction doctor had given to you, etc, etc. I have compared their completion time individually with the average time taken by the participants and provide a binary score accordingly.
Analyzing the Insights:
In this phase, I analyzed all the insights from my usability testing and user study to make data-driven decisions. With the help of analytics, I can validate my assumptions and find out the usability issues of prescriptions.
(1) Unstructured layout of the prescription makes it really difficult for the patients to find out necessary information like Vitals, Instructions, and prescribed tests.
(2) The super high cognitive load always creates a fear in patients to read and understand prescriptions. They are afraid of committing any severe mistake.
(3) Pharmacists have to spend a significant amount of time to find out the drug doses and their instructions about consumptions time
(4) Both patients and doctors get confused when they have multiple prescriptions. They have totally the dates or other details to organize them chronologically
(5) Most of the time patients can’t able to understand the terminologies used in the medical prescriptions.
(6) If a person wanted to buy medicine from a remote medicine shop (which is not in the parameter of the doctor’s chamber ) there is a very chance that the pharmacist might not able to understand the prescription properly.
(7) When a doctor wanted to go through a prescription written by another doctor he/she might face some difficulty as the structure, writing pattern and composition is different.
(8) Doctors forget to write details on the prescription which can lead to medication error.
“Data are just summaries of thousands of stories — tell a few of those stories to help make the data meaningful.” — Chip & Dan Heath
Ideation💡:
In the ideation phase, I use Design thinking principles to understand the scenario and proceed accordingly. To start out the ideation phase, I conducted an affinity diagramming exercise.
Target Audience :
Prescription is a thing that is used by millions and billions of people. Doctors, Pharmacists, and Patients are the primary stakeholders of prescription. Doctors from different specializations, people with different ethnicity, culture, and educational backgrounds use prescriptions extensively. Not only patients but the prescription are also very important for the pharmacists because they need a prescription for drug reference. Even radiologists, pathologists, and other test clinics also refer to prescriptions for clarity.
Patient journey mapping:
A patient mainly has to travel through either of the two different sequences in a medical center / Doctor’s chamber. In the urban area, most have to go through a three-step process. At first, they ask the receptionist to book an appointment, then they visit the doctor and consult their problem. At the very last stage, they have to revisit the receptionist to get their prescription which is directly sent to them by doctors. In the rural areas patients directly collect the prescription from the doctors.
Storyboarding:
I have created a storyboard to better understand the scenario & problems of the users. The storyboard contains animation with respect to different situations.
Let’s see the result of this extensive research:
The result of this extensive research is the newly designed prescription which is super intuitive to understand and use. I have designed three different versions for different doctors i.e. Gynaecologists, Dermatologists, Physicians.
A prescription is divided into different sections i.e. sections for vitals, instructions, tests, tables, and medicine. The tables will help the doctor to record the temporal change in different parameters like weight or blood pressure. I have designed a box in the header part which can be used for indexing the prescriptions. The highlighted part can be used to write special instructions for the patient. The highlighted part will attract the user instantly. Also, I have designed specific parts for doses and their instruction guide.
Design iteration:
After a couple of rounds of testing with my newly designed prescription, I found that doctors use some very specific terminologies for medicine instructions. The doses also include specific portions, before and after meal instructions, and a couple of other things which I won’t include in the previous design.
So, I took a significant amount of time to under the terminologies and how they work together. After that, I reiterated the design process and came up with a new and different design which have all the required parameters 👇
The new iterative version is color-coded. I have used different colors to represent Morning, Day, Night and their associated parameters like before meal or after a meal. The last vacant option is for any special instruction doctors may want to write.
What are the usages of the QR?
This QR can be used to build a digital dictionary of the terminologies or medicines that the specific doctor is prescribing. This can help both the patients and pharmacists to understand the prescription more fluently.
Conclusion:
The users had great importance and role in this case study. The whole design, testing, and evaluation are based on data-driven information. Throughout the study and research phase, I got to know about the different cognitive biases of the users. I had also successfully applied ethnographic research in Indian pharmacies. I also dug into the problems faced by millions of patients. In that redesigning process, I have also found out ways that can help a doctor to write patient-centric prescriptions easily.
Developing and underdeveloped countries need a lot of innovation- innovations that can solve their problems. In this research phase, I have interacted with tons of people from rural India. I got to know about their culture, problems, and barriers.
This case study is just a beginning to redesign the whole healthcare industry. I will keep continuing my study on health care problems and find out intuitive solutions.
After a great discussion, It's time to wrap up this case study ….
I hope you guys found the case study useful, informative, and innovative. Feel free to hit me up on any social media platform if you have any questions, suggestions, or opportunities for me. I would be more than happy to have a conversation with You 🦸
