Electronic Patient Record - Discharge Planning Tool

Product Design Team - Surrey and Borders Partnership NHS Foundation Trust

Brief

To create an assessment to support early identification of barriers to discharge, which are often not tackled early on in the Service user’s (patient) admission. The assessment will catch these barriers early on in the process using the Electronic Patient Record (EPR).

All instances of the Electronic Patient Record (EPR) displayed are in the demo version of SystmOne, with test/dummy patients. This is the demo EPR and ONLY uses test patients, not live/real patient data.

Our Trust uses SystmOne (Electronic patient record software) created by TPP for the NHS. Our Teams work using Agile Scrum and User Centred Design.

Project Goals

Barriers to Discharge are identified soon after admission and are resolved prior to the person becoming medically fit.
Reduce length of stay, which is better for the person as well as freeing up capacity for new admissions.
Cost reduction
Improve communication between discharge coordinators, wards, carers and community teams.
Improves service user experience (patient experience)
Reduce reliance on private providers

Challenges

Some limitations to make changes to the EPR software
The Private Provider solution still needs to be defined (will be in another release).
Tight deadlines (our projects support front line NHS staff and resources).

Project Team and my involvement in the project

Immediate Team: (Design Team Flow) Product Owner, 2X UX Researchers, 3 UX Designers, Scrum Master (I owned the UX design in this Project).

Wider Teams: Learning and Adoption team, App Support team.

Primary users: Discharge Planning Coordinators.

Secondary users: Any ward staff, MDT (Nurse, Admin, Medical, Pharmacist, Therapy Lead, Home Treatment Teams, Community Mental Health Recovery Services.

Stakeholders: Discharge Planning Coordinators, Associate director Working Age Adults and Inpatients, Associate Director of Flow and Bed Optimisation, Associate Director of Digital Transformation Delivery.

My Involvement in the project:

I created the Co design workshop documentation, and led the workshop as the only UX designer at this point in the project
At usability testing stage, I worked with another UX designer. I designed and led on the usability tests and the Beta testing. The UX Design Specialist (my Line Manager) set up the questions that needed reporting codes attached, and he managed the data flow test
I led on the first release of this project

Skills & Software

UX Research
Leading and designing workshops
UX Design
Prototypes
Usability testing

Miro
Adobe XD

Discovery - Process maps

This is a user centred design project involving the users continuously throughout the process.

The UX Researchers did Contextual Studies with the primary and secondary users.
There were also stakeholder meetings. Some of the users were also stakeholders.

In this section, I’ve included the ‘TO BE’ Process map to show all the steps of the whole service. The green boxes are SystmOne EPR / where our solution will happen in the process timeline.

Pain points

“Person is not always well enough to engage in the first 72 hours - but assessment will assessment will be completed with in the first 7 days.”

“Contracted/OAP Wards (Private Providers) have their own EPR systems. This means there are delays receiving information from the PWUOS (patient), or the ward via telephone call or email - we have to constantly chase for replies”

“Care Coordinators / Lead Professional allocation is not always completed in 72 hours.”

**Above:** This is the ***‘TO BE’*** Process map. **Please select image to read in more detail.**
The Discharge Coordinator Process is part of the **Inpatients Discharge Pathway.** (*Grey shape indicated this)

*Pink - The pain points
*Green - SystmOne EPR / where our solution will happen in the process timeline.
*Orange - Non-SystmOne Process (outside the Electronic Patient Record).

Discovery - Personas

**Above:** Primary User Persona, SABP Discharge Coordinator.
The design team created this Persona.

Discovery - User Story Map

I’ve created this user story map.

This UX artifact is designed to map activities, tasks/steps and User Stories. I created this afterwards to improve learning and the research process for future projects, as we didn’t have enough time to create during this stage of the project.

**Above:** I created a Miro User Story map. 72 Hours following Admission, the first stage of the Discharge Coordinator’s Process. The items in yellow filled rectangles are activities done in SystmOne, the Electronic patient record. **Please select image to see details of PDF full journey.**

Alpha Phase - Initial Co Design Workshop

I created a Co-Design workshop plan and hosted the initial Co-Design workshop for The Discharge Planning Tool.

The workshop was held onsite at the hospital, using post-it notes and users sketched out how they saw the design working for them.

Alpha Phase - Critique Workshops

We did two rounds of Critique workshops. The wireframe designs were put on Miro as single pages with post-notes and framing questions.

Potential Low Fi solutions were discussed from the wireframes design ideas and screenshots of SystmOne. The screenshots included existing features on SystmOne that was initially explored which can be configured like different types of care plan and Word letter template that mail merges data from SystmOne EPR)

**Above:** LO FI questionnaire wireframe of Discharge Planning Tool

Alpha Phase - Usability Testing

Above: Video of the Discharge Planning Tool questionnaire prototype. The prototype is showing logic based questions depending on the answers chosen. The questions were captured by the UX researchers in Discovery in an Excel sheet. (This video is me showing the prototype, not users).

I led the Usability Testing doing 2x rounds of qualitative testing in a live prototype in a Demo sandpit version of SystmOne Electronic Patient Record.

I created the testing plan and designed both the tests.

Agile decision to meet deadline

At this point in the project, we had to ONLY commit to deliver the NHS SABP Solution. The Private Provider Solution of the Discharge Planning Tool would have to be another release.

Some important take aways that we use to amended the working Prototype:

Use previous answers functionality really helped, and saved time updating the DPT questionnaire with new information to add.
Before completing the questionnaire - we need to add a question asking is the patient able to answer questions. This is because sometimes they aren’t well enough (which is in the pain points).
Initially I added : “Are you well enough to answer the questions? “Yes/No.
The user reworded to: “ Would you like to participate in this screening tool to plan your discharge?'“ Yes/No.

Good feedback from a primary user and Stakeholder.

I had some good feedback regarding my involvement in the project (leading with the design and guiding the users through the UX design process).

They said they could see the value of being involved from the start. The person felt listened to and appreciated that I had tried to take on board their needs.

Clinical Reporting questions

Clinical reporting is necessary to measure discharge issues. the NHS uses read codes to do Clinical Reporting. The UX Design Specialist attached the read codes to 5 Questions that would measure the KPIs. The questions had to match existing read codes.

Beta Phase - Beta / UAT Testing

I created the Beta / UAT documents for the Discharge Planning Tool and led on some of the Beta / UAT tests with Users.

The were a few minor tweaks, but all went well.

Hand over to App Support, Data flow test and Go Live.

I did a Microsoft Teams call demonstration of how the MVP worked in the Demo version of SystmOne (EPR). This was to the Learning & Adoption team and Apps Support team.

App Support team re-create our MVP in the Live SystmOne EPR.

The deadlines were met and the project went live on the 6th February 2023. This is the NHS SABP solution of the Discharge Planning Tool. The Private Provider solution will be release later.

There will be a extra part of the project. The Private Providers solution for the Discharge Planning Tool will be a release at a later date.

**Above:** Discharge Planning Tool Care Plan template. Roles of people who need to be Informed and Agreed by will be added to on this part of the Care Plan.

**Above:** Discharge Planning Tool Care Plan template. Actions to remove barriers to discharge will be added on this screen.

**Above:** Discharge Planning Tool (which links/opens through the Care Plan template). When selecting the Discharge Planning Tool Care Plan from the Care Plan list, right click and choose ‘perform a care plan’ from the options.

**Above:** Test version of the Word letter template (mail merge) that pulls through care plan and questionnaire data. This document is printed out and given to the PWUOS/patient. **Please note:** I could not change anything about the layout table look and feel on this document.

Beta Phase - Pilot

Feedback and data from Pilot goes here

Results -

These will be updated in several months when we get the data back from the Clinical reporting (need to update this).

The UX Design Specialist (my Line Manager) then did later releases of this project in 2023/2034) which I did not work on at all.

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