Guidance AMS

A responsive cloud based application for antimicrobial approvals management and review used in major hospitals and healthcare facilities across Australia.

Challenge

To help doctors quickly and easily obtain appropriate antimicrobial approvals, and AMS teams to review and audit prescribing practices, to ensure appropriate drug use and improved patient outcome.

Users

Pharmacists, doctors, nurses, infectious disease specialists, antimicrobial stewards and healthcare facility administrators.

Role

Sole designer responsible for UX, UI design, rebranding and compliance with ISO 62344 (Usability Engineering Standard for Medical Devices)

Joining the fight against antimicrobial resistance

About Antimicrobial Stewardship

Antimicrobial resistance is one of the top ten threats to global health. Antimicrobial Stewardship (AMS) is the systematic effort to educate and guide prescribers to follow evidence-based prescribing to minimise the adverse effects of inappropriate antibiotic use, which include resistance, toxicity and costs.

The Stewards

I was privileged to work with world experts in this field at the National Centre for Antimicrobial Stewardship on a complete redesign of their existing antimicrobial stewardship application, Guidance MS, alongside pharmacists at the Royal Melbourne Hospital, clinical content writers and developers.

Guidance MS – the legacy product

NCAS’s legacy product, Guidance MS was an integral tool for AMS activities in hospitals Australia-wide, but there were significant obstacles to growth and user satisfaction, including old technology & outdated GUI, problematic usability, an inability to cater for overhauled therapeutic workflows, new and advanced competitors entering the market, incomplete features and missing user goals.

Understanding User and Business Needs

I leveraged insights from existing customer research and feedback and delved further into user and business requirements:

I interviewed clinical, technical and business stakeholders to establish their needs, expectations, limitations and boundaries (eg. privacy, safety, technology, resources).

I conducted competitive & heuristic evaluations of Guidance MS and similar products to identify strengths, pain points and missed opportunities.

I observed AMS teams on ward rounds managing their tasks and interviewed them to understand their goals and expectations.

I ran workshops with clinical experts to explore user psychology and goals, create our key personas and identify potential hazards to patient safety.

Clarified User and Business Goals

Give Doctors

A fast path to obtaining approvals for drug therapies appropriate to their patients’ needs, with resources to support and educate them.

Give AMS Teams

Robust, extensive tools for therapy management and review with measurable, actionable insights into prescribing practices.

Give Administrators

Tools to manage facility set-up and licences, and user accounts and roles in hospitals with Internal User Management systems.

Deliver this all with

Advanced cloud technology and a superior, responsive user experience.

Medical device compliance

As antimicrobials can cause serious harm if inappropriately issued, Guidance AMS was assessed as requiring the classification of software as a medical device.

Responsible for the Usability Engineering Standard (ISO 62366), I created our Usability Engineering Plan and oversaw compliance, ensuring at every stage of design and development we identified potential hazards within the UI, addressed these with design controls and conducted verification and validation accordingly.

UX Process

UX activities began with crystallising the overall site architecture and interaction, then dove deep in cycles for each primary module and feature.

I ran workshops with clinical and dev teams to develop use scenarios for our personas.

I designed wireframe prototypes and wire flows and reviewed these with clinical and dev teams.

I ran weekly review sessions with clinical experts and dev teams to verify and refine the UX and assess risks in the UI.

I presented the prototypes to high level stakeholders to ensure commercial requirements were also satisfied.

Visual design

I ran workshops with stakeholders to clarify brand values, and the product’s relationship to its parent brand.

I iterated logo options, reviewed them with stakeholders and refined to the final logo and brand.

I applied the branding to wireframes which underwent review and redesign until complete.

I created a style guide and documented usability principles (accessibility, error handling, language etc).

Approvals Module

Antimicrobial and indication workflows offer full decision support or appropriateness assessment based on available guideline support.

The form steps doctors through clinical questions about their patient, offering local and TGA resources for additional support, to issue approval types based on appropriateness and hospital drug restriction categories.

The module educates and directs doctors towards best practice, delivers insight into prescribing behaviour, helps identify patients in need of intervention and ultimately improves patient outcome and reduces hospital costs.

The existing module:

Outdated and unclear UI
Confusing UX leading to many dead ends
Limitations to doctor issuing authority
Lack of relevance between approval courses
Too long to navigate these issues and obtain approval led to frustration and time wasted in a time-critical environment

How we improved it:

Clearer and more comprehensive workflows
Clean and intuitive UI
Fast query flow and approval issue
Increased flexibility and controls
Clear, meaningful messaging
Smart alerts management
ID nomination for accountability
And more!

User evaluation findings:

Intuitive and speedy navigation (average 30 seconds to approval)
Appreciated the speed and accessibility
New UI – clean, fresh and clear
Junior doctors especially valued decision support
Minor UI updates for clarity of recommendations panel
Minor content updates for workflows

Post Prescription Review Module

The PPR module helps AMS teams prepare and manage their ward rounds and review patients on antimicrobials in need of intervention.

Patients with antimicrobial therapies of potential concern are triaged from patient lists and added to AMS ward rounds. On the rounds (by desktop or physically in the wards) interventions are recorded in the review form.

Actionable recommendations are added to the patient history for doctors, and key measurable data from the reviews is saved for reports. An optional Acceptance Audit can also be conducted on rounds to capture how often doctors are acting on AMS recommendations.

The existing module:

Convoluted and dense UI
No ward round history
Tunnel flow limiting user oversight of reviews in progress
Limited filters for patient triage
Not responsive making physical ward rounds paper dependent

How we improved it:

A clean and intuitive UI
High visibility on key tasks and statuses helping focus in time poor, distracting environment
Clearly separated and easily accessible task areas
Multiple spaces for different ward round types
Ward round, review and audit statuses for better workload management
Responsive for ward round annotation and reviews

User evaluation findings:

Very different to the existing tool so some orientation required “It’s very different, but once you get it it’s really easy.“
Fast, intuitive progress through workflows
Liked ward round status indicators
Appreciated strong colour messaging for key actions which helped them quickly identify statuses and items for attention
Confusion over new concepts of ward round spaces vs ward rounds, but on refinement of presentation clarified successfully
Liked the aesthetic – “Calm – very different to what I’m used to with (eMM) Epic.“
Overall better ability to manage ward rounds

Patient Lists

Patient Lists give clinicians powerful tools to find and manage patient approvals, alerts and recommendations.

AMS teams can save multiple lists to quickly access the patients relevant to their rounds (eg. regular, special units or antimicrobials flagged for monitoring), and page and table filters provide advanced list management.

Cards display a patient’s approvals and reviews in the current admission – the summary view providing first level triaging and the expanded view giving full details and history. Patient, approval and review management tools are available from action menus.

Patient Lists save critical time in the busy hospital environment.

The existing module:

Dense and confusing UI
Rudimentary triage details
Full approvals details and history buried deep
Limited control over lists with few filters
Single patient list requiring repetition of search tasks to filter patients for every round

How we improved it:

A clean and intuitive UI
Configurable lists for regular rounds
Powerful filtering tools
Patient flags for alert statuses
A concise summary view of items with key data for initial triage
Rich content views for each patient enabling deep dive down through patient history
All current admission patient data available on one screen
Clear, quick and easy EMM approvals import

User evaluation findings:

Appreciated ability to expand patient history quickly in one place
New concept of custom lists required orientation but once understood AMS teams highly valued the ability to save filtered views for fast triaging
Intuitive filtering and navigation
Far fewer clicks to get to find patients than in old module
Some lack of obvious connection between lists and rounds, but once visual messaging addressed immediately created meaningful links

Smart Alerts Management

Improving prescription relevancy

One of the major improvements we made to the new Guidance platform was to improve the breadth, accuracy and meaningfulness of approvals alerts which are critical to providing relevancy in prescription histories.

Connecting the dots

When an approval requested, these alerts identify whether an approval or prescription alert already exists for that patient and drug, or a which may indicate the need for an extension, conversion or linking rather than a new course.

Better antimicrobial management

This is especially key to ensuring accurate reporting, as by helping prescribers to connect therapeutic courses it gives AMS teams a truer picture of patients’ antimicrobial management, and therefore better insight into antimicrobial efficacy.