Epileptic Connection

Problem to Solve

Medical non adherence is a global problem requiring a multi-faceted approach. Non adherence can account for up to 50% of treatment failures, around 125,000 deaths, and up to 25% hospitalizations each year in the United States (1). One of the ways non adherence has been counteracted is by promoting trust between a patient and their physician. Patients who have more routine contact with their physicians are more committed to consistently following their medical regiment (2). In developing countries, especially rural areas, building trust is crucial to improve medical compliance. Through the partnership and collaboration of a team of engineers at Washington University in St. Louis, we have approached this problem from the side of the physician to help build more trust and hold patients accountable for their health and wellness in rural parts of Ecuador.

We have chosen to solve this problem through the creation of an application that reminds, tracks, and stores an epilepsy patient’s health information. The application notifies and allows a physician to quickly pull up and check a patient’s adherence to a previously discussed medical regiment, and keep a patient accountable while strengthening the communication between a patient and their health provider.

Tasks

WebsiteDisplay_EpilepticConnection.png
  1. Application for Android LG tablet “8”

  2. Develop a logo and color scheme that captures the values of the Ecuadorian culture

  3. Application helps remind and monitor epilepsy patients with:

    • whether the medication was taken

    • what dosage to take

    • how frequently the dose should be taken

  4. Application keeps physician informed of patient’s success/failure to stick with treatment plan

The Outcome

The application was implemented and given to our physician contact in Ecuador. Follow up and feedback was tough to get regarding the efficacy of the app, but initial impressions were positive.

Target Audience

Physicians in rural Ecuador

Programs Used

Adobe Illustrator, InVision, Unity

Role

UX Designer and UI Designer


The Design Process

Defining the Problem

Epilepsy is one of the world’s largest non-communicable diseases. It is estimated that the condition affects approximately 50 million people, around 40 million of them living in developing countries (3, 4). Medical non adherence among epilepsy patients in rural Ecuador is a huge problem. Due to the stigmatization of the neurological disorder, low prioritization, poor healthcare system infrastructure, and several other factors medication adherence is extremely low.

To make sure the requirements for the application were relevant to epileptic patients and physicians I sought out a contact, Dr. Pandey, a physician epidemiologist at the University of Illinois at Chicago, to help develop the requirements for a successful app.

Requirements

Requirements were negotiated and established with the help of the engineering team at Washington University at St. Louis along with Dr. Pandey.

  1. Application specifically built for Android LG tablet “8”

  2. Multiple doctors should be able to use the application

  3. Each doctor should have their own access and be unable to access another doctor’s patient list

  4. Doctor should be able to add, edit, and delete patient information from the app

  5. Application should be able to send an SMS message within 3 minutes of a set time on the app to patient’s to remind them to take their medication

  6. Patient’s should have the ability to opt-out of the SMS messages if they chose to

  7. Application helps remind and monitor epilepsy patients with:

    • whether the medication was taken

    • what dosage to take

    • how frequently the dose should be taken

  8. Application keeps physician informed of patient’s success/failure to stick with treatment plan

Understanding the Target Audience

Before designing the application, it’s important to understand the audience you’re designing for. To best understand the target audience, it would have been beneficial to travel to Ecuador and understand both patients’ and physicians’ motivations and needs. Unfortunately, due to funds and a tough time getting a hold of our contact in Ecuador, I worked more closely with the engineering team at Washington University in St. Louis to gather information about Ecuador and it’s people through reading books and articles, in order to develop an app that would help address their accountability needs. Insights from my research were as follows:

  1. Medical non adherence among epileptic patient’s in Ecuador stems from judgment around the disorder, as well as the lack of conversations about the topic. The topic of epilepsy is viewed as one that is highly taboo.

  2. It’s tough to visit the physician consistently since for many people in rural Ecuador travel is limited, this can lead to not getting medication when needed. Furthermore, the poor healthcare system infrastructure in place makes it tough to stay on top of taking medications.

User Site Map: General Overview of How the Physician would Enter/Look Up a Patient

UserSiteMap_EC_(1)-8.png

Sketches of App Designs

To start to figure out the content and placement of that content, I used graph paper and pen to quickly work through potential features and positions of those features on a screen. Below is one of the versions created to start to figure out content.

Buy In from Engineers and Dr. Pandey

After going through a number of iterations, we settled on the content and user flow of the application.

Logo & Color Scheme

The next step was to develop the logo and the color scheme that would showcases Ecuador’s values. To do this, I began by researching what the Ecuadorian culture was like, looking at things such as colors used in ceremonies, on the flag, and even reading into Ecuador’s history to better understand where the country had been and where they were going. After much research, I settled on a color scheme that emulated the colors of the Ecuador flag (blue, red, yellow) to give the users a sense of pride in using the app and making the app feel more a part of the culture. Furthermore, I did a design exercise where I created several versions of logos thinking about the words and concepts that came to mind for the app that we were creating. Below are a number or examples of words associated with the app and logo options presented to the Wash U engineering team for approval. We decided to go with the name - Epileptic Connection and Option #5 for the logo. Both logo and name emphasize Ecuador’s mix of cultures that create one country. Furthermore, the culture and unified culture is vibrant and beautiful which is represented through the color choice and circular ring of 3 different color strands.

Finalizing Designs

Once both the concept and the content design of the application were approved, it was time to pull the design together. The screens were developed and exported from illustrator as .pngs and brought into Unity for front end development to be prototyped on an Android LG tablet “8”.

Testing the Prototype

To test out the prototype and verify that the application successfully met the original requirements, I asked Dr. Pandey and one of his graduate students to test out the app. In an ideal world, we would have gotten our contact in Ecuador to go through the design and provide feedback on whether it successfully addressed the medication adherence problem we had originally identified and whether there were elements or features that would make the app even more useful as a tool for physicians to help their patients build trust and improve their own medial compliance.

User Research Method: Usability Testing – participants were asked to complete two tasks:

The participants taking part in the usability study were part of the University of Illinois Rehabilitation Center. They closely worked with epilepsy patients and were the closest we could come to testing out the prototype on our end users.

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Task 1 –

You are new to the Epileptic Connection app and need to create an account. After creating an account, you are asked to log in, and you would like to input your first patient with the information below:

Patient Information

Patient Name: Patient X

Nickname: X

Birthdate: 02/08/2010

Message Information

Message:

“This is a reminder to take your Topamax. Text ‘yes’ to confirm the pill was taken.”

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Task 2 –

You need to change the number of times per day that patient, Jane Doe, takes Klonopin. Currently, the patient is taking the drug once a day. You want to increase this to 2x a day. Navigate through the app to make this change to the patient’s medical record. When you’re done, you should log out of your account.

 

Observations 

Below, I have included the notes taken while taking both users through the app.

Graduate Student

Task #1:

Flow of Screens: Log in Screen -> Register -> Log In Screen -> New Patient Screen

-> Home Page Patient -> Message Page

  • Didn’t initially click on register - wanted to tap on the main screen and just type where said username and password - needed to be directed to register to figure out what to do.

  • Comment to use dots for filling in password instead of seeing the password typed out.

  • Very easy to decide which icon is new patient

  • Message screen - couldn’t figure out how to edit the message - wanted to tap into the message

  • Once got into message - would have liked to be able to have an automated message ready to go, and to have a drop down to change for medication, frequency, dosage, etc.

Task #2:

Flow of Screens: Current Screen -> Current Patient -> Medication -> Edit Medication -> Back to Home Page (using back button) -> Log Out

  • For medication could navigate to page where changes would be made. Confused by the inability to just click on medication name, dosage, frequency icons. Couldn’t move on without redirection to bottom of page where edit button was.

  • For logging out proceeded to press the back button until reached patient home page. Didn’t consider the hamburger button as an option.

Physician Epidemiologist

Task #1:

Flow of Screens: Log in Screen -> Register -> Log in screen -> New Patient Screen -> Home Page Patient -> Message Page

  • Prompt asked to create a new account - first reaction was to click Log in, when didn’t work looked to see what other options available

  • Trouble typing on tablet

  • would have liked the date to be more automatic where slashes would be incorporated

  • Pressed rectangle to change text before seeing the edit button at bottom of screen to press first

  • commented on how no one should be typing that much into a message

  • Would like to see a message already there with dropdowns for the medication and other influencing factors

Task #2:

Flow of Screens: Current Screen -> Current Patient -> Medication -> Edit Medication -> Back to Home Page (using back button) -> Log out

  • On medication page tried to click on icons and words to change them

  • very intuitive to press dropdown for frequency

  • Wasn’t sure whether to hit back button or hamburger button to log out - a bit hesitant

  • Would like there to be more follow up questions for the purpose of medical compliance. Patient could be asked how they are feeling etc so that there is more conversation with the patient besides whether they took their medication, since epilepsy patients have other symptoms besides seizures to take into consideration such as depression.

Outcome

Updates needed to be made to the app based on Dr. Pandey and his graduate assistant’s feedback. After updating those changes, the designs were sent over to the engineering team to implement and integrate into the software to successfully send SMS messages and allow patients and physicians to communicate with one another. The app was then deployed and available for physician’s in Ecuador to try out. Positive feedback was received.

Learnings

  • If possible it’s important to be able to have contact with your end user, but the next best thing is to find individuals who represent or can simulate the population that will receive your app.

  • Be aware since you don’t have contact with your target audience you are making some assumptions. Prioritize whether you can assume something or if further research and work is needed to further elucidate the problem and effectiveness of the solution.

  • It’s tough to keep everyone on the same page when different teams are located in different areas of the country and world. Example: design was in Chicago, engineering was in St. Louis, and the customer was in Ecuador. Communication is even more important in these situations!