Neopenda  

Role in project

Sprint Planning • Sketching • Research • Concepting •

Usability testing • User flows • Prototyping • Test planning


Teammates: Ashlynn Denny, Michelle Wang, Jacqueline Wijaya, Jason Wong

Tools: Axure, Sketch, Keynote

Deliverables: Research plan, research notes, application map, user workflow graph, wireframes, prototype


Neopenda

Neopenda is a medical device startup that gives patients in low-resource settings access to high-quality care. Our clients, Sona and Tess, are the CEO and CTO, respectively. They started Neopenda in school in 2015 when they had a professor who was the conduit and they started working with nurses to help improve newborn mortality.

Scenario: In Uganda, neonatal care is a predominant issue. The wards that care for neonatal infants are severely low in resources, where babies with hypothermia are treated with nothing but plastic bags to keep them warm. Our clients informed our team that the ratio of infants to nurses reaches 80:3. Because they are stretched so thin, the nurses are unable to consistently monitor infant vitals in the ward. Therefore, the nurses are forced to play a high-stakes guessing game regarding treatment. The product and platform we were designing for was a wearable device for neonatal infants. The device transmitted live vitals onto a tablet and allowed nurses to monitor vitals in real time.

Neopenda wearable device

Neopenda wearable device

Diving into each client-conducted field report helped me empathize with not only our stakeholders and the behemoth of an issue they’ve tackled, but with our potential users as well. I learned that there are 3 million newborn deaths every year, and 80% of those deaths are preventable, especially in low resource environments.

Tubes are wrapped around infant's’ head with gauze due to lack of proper medical equipment

Tubes are wrapped around infant's’ head with gauze due to lack of proper medical equipment


Initial client meetings

Sona and Tess put together a current platform. However, they both expressed that they felt it lacked the user experience element. After thorough discussion and shaping a research plan, we found that Tess and Sona's main goal was to make their platform more user-friendly, especially for ESL users. In addition, they wanted to become more user-focused in their operations moving forward and asked our team to create a research plan that they would be able to continue utilizing on their own after returning to Uganda.

Starting with the problem statement exercise, our clients gave us multiple options for nurses, doctors, and hospital admins, but we collaboratively narrowed down to:

Nurses need a way to know which patients are in the most danger because they want to improve care, save lives, and be efficient. Currently, nurses have too many tasks to manually take care of at once.

 

Considerations: It was disclosed to us that Ugandans were historically weary of western practices of medicine. Until they or their loved ones were in grave health, they would rather stick to African potions. We weren’t only crossing medical standards but cultural boundaries as well. Moving forward, our design and layout should make sense to Ugandan doctors and nurses. Sona and Tess chose an Android tablet format, due to the efficiency of bringing them from the US to Uganda. However, there were issues to address with the tablet format, such as the high tendency of theft of technological equipment in Ugandan wards.

Neopenda current layout highlighting four essential vitals

Neopenda current layout highlighting four essential vitals

Current neonatal ward vital display with lack of context

Current neonatal ward vital display with lack of context

Takeaways:

  • It’s common for wards to have an average of 20 neonatal infants

  • The tablets needed to communicate:

    • Oxygen levels (SPO2)

    • Respiratory rate

    • Heart rate

    • Temperature

  • How current nurses diagnose in neonatal care is still guesswork

  • Mothers stay with the infants at the ward while being compliant to the nurses’ guidance

  • Reports on paper aren’t efficient and the data is sometimes made up, due to the hectic environment and lack of time the nurses are given to debrief

  • Twins are a very common occurrence in Uganda. There are instances of wards consisting up to 30%-40% of twin infants, being named Twin 1 and Twin 2

  • Current format nurses and doctors prefer to help phrase interview questions:

    • APGAR score, a ranking from 1-10 that categorizes the baby’s health,

    • Alarm rings when a baby’s vitals drop or exceed a certain ‘stable’ parameter

      • Certain alarms go off so often, nurses begin to ignore them

    • Issues locating the baby in a packed NICU ward   

 

Domain research

After going through the onboarding material Neopenda had provided for us, we focused on how to present large amounts of data in an easily digestible format. Our goals with desk/domain research:

 
  1. Learn about wearable technology monitoring vital signs for newborns and similar wearable vital monitors

  2. Understand the current state of monitoring vital signs for neonates in Africa

  3. Differentiate American vs. East African medical technology standards

 

We then divided specific emphasis of research. I focused on presenting large amounts of data and gathered inspiration from Edward Tufte, as well as practices in other markets like the stock market and airport FIDS. UX best practices and the iNICU dashboard view show the use of cards to display patient information as well as pertinent information about the patient without cluttering the screen.

Stock market displays utilizing lateral space given to display information

Stock market displays utilizing lateral space given to display information

HerdDogg    dashboard displaying large amounts of livestock vitals

HerdDogg dashboard displaying large amounts of livestock vitals

iNICU dashboard utilizing card format for scannability

iNICU dashboard utilizing card format for scannability

Part of our onboarding materials was a competitive analysis conducted by our clients, which included different health monitoring organizations. We conducted a competitive analysis but looked outside of the healthcare industry for inspiration. We came across a similar platform that  monitored vitals of livestock through wearable technology and first responder/EMT software. A key issue was displaying large amounts of vitals in an organized way. All platforms addressed the problem statement collectively.


User interviews

We interviewed 6 users total including: OBGYN doctors, nurses who’ve worked in Uganda, neonatologists, Ugandan doctors, and one of Neopenda’s formal advisors. All users and SMEs were remote, so we were limited to phone and video calls via Skype, Zoom, and Facetime. As a team, we encountered various obstacles through the interview process. In order to solve for the limitations of testing over the phone, we emailed screenshots of the interface beforehand to get feedback on the Neopenda platform.

Our team wrote interview questions with the goal of clarifying the assumptions:

  • Do only doctors get access to changing threshold vitals for preterm and full term babies?

  • Do healthcare providers in Uganda have the same level of education/knowledge as doctors in the US?

  • Is English the predominant language?

  • Is there a universal baseline of knowledge of newborn care?

  • Is it too difficult to keep track of 20 vital cards at once?

Our clients confirmed that 20 different cards would be ideal due to the fact that all vitals need to be constantly monitored by the nurses for their platform. The rest of our assumptions would be verified or corrected through emails with our client and user interviews.

Overcoming technological constraints in user interviews by facetiming a Ugandan doctor, who is showing us his neonatal ward

Overcoming technological constraints in user interviews by facetiming a Ugandan doctor, who is showing us his neonatal ward

All of our user interviews were made via Skype, Zoom, and Facetime

All of our user interviews were made via Skype, Zoom, and Facetime

After interviewing users and subject matter experts of varying backgrounds, we mapped out their insights. This activity revealed specific themes around current processes and workflows, cultural considerations regarding the environment in NICUs, and pros and cons of the current Neopenda dashboard.

After our user interviews, we synthesized our findings with an affinity diagram. We split up interview notes and as a team combined insights. Through those insights we discovered four primary emerging trends:

 
Sorting various perspectives in Uganda and the US

Sorting various perspectives in Uganda and the US

 

1. Visual display over auditory: We showed our interviewees the current Neopenda dashboard and found that nurses preferred visual alarms over auditory ones, due to the distraction factor

 

2. False alarms: Babies tend to roll around so the device often slips off of them, which triggers many false alarms.

 

3. Hospital record-keeping: There were particular discrepancies between what visitors and Ugandan natives reported on patient record frequency and ease of access.

 

4. Location of babies: Nurses have a lot of difficulty locating and keeping track of the high number of neonatal patients in critical condition.  


Multiple nurses stated that, “All four numbers are important, but it’s difficult to scan quickly.”

This is especially true when overseeing a large amount of neonatal infants. This validated assumptions in regards to the perception of the current platform. We also learned that if beds aren’t labeled in the room, the layout of vitals would not make sense. There were sometimes two or three babies to a bed or incubator, so we needed a flexible labeling and organizational structure for varying physical environments.


Due to that frequent annoyance, nurses would mute the alarms, especially the respiratory rate alarm. Upon asking the US doctors how they prevent false alarms, they explained that alarms don’t go off for a set period of time for breathing and heart rate. Both doctors and nurses stated that nurses typically know the equipment better, and are accustomed to setting parameters based on the neonate’s age.

Alarm parameters shouldn’t be easy to change by mistake, and nurses should change the alarm as the first responders.


The Ugandan doctor we spoke to mentioned that the charts are filled out regularly based on the severity of the babies’ condition and patient charts are kept nearby. However, US doctors visiting Ugandan hospitals mentioned that nurses in Uganda are too busy to record patient information. We learned that even in the US, vitals are recorded by hand. This depended on the unit but it was common practice for vitals to be recorded by hand and then transcribed onto a computer. In Uganda, there are generally no electronics available for that purpose.

From user interviews, we found that everything is manual, and that there is no access to printers in NICUs, which indicates the need for a digital platform.


We learned that patient capacity varies from ward to ward, which also influences the organizational layout of beds and equipment. Some nurses and doctors mentioned that up to five to six babies are placed on a single bed. Because of this, nurses try to organize babies by issue whenever possible, which means that the sickest babies are kept closest to each other. Overall, better organization is preferred but that isn’t always an option for nurses.




Many babies have come into the NICU wards with no name. This posed an interesting challenge for our design to accomodate a relatively disorganized ward and allow nurses to address neonates in critical condition as soon as possible.


Revising

After we synthesized our user interviews, we revised our initial problem statement to:

There is currently a lack of medical equipment, space, and staff in low-resource environments.

Neonatal nurses in low-resource environments need a way to efficiently scan vital monitoring information and find neonates in critical condition so that they can channel their energy to the child with the most need.

Our team revised our problem statement to narrow our scope on the nurses and the most immediate issue at hand: being able to scan neonatal infant vitals and find the neonates in the crowded ward. My team used four design principles to guide our designs moving forward:

 
neopendaDP.001.jpeg
 

My team and I performed a heuristic evaluation on the current Neopenda platform to gain insight on ongoing practices and to evaluate how we could improve their product.

 
heuristicevaluation.png
 

Initially, our team discussed whether or not we would improve their platform, or start from scratch. However, as we proceeded, we realized that Neopenda had built their platform based on market research and the way vitals are presently being tracked.

So when our users expressed that the screens made sense to them, we decided to pivot and improve the platform rather than eliminating it altogether, leading us to concept new ideas while solely focusing on nurses within our scope.


Concepting and testing

In previous client projects, concepting was a struggle in terms of keeping the focus on the scope of the project without being feature-focused. This time around, utilizing 6-8-5s and leveraging inspiration from our client’s progress were key parts of my process. Guided by our research, problem statement, and design principles, we began to draft our initial ideas and inspirations. My goals with concepting were to address the problem statement at hand. I mapped out four different concepts within an hour time span with the hopes of solving our client’s biggest concern: how to monitor 20 neonates vitals, while efficiently locating infants in the ward of varying sizes.  

Our team completed five out of the six concept tests we had originally scheduled with our users. Just like with our user interviews, we were presented with challenges including: scheduling between Ugandan and US time zones, technological constraints with concept tests relating to screen sharing capabilities, unfamiliar medical jargon used in a healthcare ward, and making sense of the differing user perspectives. We were able to make changes and continued to iterate as we began prototyping. Designing based on assumptions (not testing with Ugandan nurses) was an uncomfortable step, which since then, has changed. Recognizing that Neopenda would continue usability testing on their own, our team would come with equipped our clients with a test plan to follow.  

My concept that eventually reached the concept testing round with our users is what I called, Queue Up.

Queue: infants in need    Stable: infants that do not require immediate attention

Queue: infants in need

Stable: infants that do not require immediate attention

What we tested

  • Utilized card format for baby vitals and highlighted neonatal vitals that are outside of “safe” parameter ranges

  • Infants who currently don’t need immediate assistance will be placed in a section labeled “stable” and with 4-5 cards on each row, rotating every 10 seconds

  • Find” button that would trigger a visual alarm on the wearable device

  • Color and number naming system of infants

  • Tracking particular trends of specific infants using graphs

What we learned

  • Users found that the “queue” category is a useful and quick way to notice babies in need

  • “Find” button would be helpful for nurses locate specific infants

  • “Stable” category, which would be constantly changing, doesn’t allow for spatial memory

  • Nurses wouldn’t have time to look at or take notes on the trends page

  • Nurses gave feedback that the word “Queue” and “Stable” weren’t commonly used

  • With the word “Find” a nurse mentioned, “You don’t have to find the babies, they aren’t lost!”

 

Moving Map:

A visual way to organize neonatal infants

A visual way to organize neonatal infants

What we tested

  • Platform displaying the layout of NICU ward

  • Nurses would be able to hold and place the babies represented by icons

  • Tapping into the individual baby icon would expand into the baby’s vitals

What we learned

  • This would create additional work for the nurses on the floor

  • Would be too complex to implement in different wards because not one NICU ward is formatted the same

Due to the lack of feasibility and efficiency, which goes against our design principles, we removed this concept after two tests.

 

Don’t Snooze:

Tracking alarms, building accountability

Tracking alarms, building accountability

Screen Shot 2018-08-16 at 4.10.39 PM.png

What we tested

  • Card format platform that would present the four vitals important to nurses, as well as a color and numbering system

  • Timer that starts when an alarm goes off, tracking the time it takes for a nurse to respond to it, for accountability

  • Graph of the selected vital depicting trends, while also displaying the other three vitals, allowing the user to monitor the other vitals simultaneously

  • Tooltip which a user could click into, saving real estate and giving options to view additional information

What we learned

  • Users mentioned that they prefer the standard card view

  • Doctors preferred to have timers on the alarm to keep nurses accountable, however the nurses disagreed

  • Not all alarms would trigger the same response from nurses

  • Certain vitals cause more of a reaction and that vitals in general are correlated

  • Users like the tool tip to save real estate on the card

 

Dynamic List:

Long display of all neonatal infants

Long display of all neonatal infants

What we tested

  • Neopenda platform with all infant patients that fits on a single screen

  • Vertical orientation with the horizontal view of vitals, while utilizing sparklines

  • Clicking into patient row would expand details

What we learned

  • User feedback was polarizing

  • We had to take in additional context where the insights were coming from

  • US doctor and nurse that liked this format stated they did so because it was what they were familiar with

  • US nurses with experience in Uganda mentioned it would be difficult to scan in a high pressure environment and with the nurses always running around

Referencing our problem statement and design principles, making the platform easy for nurses to scan was a main focus for our design.

Synthesizing our concept tests was the greatest challenge of our project with Neopenda. After the majority of our concept tests, we realized that there wasn’t a clear direction in which our users showed patterns of preferences. To overcome the lack of direction, we synthesized other insights, utilized our domain research, along with design assumptions  and ideated our fifth concept.

Switchboard:

An index of neonatal infants in need

An index of neonatal infants in need

What we tested

  • Quick alert bar on the top of the tablet screen indicating which babies are in immediate need

  • Drop down location of the baby

    • Which format they are placed in (i.e. bed, incubator, etc.)

What we learned

  • Users thought the alerts were a bit crowded, however appreciated the ever-present alarms

  • Preference to see alarms for specific vitals

  • Specifying infant format was not useful

    • “Sometimes there are 3 babies in an incubator” - Nurse


User workflows

With the influence of combined insights from concept tests and aligning with our clients, our team converged the initial prototype. As a team, we prototyped the nurses’ main task, scanning and finding a neonatal infant in immediate need of attention.

Our team decided to map out the workflows of every possible scenario that a user would encounter with Neopenda, which led to three workflows: New Patient, Monitor Patient, and Discharge Patient.

 
New Patient   :       An onboarding process of registering and assigning a device to a patient so that nurses could add a neonatal infant into the system. This presented the need to include a    Patients    and    Devices    screen.

New Patient: An onboarding process of registering and assigning a device to a patient so that nurses could add a neonatal infant into the system. This presented the need to include a Patients and Devices screen.

 
 
Monitor Patient   :       When the nurses are on shift and are monitoring vitals, the dashboard would allow nurses a variety of options on how to address neonatal infants. This gave us a clear guideline on how nurses would utilize this platform, and exactly what screens and features would be needed in our prototype. Specifically    Mute Alarm   ,    Locate   , tracking    trends   , and inputting    patient info   .

Monitor Patient: When the nurses are on shift and are monitoring vitals, the dashboard would allow nurses a variety of options on how to address neonatal infants. This gave us a clear guideline on how nurses would utilize this platform, and exactly what screens and features would be needed in our prototype. Specifically Mute Alarm, Locate, tracking trends, and inputting patient info.

 
 
Discharge Patient   : Mapping out this workflow answered the question of where patient information would live when a neonatal infant is discharged from the NICU ward. Our clients also disclosed to us that this would eventually be an important function of the platform and that they would like to continue    testing this feature in the future.

Discharge Patient: Mapping out this workflow answered the question of where patient information would live when a neonatal infant is discharged from the NICU ward. Our clients also disclosed to us that this would eventually be an important function of the platform and that they would like to continue testing this feature in the future.

 

Prototyping and testing

Aside from direct feedback of the concepts, our users also gave us valuable client specific insights for future productions on the Neopenda device.

  • Using different band colors for different types of patients such as: full term, preterm, and kangaroo care babies.

  • Updating hardware to light up specifically for the “Find” feature

  • Tracking Apnea because with respiratory rates the alarm would constantly be out of parameter (babies constantly temporarily stop breathing or their hearts start beating quickly).

    • The Apnea Alarm would signal if the baby has stopped breathing for more than 15 seconds.

  • Taking into account the head size circumferences for sizing full term and preterm babies.

My team and I then took that feedback and iterated on our concepts heading into prototyping in Axure. After initially building our prototype, we began usability testing. However, technical roadblocks and difficulties caused a lack of end user perspective. We ended up interviewing four users, three nurses and one doctor, through video call. Our team also made a visit to a prominent hospital in Chicago.

Despite the constraints of remote usability testing, our team made it a priority to communicate to the users the necessity of screen sharing platforms. Suggesting solutions such as Skype, Zoom, and Google Hangouts to ensure success in usability testing. And due to the hectic schedules of the nurses and doctors, I applied my client management skills to send emails and calendar reminders to follow up.

We approached our usability test with a set of tasks and interacted with our users with probing and empathizing questions. The goals for usability tests were to:

  • Gather user feedback on whether or not the updated dashboard helps users scan and find vitals

  • Assess if the sidebar hinders user workflow

  • Determine how users respond to temperature and other vital alerts

Task 1: Monitoring Vitals

Iteration from concepts   :    • Allow vital-specific alarms, specifically temperature

Iteration from concepts:

• Allow vital-specific alarms, specifically temperature

 

Task 2: Add A Patient & Set Parameters

Iteration from concepts:     • Babies aren’t always identified by name, but they always have a Medical Record Number    • Include the information: Date of birth, gestational age, weight, and APGAR score    • Highlight if the baby is a twin, because before given any medication based on previous medical history, it’s important to have the right baby

Iteration from concepts:

• Babies aren’t always identified by name, but they always have a Medical Record Number

• Include the information: Date of birth, gestational age, weight, and APGAR score

• Highlight if the baby is a twin, because before given any medication based on previous medical history, it’s important to have the right baby

 

Task 3: Viewing Trends

Iteration from concepts:     • To have nurse and doctor views for the trends.    • Doctors find a more macro scope of days to a week helpful, while nurses are more concerned about 24-hours or less.    • Initially the team and I discussed building out a doctors’ view for trends. However, maintaining our scope we focused on the nurses’ view.

Iteration from concepts:

• To have nurse and doctor views for the trends.

• Doctors find a more macro scope of days to a week helpful, while nurses are more concerned about 24-hours or less.

• Initially the team and I discussed building out a doctors’ view for trends. However, maintaining our scope we focused on the nurses’ view.

 

Task 4: Patient Discharge

neopendaarchive.png
 

Additionally, our clients asked for a list of recommendations of changes based on our research. I took this as a sign that they trusted our process, research, and ultimately, our ability as designers to guide the immediate next steps of developing their process. So a teammate and I, established a list of recommendations ranked “immediate”, “soon”, and “later” along with our final prototype.

Walk through the neonatal nurse’s journey below:

High fidelity dashboard:

Neopenda Dashboard.png

Neopenda test plan: now and later

A big focus of our process with Neopenda was preparing a test plan for future usability testing on the platform. The challenge was explaining design terminology and the testing process to individuals who are not familiar with design. The goal of the test plan was to be flexible & modular for future use.

In order to accomplish that, my team and I included:

  • A “happy path video” with PDF instructions on how a usability test is run in a best case scenario

  • Set up instructions of free recording software, software to install, and setting up the prototype on the tablet with an offline viewing option in case WiFi was an issue

  • Explaining roles in a usability test and giving examples of different question types

  • Collecting data by sorting outcomes, tasks, scenarios, recommendations, etc.

By implementing our future recommendations, we were able to provide nurses in low-resource environments a way to quickly notice and locate neonatal infants in need. And as a result, Neopenda now has an improved platform to help save lives. Building from what our team was able to accomplish in just three weeks, Neopenda now has a strong foundation to continue testing and iterating. In the future, they can expand the platform to cater to doctors and hospital admins, going beyond being a monitoring platform and becoming an informational hub of neonatal wards.


My Neopenda experience

Working with Neopenda, I learned the importance of aligning initiatives with my clients from day one. Once bridging the gap of communication and developing the relationship, I learned that the product and solutions following, become more purposeful and intentional in the outcome. I applied my strengths in building rapport with clients and users, presenting to clients, and well as concepting.

Areas in which I grew:

  • Furthered my comfort level with having a lack of users

  • Designing on assumptions, as long as there will be testing with iteration in the future

  • Conducting user interviews, concept tests, and usability tests remotely

  • Introducing and teaching my design process to my clients

  • Iterating designs through user feedback and continuing to test those changes  

In just three weeks, my team and I were able to conduct our design process and overcome technological setbacks through continued iteration and basing our decisions on user insights and domain research. We were able to make a positive impact and changed the trajectory of the Neopenda direction to better help save lives in Uganda.

My client relationship feedback:

Screen Shot 2018-09-08 at 6.43.53 PM.png