ZSFG Billing & Documentation
Helping providers understand the implications of the new billing and documentation mandates in their clinical workflow.
UX Designer (Feb 2023 - June 2023)
Challenge
How might we reduce the barriers for residents and attendings to adopt the new ED billing and documentation changes?
One of many solutions to address the challenge
A visual and workable template showing the billing and documentation changes as part of change management and education.
Our impact
Reduced barriers to adopting the new billing and documentation changes.
Uncovered challenges within the new billing and documentation rollout.
Created opportunities to further reduce the complexity of the billing and documentation process.
Members
Emergency Department Team - Dr. Aaron Harries, Dr. Christopher Peabody, Dr. Jaskaran Bains, Dr. Alan Gelb
Our Design Team - Ana Buenaventura (designer), Beth Berrean (design director)
The Messy
DESIGN PROCESS
CLEARING THE FOG
Understanding the current state
Our first task was to gather documentation and talk to our clients to get a sense of the current state, including the following data sources:
Quantitative results from edrive survey and study (prior to the billing and documentation changes)
Training materials and lecture presentations
ED team informational session with SOM Tech
Literature review - existing notes, presentations, and other documentation.
Laying out assumptions and what we still need to learn
Through multiple conversations with clients, we laid out our assumptions around the change management and how the new changes are perceived. However, we still needed to explore in depth how the residents, attendings, and fellows are responding to these changes.
Newly rolled out “tip sheet” to help educate residents, attendings, and fellows on the new billing and documentation changes in the EHR.
Observations to understand current adoption of the new changes in their environment
I conducted two observation sessions with two attendings from UCSF and ZSFG to understand how and where in the workflow they’re incorporating the new billing and documentation changes.
Interviews to validate or invalidate our assumptions
In conjunction with the observations, I conducted eight interview sessions with attendings, residents, medical students, and administrative directors to understand how they are currently adopting the new changes to the billing and documentation process, their pain points, and explore other learning techniques and how they get feedback around compliance.
Observations and interviews.
Presenting my initial findings to stakeholders. This was an iterative process and they also helped validate some assumptions.
SETTING THE RIGHT DIRECTIONUsing facts to formulate insights
After presenting the facts mapped into themes, I then presented the insights and grounded the discussion on those insights.
Specifically, I wanted to reiterate that this is more than just a “revise the tip sheet” problem, though that was one of the many potential solution.
The actual purpose that most are trying to address are not only around the rollout of the new changes including the tip sheet, but around getting feedback if they are implementing the changes “the right way” in their practice.
Using insights to brainstorm prototyping opportunities
Now that we’ve surfaced some insights, it was time to brainstorm some ideas that goes beyond just revising the tip sheet. I encouraged our clients to think outside the box— anything from AI to templated feedback emails.
In the future, I would love to do this in person and do some sort of design activity with our clients (instead of just discussion format).
Presenting insights and brainstorming prototyping opportunities.
Converging on ideas and making tradeoffs
Our clients have a wealth of historical and institutional knowledge to understand that some of our ideas will be difficult to operationalize. But the nice thing about the brainstorming session was that they were able to come to an agreement on prioritizing the tip sheet to make it more readable and usable.
SPEEDING AHEAD
First mockup of the Tip Sheet
I took a first pass on mocking up the newly revised Tip Sheet to get some ideas flowing. I incorporated my insights into the design — specifically making the Tip Sheet reflect what is actually on the EHR display (aka “note writer”), which was not done in the previous Tip Sheet. I also made it less verbose and simplified the language.
“Show and Tell” exercise
Instead of me presenting another iteration of the mockup of the Tip Sheet to the clients, I decided to have them do their own version of the Tip Sheet to make it a bit more interactive. At the next meeting, we had a show-and-tell where each client presented their ideal Tip Sheet.
This exercise allowed the team to converge on the elements that are most important to them. It also helped some of them realize that there are many different ways attendings, residents, and fellows learn and adapt to new changes.
Show and tell exercise.
Operationalizing the new design
I originally created the Tip Sheet in Figma. However, one important consideration was to create a template that they can use for other use cases apart from billing and documentation. Since the ZSFG team has access to Canva for free, I redesigned the Tip Sheet in Canva so they can own and get full control of the content.
LOOKING BACK... TO LOOK AHEADKey takeaways from this project:
Even though clinicians don’t have a lot of time, it was still important to find ways to co-create with them. This is also a good mechanism to let them understand the value of co-designing and iterating.
People have various ways of coping with change. It’s important to be open-minded and deeply understand those who may be resistant to change beyond the surface level (ie: “I don’t like this, I think it was fine the way it was.”)
Packaged deliverable — challenges, design process, and outcomes.
Next steps:
Present the new Tip Sheet to all ZSFG residents, fellows, and attendings.
Get feedback and explore other prototyping opportunities.