What is MedRec (Medication Reconciliation)?
One thing we learned while working with the staff at MD Anderson was the importance of tracking the medication each patient was taking. This sounds like a simple aspect of care for the patient but working with our users, we learned it was much more involved than we had thought. The MedRec app was a solution to the cumbersome and manual process of tracking meds in the EMR (electronic medical record).

My role and business objective?
The business objective was to create a solution that would address the painpoints in the current medication reconciliation process at MDA. My roll was to interview internal IBM physicians and shadow nurses at MDA while they conducted a reconciliaition of a patient’s medications. Then I created proposed user flows and design solutions to my team, which included development and management.

The key users and how they were identified?
Our team was very fortunate in that we had sponsor users at MDA who we had already been working with for the Oncology Expert Advisor solution. When a patient goes for an evaluation at MDA, they must report every medication they are on. This is a standard part of every visit. Although, due to privacy issues, I was not able to shadow the care giver with the patient, I was able to interview the care giver in the examination room as she walked me through the process. The data I gathered from this interaction was an integral part of the design solutions I proposed to the team.

How I practiced IBM Design Thinking
Although at this point in time, we were not conducting design thinking workshops at MDA, I was able to interview the users and bring my data back to IBM so that I could start to create proposed user flows to the team. We are very fortunate to have physicians on staff at IBM that I could question as needed. The process of med reconciliation is, for the most part, the same across all facilities but cancer facilities have the added challenge of balancing multiple medications with the patients’ cancer protocol. They also often deal with elderly patients who may be under the care of a family member and do not always know what they are taking.

Using the needs statements of an actual care provider of a cancer patient, we created requirements for the app.

The actions I took
Through research and user interviews I learned that a big part of medication reconciliation is finding duplicates. Very often a patient may be taking two medications that perform the same result. Sometimes this happens because the patient has added an over-the-counter medication. Sometimes they have a generic and brand name of the same medication.

It’s important to keep a “chain of custody” for a patient’s medication list. Often patients see multiple doctors and don’t report the medications they are on. This puts the patient at risk for harmful interactions that may cause adverse reactions. If a patient is having an adverse reaction the medication must be stopped. Or sometimes they just stop taking the medication on their own.

With this knowledge and data, the team created a corpus that contained an endless amount of data on drugs. It was up to me to create the front end UI for the user.

What artifacts I created and the key principles I applied
On the back end, Watson created a way to show users the duplicates and possible hazardous interactions in a patient’s medication list. To keep the “chain of custody” we added a feature to create clinic notes to show reasons why a drug was deleted or added for the patient. While a care giver reconciles a patient’s medication list, it’s important that he can always view the original list while working on the updated list. When he’s ready, he can save the the new list.

Another thing that was important was to show the "class” of each drugs. Drug classes are often how the care giver finds interactions. Different classifications interact with one another. So, we let the user view the list alphabetically or by class. They could also sort by duplicates which would float the duplications to the top of the list.

For this project I provided the development team with graphics, blueprints and a user flow. We iterated together while development and design overlapped to create a solution that was best for MDA.