assistER

Year

2022–2023

Role

UX DESIGNER / SOLO CREATOR

Brief

A mobile app that minimizes frustration and anxiety in noncritical medical patients, and the people accompanying them, during long waits in the emergency room

Overview

Motivation

In fall 2022, I visited the ER for tests during a migraine episode. I waited more than nine hours, and during that time, I often felt ignored or forgotten by medical staff. I considered leaving without being seen. Other patients also appeared frustrated.

ER wait times across the US have been trending upward for decades. During the COVID-19 era, they reached an all-time high, with reported cases of up to 48 hours.

Problem

Long ER wait times correlate with decreased patient satisfaction, which makes patients more likely to leave without being seen and to avoid returning even if they need medical help. This puts their health at risk.

Process

People from all walks of life visit the ER and for many reasons. To ensure that I’d adequately meet users’ needs, I followed an intensive, iterative design process.

Solution

assistER is a mobile app that minimizes frustration and anxiety among noncritical patients, and the people accompanying them, during long waits in the ER or other medical settings.

It serves as a streamlined platform for real-time updates, including estimated wait times, alongside features meant to help users be more proactive in gathering and sharing information.

Research

Secondary Research

I certainly had feelings about my own ER experience, but if I was going to design a product for more than myself, I needed to understand ER wait times in a broad context. I sought out existing data related to ERs from the past 10 years, consulting medical journals, news stories, and health care websites.

Key Findings

  • ER wait times in the US are longer than ever and increasing

  • Long wait times increase patients’ stress and decrease satisfaction

  • Dissatisfied patients are less likely to follow through with ER care

  • Patients’ stress might be mitigated by keeping them better informed

“Among the most stressful situations you may ever experience is sitting in the waiting area of a hospital emergency room while you or a loved one is in pain and discomfort from a sudden injury or illness. By its very nature, you may think, an emergency room is a place where waiting for care should never be necessary.”

— The Health Nexus, “In Case of an Emergency: ER Wait Times Explained and More”

Competitor Analysis

I also needed an overview of digital products already being used to communicate with people in the ER. I focused my attention on two types of mobile apps.

MyChart

Healow

Patient Portal Apps

Widely used by health care systems, principally for sharing patients’ medical history. MyChart and Healow are the two most prominent.

Features

  • Capture patients’ medical history

  • Real-time test results and updates

  • Extensive functionality, including messaging, medical literature, and appointment scheduling

Limitations

  • Don’t directly address the waiting experience

  • Complex, even labyrinthine interfaces

  • Potentially overwhelming quantity of features

Ease

Medical Communications App

Ease is a new app marketed to health care systems for communicating specifically during medical visits.

Features

  • Streamlined, intuitive interface for receiving and sharing updates from medical staff

  • Supports text-based and video messages

  • Platform for video conferencing

Limitations

  • Principally passive user experience focused on one-way communication from medical staff

  • Doesn’t capture medical history

  • Few functions and no use outside medical visits

Survey

To build upon my understanding of ERs as a problem space, I conducted a survey of people who had been to the ER in the US within the previous two years. I discovered who the principal ER users were and their top challenges.

Principal ER users

  • Patients in noncritical condition

  • People accompanying patients in noncritical condition

Top Challenges

  • Long wait times

  • Not knowing how long the wait would be / frustrating paperwork

  • Unhelpful or rude medical staff

Interviews

Of course, statistics can convey only so much about human experience, so I interviewed six survey participants, discussing their pain points in depth.

Subject Characteristics

  • Visited the ER in the US at least once in the previous two years

  • Either was a noncritical patient or accompanied one

  • Between ages 18 and 45

Chief Pain Points

  • Stress caused by lack of information about long waits

  • Failure to utilize time while waiting

  • Feeling neglected or forgotten by medical staff

“I got kind of panicky, just because I didn’t know what was going on ... I didn’t know what the course of action was. I didn’t know what to expect. I didn’t know anything. And so already sitting there in pain worse than any I’ve really felt hardly ever, and then not being told anything about what’s going on with me ... It added to the fear.”

— Interview Subject

Affinity Map

To translate the interview data into a direction for product design, I categorized everything that the interviewees’ had said according to commonalities.

Shared Traits of People Waiting in the ER

  • Strongly dislike having to wait for a long time

  • Want to know the expected length of the wait

  • Want to know why the wait is so long

  • Don’t know how best to spend their time

  • Are frustrated by lack of communication from medical staff

  • Dislike having to go to staff to ask questions

  • Want an easy, unobtrusive way to ask questions

  • Want information to share with family, friends, etc.

User Personas

Based on these shared traits, I developed two user personas, one for each of the two major types of people who use the ER, to keep my thinking centered on user needs, not just my own frustrations, while designing an app.

The Independent Patient

  • Young professional

  • Has a relatively minor ongoing health issue

  • Typically goes to the ER by themselves

Goal

Receive medical attention and return to normal life as quickly and painlessly as possible

Wants

A simple way of gathering details of their ER visit to understand the scope of the visit, utilize their time while waiting, and update coworkers and loved ones

The Supportive Partner

  • Young professional

  • In a relationship with someone who has a relatively minor ongoing health issue

  • Typically goes with their partner to the ER

Goal

Provide support to help their partner return to normal life as quickly and painlessly as possible

Wants

To know the basic details of their partner’s ER visit to understand the situation so they can best help their partner and not have to ask lots of questions

Design

Ideation, Round 1

In a series of rough sketches, I began brainstorming possible ways to help the user personas achieve their goals, entertaining even fanciful ideas such as a cartoon virtual assistant and guided meditation exercises for stress relief.

User Stories

As part of the ideation process, I outlined the ways users might engage with an app during the stages of an ER visit, from creating an account to following up.

Ideation, Round 2

Having plotted out and prioritized possible usage situations, I selected the most practical ideas to explore further. My sketches started to revolve around a dashboard displaying the user’s place in line. Other functions included a chatbot for asking questions and the ability to share visit details.

Information Architecture

A design direction was coming into focus, so it was time to map out the functions of the app to determine what screens I needed to design and how they connected.

User Flows

I also thought through the most straightforward ways a user might navigate the app to reach their goals, which helped prioritize the screens I needed to design.

Paper Prototype

I sketched all the main screens and built a clickable prototype in Marvel POP so I could test a rough version of the app on users and gather feedback for refinement before moving on to more sophisticated design software.

Guerilla Testing

I conducted in-person usability tests with five people, asking them to imagine being in an ER and using the app. I gave them a series of tasks to complete.

All participants successfully completed the tasks and praised the app’s simplicity. This confirmed the direction of design. Participants also suggested a number of minor improvements in the features.

“I like the simplicity of [the app]. I don’t think that hospital apps should be complicated.”

— Test Subject

Moodboard and Style Guide

With the basic shape of the app set, the next step toward a full prototype was to determine the aesthetic, including colors and typography. I gathered imagery reflective of key ideas that the app would need to convey to users.

Ideas

  • Clear guidance

  • Comforting assistance

  • Reliability

  • Partnership

Imagery of people supporting each other, giving directions, and being helpful suggested a calming, muted color palette and simple, unadorned visuals. 

UIs

UI Evolution

Moving from the paper prototype to a final design was a careful process with many stages. First, I rebuilt the UI in Figma, incorporating feedback from guerilla testing. Then I explored visual variations based on the style guide.

Key UIs

Initially, UIs were designed to immediately address only the pressing user needs. But as they were revised through feedback from usability tests, the UIs became streamlined and more intuitive, and additional features, such as the ability to request prescription refills, were built to compliment existing ones.

Home

A hub for the user’s current ER visit

Wireframe

Final Prototype

Key Features

  1. Prominent status indicators that help the user to understand the state of their ER wait at a glace, including place in line and expected wait time

  2. Access to important features that help the user to be more proactive during their wait, including personal notes and an interactive building map

  3. Access to standard data about the current ER visit, including test results

Ask Blue

A chatbot that answers users’ questions and prevents overreliance on medical staff

Final Prototype

Wireframe

Key Features

  1. Users can type questions or select standard and frequently asked questions from a list rather than type everything from scratch

  2. Offers standard and readily available answers, alerting staff only to complex questions or urgent needs requiring assistance

My Notes

A place for users to record information for personal use or to share with contacts

Final Prototype

Wireframe

Key Features

  1. Users can write text-based notes or record voice memos

  2. Users can share notes with their contacts

Validation

Usability Testing

I conducted two rounds of usability tests for the high-fidelity prototype, revising after each round, to confirm previous revisions and continue ironing out minor issues. I recruited five participants per round and gave them tasks.

Round 1 Key Findings

  • All participants successfully completed the tasks, validating the design

  • Participants appreciated the proactive features and suggested more

  • Participants asked for more specificity about what the “Share” feature was actually sharing or for control over what was being shared

Round 2 Key Findings

  • All participants successfully completed the tasks, validating revisions

  • Participants at first didn’t understand that the “Home” screen pertained just to the current visit

  • Participants were curious about what the home screen would look like outside medical visits

“I liked the simplicity and straightforwardness of the information. It was very clear where I was supposed to go to get what I needed.”

— Test Subject

Final Prototype

Insights

Be attentive to diminishing returns

The amount of data related to ERs is vast. The secondary research phase of this project could have gone on forever, but the more sources I consulted, the more they corroborated the same basic things. It was time to move on.

Some issues should be bracketed

Patient privacy policies are extremely complicated. My project might have been derailed if I’d tried to account for them fully. Instead I made an app for an ideal world that demonstrated user demand and could be tailored later.

Engage users in the way they want

Many digital products are designed to keep users engaged, but with some problems, such as medical emergencies, what’s truly delightful to users is a product that gives them what they need quickly and doesn’t beg for attention.