assistER

A mobile app helping noncritical patients navigate their emergency room experiences

Overview

Motivation

In fall 2022, I visited the ER for tests related to a migraine. I waited more than nine hours and often felt ignored or forgotten. Other patients also appeared frustrated.

Problem

Across the US, ER wait times have been trending upward for decades. During the COVID-19 pandemic, they reached an all-time high. Long ER wait times correlate with decreased patient satisfaction, which makes patients more likely to leave without being seen or to avoid returning even when they need to. This puts their health at risk.

Solution

assistER is a mobile app that minimizes frustration and anxiety among noncritical patients, as well as the people accompanying them, during long waits in the ER by keeping them well informed through real-time updates, alongside features meant to help them be more proactive.

Process

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

Research

Secondary Research

I certainly had feelings about my own ER experience, but 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 medical 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”

Competitive 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.

Patient Portal Apps

MyChart and Healow are the two most prominent, widely used by health care systems.

Features:

  • Capture patients’ medical history

  • Real-time test results and updates

  • Extensive functionality, including messaging

Limitations:

  • Complex interfaces

  • Potentially overwhelming quantity of features

Medical Communications App

Ease is a new app for communicating with patients during medical visits.

Features:

  • Streamlined interface for text and video messages from medical staff

Limitations:

  • Principally passive user experience

  • 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. This helped me to identify the principal ER users 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 past two years

  • Was either 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 the things 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 a simple, unobtrusive way to ask questions

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

User Personas

I developed two user personas based on these shared traits, one for each of the two major types of people who use the ER, to keep my thinking centered on user needs while designing an app.

The Independent Patient

  • Young professional

  • Has a 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 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 minor ongoing health issue

  • Typically goes with their partner to the ER

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

Wants to know the basic details of their partner’s ER visit so they can best help their partner without having 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.

User Stories

I outlined the ways in which 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 uses of the app, I selected the most practical ideas to explore. My sketches revolved around a dashboard showing the user’s place in line.

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 in which a user might navigate the app to reach their goals, which helped prioritize the screens I needed to design.

Paper Prototype

I sketched the main screens and built a prototype in Marvel POP so I could test a rough version of the app on users and gather feedback 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, confirming the direction of design.

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

— Test Subject

Moodboard and Style Guide

The next step was to determine the aesthetic of the app. I gathered imagery reflective of key ideas that the app would need to convey to users.

  • 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. 

Inferfaces

Interface Evolution

Moving from the paper prototype to a final design was a long process with many stages. After I built the interface in Figma, I explored visual variations based on the style guide.

Key Screens

Home

A hub for the user’s current ER visit

Features:

  1. Prominent status indicators that help the user to understand the state of their ER wait at a glance

  2. Access to important features that help the user to be more proactive during their wait

  3. Access to standard data about the current ER visit

Ask Blue

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

Features:

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

  2. Offers standard 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

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 on the high-fidelity prototype, each with five participants completing a set of tasks that helped me identify room for improvement.

Round 1 findings:

  • All participants successfully completed their tasks, validating the design

  • Participants appreciated the proactive features and suggested more

  • Participants asked for more control over what the “Share” feature shared

Round 2 findings:

  • All participants successfully completed their tasks, validating the revisions

  • Participants at first didn’t understand that the “Home” screen pertained 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

Prototype

Insights

Be aware of 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 said the same things.

Some issues should be bracketed.

Patient privacy policies are complicated. My project might have derailed if I’d tried to account for them fully. Instead I made an app demonstrating user demand that could be refined later.

Engage users in ways that matter.

Apps are often designed to keep users engaged through gamification, etc. But situations such as medical emergencies, what users need is a product that doesn’t monopolize their attention.