Follow-Up Visit Experience

98point6 Inc

The follow-ups project creates a new experience in the 98point6 app by adding the ability for a patient to follow up on a previous visit in a streamlined way.

Problem

98point6 provides text-based primary care delivered through a mobile app, and is looking to create a follow-up experience for their patients. There is currently no way for patients to follow-up on a previous visit. Patients must start a new visit and explain why they are back. This is a poor patient experience, and also takes up valuable physician time. The goal of this project is to create a follow-up experience for patients that is streamlined, and meets their needs while maintaining efficiency for the physicians.

role

I served as the User Experience Researcher on the Patient Experience team for this project. I worked closely with a User Experience Designer and my responsibilities included conducting generative research to guide the initial designs as well as evaluative research to test the designs.

SUmmary

This project created a new experience for patients; allowing them to complete a follow-up visit on a prior visit. In designing this experience, several rounds of research were conducted to understand the needs of the patients, and evaluate designs before launch.

EXPLORATION RESEARCH: Generative

I conducted generative research to kick off this project. This round of research focused on answering the below questions. These questions were compiled based on stakeholder input. After gathering all of the open questions from stakeholders, I generated the following research questions to focus on during the exploration research phase.

1. Do patients see follow-ups as a valuable and useful feature? 

2. What are the reasons for typical follow-ups? 

3. How do patients feel about following up with a different physician? 

4. What kind of reminders make sense in this situation?

5. What types of visits do patients typically need to follow-up on?

6. How long after a visit is reasonable for following up?

7. Do patients need the ability to follow-up on any visit, or should this be limited to when the physician decides it is necessary? 

8. At what point do notifications become more frustrating than useful? 

These questions were answered thorough a couple of methods. A user survey was conducted with 20 participants who had completed a visit in the last month. A literature review was completed to look at existing industry research in the area. Finally, a data analysis of repeat 98point6 visits was completed.

Exploration findings and recommendations

SUmmary of findings

• All participants found follow-up visits to be useful in some way.

• The majority of people have needed some sort of follow-up care in the past 2 years.

• The most common reasons for a follow-up are to ask a question, discuss lab results, and because symptoms are not improving.

• There is a strong preference for scheduling a follow-up with the same physician rather than getting on-demand care. The most common reasons for preferring the same physician for a follow-up were familiarity with the case,  consistency, and existing rapport.

• Roughly 60% of surveyed participants like the idea of a physician office sending push notifications for the purpose of messages, appointment reminders, or checking in on them. 

top recommendations

• Continue to prioritize the follow-up project as a way to extend continuity care and create a feeling of end-to-end care. Consider targeted outreach for follow-ups rather than broad. 

• Be sure to consider the various reasons for potential follow-ups, as members will expect these to be available.

• Make it a priority for physicians to be able to quickly get up to speed on the initial visit. Prioritize ways for physicians (or bot) to easily make a personal connection with patient.  

• Proceed carefully with the implementation of notifications. Allow simple user level configuration.

• As we start to see follow-ups come in, prioritize our system learning the certain conditions that need follow-up and the time frame associated with them. This will allow us to move towards automation.

• In the long term, design for flexibility where a patient can always create a follow-up, but also allow for physicians to proactively reach out at specific times for some cases.  

design sprint 1

The designer then generated this first iteration of designs based on the findings and recommendations from the exploration research.

evaluative research

The next step was to evaluate the designs from the first sprint through testing. The goals of the evaluative research were:

1. Determine whether the workflow to start a follow-up visit is intuitive and easy to use.  

2. Determine whether the concept of a follow-up on a follow-up is clearly communicated 

3. Determine if users understand how to  complete multiple follow-up visits. 

Task-based usability testing was conducted. The prototypes were tested on a mobile device. Two different scenarios were tested; starting a first time follow-up, and a second follow-up.

SUmmary of findings

• The workflow for a follow-up visit is generally intuitive and easy to use. All participants were able to successfully start a follow-up visit. 

• When a diagnosis changes in a first follow-up, users expect to see that new diagnosis for future follow-ups. 

• Indicating that there are existing follow-ups for a visit is helpful for users finding the right visit for a second follow-up.

• The abbreviation for Upper Respiratory Infection (URI) is not commonly known.

Recommendations

• Consider adding the second diagnosis to the list of recent visits if a diagnosis was changed in a previous follow-up. 

• Update the diagnosis to be more patient friendly as we are expecting patients to make a decision based on these. 

design sprint 2

After the first round of testing, the designs were updated based on the recommendations. The screen where a patient selects the visit they are following up on was updated. The most recent diagnosis was shown to patients with multiple follow-ups, rather than the original. Additionally, the team decided to create patient-friendly diagnosis names for the most frequently used diagnoses, as the system diagnosis proved to be difficult for patients to understand.

Validation Testing

A final round of testing was done to validate the changes made from the first round of testing. We were specifically looking at a situation in which the patient is starting a second follow-up and the diagnosis had changed during the first follow-up. In this study, the task is identical to the task given in the first round of testing in order to validate the changes made.

Results

• 5/5 participants quickly and easily started the second follow-up/

• 0/5 participants expressed confusion about the diagnosis card with a previous follow-up. 

• 2/5 participants expressed that they had to ‘really think’ on the first screen to decide if they needed a follow-up or a new visit because the start a new visit button was so large.  

Recommendations

Based on the results of this study, I did not propose any changes to the follow-up screens. The design changes were validated and the flow was proven to be intuitive. 

impact

16,319 completed follow up visits

Since launch, there have been more than 16,000 follow-up visits completed. This shows the patient and clinical need for follow-ups.

1.05 minutes saved in overall chat time

Follow-up visits save an average of 1.05 minutes per visit in overall chat time. This is a savings for both patients and physicians. This means more efficient visits for patients, which is an important goal of the product.

4.83 minutes of Physician time per visit saved

Follow-up visits use an average of 4.83 less active physician minutes. Saving physician time per visit is a company KPI, and this project was able to make an impact on this goal.

consistent nps score

In the months following the launch of this project, we saw the average NPS score for all visits increase slightly. The average NPS for the three months before the launch of this project was 66, and the average NPS score in the three months after the launch was 69.7. Looking at the NPS for follow-up visits on their own, the average NPS was 67.7 in the first three months after launch. These NPS scores show that the follow-up visit experience was good, and consistent with regular visits.

Positive user Experiences with opportunities for iteration

Post-live research included user interviews with patients who had recently completed a follow-up visit. Feedback from these interviews was generally positive from patients. There were also identified areas for improvement including more customization in the beginning of the visit, and ability to complete some follow-ups asynchronously.

constraints

This project was constrained by both resources from other organizations, and time. We would have preferred to offer a more tailored experience based on specific reasons for following up, but due to engineering resource constraints we were not able to launch with that for MVP. These specific follow-up paths were moved to a second iteration, which is underway.