CASE STUDY:
MedWiz eMAR

INITIAL RESEARCH

For the MedWiz eMAR System, we began our research by learning about the paper documentation the digital system would be replacing. We studied paper Medication Administration Records, prescriptions, inventory logs, and other documents and processes used to manage medication in assisted living environments. We conducted interviews and contextual research with facility administrators, medication room employees, nurses, doctors, pharmacists, and pharmacy technicians to get a thorough understanding of how medications are prescribed, filled, administered, and tracked. While on-site at multiple assisted living facilities, we saw firsthand not only the processes, but the environments and conditions in which the system would be used.

USE CASES / JOBS TO BE DONE

During and after the initial research phase, we defined the use cases the system needed to address. Each basic task was refined and broken down. We developed personas for physicians, med room staff, supervisors, pharmacy staff, etc.

The use case development process basically consists of asking questions, proposing and testing out scenarios, and thinking of contingencies. Use cases continue to be revised throughout the process when there is new information or technology or scenarios we didn't catch initially.

Some of our broad use cases for the eMAR began as:

• A prescription is input into the system

• A prescription is scheduled to be given at appropriate times

• Medications are marked as either “Given” or “Not Given”

• A refill is requested from the pharmacy

• A reorder is requested from a physician

A partial expansion of "A prescription is input into the system" looked like this:

• A physician creates a new prescription

  • • A physician creates an order for a controlled substance

    • A physician creates an order for a drug that is in the drug database

    • A physician creates an order for a drug that is NOT in the drug database

    • A physician tries to create an order for a drug the patient is already taking

    • A physician tries to create an order for a drug that has an allergy or interaction warning for the patient

DESIGN...PROTOTYPE...TEST...REFINE

Use cases, workflows, and personas helped us get a good sense of the big picture we were designing for. Sketches of initial ideas turn into refined wireframes and screen designs. As quickly as possible, we began linking screens together to make click-through prototypes. Feedback is essential throughout the design process.

We worked through design ideas and prototypes with developers to ensure technical feasibility and to generate new ideas. As soon as possible, we got prototype ideas in front of folks who would be using the system. Depending on the fidelity of the prototype, the feedback process could be a guided walkthrough or something more like a usability test.

This testing and refinement process helped us get to better solutions. For example, we learned that using tabs on the med pass screen was preferable to scrolling or cycling through pages. Workers needed to jump around to find things and tabs were easier for them.

DELIVER

The design and refine process continued until we were able to get enough of the system built to be a cohesive solution for a med room to begin using.

The MedWiz Technologies eMAR System was built using Ruby on Rails and was initially launched into a first facility in 2009. The dev team size ebbed and flowed with 3 devs on staff supplemented by 3-4 contract devs at various times. We continued to work iteratively after initial launch, adding and refining features.

It is still currently in use by over 30 facilities in multiple states to record medication passes, manage medication inventory, and coordinate with physicians and pharmacists.