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Hemodialysis

Educate the patients to do hemodialysis at home

- UX Research, Design Thinking & Human Interaction Design
- Design Thinking

Timeframe

Jan 2020 – Aug 2020

Team Members

Vinethaa Krishnaswamy Govindaraj, and Omar Mohamed

Industrial Collaborators

St. Joseph's Healthcare, Hamilton, Ontario, Canada

Project Summary

Chronic Kidney Disease is a condition that gradually decreases the function of kidneys over time. Dialysis is required when the patient’s kidneys are functioning below 30%. Hemodialysis is the process that uses an artificial kidney (dialyzer) to remove waste and extra fluid from the blood. The patients can do the hemodialysis process independently at home. The project is about designing a solution that encourages the patients to prefer Home Hemodialysis over in-clinic dialysis by improving their training experience in a way that makes them feel more comfortable to dialyze by themselves.

Specific Problem

Home Hemodialysis patients experience difficulties in machine set up, troubleshooting and self-needling while doing the dialysis process independently at home because of the lack of a proper instructional manual. It makes them feel intimidated and choose the simpler option which is to be an in-clinic patient.

HMW Statement

How might we help the dialysis patient to do hemodialysis independently at home?
How might we increase the number of beds at hospital?
How might we make the dialysis process simple and easy to understand for patients with different ages?
How might we reduce the cost that spent on dialysis by Ontario government and hospitals?
How might we convert in-clinic patients into home hemodialysis patient?

Specific User

Hemodialysis Patient

Solution

Developed a mobile application which has an interactive digital manual with AR design that walks through every step of dialysis process and educates the patients by providing a practical experience. It improves the learnability, memorability and rememberability of the patient with respect to machine setup, needling, treatment monitoring, troubleshooting and cleaning. It helps the patient to do the dialysis independently at home.

My Role

  1. Interviewed the patients who are currently doing in-clinic dialysis
  2. Gathered data and created empathy map, user personas and journey map to identify deeper needs
  3. Developed current and future scenario storyboards. Collected feedback and improved the storyboards
  4. Provided insights in building machine setup wireframes via brainstorming activity
  5. Created the AR Needling wireframes using Adobe XD, Sketch, Photoshop, & Invision and did the usability testing via Zoom call with patients (due to COVID19)

Methodologies

User Research
How Might We and What If questions?
Storyboards, Finding Analogy
Design thinking and Human Centred Design Principles.
User Flow Chart & Journey Map
Wireframes and Usability Testing

Tools

Adobe Illustrator - Logo design
Adobe XD, Sketch - Wireframe
Invision - Prototype
Mural - Online Design Work Space

Overview of Design Process

Design Process in detail

User Research

Visited the dialysis unit at  St. Joseph Hospital, King Campus, Hamilton, and explored the home hemodialysis machine that is currently used by the patients. To know the patient’s pain points, with the help of Nurse Trish’s guidance, we started setting up the dialysis machine by referring to the manual.

Bubble Diagram

Interviewed the stakeholders of the project, interacted with the patients at the hospital. Noted down their difficulties.

Stakeholders Map

Quotes from stakeholders

"I did not find much difficulty in machine setup tube connections but as a newbie, I experienced difficulties in troubleshooting, needling, and cleaning processes. In particular, the self needling was challenging ”
                                                                  - John Brown, a new Home Hemodialysis patient, St.Joseph’s Healthcare Hamilton.
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"I do the connections by reading the instructions from the manual. I find it hard to read and connect the machine simultaneously. Since the steps are not easy to remember.”
                                                                  - MarieAnne, wife of patient Paul, who is in-clinic Hemodialysis training.
‍
“The instructions manual is designed by experienced medical professionals for the nurses, thinking that the nurses are the only users of the manual. So the patients without the medical knowledge find it difficult to understand and the manual was never updated since the initial release.”
                                                                - Trish Smith, Charge Nurse, St.Joseph’s Healthcare Hamilton.
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“The patients do not know the medical terms or the components' names since the manual does not have pictures to refer to so it is difficult for them to describe the problem and understand the solution over the phone call.”
                                                                               - Denis Rabbat, Technical Manager, St.Joseph’s Healthcare Hamilton.
‍

From the user interviews, we have gathered the patient’s pain points

Pain Points Identification

User Persona & Empathy Map

Created user personas to describe the patient’s behaviour and the barriers that stop them from achieving the goal.

User Persona

Name:
Peter
Age:
68
Occupation:
Supervisor at The Home Depot
Needs/Concerns:
Setting up the dialysis machine, doing self needling and finding out the issue in the middle of the dialysis process to turn off the alarm sound (troubleshooting) are the reasons that stop me from choosing home hemodialysis.
Goals:
I would like to spend more time with my family and friends. All my days in a week are filled with dialysis treatment including weekends. I miss my family.

User Persona

Name:
Sofi
Age:
50
Occupation:
Teacher
Needs/Concerns:
I'm facing trouble with self needling part. It is very hard to learn the process and getting comfortable.
Goals:
The dialysis process not only affected me but also my family members who are helping me with needle insertion and needle removal process. I need to be independent and make my family members happy.

User Personas

Empathy Map

The empathy map is created to identify the patients' deeper needs

Empathy Map

User Journey Map

From the user persona, Empathy map and stakeholders interview we identified the issues and listed them below
  1. Machine setup is a foundational problem
  2. The instructional manual is not user friendly
  3. Solving and finding a solution for machine setup & instructional manual will help themeasy troubleshooting
  4. The fear of needling because patient’s don’t know the right spot & angle to insert theneedle
To address these issues, It is important to understand the patient’s complete dialysis journey

Home Hemodialysis Patient’s Journey Map

From the journey map, we identified two key insights
  1. 21 day one on one in-clinic dialysis training is given by medical professionals after the patient choose home hemodialysis option
  2. Why do patients feel uncomfortable even after trained by medical professionals for 21 days?
To get the answer, we started exploring the problems that the patient faces with the current dialysis process and came to know that the patient uses the same instructional manual since they can’t remember all the steps.

    Problems with current Training

    Developed our insights using a design concept called “Analogies”. We used three analogies to know about ​what is it like to learn how to self-dialyze? and how do we want our pre-training to feel to our users?

    Trying a MacBook in an Apple Store
    - Experience

    Learning By Playing
    - Games & Interactions

    Training Wheels
    - Pre-Training

    From the analogies, we developed our insights and implemented the design solution in their waiting period as a pre-training phase or prep-phase.
      Ideation
      We divided the dialysis process into five stages machine setup, needling, treatment monitoring, troubleshooting, and cleaning. Explored the potential solution for each stage of the dialysis process.
      Machine Setup:
      AR Needling
      Troubleshooting
      Monitoring
      Cleaning

      Prototype

      Explored possibilities for each stage in ideation phase. Created prototype for machine setup and needling using Adobe XD.
      Machine setup:
      AR Needling

      Usability Testing

      The usability testing was done by following the “Think Out Loud”  process. The zoom call has been recorded. The interaction with the app by the patient was observed and after the testing, the questions were asked to know the reason behind their every move.

      Delivering Final Design

      1. Implemented the instruction option for each screen as per the patient’s feedback
      2. Improved the application flow and visual appearance
      3. Designed the app with more interaction - (two way)
      1. Trying MacBook on Apple store
      2. Learning By Playing
      3. Training Wheels

      Project Success

      1. The prototype and other design solutions are not only used by patients but also by the healthcare training professionals.
      2. The project design solution satisfies the hospital need, healthcare team need, and patient’s need. Additionally, it is used for educational purposes for junior healthcare professionals.

      Challenges

      1. Due to COVID 19 pandemic, the hospital site visits are not allowed. So, the project heavily depended on online tools like Zoom, Microsoft Teams, and Mural Design Space.
      2. Finding the correct analogy and transforming it into an edible design solution was challenging.
      3. Understanding the patient journey was challenging because the information providers (healthcare team professionals) were too busy with COVID19. So it affected our scheduled meeting

      Key Takeaways

      1. More options in the design will result in more complications so keep it simple
      2. Think simple
      3. Collecting user feedback at the end of every step will definitely add value to the final design quality
      4. The user doesn’t put extra effort to learn or remember something completely new. So, it is important to design something that is easy to remember, navigate, and complete the task by themselves without depending on others

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