Video Visits at Scale

I needed to conceive a platform that could scale video visits across an entire hospital group and integrate with the existing systems hospital used to manage inpatient visits.

My team and I spent the first 2 weeks of the project understanding an hospital's outpatient visit workflow in order to articulate the problem there was to solve. 

In-patient visit: the specifics

An outpatient visit involves a sequence of interactions with multiple staff members (e.g. front desk, nurse, doctor). The number of interactions and the task performed is a function of the type of visit performed. And the sequence of interactions is enshrined within the visit management systems used by the hospital. The queue of an inpatient visit had considerably more variables than a classic video conferencing system like ours could cope with.

Video conferencing's limits 

Our video application handled visits like a single doctor would receive a patients in her consultation room. She called the next patient in line when the previous patient had left. If she had to leave the room for a nurse to perform an examination she had to contact a specific nurse, ask the patient to step out, let the nurse in so she give him the keys and then could leave, and only then the patient would be called back.  Medical video visits had integrated a videoconferencing paradigm made for a "one to one" interaction. We needed to make it suitable for a "any to one " interaction.

Give them a room

We abstracted the inpatient visit to its most essential components and found that the central component of a visit is the patient. Inspired by the final step of an hospital consultation where the patient is left in the examination room and several staff members take turn to perform enter the room and perform a specific task, we found that every patient should have their own personal and permanent video room.  

The appointment calls the shots

Then we found the appointment to be in fact the organizing entity that passed on the key to the room to the relevant staff. By retrieving an appointment definition from the hospital we could line up all the participants according to their roles and in the right order. And we would minimize human input regarding transfer of video session ownership.

We now needed to organize a queuing system that would be robust enough to handle the plethora of potential issues related to video conferencing.

BoaRd Game about queues

We modeled the visit--in the form of a board game--to test realistic interaction scenarios. 
We then introduced typical issues associated with video conferencing and medical visits. We accounted for technical problems but also staffing issues. The way large airports manage flows of passenger and staff was a great source of inspiration for this project.

PatientS who vanish and reappear

We had to make a queue system that worked for a patient that could disappear from the queue or the consultation unexpectedly. An hospital visit is emotionally charged, patient and doctor don't have much patience for troubleshooting teleconferencing issues. 
We noticed that there was an emerging problem during an in-person visit troubleshooting was done organically: if a doctor failed to show up the nurses and admins would talk to each others and make calls to resolve the issue. With a video visits and and staff who would most likely be working remote we needed to build a solution to resolve emerging issues.

To manage these issues we conceived a three tears Safeguard:
1 - a first layer provides an interface that informs about the client status, and highlights issues and their known origin,
2 - priority lines that helps staff rerouting patients where they need to be,
3 - third tear that allowed staff to communicate among each others or directly with a patient using text or VoiP.  


The final step of this three month project was to translate the theoretical research into a mock-up that we would give to our health systems (hospital groups) partners for review.

After building an exhaustive list of experience and feature requirements the team built clickable wire frames that demonstrated the primary paths for handling a visit.

Our intention was to dive relatively be deep and produced a mock-up that provided a realistic flow for multiple staff role over a consultation and how they could emerging issues.  We role played a number of scenarios simulating a disconnection, a rerouting, a missing staff member. 

The prototype was presented to our our development partners and was well received. 
The project was then passed on to a development planning phase and involved a deeper technical assessment of the features we proposed. 


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