Design In Health Care Software

I have worked for over 25 years creating and building IT applications for large and small companies. Designing with purpose feels more critical in Health Care than any other industry I’ve worked in.

Keriton started as a pair of mobile applications focused specifically on Breast Milk Management.  We managed inventory and ensured feeds were validated for safety and to catch any “near-misses”.  Considerable time was spent working directly with the NICU staff  to ensure our product was a perfect fit for their workflows. This relationship evolved from being transactional into a partnership.  We listened to and worked with these partners as we expanded our offering to do more.  While managing Breast Milk is not a simple problem, the complexity, both technical and design, grows significantly with additional substances (e.g. Donor Milk and Formula)  and different user personas (Milk Techs, Analysts, Admins, etc).

While many people believe the purpose of design is to make something beautiful, we feel the purpose of design is to enhance usability. Here’s a great definition:

Design is a craft and a discipline that applies a specific mindset and skillset to a creative problem solving process. Doing so, leads to the development of informed, inclusive, purposeful, compelling, and innovative solutions.

See: Design for Health – Bill & Melinda Gates Foundation.

Following this human-centered approach is what made Keriton originally so appreciated by our users. We worked very hard to design with purpose and not only meet the requests of our users, but to turn their feedback into features that exceed their expectations and fit smoothly into the clinical workflow.  Sometimes this requires us to push back on the feature request to understand the hidden reason for the request. Many times this requires us to ask the same question in slightly different ways, or to build prototypes so we can demonstrate the potential workflows to help users visualize the possibilities.

We have the advantage of in-house subject matter experts: senior nurses with decades of experience in the kinds of hospital units we support. Although I can claim a certain degree of technology expertise, I rely on these SMEs to explain what’s important in these workflows, and where the pitfalls are. In this time I’ve learned more about infant nutrition than I ever knew there was to know.

A non-standard example of how we worked to improve our design can be found in how our technical team combined with our SMEs worked with one of our clients to solve a supply chain problem.  Keriton initially required that all manufactured products be labeled in order to track key details like lot # and expiration date.  This works great for cans of powder and jugs of donor milk, but for this children’s hospital it was an issue to have to label hundreds of small ready to feed formula bottles.  Luckily, we realized that the required information was already on the bottle as part of the GS1 GTIN.  We accordingly updated our applications to be able to scan and use this information so that Keriton could still complete all the safety checks, but bottles only needed to be labeled if they were not used.  This saved hundreds of hours in the warehouse and improved the usability of Kare Nurse in the clinical setting.  

Our current undertaking is how we reinvent our discharge process to account for all the permutations that occur in how inventory is handled. 

One of the things I’ve found is that new features create new demands. There’s a quote attributed to Steve Jobs, “A lot of times, people don’t know what they want until you show it to them.”  I’ve found this to be true, and it’s exciting to be able to demonstrate a prototype to someone who suddenly needs a particular feature right that moment.

Hospital IT systems are not typically known for their flexibility, but because our products are SaaS (Software as a Service), we are more agile than legacy systems and deliver needed features much more quickly. 

Our users are always eager for new features. But we know that feeding premature infants is not the place for a throw-it-against-the-wall ethos . We do software testing in our development environment before we engage our customers to test with us in their per-hospital staging environments. Only after we have completed rigorous testing — that includes all the weird corner-cases we’ve found over the years — will we deploy to each hospital’s staging environment. As it’s all about “feeding the babies” for us, we choose deployment times between the scheduled feeds for the hospital’s smallest patients.

Dan Kelley is Chief Technical Officer for Keriton.