This case describes the agile management methods for an iPhone software development project. The overall objective was to design a smartphone solution that allowed surgeons access to dynamic Electronic Health Record (EHR) data to optimize their workflow. Three separate organizations distributed the responsibilities. Specifically, the lead organization, Cerner Corporation, collaborated with the University of Missouri Health Care and University of Missouri Information Experience Lab to create the technology. Project goals included increased surgeon satisfaction; improved task efficiency, as measured by time spent retrieving lab and vital sign data on morning rounds; dynamic data accessibility; and increased revenue from new product sales. To accomplish these goals, agile project management was utilized, applying iterative usability methods to create deliverables within a short development cycle. Each development cycle focused on user-centered design principles. Several challenges were encountered related to the user-centered design methods, usability data extraction, academic collaborations, and interface design choices.
Setting The Stage
Across the US, hospitals and large healthcare organizations have been progressively adding sophistication to their use of health IT. By and large, the technical capacity for sharing health information across different Electronic Health Records (EHR) is in its infancy. Federal incentives have promoted the development of health information exchanges, but they are in the early developmental stages, often limited to data exchange within a single vendor, and limited to a highly constrained core data set and exportable/importable CCDA (Consolidated Clinical Document Architecture). Since 2003, University of Missouri Health Care (UMHC) has been using at least some components of the Cerner product line. New functionality had been added stepwise over the years. Electronic availability of lab and imaging results were widely used among all physician groups. However, electronic clinical documentation by physicians was uneven, with family medicine and internal medicine among the early adopters. Some departments had special documentation needs (e.g. photographs, research protocol documentation, etc), which slowed the initial adoption of electronic clinical documentation. Physician satisfaction with the product line was low, because of concerns about system responsiveness, dependability, and learnability of the complex EHR. Other concerns expressed by the physician EHR users included: Slow responsiveness; poor dependability; large increases in time demands for daily record keeping; poor information display and general usability; and poor matching of features to user groups’ workflow needs. As such, Cerner had begun vigorous efforts to improve dependability and responsiveness on a corporate level.
As the Living Lab team considered new opportunities, four domains were considered: Market opportunities, new technology capabilities, local UMHC needs, and product-line gaps not being addressed by the larger Cerner organization. In particular, a mobile application (app) aimed at the needs of surgeons seemed a good fit. Surgeons in particular were unlikely to carry personal laptops in their daily workflow of early morning rounds and surgical cases (planned and unplanned) throughout the day. Moreover, smartphone apps from a few EHR vendors were beginning to appear, so the competitive environment made it an ideal project for Cerner to undertake.