The Physician Orders for Life-Sustaining Treatment document, commonly referred to as the "PINK FORM," goes from paper
to digital.

TL; DR

Innovation MD approached our product design team with a goal in mind: digitize the ubiquitous form known in the health industry as the "pink  form" into a mobile app. 

The POLST document is important: it contains critical information of a seriously ill patient's end-of-life care specifications. The form is filled out by both patient and health care professional and contains orders that emergency medical responders will refer to during a medical crisis.

While not technically a legal order, POLST supplements the Advanced Directive as it includes treatments that the patient may or may not want before CPR is even necessary.

It is important to note that POLST differs from a patient's electronic health records (EHR) in scope. POLST particularly covers the patient's end-of-life care while EHRs contain more archival information such as medical history, medications, diagnoses and test results.

Building POLST from end-to-end comes with its unique set of challenges. From a product design standpoint, several key issues need to be addressed:

1. The mobile app needs to be intuitive for both patient and health care professional;

2. The mobile app needs to include every section from its paper counterpart;

3. The mobile app needs to be compliant with ADA, 508 and HIPAA regulations, and

4. The mobile app will be positioned as a white-label application.

Jobs To Be Done

Since POLST do not have significant competitors, building its mobile application counterpart necessitates a thorough USMO analysis identifying key users and their motivations for using it. Through group sessions with the client, product owner and the development team, we have come up with the following relevant user stories:

1. As an older patient during a medical visit, I want my treatment preferences to be documented, so that my wishes are respected when I am no longer able to communicate.
   

2. As the decision maker for a seriously ill relative at home, I want to be educated about life care options, so that I may feel confident during his/her treatment.
   

3. As a health provider (physician/nurse practitioner/physician assistant) in a hospital, I want to easily access the patient's medical treatment specifications, so that I can provide proper care.
   

4. As an emergency medical technician (EMT) responding to a 911 call, I want to access the patient's treatment specifications, so that I can save time and reduce liabilities.
   

5. As an enterprise in a care facility, I want all relevant parties to be on the same page, so that there is freedom of choice in using in the appropriate application for the business' daily operations.

Minimum Viable Product (MVP) 

The initial ideation sessions for POLST clarified its product/market fit. The JTBD framework, resulting task flows and client input allowed us to recognize the key functions that the mobile app should feature. Through multiple explorations we are able to visualize the complexities of the onboarding process and eligibility verifications involved, along with the roles that each signatories will play while using the mobile app. Interestingly, we have also identified a "super user" that would have full access to the whole application.

For our MVP, we have concluded that the first iteration should focus on the super user plus physician flows and their corresponding features. I have contributed that a Dashboard solution is necessary because the fast-paced setting calls for urgency and clarity from the get-go. The Dashboard team then organized the form into sections: patient files, team management and account settings.

Note: Since the beginning, we have proposed that POLST be designed for tablet use; however the client pressed for a smartphone app for the initial round.

Low Fidelity Prototype and Testing

While building the lo-fi prototype, the team has decided to use Balsamiq and skin it to look more presentable to the users for testing. The form design came in two versions for A-B testing: (A) Questionnaire style; and (B) Accordion style. 

UT participants: 3 physicians, 1 PA, 1 admin

valuable User Insights

1. Hospitalists are not likely to use the mobile app.

2. Admins are more likely to use the app in clinical settings (or in hospitals, if at all).

3. Users will not text or email the form (will print instead).

4. Pending signatures need not be the priority.

5. Icon labels were readily understood, however, the labels need some clarification.

6. Physicians (or NPs/PAs) are always the last to sign the form.

High Fidelity Prototype

The insights we have synthesized from the usability testing guided our changes for the hi-fi stage. Since POLST is to be an enterprise application, we have decided to go the material design route and to keep the design minimalistic for enterprise.

The hi-fi prototype was again validated with five medical professionals and later iterated for final delivery. We handed off the deliverables for both Android and iOS versions, along with usability test synthesis and recommendations for the next iteration. 

Recommendations included more patient education that would supplement the health provider's guidance. From the user feedback, we also encouraged moving on to the tablet and web versions, which make more sense for patient-MD interactions and enterprise application. 

Since the delivery of the final Sketch / Figma files, prototype and recommendations to the client, we have been informed that the POLST mobile application is currently under development and will be first implemented in the state of California.