Contextual information sharing in patient referrals

Abstract

IntroductionThis Strategic Product Design master thesis aims to find a solution to the problem of ill fitting care trajectories that result in overtreatment, higher costs and negatively impacted health outcomes. This project was created with the recently founded Reinier Haga Orthopedic CenterLiterature and Field studiesTo understand the problem and identify solutions, research studies were conducted.A literature study identified potentials solutions, tt also provided insights into the condition of knee arthrosis and how healthcare is currently organised.Two field studies were also done. The first were interning sessions that provided additional knowledge on the organisation of the healthcare.The second were interviews with patients and treatment providers which, resulted in an understanding of what patients and medical professionals miss in the organisation of the care trajectory.Design goalFrom the literature and field studies came that a cause for the problem is the interaction between stakeholders. Information exchange between the medical professionals was chosen as the design problem. As a lack of information about a patient as a whole explains the ill fitting care trajectories. The missing information was identified as implicit contextual patient information. This often left out of the referral and can not be used when making the treatment decision. Based on the above, a design goal was formulated:Enabling easier sharing of contextual patient information between the GP and the OS in the initial referralCreative processA co-evolutionary creative process was used to create a solution. This was heavily influenced by the COVID-19 outbreak, resulting in more validations with the client rather than large stakeholder sessions.CICSThe result is the Contextual Information Communication System (CICS). CICS consists of the Contextual Sharing Tool (CST) and the requirements for its functioning.The CST is a visual tool that enables fast capture and review of contextual patient information by the GP. The GP uses it by setting 5 points for the respective information rubrics along an axis that indicates the significance of that rubric for a patient.This CST gets shared with the orthopedic surgeon, together with the textual referral. It does not provide him with the detailed information, but with an overview of significant information rubrics. The surgeon uses this impression to direct their anamnesis during patient consults. If the consult has not resulted in an explanation of the CST, there is an opportunity to clarify it with the patient’s GP in a conversation. EvaluationEvaluation was done, to validate the design. From this evaluation came that the CICS did indeed meet the design goal.Points of improvement were also identified among which the usability of the current visual design and the need for education on how CICS should be used.Recommendations & Implementation roadmapTo provide the orthopedic center the next steps in CICS development, a recommended implementation roadmap was created. This roadmap shows the steps necessary to reach three defined horizons:The start of a CICS pilotFull CICS implementation in the knee arthrosis trajectoryExpansion of CICS to other care trajectories.