Pathology Consult - A Case Study

PathConsult: a case study

Presented By: Jonathan ClarkDate: May 15th 2006

PathConsult

user understanding is critical iterative development keeps the

focus on the user think outside the book

But was it rapid? I’ll let you be the judge of that!

Understand the user, their tasks and their goals

Evaluate the UI,not the user

Design for the user, make sure

they can efficiently and

easily complete their tasks

Development starts & ends with the user

user-centred design

Librarian

Morning Lunch Afternoon After Hours

Researcher

Student

Practitioner

Significant generalizations; Use of Elsevier electronic products is much smaller

Example: Electronic Information Retrieval

It all started with a book..

3000 pages >8000 images organized by organ

system 9th edition includes diagnostic

pearls

Psychology of a Pathologist Prototypes for Obsessive-Compulsive Disorder

and Introversion Most are fanatical about their hobbies (eg,

cooking, wine-making) Typical work week for a Pathologist: 50 hours Pathologists HATE change more than most

physicians More like a surgeon than they care to admit Most feel as if they are the Rodney Dangerfields

of medicine

What does a pathologist do? 90% of what a pathologist does is:

Look at microscope slides & make a diagnosis If they cannot make a diagnosis, they:

Look up information or ask a colleague or order additional stains or send out to an expert

Why do they look up information? They’re not sure what they’re looking at They can’t decide between 2 or more possible diagnoses They know what the diagnosis is but need additional information They need help on what to do to determine a diagnosis

Pathologists at work

Life Goals Be good at my job

Experience goals Don’t waste my time Don’t be condescending

End goals Answer a specific question

about a possible diagnosis Find a picture Find a specific piece of

information for a case Be more efficient

Perry, Private Practice, 42• Has been in private practice for 8 years• Comfortable using computers, but currently doesn’t use them as much as his

books for pathology-related questions• Often has very specific questions related to thresholds, margins, staging,

grading; just wants the important bits, not all the background or foundation information

• Driving need: Needs something that can help him work more quickly, more efficiently, and more effectively.

Perry works in a private practice located in a medium-size hospital in the western suburbs of Chicago, Illinois. There are 6 pathologists in the office, plus a pathology assistant who handles gross. Perry is the “go to” person in the office for gastrointestinal cases, but everyone handles a bit of everything.

His day is incredibly busy, with sometimes as many as 60 cases to review. The majority of the cases are fairly straightforward, though sometimes he will have a rare diagnosis. Perry usually eats lunch at his desk around noon, but often won’t it finish until a few hours later because of the number of cases he has to finish in a day.

Perry has a large library of books and refers to them often. Usually he looks for a specific picture to match a case, trying to pinpoint a diagnosis. He gets frustrated having to read through lots of text to just find the one piece of information he’s looking for, and wishes he could just jump past all of the basic information right to the things he needs. Sometimes his work is interrupted, as colleagues ask for opinions on other cases. While this can be frustrating, he doesn’t mind, as Perry often asks them for help with areas about which they are more knowledgeable.

He tries to keep up with new developments in the field, but it’s not as important as when he was an attending, since he mainly sees the same types of cases. Still, it’s good to know about new immunostains and emerging areas like genetics, even if they’re not always useful in his day-to-day work. Perry works hard, and tries his best to leave on time to get home and spend time with his wife Jeanne and his three kids.

Primary Persona

Elsevier Agile Development Process

Iterative Development

Iteration 1 Iteration 2 Iteration 3 Iteration 4 Iteration 5 Deployment

Preparation Feedback / Usability Testing

Release!

Initiate Project

Architect/Developer (IT Lead)

Analyst

QA Specialist

Iteration Manager

Project Manager

Product Manager

Content Workflow Manager

UCD

Prototyping

Initial Story Writing

Initial Spikes

Content Planning

+

+

+

+

Release Planning

Write Stories & Tests

Review Stories

Kick-Off

Prioritize Stories

Functionality Review

Ranking/ Estimating

Design Session

Development

Select Story

Write Tests

Verify Story

Write Code

Monitor Progress

Testing

Run Functional

Tests

Run Regression

Tests

Fix/Correct

IterationShowcase

Update Stories

UsabilityTesting

Spike

pathologist

pathologist

pathologistconsultant

developers

product mgrthe boss

UCD developer

developers

High-level features & benefits list A website for pathologists should contain:

Lots of high-quality pictures, with descriptions Clear, concise, and current diagnosis info Ability to compare differential diagnoses Immunohistochemical stain information

For each diagnosis, pathologists want Clinical information Gross and microscopic description Prognosis Pictures Differential diagnoses, including pitfalls and tips on what to look for

Content has to be: Concise, bulleted style Differential diagnosis information Diagnostic pearls

High-level features & benefits list A website for pathologists should contain:

Lots of high-quality pictures, with descriptions Clear, concise, and current diagnosis info Ability to compare differential diagnoses Immunohistochemical stain information

For each diagnosis, pathologists want Clinical information Gross and microscopic description Prognosis Pictures Differential diagnoses, including pitfalls and tips on what to look for

Content has to be: Concise, bulleted style Differential diagnosis information Diagnostic pearls

Amyloidosis

Clear cell tumors

Hürthle cell (oncocytic) tumors

Hyalinizing trabecular adenoma and related lesions

LYMPHOID TUMORS AND TUMORLIKE CONDITIONS

Malakoplakia

Medullary carcinoma

MESENCHYMAL TUMORS

METASTATIC TUMORS

Other neuroendocrine tumors

Parathyroid tumors

Poorly differentiated carcinoma

Home >

Differential Diagnoses

Then, select up to 5 diagnoses to compare

Add

Remove

Follicular carcinoma

Follicular adenoma

Papillary carcinoma

First, select a body system

Thyroid Select a different body system

View Differential

Differential Diagnosis: low-fi prototype

Home > Differential Diagnoses >

Comparison

Image caption (stain, magnification)



• Diagnostic Pearl



25 additional images available

View complete diagnostic information for Follicular carcinoma





View complete diagnostic information for Follicular adenoma





View complete diagnostic information for Follicular carcinoma

Papillary carcinomaRemove from comparison

Follicular adenomaRemove from comparison

Follicular carcinomaRemove from comparison

Differential Diagnosis: low-fi prototype

As a Persona C

I want to be able to

view diagnostic information on a group of

conditions

so that I

can decide between possible diagnoses.

Story 7

Differential Diagnosis: as deployed

Differential Diagnosis: as deployed

3000 pages >8000 images organised by organ

system 9th edition includes diagnostic

pearls

From Pathology Book….

Online diagnostic clinical decision support covering general pathology.

Designed to be used at the point of work. Image based. Core is differential diagnosis tool to compare conditions. At launch will includes 500 most useful conditions based

on feedback from Pathologists

.....to Diagnostic Tool

Timeline Field study April 2005 Kick-off workshop July 5-7th, 2005 Lo-fi prototype July 13th, 2005 First customer demo September 7th 2005 Second customer demo November 10th 2005 Third customer demo February 17th 2006 Launch May 17th, 2006

PathConsult

Our lessons learned: that user understanding is critical that iterative development keeps the

focus on the user and to think outside the book

Thank [email protected]

Business

Pathology Consult - A Case Study