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Customer Experience and Design

Healthcare User Experience and the Importance of Reimbursement

As a user experience designer, my goal is to help design products and software that are as easy, efficient, and enjoyable to use as possible. A critical part of this design process involves understanding the needs of the various stakeholders–everything from the need for end users to be able to use the product without hassle on up to the need for the product to provide sustainable revenue for the business. And when it comes to healthcare, there are several unique factors that are important to stakeholders. In this post I’d like to focus on one specific and often overlooked factor: reimbursement.

First, some quick background. “Reimbursement” is an industry term for the payments made by either private insurance or Medicare to healthcare providers in exchange for specific healthcare services rendered. In the US, most such payments follow the ICD-9-CM (soon to be ICD-10-CM) guidelines published by the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services. In simple terms, providers use these codes to characterize each patient interaction and, assuming everything goes smoothly, receive corresponding payments.

Along with a variety of other factors, reimbursement helps shape and constrain clinician workflows, so by gaining an understanding of how reimbursement affects workflow a user experience can be designed to help optimize clinician workflow. For example, a common feature in a number of healthcare applications is a list of patients that needs to be reviewed by a physician. The following image shows a simplified version of such a list:

Table showing one row per patient

At first blush, it may seem that the best way to meet the needs of the clinicians who will be using the list is to organize the list on a “per patient” basis, with only the most recent patient listings shown. That is, if a patient has multiple procedures that need to be reviewed, the procedures would be grouped together into a single row for that patient. Such an arrangement is shown above.

However, if we consider the nature of the relevant reimbursement codes, we may find a slightly different table arrangement to be preferable. If, for instance, the reimbursement code is structured such that each time a patient receives a given procedure the provider is entitled to receive a payment, then it may be advantageous to structure the list on a “per-procedure” basis in chronological order, as this may be the order in which clinicians must enter the reimbursement codes in the Hospital Information System (HIS). This modified arrangement is shown below; the highlighted row shows where the difference is.

Table with one row per procedure

This difference may seem small from a development standpoint but could make a fairly large difference to the end user, especially if it saves them time. Moreover, there may be even larger gains from aligning the design of a healthcare application with the end user’s workflow if such consistency helps reduce medical errors.

The bottom line: when understanding how clinic workflows work, be sure to consider the impact that reimbursement has on that workflow.

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Christopher Monnier

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