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Digitizing a Paper-based Tool to Improve Hemophilia Assessments

The Hospital for Sick Children (SickKids) and the global team behind the Hemophilia Joint Health Score (HJHS) were looking to translate their paper-based tool into an electronic application for easy access and more efficient and accurate assessment of patients.
 

Challenge

The HJHS measures joint health by assessing the structure and function of the joints most commonly affected by bleeding in hemophilia: the knees, ankles, and elbows. The HJHS Oversight Committee wanted to digitize the tool so that it could automate the scoring to improve accuracy, reduce the time needed to complete the assessment, make it easier for therapists to track their patient’s progress over time, and address the varying levels of expertise among assessors by including contextual instructions.
There were several challenges we had to consider as we designed the new platform. The tool would be used by physiotherapists globally, with varying levels of experience, training, devices and internet connectivity. Given the hands-on nature of the assessment with patients, the logistics of the workflow which involved carrying the tablet and the goniometer and inputting the information simultaneously had to be considered. The tool also needed to provide enough flexibility to accommodate differing clinician preferences for the sequence of the assessment items, depending on personal preference or their patients’ situation. Moreover, addressing privacy regulations mandated that the tool would not be able to save any patient data or connect directly with existing EMRs.

Process

For this project, PIVOT employed a complete end-to-end UX process beginning with qualitative research to ground ourselves in an understanding of how the different physiotherapists and musculoskeletal (MSK) experts would be using the tool. What would their environment be, what device would they be using? Would they be assessing adults or children? The answers to these questions changed depending on where in the world they were located and whether they were in a clinic or research setting. We developed personas to reflect these differences and outlined their user flows to begin to determine the structure of the digital tool. We conducted secondary research as well, to see what other platforms and features exist that our users might be familiar with.

Learnings from our research directly informed our work as we began wireframing the layout and content of the tool, working iteratively with the HJHS team. As both creators and end users of the paper-based tool, this global team of physiotherapists was instrumental in ensuring the structure and interactivity would be usable in a real-world setting. Once we had completed wireframing the entire assessment, we applied visual design to the screens and created a high-fidelity prototype for usability testing. Expanding on the visual design, we created a logotype with the acronym “HJHS” to brand the tool with a recognizable visual identity.
 

Solution

To validate the ease of use and features of the prototype, we conducted usability tests virtually with physiotherapists and physicians around the world, asking them to complete specific tasks and tell us about their experience using the prototype. We also asked about their unique contexts, revealing use cases we couldn’t have otherwise known about. This directly informed additions and design improvements that could be implemented before moving into development, allowing for a smoother and more efficient development phase.