May - July, September - Present 2023 (7 months)
Role
UI/UX Designer,
Design Researcher
Team
As a part of the research for Dr. Sienko and Dr. Kramer with 2 other interns
Skills
Semi-structured interviews, stakeholder engagement, market analysis, product design
Problem Statement: Postpartum-Hemorrhage (PPH) is a major cause of maternal death in Ghana. Coagulopathy (impaired ability to form blood clot) significantly raises risks for PPH. Current emergency testing method for coagulopathy in Ghana is time-intensive for medical professionals and inaccurate from human errors, while other existing solutions are expensive and impractical for the bedside and low-resource Ghanaian hospital settings. There is a need for a cost-effective solution addressing time and accuracy limitations.
Impact: Reduce hands-on time required per medical professional per test by 70% so that healthcare staff can focus on more important tasks and enhances the accuracy of current testing method
Figure 1: Maternal mortality rates in Ghana compared to high-income countries, Figure 2: Example of non-flowing, coagulated blood
A formal lab blood test or under urgent conditions, a bedside clotting test for coagulopathy is required before clinicians can safely operate on a pregnant patient. A clotting test provides medical professionals with knowledge on the patient's chance for excessive bleeding. With such knowledge, a clinician can begin surgery preparations, most importantly requesting blood, platelets, or plasma for patients who does have a high chance for PPH.
In Ghana, blood donations are highly stigmatized and there are very few blood resources available for the public. Blood donations for surgery normally come from the patient's direct family member. In conclusion, in the situation that the test comes back positive, it is very important to commence the process for requesting blood donations immediately so that the patient can have a chance to live.
Currently, the Ghanaian hospitals use a modified version of the Lee and White Clotting Time Test (LWCT) to assess coagulopathy among pregnant patients. The LWCT test only has an accuracy rate of 72.6%. In practice, the accuracy and consistency of the test is exacerbated by human error as medical professionals often have to juggle between performing the test among other tasks, and can't dedicate their full attention to the test.
We propose a mechanical device with an accompanying phone app as a solution to address this challenge. Our device automates the current test method and offers the medical professionals the flexibility to review the test result later.
Figure 1: Folded device dimensions, Figure 2: Device main components illustration
Figure 3: A simulated test from the phone view. The phone records the test and stores the video so the medical professional can easily scroll for the blood clot time to determine result. The blood container and heat pad are stationary for the first 3 minutes, then the motor flips the system every minute after for 8 times.
Discover
Between June and July, I led 8 weeks of user research efforts by conducting on-site contextual inquiry sessions locally in Ghana. I had over 40 semi-structured interviews with doctors, nurses, midwives, and resident doctors at Komfo Anokye Teaching Hospital in Kumasi, Ghana, and Korle Bu Teaching Hospital in Accra, Ghana, to discover unmet healthcare needs that can be addressed by technology solutions.
Quotes:
- Senior doctor: "As a tertiary referral center, we receive many high risk patients in emergency conditions on the daily. Performing the bedside clotting test is an unavoidable part of our daily workflow."
- Resident doctor: "The test is obstructive to my work. I have to use my phone timer to time the clotting test, and my phone is the only way for me communicate with my colleagues."
- Nurse: "The clotting test is performed at the ICU, and the lay-in wards for all high-risk patients. With the busy environment, I sometimes forget to check the clot time and have to estimate the result for the patient."
Benchmarking existing solutions presents us with a design dilemma: all the accurate testing devices are way too expensive for Ghanaian hospitals to adopt and only support lab tests, while available point-of-care testing options only are less accurate than current method or provide limited improvement to accuracy.
To resolve this challenge, my team and I spoke to multiple doctors and hematologists from both U.S. and Ghana with global health work experiences to obtain their professional insights. After these interviews, we determined that affordability should be prioritized over accuracy. Given the emergency settings, accuracy may be sacrificed. However, the design must be low-cost, otherwise the chance for this design to be adopted by local hospitals is very low.
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Define
- Bridges context appropriate solutions with cost-effective designs by Ghanaian standards
- Prioritizes local maintainability and minimizes components needing to be imported or consumable parts
- Standardizes current testing method, which opens the opportunity for future research
As a part of the user research I conducted in Ghana, I elicited stakeholder requirements by leveraging the following 5 ethnographic research methods: asking open-ended questions, engaging with prototype, choosing among discrete options, ranking requirements by priority, and clustering requirements.
Quotes:
- Midwife: "The power grid in Ghana is not very consistent and sometimes we face power outages at the hospital. So having alternative power source is important to us. Ideally, a device should be able to be both battery powered and be plugged. "
- Senior doctor: "An alert system is important for the ease of use requirement. Both sound and visual alerts when the result is ready are acceptable but visual alerts are preferred because of the loud environment. If sound alert is used, healthcare staff might not be able to hear the alert or be confusing the alert with sound coming from another device."
- Resident doctor: "The blood container should be disposable per hospital protocol. Blood is a contaminant."
After comparing other design options, we determined that using a phone to serve as a touch screen, a camera and an alert system is the most affordable and easiest to use option. Below are the two functions that this phone app would have:
- Testing process: Digitizes the current testing procedure and encourages the healthcare staff to label the test recording with patient name. In the future, instead of recording a video of the test, a computer vision algorithm can be implemented to determine the clot time using image processing. But, for now, due to the time frame limitations, this cannot be built.
- Recording library: Each test recordings are saved to the library and health care staff can review, edit information for, and delete the videos from the library. The library also labels the recordings by test result status (green for negative, red for positive, and grey for undetermined) and offers search and sorting features.
Design
Develop
In progress, coming soon...
View my report:
here.
