EMAR

In the post-covid era, the demand for vaccinations and hospital visits surged, highlighting the need for an efficient and safe healthcare system.

In July 2021, I contributed to a project aimed at designing an electronic Medication Administration Record system (eMAR). This is the story of how I designed an eMAR module to empower ALC (Alternative Level of Care) delivery service for the elderly in retirement homes.

Role

Junior UX Anaylst & UX Designer Intern at Verto Health(w.the help of Fay Wang)

My Duties

Managed complex information layouts
Conducted UX research
Mapped out the system's structure
Developed user cases
Proposed research solutions
Wireframing&Prototyping
Presenting the Case

Skills

Contexual Inquiry
Wireframing
Prototyping
UX Research
UI Design
Case Storytelling Presentation

Time Frame

Jul- Sep 2021

The Context

Design by Necessity

As a junior UX designer at Verto Health, I worked on a project that aimed to address a critical need—designing and creating an electronic medication administration record system (eMAR) to reduce medication errors and enhance patient safety. This project played a pivotal role in optimizing medication management for the elderly in retirement homes, as part of Verto’s Alternative Level of Care (ALC) delivery service.

The goal was to transition healthcare practitioners away from paper records to the eMAR module integrated within the company’s existing electronic medication management (EMM) application.

Urgency to Go Digital

Through meetings with other designers, I gained a deeper understanding of the project's importance. The pandemic accelerated the need for digital solutions, and administrators recognized the necessity of reducing the administrative burden on staff. An electronic care plan solution would not only improve workflow but also ensure safer and more efficient medication management.

Stolzenberg L, Huang A, Usman M, MacGregor G. A Descriptive Survey Investigating the Impact of the COVID-19 Pandemic on the Public's Perception of Healthcare Professionals. Cureus. 2023 Jul 11;15(7):e41703. doi: 10.7759/cureus.41703. PMID: 37575848; PMCID: PMC10415964.

The COVID-19 crisis strained the healthcare system, with concerns over supply shortages for clinicians, leading to significant decline of trust from patients.

Government Progressed on Interoperability

Moreover, Ontario Health’s implementation of provincial regulations in 2021, particularly around defining Electronic Health Record (EHR) interoperability requirements, further encouraged administrators to adopt digital solutions. This provided an additional push for retirement homes to seek seamless, integrated systems for managing medication records.

Figure 1 - What is the most pressing IMIT Issue that your organization is dealing with that the Health Information Technology Vendor Community can assist with?

Covid-19 pandemic exposed gaps in digital health integration and the lack of structured data for analytics.

However, the shift towards a tech-savvy workforce and efforts by Canada Health Infoway and Ontario have driven progress toward interoperability and decentralized healthcare data.

The Challenge

Module Design in 1.5 months During LockDown

The goal of the project was to optimize the existing medication management in retirement homes. As building an e-MAR system was huge and heavy, due to time limit, initially my work was simple( The original premise was simple:) to analyze users' needs under the eldely patiet context, generate design solutions and incorporate them into designing a new e-MAR module.

From Concept to Creation: My Role in the eMAR Project

After meeting with my supervisor, Mahmoud, and senior UX designer, Fay, I took on the challenge of designing the eMAR system from the ground up, working largely independently. While Fay and I collaborated to define the information structure in the initial stages, I handled the majority of the design work on my own.

My responsibilities included identifying pain points in the existing paper-based system, analyzing nurses’ needs, proposing solutions, and creating the final prototype for the eMAR system. Unfortunately, due to the lingering effects of the post-COVID era, we faced challenges in gathering primary data, as finding healthcare professionals to participate without compensation proved difficult.

Client: Verto Health and retirement home

We Claim to ...

Make it streamlined, efficient, and easy to use for healthcare professionals.

Provide healthcare professionals with more control and access over their responsibilities.

Create a platform for strengthening collaboration and deeper engagement.

Kickoff

Picking up the Pieces

During the pandemic, various factors led to the exclusion of long-term care residents, particularly elderly patients, from Canada's vaccine rollout.

Andy Yoon, 77, of Abbotsford, B.C., became the first long-term care resident in the Fraser Health region to receive the COVID-19 vaccine on Dec. 24. (Submitted by Fraser Health). Retrieved from CBC.

Covid Exacerbated Medical System Inefficiencies

Quebec strategically placed vaccine distribution centers within long-term care facilities, facilitating rapid inoculation. British Columbia promptly moved the Pfizer-BioNTech vaccine from distribution sites to long-term care homes upon receiving its initial doses to vaccinate residents and staff. Ontario chose not to administer vaccines directly in long-term care homes, resulting in a slow rollout. Despite receiving 53,000 doses of the easier-to-administer Moderna vaccine in December 2020, only 3,000 doses had been administered in Ontario by early January 2021.

Besides the decentralization of vaccination policies, varying medication management policies also result in widespread inefficiencies in the rollout.

Hover to read more!

Why We Must Replace MAR?

The unsettling truth is that patient harm due to medical treatment is an issue the healthcare community has had to confront in recent times.

Hover on the grid to see how MAR challenged HPs in everyday courses.

Unforeseen Prescription Errors

Despite protocols, HPs face a heightened risk of prescription errors caused by inadequate staffing, handwritten orders, zero errors, poor lighting, similar drug names, and misinterpreted prescriptions.

Patient Information Access Delays

Many healthcare providers struggle to adapt to paper-based records due to the inconsistent format of information, which consequently prolongs the time required to access critical life-saving information for patients.

Difficult to Amend Prescriptions

Despite needing careful diligence, HPs must use ink for prescription changes. This responsibility adds complexity to the amendment process as they are tasked with marking the prescription to associate the amendment with a specific individual.

Absent Version Tracking & Trails

Paper records lack built-in version histories and audit trails, requiring users to sign records with each change. The absence of proper logs makes it challenging for users to track the origin of changes and identify responsible individuals.

A Day in the Life: Administering Medications with Paper MAR

Before diving into the specific challenges posed by paper MAR in elderly care, let's first observe how nurses administer medications to elderly patients using this traditional system. This video will give you a basic understanding of the manual process, highlighting potential inefficiencies and risks that arise during medication administration.

Designing an effective eMAR system for elderly care requires addressing the distinct medication challenges they face, especially in light of the global pandemic.

Unique Challenges in Elderly Medication Management

Increased Symptoms & Side Effects

Higher Reliance on Care Teams

Fear & Resentment Toward Medication

Loss of Control & Independence

Self-Adjustment of Doses

These considerations are essential in designing an EMAR, ensuring a system that supports both patients and their caregivers effectively.

Research has shown that elderly patients, particularly those aged 70 and above, are significantly more vulnerable to severe complications and higher mortality rates if they contract COVID-19.

This highlights the critical need for accurate and efficient medication management, which can directly impact patient outcomes in such high-risk populations.

Hover to explore the key issues.

The Discovery

"How Do Users Use EMAR for Varying Purposes?"

Developing the eMAR module focuses on addressing user needs, enhancing functionality and accountability, and ensuring an efficient experience through a seamless user flow.

As the solo designer on this project, I faced several challenges—working within a tight 1.5-month deadline and limited resources, I lacked access to the primary data and interviews that would have enriched my process. Instead, I turned to secondary research, diving into literature reviews, Reddit discussions, and other platforms to gather valuable insights.

From my findings, I outlined key focuses for the design, aiming to create a holistic solution that truly addressed user needs:

Deliver More Efficient and Comprehensive Patient Care

Streamline User Flows to Reduce Errors and Save Time

Increase Access to Resources and Control Over Responsibilities

Provide Systematic Support for Every User Role

Foster a Sense of Connection and Inclusion, Eliminating Isolation in the Management Process

Create a Transparent, Accountable Experience, Ensuring Consensus and Avoiding Blame-Shifting

These focus areas guided me in crafting a solution that is not only user-centric but also practical, given the project’s constraints.

I found out that doctors and nurse practitioners (often as prescribers) are NOT the only user group a MAR system needs to cater to.

Another significant group includes registered nurses (RNs), particularly those who provide “check the box” medical care. Nurses are often underappreciated and require more information control to engage further in direct patient care.

Tight timing meant that I needed to be efficient in conducting user research and collecting feedback. I interviewed two friends who are RNs and NPs and delved into online discussions on Reddit to gauge opinions on MAR and medication administration duties. These varied techniques swiftly provided insights into user needs, goals, and frustrations, offering me a solid grasp of the environment and workflows.

Hover to View Roni, the Registered Nurse's Empathy Map!

The Vision

Efficient, Seamless, and Transparent Care

Our vision is to provide a streamlined, transparent, and efficient eMAR system that is easy to use, ensures accountability, and enhances consistency.

Aiming to be an all-in-one portal for healthcare professionals.

7 Key Big Data Trends to Watch in 2021 2.png

Expand

Functionality

The eMAR system should allow users to create, edit, delete, and mark medications as errors within prescription records. Additionally, the system must support documenting medication administration efficiently.

Customizing access levels based on user roles is essential. This ensures that each role can view up-to-date clinical histories and current medication plans, empowering users with greater control and insight to deliver more informed patient care.

Electronic Health Records Shape the Medical Student Experience _ Biomedical Odyssey 1.png

Streamlined Efficiency

The eMAR system should be designed for a seamless, user-friendly experience that enhances patient care while minimizing errors in medication administration.

By incorporating advanced technology, streamlining medication management process, and offering shortcuts, the system enables users to quickly navigate functions, filter information, and accurately document medication administration, optimizing space and workflow management.

9 Most Important Trends in Healthcare Technology Revolutionizing Patient Care and Manageme

Transparent

Experience

The eMAR system must promote information sharing, foster user collaboration, and ensure consensus at every stage of care. Each action taken—whether a step in patient care or a medication change—should be clearly confirmed, displayed, timestamped, and automatically recorded in the system.

This approach can strengthen ccountability and creates a transparent, blame-free environment.

The Requirements

Thinking Big, Starting Small.

Knowing who exactly I was designing for allowed me to ask myself how my design fits into their workflow.

medication-management-requirement_upscayl_6x_realesrgan-x4fast.png

After meeting with my supervisor, I was given a few key design requirements to focus on.

Understanding the urgency and the way healthcare professionals (HPs) work, I knew my solution needed to be both practical and efficient. If it demanded too much time or effort from users, it wouldn’t succeed. With that in mind, I honed in on the essential design functionality, ensuring it met the core needs without overcomplicating things—allowing me to work effectively within the constraints.

The Framework

Building Up the Design Structure

We began developing the information architecture for our system by incorporating our findings. At this stage, we created two user workflows to illustrate the main functions: creating patient prescription records and updating medication changes.

User Workflows

To truly capture how users would interact with the eMAR system, I mapped out three key user flows. Each user flow outlines the user's journey from their first entry point to their final interaction, detailing every step they would take to achieve their goals.

Whether it’s creating prescription records, editing medications, or documenting medication administration, these flows represent the core tasks users need to complete. Crafting these flows was essential to visualizing how the system’s content and functionality come together, ensuring a seamless and intuitive experience that supports user needs at every touchpoint.

EMAR User Workflow #1

User Creates a New Prescription Record

EMAR User Flow 1

Patient Records List

New Patient?

Search Medication Records

yes

Create a New Patient Record

Create Order Tab

Start a New Order

Apply Template to Diagnosis

fill in patient information (name/DOB)

Conduct Disgnosis

Cancel Order

Medical History

yes

Formulate Plan of Care Based on Diagnosis

search medications by genetic name/DIN

Fill in Other Information(dose, SIG,etc)

yes

Any Mistake in the Order?

Review&Submit

Send Order to Pharmacy

Inform Patient and Counsel about The Plan

Patient Confirm?

Legend

Action

Key Action

Decision

Location

EMAR User Workflow #2

User Renew Care of Plan & Edit Medications

EMAR User Flow 2

Receive Notifications From Administrator

Administration Record

Review Past Progressive Notes

If the Administration Succeeded?

yes

Medical History

Create Order Tab

Update Current Order

Review the health plan and prescription

Must Change All Health Plan?

yes

Start a New Prescription Record/Order

Renew Diagnose &Medication Order

Choose To Apply A New Diagnosis Template

Medication List

Review Medications In Progress

yes

Consult with Patient

Add/change/Mark medications in Error

Review & Submit New Order

Update to Medication List in eMAR

Necessary to change the medications?

Legend

Action

Key Action/Move

Decision

Location

EMAR User Workflow #3

User Documents Medication Administration

EMAR User Flow 3

Patient Record List

Patient Schedule Overview

yes

Clinician Request Progressive Information?

Find Out Schduled Patient

New Task In Mission?

Work On Other Duties

yes

Patient Record Tab

Open the Unfinished Task on the List

Enter Medication

&Clinical History

Medication List

Review the Medication Plan and Prescription

Legend

Action

Key Action/Move

Decision

Location

Review Medications Patient Takes

Administration Agenda

Review Administration Progressive Notes

Update on Task List

Report to Clinicians for Prescribing

Upload to EMAR System

Confirm Medications with Patient

Write Warning Progressive Note&Upload

Request to Change Medications?

yes

Stop/Fail the Administration

Write a Med Admin Progressive Note

Review & Upload Admin Record

Information Architecture

I created the information architecture (IA) map to serve as a blueprint for the designed pages necessary to meet the modules' functionality.

Dashboard

Pathway

Notification

Documents

Account Setting

Call/Unit Summary

Patient Schedule Overview

Start a New Patient Record

Private Message

Mention in Task

Patient Record Tab Home

Patient Inforation

Medical Records

Patient Engagement History

Medication Management

Upload New Progressive Note

Filter Record Documents

Access Management

Export Reports

Share Documents

Decide Access Level

Home

Clinical History

Patient Agenda

Templates

Diagnosis

Medication List

Administration

Task List

Add New Clinical Note

Apply New Template

New Diagnosis

Patient Profile

Edit Personal Information

Health Plans

Health Plan History

Renew Medical Plan

Create New Template

Add Dictation

Renew Diagnosis

Medical Test

Patient Name

Patient MRN

Patient Contact

Medication Records

Medication Tasks Updates

Medication History

Prescription

Controlled Substance

Biologic

Non-Prescription Medications

Natural Health Product

Admin Agenda

Admin Details

SupplementaryDcoumentation

Progressive Notes

Warning

Assigned Room

Allergies

Chronic Diseases

Appointment Schdule

Preferred Provider

Sketch the Experience

At the early stages of my design process, I used Balsamiq to quickly sketch rough drafts of key function pages for the system. While most of the elements from these initial sketches didn’t make it into the final design, they served as a crucial starting point.

These early concepts helped me identify the core functions and information that needed to be integrated, such as creating prescription records and editing medications. Though the design evolved significantly, these sketches laid the foundation for refining the user experience and system functionality.

High Fidelity Storyboard

I defined seven key pathways for our personas to explore within the app. Crafting multiple user journeys is the most effective way to conceptualize and structure the proposed content and functionality.

I storyboarded our redesign ideas to illustrate how we can improve user flows, saving time in the prototyping phase and ensuring a smooth transition to the next step. Our high-fidelity storyboard integrates the redesign, detailing a seamless and efficient user experience.

Click to unfold each pathway and read the storyboard!

Pathway 1: User Creates a New Prescription Record

Pathway 2: User Views Most Up-to-date Version of Medication History

Pathway 3: User Edits Medications

Pathway 4: User Registers Varying Access to Information

Pathway 5: User Documents Medication Administration

Pathway 6: User Marks the Medication In Error

Pathway 7: User Shares Administration Records

My Design Emphasis

Click each column to explore the features I have designed to improve the functionality, collaboration, and overall user experience of the e-MAR system.

"Expand Functionality & Optimize User Flow"

Enable Easier Medication Edits & Plan Renewals

My design aims to enhance the functionality and optimize the user flow of medication management systems by providing users with an intuitive interface for editing, updating, and renewing records in real time.

Centralized Patient Agenda:

Serves as a hub where users can create new prescriptions, renew medical plans, and edit medications.

Seamless Record Updates:

Users can easily apply new templates to existing plans, ensuring changes are integrated smoothly, preserving continuity.

Improved User Workflow:

Designed with diverse scenarios in mind, this system reduces errors by allowing for easy modifications without disrupting the flow of patient care.

Enhanced Communication:

Ensures transparency and timely updates for all relevant parties, minimizing communication gaps that can lead to errors.

Expand Functions

"Enhancing Efficiency & Improving User Experience"

Create a Streamlined Medication Management Workflow

This design focuses on creating a streamlined and standardized interface to optimize prescription and diagnosis processes; thus significantly improving efficiency and reducing medication errors.

NaviTab for Consistent Workflow:

Guides users through a clear, step-by-step process for selecting templates, writing diagnoses, renewing plans, and editing medications.

Two-Step Confirmation:

Features a "Select Medication" or "Mark Changes" step followed by a "Confirm and Order Medications" section, requiring users to review and confirm all changes before finalizing.

Familiar Interface:

A uniform process for managing prescriptions and diagnoses reduces confusion, increases efficiency, and minimizes the risk of errors.

Streamlined Information Access:

Users can quickly locate essential information, accelerating the treatment process and improving overall patient care.

Hover to View How User Creates the Prescription Record Through the Consistent & Streamlined Process

design 2 new diagnosis_upscayl_2x_realesrgan-x4fast.png

Start New Diagnosis Through NaviTab

Apply Templates to New Prescription Record

"Provide Inclusive Support within the e-MAR System"

Enhanced User Access and Role-Based Permissions

This design focuses on refining account settings to accommodate varying access levels for different user roles within the e-MAR system, ensuring inclusivity while maintaining security and minimizing errors.

Enhance Access Management:

Role-based access ensures users see only relevant information, minimizing confusion and errors.

Administrators, nurses, and prescribers have tailored access levels for efficient task management.

Default filters and universal access controls provide a streamlined experience.

Gain More Information Control:

Users can access the most up-to-date medical information, improving decision-making and collaboration.

Users can perform more comprehesive patient care.

Set Up New Sub-Account

"Enhance Data Reliability and Reduce Error-Proneness"

Auto-Save and Cloud Integration Into Documentation

This design leverages automatic saving and cloud backup to ensure data safety, prevent loss, and streamline management.

Auto-Save & CloudSave:

Every action, including medication administration, record creation, and note-taking, is automatically saved and backed up in the cloud.

Reduces the risk of data loss and ensures version control, making the system more reliable and error-free.

Enhances the efficiency of large patient volume management by eliminating manual record updates and improving access to current information.

Progressive Note is auto-saved

"Guarantee Accountability & Transparency in Medication Management"

Incorporate Real-Time Task Tracking & Increase Patient Engagement

This design aims to foster accountability and guarantee transparency in medication management by documenting all actions taken in the medication process.

Formal Consent Documentation

"Patient Engagement History" ensures transparency between patients, nurses, and clinicians.

Minimize Misunderstanding on Medication Information Among Involved Parties.

Real-Time Task Tracking Among Users

Confirmation updates at every step of the medication process are stamped by responsible users, tracking task completion, failure, or errors.

The system promotes clear communication, reducing scapegoating and misunderstandings among clinicians.

design 5 4_upscayl_2x_realesrgan-x4fast.png

User can View the Audit Trails of Medication List

"Expand Functionalities & Enhance System Efficiency"

Design an Integrated Medication Administration Module

This design mainly focuses on creating a new medication administration documentation module integrated with other key functions like prescription records and medication edits. The system serves as an all-in-one portal that connects users across functions, fostering a more cohesive approach.

All-in-One Portal

Connects users across roles (administrators, prescribers, and nurses) for a more integrated approach to medication management.

Comprehensive Administration Module

Includes Admin Agenda, Admin Details, Supplementary Documentation, Progressive Notes, and Warnings, ensuring that all aspects of administration are documented and accessible.

Closed-Loop System

Part of a comprehensive system where users can navigate seamlessly through the medication management process, reducing inconsistencies and errors.

Improved Collaboration

Facilitates better information sharing and collaboration among users, minimizing the siloed approach common in traditional systems.

design 8 1 admin agenda_upscayl_2x_realesrgan-x4fast.png

Integrated Systems within Closed Loop Medication Management

"Improve Workflow & Enhance System Flexibility"

Design Functional Shortcuts & Quick Actions

This design provides users with flexible navigation options by creating functional shortcuts and quick actions, further enhancing the efficiency of the e-MAR system.

Quick Actions

Functional shortcuts enable users to navigate directly to desired results or sections, saving time.

Flexible Navigation

Users can easily switch between tasks, reducing the time spent manually navigating through multiple pages.

This design improves the overall user experience by making the system more intuitive and responsive to user needs.

Create New Template via "Quick Actions"

"Enhance Collaboration & Increase Accountability"

Enhanced Record Management and Secure Sharing

This design focuses on optimizing documentation practices, ensuring that users can safely and efficiently access, search, maintain, and share records, thus enhancing accuracy, collaboration, and accountability in record management.

ALCOA+ Documentation Standards

Records include clear creator details, creation times, and statuses, ensuring transparency.

Efficient Search & Sharing

Quick filters and secure sharing features allow easy access to critical information, improving collaboration among users.

This design reduces the risk of errors caused by poor record-keeping, enabling faster decision-making and more accurate patient care.

design 6,2 share documents_upscayl_2x_realesrgan-x4fast.png

Share Documents to Other Clinician

Detailed Design

Introducing...The eMAR!

The gallery below shows the final proposed clickable prototype. Switch to View More!

Prototype Illustration - User can Start a New Prescription/ Edit Medications from Patient Agenda

prototype - portal_upscayl_2x_realesrgan-x4fast.png

Make User Interaction Easier

The "Patient Agenda" acts as a central hub for users to easily add notes, renew plans, and make updates.

The "NaviTab" offers a streamlined workflow, guiding users through templates and standardized steps to reduce errors and ensure consistent prescription management.

With the "Quick Actions" shortcut, users can quickly navigate and enhance care efficiency.

Hover to see how "NaviTab", Patient Agenda, and functional shortcuts make user interactions easier and time-saving with a streamlined, standardized procedure.

Promote More Comprehensive Patient Care

The key innovations we created are 1) to enable users to edit, discontinue, and mark medications as errors; 2) to document and record medication administration in the long term.

By integrating autosave and cloud-save technology, further improving documentation accuracy and accountability. This makes it easier for users to securely search, access, maintain, and share records, enhancing overall efficiency and patient outcomes.

Hover to explore how our new features expand system functionality, empowering users to edit, or mark medications as errors, document medication administration, and secure sharing information.

Prototype Illustration - User Edits and Discontinues Medications

final prototpye- edit med_upscayl_2x_realesrgan-x4fast.png

Prototype Illustration - User Can Access the Most Up-to-date Medical Information

prototype- access medical history_upscayl_2x_realesrgan-x4fast.png

Provide Inclusive Support

We revamped the system's access management to accommodate varying a ccess levels based on user roles. Previously, nurses expressed concerns about limited access to patient and medical information, leading to a sense of detachment.

With the new design, nurses now have partial access to crucial patient information, fostering better control, reducing errors, and improving their connection to patient care.

Hover to discover how my design ensures that eMAR's functions inclusively support all users by granting them information control.

Foster Transparent &Accountable Medication Management

The "Patient Engagement Tab" provides a complete history of interactions, improving communication and trust.

The updated documentation module ensures access to real-time medical records, while task lists promote accountability and collaboration across departments.

Hover to explore how my design fosters collaboration, accountability, and transparency by incorporating real-time tracking, audit trails and secure sharing.

Prototype Illustration - User is Required to Update Task List for Real-Time Traking

final prototype- task list_upscayl_2x_realesrgan-x4fast.png

The Impact

Impact on Users

Here is a summary of key design enhancements. Hover to find out how are poised to significantly elevate user experience.

01

Expanded Functionality

Enable Users to Create, Edit, and Mark Meds in Error

Enable More Comprehensive & Capable Patient Care

03

Access to Updated Resources

Access to Patient Medication History& Current Plans

Give Users Greater Information Control in Participating Direct Patient Care

05

Revamp Documentation Path

Adopt CloudSave in Creating Formatted E-Documents

Boosts Accountability and Traceability of Records Within the System

07

Add Functional Shorcuts

Enable Users to Easily Navigate & Locate Results

Save Time & Make User Interaction More Efficient

02

Streamlined User Flows

Create Standardized Prescription & Renewal Process

Simplify User Interaction, Reduce Errors & Save Time

04

Improved Account Setting

Tailor Maximal Info Access for Different User Roles

Provides Systematic Support for Every User Role

06

Cohesive User Collaboration

Encourage Records Sharing & Set Up Task List

Foster Connection and Inclusion & Reduce Feelings of Isolation

08

Build Transparent Experience

Ensure Consensus & Confirmation in Every Step