MetaDigital Online Prescription

Advancements in technology and automation continue to rapidly change the scope of how we carry out business in nearly every industry imaginable. In the case of healthcare, these advancements serve to provide better outcomes for both patients and those that serve them. One area of concern within the field stands out as medication error—not only in the administration from professionals, but specifically in the prescription fulfillment process. 

Often the victim of jokes, reading the handwriting of a doctor is a job only a pharmacist can do. But as funny as the punchline can be, the errors that come from misreading handwriting (or worse, forgeries) can and do have detrimental consequences. The process of prescription fulfillment in its current form sets the stage for a severe amount of fraudulent prescriptions. Cases relating to fraud equate to the tune of a $60 billion loss in North America alone. 

That $60 billion can be broken down into three main factors: 

• $30 bb in Substance Abuse & Treatment Costs

• $21.4 bb in Lost Productivity Costs

• $8.6 bb in Criminal Justice costs

Let's not make this only a numbers issue, but recognize the equally severe human impact of these errors. An estimated 133,240 deaths related to opioid abuse stemming from fraudulent prescriptions and errors occurred since 2015. That's over 133K families who lost a loved one. That's over 133K seats that will remain empty at family holiday gatherings. It's tragic. 

The Problem

Tracing the steps from diagnoses to prescription pickup immediately shows the number of red flags where fraud and mistakes can happen. Most healthcare providers offer a hand-written note with prescription information that patients present to their local pharmacists. In that process alone, the chances for altering scripts by changing refill counts, dosage, number of pills, drug names, and even adding drugs that were not authorized during the time of visit contribute to fraudulent claims. Many of those successful at committing prescription fraud use tactics that bypass the need for office verification. 

This leads to an increased risk for medical practitioners who can lose their licenses, investigations, and legal costs at the expense of fraudulent prescriptions. Arguably some of the hardest hit financially are insurance companies, who in good faith put through transactions. Consider the fact that 99% of prescription drug claims are electronic and the adjudicators see no real prescription or receipt before they approve and pay the pharmacy. And further, no real-time verification for submitted claims currently exists. Prescription fraud touches on nearly every pain point, including compliance risk and regulatory breach.

Also important to note are that fulfillment errors are not always necessarily fraudulent. Contributions towards it include switching to a generic instead of name-brand, manual errors in entering the script into the system, and reading the wrong transcription from poor handwriting. Oxycodone looks awfully close to Oxycontin, and while dosage can usually tell the two apart, mistaking the two drugs can be a lot more common than one might expect.

The Solution

Our team set out to tackle these issues head-on by creating a new way of issuing medical prescriptions. Its solution aims to reduce the risk of error and the negative outcomes associated with fraudulent prescriptions. Keeping in line with advanced automation, the app would allow users to prescribe accurately and securely. Doctors can digitally issue prescriptions straight to a patient's mobile device with its application. This style of prescription acts as an immutable chain between the doctor, patient, and pharmacy, preventing altered or duplicate prescriptions—either from forgery or "doctor shopping," a process where a patient sees multiple doctors for the same script. And for insurance companies hit especially hard, the solution allows seamless verification in real-time to prevent false or incorrect claims.

The Goals

The goal of any successful UX designer is to create platforms that enhance users' experience, but while also meeting the business goals associated with them. And as with this case, better user experience thrives when it takes the guesswork out of complex business processes. The goal involved the delivery of a product that reduced bottlenecks and prevented areas where errors could occur to ensure better security and fair dispensation of prescriptions. This product needed to be a simple (yet highly effective) solution that tackled a growing problem without punishing those that are using prescriptions safely. Ultimately, I needed to simplify the process all around, making it a solution at both ends of the spectrum.

Research

Our research included a wide range of users across the entire prescription fulfillment process, from medical professionals to insurance agencies and beyond. Additionally, we poured over legal guides and forms available from the government and other authoritative organizations. Creating a highly intuitive and precise solution required extensive knowledge on not only what the problem was, by why it was there to begin with. From that launch point, we began to devise a better framework.

Benefits to Stakeholders

Planning

After dedicating copious amounts of time to collecting all the information needed, we had a pretty good idea of what our solution needed to target specifically. In short, our product needed to do the following:

• Offer a better user experience for all parties involved

• Connect users through a safe and secure network

• Ensure prescriptions were entered and fulfilled accurately through every stage of the process to prevent fraud

• Verify every claim for 100% accuracy and legitimacy for healthcare organizational billing and insurance companies

IA Map

User Persona

We did an extensive level of research and now it was time to see the process through the eyes of the user. To do that, we created two user personas to really get the feel of both key players who would use our product. Enter Helen and Sam. 

Helen is a doctor who sees 10-15 patients per day and needs a system that stores all the information on her patients in a way that is easily accessible and viewable. She wants to make sure that when she writes a script and sends it off to Sam the Pharmacist her patients get the correct prescription at the right dosage. Currently, all parts of the manual system are separated and there are plenty of opportunities for fraud. She also would like to follow up with patients to see how the treatment goes post-visit or post-acute. And for her patients prescribed with lifetime meds, she wants an easier way to refill medication without having to write a script every few months.

Sam is a pharmacist who needs much more information about Helen's patients than offered on the script—especially when involving a controlled drug. Gathering the needed information and verifying the script takes a much longer time than necessary and leads to longer wait times at the counter. Sam deals with a complicated system with many bottlenecks causing a backlog in verification fulfilling scripts. When it comes to calling Helen's office, communication strains heighten after office hours when calls go into an answering service. Factoring in insurance verification and billing adds even more time and obstacle to the process. Overall, the inefficient workflow leads to heavy backlogging, unsatisfaction, and high costs for every participant involved.

User Flow

When we took a look at it through Helen and Sam's point of view, we found that the core issues were that the prescription processed needed to be simplified and that there needed to be a way to expedite the verification process. If we could find a way that made communication clear, easy, and quick, we could remove many of the problems both parties faced.

Simplify & Empathy

In this exercise, we explored their experience and how we could create an application that targeted their pain points. But while we were doing so, we couldn't help but asking another point about the process: can technology and automation actually be humanized?

Paper Prototype & Testing

The greatest innovations seem to always start out with paper and a pen. we scratched out the process of how prescribing a medication would look like, including what fields of information Helen would use and what actions she would take to communicate with Sam. After we had all the steps out in process, we put together the pages to function as if we were using the application itself. To increase the UX appeal, we made the following changes:

Based on feedback from the paper prototype testing we have made the following changes before moving into the mid-fi prototyping.

• We set a progress bar on top of each page that visually represented their completion percentage. Too long of a process can be daunting for users, and a progress bar reduced the stress created by filling out the information.

• We opted for a horizontal layout instead of an infinite scrolling vertical page like other form-filling sites used. We felt that scrolling down, especially with longer forms requiring a lot of patient information, would make users feel tired and stressed from its complication. We also found that a vertical format tended to result in more errors and missing fields.

• Although the long forms were broken down into manageable sections with the horizontal format, there were still opportunities for missing information fields. To combat that, we added "NEXT" buttons that remained inactive until all mandatory fields were filled in. Not only did this reduce errors by having users check their information, but once the script released to the pharmacy, it ensured pharmacists had all the necessary information to reduce callbacks to the office.

Hi-Fidelity Prototype and Testing

A bulk of the fraudulent activity and errors surrounding prescriptions originated from hand-written notes. But to take it a step further, we wanted to make sure that doctors could prescribe medications right from their phone or tablet device. In a study conducted by HIMSS in 2017, 80% of clinicians used tablets and 43% used smartphones to manage patient information and carry out patient care. 

The use of smartphones and tablets also helped reduce bottlenecks in the system by transmitting information directly to the patient's pharmacist of choice rather than going through a third party. This both opened up better communication that sped up verification processes while ensuring the exact script was transmitted properly to avoid human alteration. And because scripts go directly to pharmacists during office hours, pharmacists have easier access to the office without having to worry about off-hours should the script require a callback. 

Conclusion

We believe wholeheartedly that Meta Digital is a winner—a much-needed solution to the costly and fraud-prone process of prescription fulfillment. 

In short, Meta Digital is a product that:

• Offers a simple way for doctors to prescribe medication

• Provides a safe and secure way to communicate directly between doctors and pharmacists about prescription information

• Ensures greater compliance across all regulatory sectors

• Reduces fraudulent activity and human error

• Helps Pharmacists acquire and verify the information needed to fill scripts

• Provides accurate information to insurance companies

• Reduces patient wait times and increases their satisfaction