MSK Navigator Reassurance Service Design

msk patient navigator serviceservice design | mark jones | f09

aparna unnikrishnanprashant desaital shayvan vuong

I have CANCER

I have CANCERIs this normal?

What are the side effects?

How much work will I miss?

Will I lose my hair?

I have CANCER

How will this affect my family?

What are the chances of survival?

How much is this going to cost?

What are the financial assistance available?

Is this normal?


Is this pain from the Chemo or something else?

What can I eat?

When will I be able to come back to work?


How long with it take?


Nurses

Doctors

Physicians Assistant

Is this normal?



Nurses

Doctors

Physicians Assistant

Dietitian

What can I eat?



How do I treat the side effects?

Social Worker

Receptionist

Volunteers

Previous patients

Volunteers





Counselor

Previous patients

Caregivers

Friends and Family


What happens to my relationships?

I’m depressed what can I do?

Who has the knowledge to answer these uncertainties at MSK?

medical info physical comfort logisticsemotional

logisticsemotional

Who really answers these uncertainties?

NursesIs this normal?



What can I eat?








What happens to my relationships?

I’m depressed what can I do?

medical info physical comfort

start 1st round of treatment

start 2nd round of treatment

start 3rd round of treatment

The patient journey and the need for reassurance

Medical Information

Physical Comfort

Logistical

Emotional

need

for

rea

ssur

ance

start 1st round of treatment

start 2nd round of treatment

start 3rd round of treatment

need

for

rea

ssur

ance

How can we better reassure first time patients who have emotional, physical, medical and logistical uncertainties throughout their journey?

most need for reassurance is after first treatment when things are unfamiliar

Matching the right source to deliver each types of reassurance

medical, physical

medical professionallogisticalMSK veteran

emotionalprevious patients

physicalpatient

msk patient navigator service


Components of the Navigator Service:

Navigator team is a group of clinically trained professionals hired to help patients navigate the health system and answer logistical, medical, physical and emotional uncertainties


Components of the Navigator Service:

Navigator team is a group of clinically trained professions hired to help patients navigate the health system and answer logistical, medical, physical and emotional uncertainties

The mobile application allows patients to track symptoms at anytime and anywhere


Components of the Navigator Service

Navigator team is a group of clinically trained professions hired to help patients navigate the health system and answer logistical, medical, physical and emotional uncertainties

The mobile application allows patients to track symptoms at any time and anywhere

The web portal allows patients to get personalized service from the Navigator Team, learn from their experiences, and connect with past patients to resolve uncertainties

Navigator initiates communication by contacting patient + monitors them from remote location.

Navigator helps patient find their way through MSK services and the web. They guide the patient through other uncertainties that might be out of their range of expertise and contact other experts when needed.

Anytime access to previous patients who can relate to what you’re going through. An international network of survivors allow patients to ask questions at all times.

Patients learn how to track their symptoms - thus learning how to reassure themselves.

Interpersonal service Guidance to MSK Volunteer network Symptom tracker

From interpersonal guidance...

...to self-reliance





Scenario 1: The initial call and introduction to web portal


The Navigator initiates the communication

“How are you doing?”

Jane fears she is missing too much work because of nausea

Jane reviews information sent by Navigator through the web portal

What is on your mind?

Side-EffectsAccording to your treatment profile you might expect these side-effects. Click to learn more about treatment for side-effects.

Mouth soresHair lossNauseaLoss of appetite

Sypmtom Tracker

Pain Tracker

submit

Andrea's StoryAndrea in Austria

It began November 2004. Andrea was in her junior year at The Ethel Walker School, an all-girls boarding school in Simsbury, CT. She developed a serious pain in her hip, which she attributed to the intensive dance program she had joined at the beginning of the semester. A trip to the on-campus doctor resulted in a prescription for a muscle

Stories chosen specially for Jane

Hi Jane,

You are logged on to your profile.TREATMENT TRACKER

preferences




Sypmtom Tracker

Pain Tracker

submit

Hi Jane,


preferences

message from Navigator (1)





Scenario 2: Tracking, learning and enabling





Sypmtom Tracker

Pain Tracker

submit




Hi Jane,


preferences




Sypmtom Tracker

Pain Tracker

submit

Hi Jane,


preferences




Sypmtom Tracker

Pain Tracker

submit

Hi Jane,


preferences




Sypmtom Tracker

Pain Tracker

submit




Hi Jane,


preferences

PREFERANCES

I would like to track this by myself

I would like a nurse to help me track my treatment

I would like a family member to help me track my treatment

no

yes

yes (email only)

CONTACT

Would you like a nurse to call you periodically for consultations

Jane has the option of having a navigator help her track her treatment and periodically call

She can also track her pain at anytime through a mobile application

Joan MSK Navigator

Hi Jane,

You are logged on to your profile.

Sypmtom Tracker

Pain Tracker

TREATMENT TRACKER

tags:

mouth soresnausea

Message from nurse Jackie:Nausea is one the most common side effects of chemotherapy.There are couple of things you can do to keep it under control though; Eat small meals through-out the day. Also do not eat fatty, greasy foods right before or during treatment and drink lots of fluids at room tempera-ture

hour day week month

week month

preferences

slide 2) Nurse inputs solutions for certain side e�ects and this appears for the patient toreview

As Jane tracks her symptoms the navigator reviews the data and provides timely advice though the portal.

Sypmtom Tracker

Pain Tracker

PAIN TRACKER

hour day week month

Nurse View

You are viewing Jane’s data.

feb 1

feb 2

feb 3

feb 4

feb 5

feb 6

feb 7

feb 8

feb 9

feb 10

feb 11

feb 12

7pm 8pm 9pm 10pm 11pm 12a6pm

4 7

8

8

7

7

7

7

5pm4pm3pm2pm1pm12pm11am

preferences

After a few weeks of chemotherapy, the nurse notices patterns in the patients pain tracker. She calls the patient to check up on her. “I noticed you have consistent pain around lunch and dinner time a lot, are you eating something thatmight be causing this? sometimes eating certain foods might cause reactions”

Sypmtom Tracker

Pain Tracker

PAIN TRACKER

hour day week month

Navigator View

You are viewing Jane’s data.

feb 1

feb 2

feb 3

feb 4

feb 5

feb 6

feb 7

feb 8

feb 9

feb 10

feb 11

feb 12

7pm 8pm 9pm 10pm 11pm 12a6pm

4 7

8

7

7

7

7

5pm4pm3pm2pm1pm12pm11am

preferences

While reviewing Janes data, the navigator sees patterns and calls Jane to check up on her

After a few rounds of treatment, Jane is able to track and interpret her own data.

Hi Jane,

You are logged on to your profile.

Sypmtom Tracker

Pain Tracker

TREATMENT TRACKER

tags:

mouth soresnauseapain

hour day week month

week month

feb 5 feb 6 feb 7 feb 8 feb 9 feb 10

1

2

3

4

5 5

6 6

7 7 77

8 8

9

10

preferences





Scenario 3: Access to a wide network of volunteer cancer survivors 24/7


It is late and Jane has uncertainties...

A volunteer from across the world answers Jane’s questions instantly

Blueprint: navigator and symptom tracker (scenarios 1+2)

Navigator contacts patient if there is a need for closer follow up

Physical Evidence

Support processes

Customer Actions

Contact personOn stage

Contact person Backstage

line of interaction

line of visibility

line of internal interaction

Patient receives check ups from navigator and tells Navigator about their worries

Patient receives check ups from navigator and tells Navigator about their worries

Patient / family member inputs patient progress

Patient tracks their progress and suggestions from the navigator

Patient reviews their previous progress before next treatment to anticipate what to expect and plan accordingly

Portal creates a visualization of patient progress throughout time

Database of prepared texts for suggestions for common conditions

Database of patient treatment dates, type of treatment and contact information connected to Navigator calendar

Navigator contacts patient to ask how they are doing and answers questions. Has personal dialogue

Navigator introduces patient to the symptom tracking service, and shows an example of logging today’s symptoms in the system

Navigating serviceSymptom tracker serviceStarting point

Navigator tracks patient progress and inputs advice for patient

Phone

Web portal

Web portal

Mobile application

Web portal

Email

Patient receives latent response with package of information.

Navigator contacts relevant MSK services to find answers for patient questions if they can’t answer it themselves

Navigator sends patient answers or directs them to appropriate sources. Navigator may have personal conversation to deliver and translate info

Web portal Phone

Blueprint: volunteer network (scenario 3)

Physical Evidence

Support processes

Customer Actions

Contact personOn stage


line of interaction

line of visibility


Patient experiences concern

Volunteers sign up for time slots when they are available and can be reached

Volunteer profiles are updated on the site

Web portal Online chat

Phone

Patient reviews profiles of volunteers who can be contacted at that time

Patient chat online or call the volunteer

Volunteers update their status if they are currently in a chat / phone call with a patient

Access phone numbers directed to volunteer phone, to allow free calls and protect volunteer personal contact info

Expected insights and next steps

Testing value proposition and business case assumptions

Assumptions to test Resources required to test assumptions

Experiment results measurements

Whether patient are comfortable and interested in tracking their own symptoms over time.

If the volunteer network will be willing to contribute their time and support through the patient portal

If patients will feel comfortable inputting emotions through a mobile device.

Offer the personal symptom tracking feature to a limited test market within the Memorial Sloan Kettering patient portal.

Create an “E-mail” test scenario within the existing Volunteer-Patient network.

Provide a test group of patients with small personal journals and have them log their emotions in their notebooks.

Frequency and exhaustiveness of patient symptom logs

Satisfaction levels of participating patients with regards to volunteer response and support.

Frequency of patient emotion logs. Determine if patients are willing to log this information (and when they remember to)

The results of this experiment will provide usability data for the symptom logger - this data can inform future improvements to the patient portal

If the volunteer network will be willing to contribute their time and support through the patient portal - if they are, then a volunteer communication tab can be designed for the patient portal

Results of the paper prototype can be used towards designing an appropriate mobile UI.

THANK YOU!

appendix

additional materials+previous project versions

service design F09 | desai | shay | unnikrishnan | vuong

Physical Evidence

Support processes

Customer Actions

Contact personOnstage


line of interaction

line of visibility


CHA-CHA BLUE PRINT

Mobile phone

Mobile text

Cha-Cha website

customer texts cha-cha with question

customer calls to ask question verbally

Cha-cha receives question from customer

Generalist or specialists searches for answer or searches for stock answer

Message is sent to expeditor or translator

Forwards formated question to generalist or specialist

Guide sends answer to customer

Cha-Cha sends automated thank you

customer waits for response

Customer receives answer to question in natural language from a person via SMS

Receives thank you from Cha-cha

Cha-Cha sends automated welcome message

Cha-cha sends automated confirmation message

Customer receives welcome message

Customer receives confirmation that message has been received


Physical Evidence

Support processes

Customer Actions



line of interaction

line of visibility


NEWBORN AFTER HOURS ANSWER LINE BLUE PRINT

Mom calls clinic

Phone

Service bill is added

for patient’s next bill

Mom tells

receptionist she

Receptionist checks

if someone is

call

Machine instructs

details to leave in

message

to message

the mom back

Mom leaves a

on machine +

contact details

Receptionist

for the nature of

your call

pages person

provide guidance on

Receptionist asks

the mom to leave a

message on machine

no

What value does this analogy add to our service?


Physical Evidence

Support processes

Customer Actions



line of interaction

line of visibility


ID ORIENTATION AND REGISTRATION BLUE PRINT

New Students receive

email / student access

to Google Groups

email messages,

google group webpage

Print collateral

Mailing Envelope

Voice mail, Email Course Info sheet ,

checklist, schedules

Websites : ID, IIT

and other design related

websites, emails

Emails, ID registration

forms, MyIIT

registration site.

New Students receive

information package

New Students receives

contact from the

mentor

Students attend the

course introductionStudents seeks for

additional information

New student looks at SeeID and IIT

New students speaks to current students

New student does non

IIT research about the

subjects

The Admin schedules

the course introduction

event

Admin sets up the SeeID.

IIT website is updated

Faculty puts the course

descriptions on See ID

ID and IIT admin

collaborates and

registers students into

the IIT system

Admin is receiving

information from

new students on new

chosen classes.

Ongoing dialogue

between faculty,

advisors and admin.

Admin provides with the

registration materials

Advisor signs o� on the

chosen courses

Student registers at IIT

website

The new students are

informed about the

course introduction

dates and time.

Students, Professors

interactions takes

place.

Faculty prepares the

content

Administration

organizes

the groups and

gets together

email IDs of the

new student

body

The current student body or the

admin designs the package and

puts the content together.

Welcome ID recruits mentors and

pairs them with the mentee

The new student addresses are

collected

Mentors and mentees are asked to

send in information so that they can

be paired up.

The current ID

students sets

up the Google

Groups

The

administration

sends out the

information

Mentor reaches

out to the new

students, (their

respective

mentees )

Mentor and

mentee interacts

and exchanges

information

either through

phone, email, in

person

ID announces to

the new student

group abt the

Google Groups.

New students

start interacting

within

themselves and

also current ID

students through

message posting

and answers

Students receive the

PIN for registration

Student makes the

course decision

ORIENTATION REGISTRATION

Reassurance

Medical

PhysicalComfort

Logistical

location

Process --> treatment

process --> admin

finding credible info

doctors/nurses

familyfriendsNED

Stress

Anxiety

Depression

Symptoms

Workarounds for them

Pain

have asked the right questions in the right way

Emotional

What kinds of uncertainty do they

have that don’t stem from lack of

disease information?

New Cancer Patients

more info

(before

consultation)

2nd Opinion

State of

Mind

need for reassurance

Emotional feelings

Medical

DocNursesvolunteers

receptionists

anxieties

what to expect

Chemo Brain

way finding

other docother treatment

side effects

symptom meaning

tests: make sure all needed are done

interpret results

diet

finance

NED- No Evidnece of Disease

Family

Friends

Kids

Partner

chemo

longer than expected Problems

Home

Clinic

Social Support/Lifestyle

People at

Clinic

Who is your target customer: First-time cancer patients

What are their concerns: Emotional Reassurance, becoming comfortable with the treatment in the initial phase when you are more lost. What are the kinds of uncertainties do they have that don’t stem from lack of disease information?

What are their unmet or underserved needs: Emotional reassurance and physical comfort

What are our offerings for these customers: + Personalized experience+ Concierge/ buddy/ advocate+ Direct link to profession+ immediate feedback+ individualized learning tools (tracking symptoms so you know when to expect side effects)+ guidebook

What are the benefits of our offerings: + immediacy of reassurance+ personalized experience+ accessable support+ proactive/ solution oriented+ push not pull+ Help predict future experience

Online communities ie http://patientslikeme.org, http://www.caringbridge.org

Compared to what is offered by our competition?+websites+patient- to- patient service+online forums+social support groups+ doctors/staff at clinic

Value Statement:Provide first time patients highly personalized, immidiate, interpersonal reassurence and feedback, for when they experience uncertanities in between treatments.

Value Statement Draft

Provide first time patients continuous, personalized, interpersonal reassurance and guidance, for moments of treatment-related uncertainty, pain, and confusion through offering timely, patient-specific awareness tools and professional support between treatments.

The MSK Navigator Portal enables MSK’s team of friendly nurses to work together with their patients to monitor cancer symptoms, side-effects, and pain over time resulting in greater predictability for the patient. They gradually transition from Navigator initiated follow-up and guidance to patient self-service.

Service Description Draft

When starting chemotherapy treatment, a patient can be overwhelmed with information about what to expect – particularly in regards to pain and symptom management. While the internet holds a wealth of information for cancer patients, it is often cumbersome and confusing to navigate non-personalized websites in hopes of locating relevant, in-the-moment information.

The MSK Navigator Portal enables MSK’s team of friendly nurses to work together with their patients to monitor cancer symptoms, side-effects, and pain over time resulting in greater predictability for the patient. They gradually transition from Navigator initiated follow-up and guidance to patient self service. Through the MSK Navigator portal, patients are encouraged to track the distressing side-effects of cancer and treatment and are provided 3 different options to do so:

(1) Self-Tracking (Patient Self-Service): By selecting the self-tracking options, patience can develop self-awareness over time, and are able to anticipate and preemptively prepare for the next occurrence of cancer and treatment related side-effects. Patients are also able to communicate with a nurse directly if any additional concerns arise and are able to do so through indicating their preferred communication channel at the MSK Navigator website.

(2) Nurse Assisted Tracking (Nurse Link): The Navigator Portal provides a direct connection to MSK nurses. In MSK Navigator, patients are provided the option of allowing nurses access to view their pain and symptom logs. By sharing this information, patients enable nurses to track their personal logs over time, and subsequently provide timely medical support and intervention. With MSK navigator, nurses are able to provide first time chemotherapy patients with personalized pain and symptom specific reassurance through continually anticipating patient-specific needs throughout chemotherapy treatment.

(3) Family member assisted tracking (Family & Friends Link): Patients can also provide their loved ones access to their logs. In doing so, family members can help monitor the patient’s progress and provide a more complete picture


Physical Evidence

Support processes

Customer Actions



line of interaction

line of visibility


PATIENT SUPPORT BLUE PRINT

Mobile

Email

Phone

Website

Mobile

Phone

Email

Patient has uncertainties and contacts their navigator via SMS, email, website or phone

Patient gets immediate response Patient recieves check

ups from navigator and tells Navigator about there worries

Patient receives confirmation message has been received, approx time for answer.

Patient receives latent response with package of information.

Expert team on call to answer navigator questions. MSK provides support for navigators. To direct them to answers they cant find themselves

Navigator sends patient timely messages or calls patient to inform them about treatments, potential side effects

Navigator does investigation for questions they can’t readily answer

Navigator recieves message and imediately answers or sends message that they are working on it

Navigator sends patient answers or directs them to appropriate sources. Navigator may have personal conversation to deliver and translate info

Navigator contacts patient to ask how they are doing and answers questions. Has personal dialogue

possible starting points

MSK has a team of experts and specialists composed of a nurse, counselor and information science person. Navigators are given basic information from the experts in the form of workshops and training.

MSK web portal that helps answer questions and directs to relevant stories and information.

Team of experts dispatch answers to navigator. If there is a lot of content, they may package information in an email or other printed material.

Navigator is given basic information about treatment and is educated on basic information.

the end...

MSK Navigator Reassurance Service Design

Design

Transcript of MSK Navigator Reassurance Service Design