Pathology Consult - A Case Study

Slide 1: PathConsult: a case study Presented By: Jonathan Clark Date: May 15th 2006

Slide 2: PathConsult  user understanding is critical  iterative development keeps the focus on the user  think outside the book But was it rapid? I’ll let you be the judge of that!

Slide 3: Development starts & ends with the user Understand the user, their tasks and their goals Design for the user, make sure they can efficiently and user-centred design easily complete their tasks Evaluate the UI, not the user

Slide 4: Example: Electronic Information Retrieval Morning Lunch Afternoon After Hours Librarian Researcher Student Practitioner Significant generalizations; Use of Elsevier electronic products is much smaller

Slide 5: It all started with a book.. 3000 pages  >8000 images  organized by organ  system 9th edition  includes diagnostic  pearls

Slide 6: Psychology of a Pathologist Prototypes for Obsessive-Compulsive Disorder  and Introversion Most are fanatical about their hobbies (eg,  cooking, wine-making) Typical work week for a Pathologist: 50 hours  Pathologists HATE change more than most  physicians More like a surgeon than they care to admit  Most feel as if they are the Rodney Dangerfields  of medicine

Slide 7: What does a pathologist do? 90% of what a pathologist does is:  Look at microscope slides & make a diagnosis  If they cannot make a diagnosis, they:  Look up information or ask a colleague or order additional  stains or send out to an expert Why do they look up information?  They’re not sure what they’re looking at  They can’t decide between 2 or more possible diagnoses  They know what the diagnosis is but need additional  information They need help on what to do to determine a diagnosis 

Slide 8: Pathologists at work

Slide 9: Primary Persona Perry, Private Practice, 42 • Has been in private practice for 8 years • Comfortable using computers, but currently doesn’t use them as much as his books for pathology-related questions • Often has very specific questions related to thresholds, margins, staging, grading; just wants the important bits, not all the background or foundation information • Driving need: Needs something that can help him work more quickly, more efficiently, and more effectively. Perry works in a private practice located in a medium-size hospital in the western suburbs of Chicago, Illinois. There are 6 pathologists in the office, plus a pathology assistant who handles gross. Perry is the “go to” person in the office for gastrointestinal cases, but everyone handles a bit of everything. His day is incredibly busy, with sometimes as many as 60 cases to review. The majority of the cases are fairly straightforward, though sometimes he will have a rare diagnosis. Perry usually eats lunch at his desk around noon, but often won’t it finish until a few hours later because of the number of cases he has to finish in a day. Life Goals  Perry has a large library of books and refers to them often. Usually he looks for a specific  Be good at my job picture to match a case, trying to pinpoint a diagnosis. He gets frustrated having to read Experience goals  through lots of text to just find the one piece of information he’s looking for, and wishes  Don’t waste my time he could just jump past all of the basic information right to the things he needs. Sometimes his work is interrupted, as colleagues ask for opinions on other cases. While  Don’t be condescending this can be frustrating, he doesn’t mind, as Perry often asks them for help with areas End goals  about which they are more knowledgeable.  Answer a specific question about a possible diagnosis He tries to keep up with new developments in the field, but it’s not as important as when  Find a picture he was an attending, since he mainly sees the same types of cases. Still, it’s good to  Find a specific piece of know about new immunostains and emerging areas like genetics, even if they’re not information for a case always useful in his day-to-day work. Perry works hard, and tries his best to leave on  Be more efficient time to get home and spend time with his wife Jeanne and his three kids.

Slide 10: Elsevier Agile Development Process + Prototyping Architect/Developer (IT Lead) QA Specialist Initiate + Initial Story Writing Content Workflow Manager Project Manager Release Project Planning Initial Spikes + Iteration Manager Product Manager Content Planning + UCD Analyst Iterative Development Feedback / Usability Testing Preparation Spike Release! Iteration 1 Iteration 2 Iteration 3 Iteration 4 Iteration 5 Deployment Run Run Write Functionality Write Write Iteration Select Prioritize Functional Regression Stories Review Code Tests Showcase Story Stories Tests Tests & Tests Kick-Off Development Testing Update Usability Monitor Verify Ranking/ Design Fix/ Review Stories Testing Progress Story Estimating Session Correct Stories

Slide 11: consultant the boss pathologist pathologist product mgr developers developers pathologist UCD developer

Slide 12: High-level features & benefits list A website for pathologists should contain:  Lots of high-quality pictures, with descriptions  Clear, concise, and current diagnosis info  Ability to compare differential diagnoses  Immunohistochemical stain information  For each diagnosis, pathologists want  Clinical information  Gross and microscopic description  Prognosis  Pictures  Differential diagnoses, including pitfalls and tips on what to look for  Content has to be:  Concise, bulleted style  Differential diagnosis information  Diagnostic pearls 

Slide 13: High-level features & benefits list A website for pathologists should contain:  Lots of high-quality pictures, with descriptions  Clear, concise, and current diagnosis info  Ability to compare differential diagnoses  Immunohistochemical stain information  For each diagnosis, pathologists want  Clinical information  Gross and microscopic description  Prognosis  Pictures  Differential diagnoses, including pitfalls and tips on what to look for  Content has to be:  Concise, bulleted style  Differential diagnosis information  Diagnostic pearls 

Slide 14: Differential Diagnosis: low-fi prototype Home > Differential Diagnoses First, select a body system Thyroid Select a different body system Then, select up to 5 diagnoses to compare View Amyloidosis Follicular carcinoma Differential Clear cell tumors Follicular adenoma Hürthle cell (oncocytic) tumors Papillary carcinoma Add  Hyalinizing trabecular adenoma and related lesions  Remove LYMPHOID TUMORS AND TUMORLIKE CONDITIONS Malakoplakia Medullary carcinoma MESENCHYMAL TUMORS METASTATIC TUMORS Other neuroendocrine tumors Parathyroid tumors Poorly differentiated carcinoma

Slide 15: Differential Diagnosis: low-fi prototype Home > Differential Diagnoses > Comparison Follicular carcinoma Follicular adenoma Papillary carcinoma Remove from comparison Remove from comparison Remove from comparison Image caption Image caption Image caption (stain, magnification) (stain, magnification) (stain, magnification) • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl • Diagnostic Pearl 25 additional images available 15 additional images available 18 additional images available View complete diagnostic View complete diagnostic View complete diagnostic information for Follicular information for Follicular information for Follicular carcinoma adenoma carcinoma

Slide 16: Story 7 As a Persona C I want to be able to view diagnostic information on a group of conditions so that I can decide between possible diagnoses.

Slide 17: Differential Diagnosis: as deployed

Slide 18: Differential Diagnosis: as deployed

Slide 19: From Pathology Book…. 3000 pages  >8000 images  organised by organ  system 9th edition  includes diagnostic  pearls

Slide 20: .....to Diagnostic Tool Online diagnostic clinical decision support covering  general pathology. Designed to be used at the point of work.  Image based.  Core is differential diagnosis tool to compare conditions.  At launch will includes 500 most useful conditions based  on feedback from Pathologists

Slide 21: Timeline Field study April 2005  Kick-off workshop July 5-7th, 2005  Lo-fi prototype July 13th, 2005  First customer demo September 7th 2005  Second customer demo November 10th 2005  Third customer demo February 17th 2006  Launch May 17th, 2006 

Slide 22: PathConsult Our lessons learned: that user understanding is critical   that iterative development keeps the focus on the user  and to think outside the book

Slide 23: Thank you j.clark@elsevier.com