As the Product Manager and Designer for CuraviGo, I was in charge of all facets of this project, including discovery research, project management, software and hardware design, gathering feedback and data, as well as iterative changes and updates.
A total of three versions went through four pilots at various skilled nursing facilities, each incorporating learnings from the previous iteration. The project ran over the course of three years and is extremely rich - this is just a taste of my process through the product lifecycle.
Curavi Go
Create a portable version of the telemedicine offering, extending the reach of our virtual doctors, and expanding the company product offerings.
Project Goal
Discovery: 2 months
Define: 1 month
Design: 3 months
Iterate: 2 years
Overall: 2.5 years
TimeFrame
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Competitor Research
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Ethnographic Research
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Customer Journey Mapping
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Scholarly Journal Review
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Bodystorming
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Paper and foamcore prototyping
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Moderated usability studies
Methodologies
The Goal
With the success of the CuraviCart, leadership decided it was time to make its telemedicine offering portable. Designed to be taken into the home or on a multi-level campus, it would allow a nurse to enter the home and get provider-based care without having to move the patient from their current location or wait for an appointment. Initially conceived to be a backpack, the product offering evolved based on customer research and feedback.
To determine the needs of the project, I first met with the Chief Medical Officer of Curavi to determine why the company was interested in pursuing a portable version of our telemedicine and what value it would bring to our customers and users.
The first Version
At the time that I joined Curavi, there were already some preconceived notions of what the product should be. Given the success of the larger cart, it was assumed that the Curavi Go unit would be a scaled-down version with similar peripherals, but I decided to do some research to find out.
Stakeholder Alignment
After vetting a few partner facilities, one Continuing Care Retirement Community in particular showed interest in partnering with us to pilot the new unit. Once the agreement was drafted, I met with several administrators to understand their goals for the pilot. From there, I proposed metrics with numeric ranges for "poor," "acceptable," and "excellent" outcomes to guide our project.
User Research
I started research with a series of phone calls with the end-users to understand their workflow. This was followed by moderated in-person sessions (example discussion guide here) where nurses demonstrated their processes and explained how they hoped telemedicine would assist them in their work.
Based on their existing process, I drew out a rough outline of the proposed workflow:
After having built a rapport with the nurses on the phone, I came on campus to perform some bodystorming exercises simulating base assumptions about the unit, and shadow their daily incident response. In-person observation revealed an unexpected insight: security personnel typically arrived first at incidents.
This discovery led to a pivotal concept - enabling security staff to initiate telemedicine connections instead of nurses. The next day, I shadowed security personnel to understand their incident response protocols and how they already routinely transported medical equipment for responding nurses. This fit into the new proposed workflow perfectly.
The Finalized Workflow:
Design decisions And tradeoffs
Designing the new unit balanced hardware limitations with portability requirements. Key tradeoffs influenced the final design in several critical areas:
Size and Weight
The most obvious constraint was size and weight, since the company already offered a larger form factor. Since discovery research revealed security's role in transporting equipment, this allowed for a slightly larger unit than initially planned. I incorporated nurses' equipment directly into the case, both reducing their burden and incentivizing usage by having necessary supplies readily available.
Connectivity
Despite campus-wide WiFi at the pilot facility, I added a portable WiFi generator for redundancy, and to test the concept in locations with limited connectivity.
Battery Life and Charging
Learning about security's dedicated transportation, I designed two ways to charge the unit's batteries: in-vehicle and at residents' homes.
After looking at data to see that the average consult length was 30 minutes, and there was a possibility of multiple consults before recharging, a minimum 3-hour battery life was required to support potential back-to-back consultations.
Peripherals
Scanner
Despite testing multiple portable scanners, I was not able to include one due to size restrictions. However, my initial research showed that the providers needed certain documents like medication lists and advanced directives. To satisfy this requirement, I developed a new flow for the “scannerless upload” where either security or nurses could take pictures of the resident’s documents to send to the provider
Vitals
I decided to consolidate our equipment with what nurses already carried. This would streamline their workflow and encourage them to use the telemedicine case that security would deliver.
EKG
In this version, our regular 12-lead EKG would not work due to its size and complexity. After consulting with experts at UPMC's Heart and Vascular Center, I opted for a 4-lead EKG that could use either electrode pads or clamps with gel. This gave us the essential functionality in a more compact form.
Layout
From our bodystorming exercises and ethnographic studies, it was clear that certain elements were used more frequently than others and needed to be more accessible. I created a tiered compartment design that kept cables and core components tucked away where they wouldn't be disrupted during regular use. This also allowed me to pre-wire all everything and not require plugging and unplugging equipment.
For the top layer, I went with custom foam cutouts so everything had its designated place. This made it intuitive to return items and provided protection for the equipment. The layout reflected actual usage patterns we observed in the field.
Documents
To provide consent, I worked with administration to create the consent for treatment and provided the paperwork in the case. The paperwork was designed in large print with high contrast so users would not need reading glasses at the time of the incident.
Software
On the other side of the consult, our providers had to adapt to a new workflow. Firstly, I needed a way to indicate that this was not a “standard” telemedicine call, but one where the patient was out in the field and would not have their medical records accessible. My solution was creating a distinct consult type clearly marked across the top of the consult card.
Next, since they were not able to read the patient’s records, thorough documentation was critical. I added an in-video dialog box that allowed for documentation while meeting with he patient and nurse. This would push to the patients' records that would be faxed to the facility and reduce redundancy for providers.
Initial releasE
After completing the prototype, I went back to the facility to meet with nurses and security. Before any formal training, I conducted quick usability studies with each person to identify what they could figure out intuitively and what needed explanation or refinement. This gave us valuable insights about the design's intuitiveness and highlighted areas where additional instruction or design changes might be necessary.
incident analysis and Iterative research
After the pilot was launched, I met weekly with administration, security, and the nurses to understand:
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Which incidents was the unit being used for?
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Were there any incidents that would have been a good use case but did not employ the unit, and why?
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Were there any incidents it was used that were not good fits, and why?
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Were there any issues or feedback with the unit?
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How were we hitting our goal metrics?
By keeping track of these metrics, we were able to determine the success of the pilot and identify more opportunities for use. With a 97% Treat In Place (TIP) rate, and an 82% Potentially Avoidable Hospitalization (PAH) rate, the initial release was a success!
Round Two
After the success of the first pilot, the Chief Medical Officer wanted to expand the offering and publish the results. After some discussions, we decided to use a Certified Nursing Assistant (CNA) as the telepresenter to reduce provider costs while still being able to administer care.
Requirement Changes
This pilot had a different setup: instead of staying on campus, we partnered with Senior Helpers and Capital Coordinated Management to bring care directly to patients. We were no longer staying "on campus" at a retirement community, but rather going out to patients' homes to provide care.
This shift changed both the workflow and the users, leading to new requirements.
Core changes:
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Smaller form factor
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No EKG
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No glucometer or sharps container
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No otoscope or otoscope tips
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No need for an external battery to power peripherals
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No need to scan documents - the provider already had them in her system
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Quick turnaround - no time to send out to manufacturing for custom foam cutouts
Due to these new constraints, I explored out-of-the-box solutions that might work such as train cases, makeup organization systems, camera bags, gun and weapon carrying cases, and even puzzle transportation systems. Knowing we would be making iterative changes through the duration of the pilot, I settled on camera organization systems within a smaller version of the hard case we had used in the previous pilot.
The New Design
After settling on the camera organization system, I put together the case and ran through it with the CNA again, and got her approval. I nestled the tablet on top of the contents and the case was ready to go!
Refinements
Once the pilot was underway, we met with the provider and CNA daily to get their feedback. We quickly discovered that some patients had very cluttered homes and no place to rest the tablet, and the CNA's arm was getting tired of holding the tablet for so long, so I decided to add a tablet case with a carrying strap in addition to a collapsible tablet stand.
Having already established a rapport with the care and security teams, further rounds of feedback and iteration went much more quickly. After a few weeks, I updated the design to include a magnetic mount for the tablet, avoiding the need for the new tablet stand, as well as a smaller case with fewer supplies when it was discovered that the nurses did not care to use all of the contents. A "quick start" guide was added to help remind the CNAs after they had forgotten the steps after returning from vacation.
Outcomes
The full results of this pilot were published in a whitepaper found here.
Major findings included:
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Patients were able to be seen an average of 1.6 days sooner, resulting in less urgent conditions.
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The provider was able to see more patients in a day, resulting in a 15% cost savings for 30-minute consults, and 32% for hour-long consults.
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Potentially Avoidable Hospitalizations (PAH) decreased by 21%.
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Connectivity could become an issue, especially in remote areas or in buildings made with older materials.