Evaluating the problem and gathering insight

The goal of the project was to develop a product that served as a single source of truth for HMOs and HSPs. Understanding how the existing system works was crucial to effectively do this. Therefore, I started by carrying out literature reviews on all the documents provided by the client, of which the main document was the financial module documentation of HL7’s Fast Healthcare Interoperability Resource (FHIR).

Though the literature reviews provided substantial information on how data exchange between all involved parties should be done, it was crucial to compare and contrast that system against how things are done in the target market – Nigeria, to develop a system that matches the day-to-day tasks of the users while enabling them to perform such tasks more efficiently. Given that I had no access to real users, I settled for interview sessions with the Subject Matter Expert (SME) on the project to gain some insight into the existing processes, structure, and communication protocols used between Health Maintenance Organizations (HMOs) and health service providers in Nigeria.

Designing the system

With the insights gathered from the literature reviews and interviews, I identified key tasks performed by different actors throughout the entire system and the activities involved in performing those tasks. I also identified three communication channels that are vital to the system – Patient-HMO communication, HMO-HSP communication, and Patient-HSP communication.

Given that I had limited time and resources on the project I had to adapt my design process to provide the team with design solutions that did not compromise too much on the quality of the experience provided to the users while meeting business demands.

I relied primarily on the interaction flows and other specifications provided by the FHIR documentation as the foundation of the design solution while carrying out cognitive walkthroughs for each phase of the interactions to ensure they are in line with the identified user needs.

Unfortunately, the project was terminated three months later due to issues with funding. However, I was able to develop designs for the insurer (HMO) portal which are shown below.

Insurer portal

The insurer portal comprised of three primary modules. The beneficiary management module, provider management module and claims management module. While these were the meat of the portal, a setup wizard was included to assist first-time administrative users to setup the required data that allows the system to run as intended.

Setup wizard

Given that the target market for the product is a well-established market with terabytes of existing data, as well as a standardized method of organizing the data, I decided to design the setup wizard to be primarily for data import.

Beneficiary management module

This module allowed HMOs manage beneficiary accounts. From simple automated tasks like sending due payment reminders to complex tasks like managing organization level accounts, this module allowed users easily manage all.

Provider management module

This module allowed users perform tasks like adding new providers, updating provider specific tariffs etc. I tried to make the interactions as simple and straightforward as possible to ensure increased efficiency in day-to-day operations.

Claims management module

Managing claims and providing timely responses to providers is one of the core features of the product. The claims management module designed to provide seamless communication between internal actors of an HMO as well as providers. Features like in-app mailing/messaging and live notifications were added to enhance communication.

Conclusion

This project was an eye-opener for me. It exposed me to the inefficiencies in the operations of the Nigerian medical system and areas in which improvements can be made. Also, the HL7’s FHIR was a great deal of help in forming a foundation for the solutions I was able to come up with.