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Postcard #14 - Design Development of Smart Prescriptions

Last week, the IDEO team was back in London, following 2.5 weeks of live concept testing In Kenya and India. We started to sketch out some of the insights from the initial doctor feedback, as well as think about the design developments we'd like to make to Smart Prescriptions. We began conducting the follow up Skype interviews with our GPs and looking at the data coming in from the back end of the system.

Overall the headline is that the concept seems to be really appealing for doctors and they'd be happy to continue using it, with some tweaks to functionality. There are definitely some 'power' users and some lighter ones (currently it seems to be that those without existing EMR's are more likely to be using it with all patients). We've also noticed that the Indian doctors are prescribing more than the Kenyan ones - something which could be down to the fact they tend to have much busier clinics (30 patients a day vs 10).

A few quotes from our doctors

"As a GP your knowledge is much more wide than deep. With all the information about conditions, symptoms and guidelines, it's impossible to remember them all. This is a real help"
"There are different types of user that would need to be approached in different ways to use the service. People like me who already enjoy using tech in healthcare. Then people who are not following guidelines, they will need to be first sensitized to the issue and introduced to antibiotic stewardship, then they would be more open to trying it out."

In our follow up interviews we've been showing the doctors their own stats as a mini dashboard for discussion. All of the doctors are really excited by this feature.

An example mock up of one of our Dr reports

It's been great to chat through how this comes across, as well as gather builds from doctors about what else they'd want to see. We have especially talked through cases where they didn't follow the guidelines and why that was.

A common request has been to circle back with the patient to understand whether avoiding an antibiotic was successful - as often the doctor doesn't know if the patient got better or simply switched doctors

"I'd like to have an overview of which antibiotics I prescribed and for which URTI's - a little more detail. And if I could use the SMS function to follow up with patients about their outcome, that would really help me. I'd then be sure it was the right course of action"

We also heard requests to use the system to alert doctors about patterns in patient cases which need further attention:

A few fun stats:

- We've now had over 500 prescriptions made using Smart Prescriptions

- We have full data for 247 of these (tracking back end was finished mid way through the launch)

- Around 70% of these are for non URTI's (i.e. other cases the GP's are seeing) and 30% for URTI's. This is a great sign of potential adoption - doctors were specifically requested to use it for URTI's and simply try and use it as much as possible for other conditions.

- The guidelines are being followed on average 76% of the time

We've been building a new feature into the tool which asks doctors to give us insight as to why they didn't follow the guideline, when that happens.

The new feature we're building to capture reasons for overriding

This is a great opportunity to start collecting more nuanced local data about when guidelines don't feel appropriate to follow, and came as a direct result of requests from docs to qualify their activity.

"There are the times where you have to cross over the guidelines, but if I am able capture  why I am not following them, that makes lot of sense. You can go back and audit the reason why it is happening. So this could become evidence for me as I go on and practise". Dr Idris, India

The prototype is still being used by doctors in both markets (optionally) - until Friday when the testing period ends. We're prepping ahead of the CTA conference happening in Ghana on Monday and Tuesday next week - hopefully see some of you there!

Next up: CTA conference + design development

If you missed our previous postcards you can find them here:

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