Peter Rest

Work

About

Resume

How my team is building a 0-to-1 EHR web app to combat the opioid epidemic

My Role: Sr. Product Designer

Timeline: 3 years

Disclaimer

This project is protected under a Non-Disclosure Agreement (NDA).

As such, specific details, contexts, and proprietary information have been generalized or omitted to comply with confidentiality obligations and privacy requirements. Additionally, all photos and data shown are sourced from publicly available sources.

Problem

The opioid epidemic continues to be one of the most disruptive public health crises in US history. For patients struggling with opioid addiction, treatment often involves Opioid Treatment Programs (OTPs), which are (typically) standalone facilities that provide evidence-based care like medication-assisted treatment (MAT), counseling, and behavioral therapies.

These programs are critical for recovery, yet they rely heavily on efficient, robust software to operate. Our team has the vast majority of market share in the MAT/OTP software space, providing thousands of facilities across the nation with an electronic health record (EHR) from our suite of four OTP products.

Unfortunately, all of the existing legacy products are desktop applications and at the end of their lifecycles. They are becoming increasingly slow, harder to maintain, and are hindering the ability of already-understaffed providers to deliver effective care to a rapidly growing patient population. The catch is, they each encompass over 20 years of functionality that facilities rely on every day.

Solution

Modernize the OTP industry by creating a new, scalable, best-in-class web app encompassing the best functionality of all legacy suite products.

ℹ️ The crisis in context

Opioid Treatment Programs (OTPs) operate under some of the most stringent regulations in the country, requiring staff to navigate an intricate web of federal, state, and even county-level oversight. These regulations often overlap or conflict, making compliance difficult (and expensive).

We are failing to address this crisis as a nation, and there is an undeniable relationship of this failure to many factors, one of which being the now antiquated technology available to those on the front lines that makes compliance difficult and clinical efficiency a pipedream for most.

As of May 2024, there are roughly 2.1 million known cases of Americans with opioid use disorder (OUD).

Only 19% receive treatment at OTPs.

Graphic showing the rapid increase of opioid overdose deaths in the United States

💼 Forming the team

In May of 2022, a private-equity backed, multi-disciplinary team (including myself as the Product Designer) was assembled to build the new, modernized EHR that would be the successor to the company's four in-production legacy EHRs.

💬 Interviewing

With a project this large and complex, what better way than to start simply—listening to OTP staff on the front lines.

Myself and the Product team traveled to OTPs across the country observing staff during their day-to-day.

It's hard to put into words the experiences we had, but the most striking thing we took away was the resilience of the human spirit. The staff in these OTPs were visibly tired, stressed, and burned out, yet their interactions with patients were kind, compassionate, and at times parent-like. It was sad, beautiful, and inspiring all in the same vein.

We visited facilities with less than 100 active patients, others with over 10,000. We observed staff using the EHR during peak dosing hours when they had dozens of antsy patients in line for treatment at any given time, and at nights when they would prepare take-home medication for patients scheduled to dose the following day.

We observed pain points of the industry and its people in all dimensions—inside the EHR and out.

Clinic staff member at Brockton OTP interacts with a patient receiving a dose of methadone. Source

📋 Organizing and analyzing

After our initial research activities, we set out to compile what we had learned into artifacts. These eventually informed action items in the early stages and throughout the project.

Artifacts included:

Affinity diagrams to understand the information
Proto-personas of key clinic roles which we eventually matured into high-fidelity personas
Task analysis current state vs desired future
Journey maps
Information architecture maps
User stories

🧱 Establishing foundations

To start somewhere, we began sketching and low-fidelity wireframing the foundational interface, structure, and navigation patterns of the new EHR. We weren't focusing on designing clinical workflows yet, just the "shell" that would house them in the new system.

This allowed us to have more detailed conversations about how ideas for the various application structures would influence some of the clinical workflows that would follow. To get as specific as possible, things like:

Searching and selecting a patient in a way adherent to Protected Health Information (PHI) regulations
How users could navigate between different areas of the app without losing progress on a workflow
How users could quickly reference small pieces of information without leaving their current workflow

A fictitious, generalized example of task analysis that resembles similar diagramming we did in early-stage ideation.

🔨 Building & scaling

After designing a core UI we felt comfortable with (knowing we'd mature it alongside the app), we began designing out the workflows, or "modules", that would live within it.

As a Product team, we agreed that to achieve feature parity of the core workflows that existed in the legacy application and account for the user stories we wanted to address, there were 8 modules we needed to design and build.

Each had sub-modules and significant functional interdependencies with the others, so we decided to start with one that had the least dependencies.

Through this initial project, we also established the foundations of our design system, innovation and design process/activities, and for the developers, our tech stack and high-level system architecture.

Each subsequent project matured our design and development practices, increased our efficiency as an agile team, and most importantly, showed progress on our new product.

Our application and team took significant shape and garnered much excitement from the industry and our clients.

A fictitious, generalized example of high-fidelity mockups that resemble portions of our application.

📍 Acquisition and current state

In November 2023, our company was acquired. This is another area where I'm unable to share many details, but in short the project has progressed significantly, and our design and development teams grown exponentially.

An acquisition provides many great learning and growth opportunities for any company and team, and our experience was no different.

Much of the conversations post-acquisition revolved around scaling our team, product, and its delivery and implementation timelines concurrently. Additionally, how the company could mature the design team and its practices as a model for similar EHR projects in the future.

We have since rolled out certain modules (outside of a full standalone application) to very a positive reception from our users, providers, and the industry at large.

💭 Reflection & next steps

This project has been as rewarding and educational as (I feel) it has been important and impactful to the people it serves. I am incredibly honored to have played a part in its journey thus far, and beyond thankful for our amazing team, and the friends within it I have made along the way. Working so closely on a cross-functional team has been an amazing experience. Learning from and collaborating with engineers, product, SMEs in the industry, and other designers through such an important mission has been the highest privilege.Design is never done and I am so excited to see how this product and its team continues to evolve and serve the people who use it, and the patients they care for.