UX Case Study
MyChart Billing Reconciliation New Feature
Project Overview
Hospitals and clinics have invested heavily in enterprise applications that allow for secure and easy sharing of patient medical information. This case study focuses on improving the user flow for patients tracking their past payments made to the hospital using the EPIC enterprise application’s patient portal, MyChart.
Time Frame
80 – 100 hrs over 3 months
Check out the final MyChart prototype with its new billing reconciliation feature. It was created with Figma.
Define
Problem
MyChart users are:
- Unable to confirm if a similar balance is the same as current balance due
- Confused about how a payment was applied
- Unable to tell which statement or date of service was paid previously
MyChart users were eager to share their experiences. I gathered a few anonymous quotes from patients needing help using MyChart’s billing platform. These quotes are from users with varying demographics; they have been included to underscore the visceral reaction of people using MyChart’s current billing reconciling features.
Research
Research Questions
The research uncovered the methods used to pay medical bills, artifacts/tools used, the atmosphere in which they like to pay or track their medical billing, and what they expect when they are paying their bills.
- How do people want to pay medical billing and track it?
- Who is using the patient portal to pay and track their bills, and why?
- When are people using a patient portal? Is it a first choice? Is it part of their general process?
- What sort of notifications, paperwork, etc are needed for the user to pay their bills?
- What puts people at ease when dealing with medical billing? Are there things that make it easier or confident that the medical bill was paid correctly?
Research Methods and Persona
Secondary Research
Market Research/Competitive Analysis: Gathering this data was difficult because most direct and indirect patient portals are private, proprietary, or customized. The research relied heavily on publicly available information and reviews/ratings by customers.
Primary Research
1:1 Interviews: I interviewed MyChart users about their past experiences with their medical billing in hopes of uncovering shared processes/tools, user pain points, motivations, and goals.
Competitive Analysis
There are many kinds of healthcare enterprise applications available with patient portals. A competitive analysis allowed for direct and indirect comparisons of these existing businesses’ online offerings.
Competitor’s shared positive attributes::
- Clearly defined user flows
- Professional, well-thought-out content that pertained to assumed main user goals
- Responsive sites
- Easy to well organized information and easy to follow processes
Analysis of top-ranking g2.com medical enterprise applications with patient portals.
1:1 Initial Interviews
1:1 remote interviews allowed for the opportunity to gain meaningful insight from participants that pay their household’s medical bills and might use patient portal applications to pay or track payments with their patient portal.
During the interview process, it seemed that most users knew the basic terminology for medical billing and felt comfortable with the overall claims process. It is worth noting that this is not a given with all patients that pay their medical bills or use online billing; interviewees had had terminology and payment processes modeled for them by their family growing up or from their employment.
Most interviewees looked over bills once they were alerted that they owed a balance and confirmed they went in for the particular service. If nothing seemed odd with the balance due, the statement balances were accepted as correct and paid. Most reconciling for billing mattered only when there was an obvious balance issue due to coding errors or if a patient could not confirm if a balance due had been paid already.
“…for some reason there’s a delay when the billing office shows your payments that come through. It’s kind of confusing where it lines up- it’s almost like they state that you still owe money when you’ve totally paid your invoice already.”
-Participant 4
Journey Map
Multiple touchpoints are left out when considering interactions just within MyChart. When I created a journey map it helped me follow the user’s full experience. It also showed me a fuller vision of how a patient might be using the app. After completing the journey map, the primary persona became more fully realized and sympathetic, and user needs, motivations, and pain points became clearer.
Defined Persona
This study incorporated primary and secondary users. Primary users generally took care of medical bills for themselves and their immediate family. Secondary users help the patient understand, pay, and track their medical bills. Personas and Empathy maps were created for both kinds of users.
Design Moving Forward
The user interviews and competitive analysis helped determine user needs, motivations, processes, and pain points regarding past medical billing experiences. Application iterations will focus on MyChart’s current billing offerings and decide how to edit, revise, and expand on what is currently available.
Ideate
The initial research from primary and secondary resources helped guide the process of formatting case study personas which, in turn, created the parameters of the new feature. The current MyChart does have some detailed billing, but it is limited. Ideation will focus on how best to expand, combine, and build out the existing app’s offerings to meet user needs and expectations.
Feature Roadmap
The feature roadmap for this project is simple and straightforward for good reason. It will be important to keep coming back to the minimum viable product during the ideation portion of the design process since wandering too far could make the project scope creep out too far. The challenge is only to make billing reconciliation in the app easier and to avoid scope creep. The things that must absolutely be included in the feature are laid out below in the “must-haves” section.
Must Haves
Feature One- Matched payments to dates of service
Show billed dates of service, general description, insurance payments and adjustments, patient payments, and dates paid
Research Supporting Feature: User interviews and Comparative analysis
Nice to Haves
Feature Two – Billing Call to Action (CTA) on landing page
Clear icon and CTA to let patients know where billing features are located on the app
Research Supporting Feature: User interviews and Comparative analysis
Surprising & Delightful
Ability to request detailed billing to submit as a receipt to FSA or HSA
Research Supporting Feature: User interviews
Must Haves
Matched payments to dates of service
Show billing details, insurance and patient payments, and balances owed
Research Supporting Feature: User interviews and Comparative analysis
Nice to Haves
Billing call-to-action on landing page
Clear icon and call-to-action to let patients know where billing is located on the app
Research Supporting Feature: User interviews and Comparative analysis
Surprising & Delightful
Ability to ask for detailed billing
Ability to request detailed billing to submit as a receipt to FSA /HSA or to have as proof of payment
Research Supporting Feature: User interviews
User Task Flow
The new feature seeks to make it more clear how patient and insurance payments are applied and to be able to get an itemized statement once billing and charges have been finalized.
Currently, the only way to check where patient payments are applied is to reach out to customer support; the task can not be completed on MyChart as it is set up.
The flows for the current version of MyChart are shown below in the left-hand column. The flows with the proposed feature added are in the right-hand column below. It was essential to analyze how MyChart works now to know how to try to improve this flow.
Current MyChart Task Flow
Current MyChart Task Flow, Task: Patient trying to see past payments made for their visits.
Proposed MyChart Task Flow
MyChart Task Flow with Feature, Task: Patient trying to see past payments made for their visits.
Current MyChart User Flow
Current MyChart User Flow, Tasks: Patient trying to confirm if a bill and date of service has been paid.
Proposed MyChart User Flow
Mychart User Flow with Feature, Tasks: Patient trying to confirm if a bill and date of service has been paid.
Wireframes and Sketches
After getting all of the essential pages laid out, I did preliminary sketches for the landing page’s filtering and call-to-actions.
Wireframes were heavily based on the existing layouts and pages for MyChart since this feature needed to fit in with the design decisions already in place for the application. This was an important part of the project to focus on- not changing the styling. I have included a Figma prototype showing the current MyChart page layouts, styles, and UI patterns to show what I had to work with to start the project.
This is a prototype showing the layouts, styles, and UI patterns of currently used by MyChart. It was created with Figma.
Wireframes
Wireframe Interactions
High Fidelity Mockups
The high fidelity mockup used the existing user patterns/modules and branding of MyChart. It was essential to make the new feature fit in as seamlessly as possible so that users could not spot where the current MyChart pages stopped, and the new feature began.
Mychart Wireframes
Mychart Hi Fi Mockups
Test & Iterate
After setting up interviews, finishing the mobile prototype, and running through the chosen interview questions- it was time for the actual UX test.
Info gathered while assessing task completion and user feedback would be critical to check out site interactions and user flows.
UX Testing
Participants were asked to complete tasks remotely while recorded their responses and screens. The hope is to determine which parts of the new feature worked and which parts needed further iteration.
Test Goals
- Checking on ease of finding billing information
- Does the patient know how to find billing previous payments without direction?
- Can the patient see how past payments were applied (using the new feature)?
- Does the patient understand which service dates have been paid and if there are still balances owing on them?
- Overall feeling/satisfaction using the feature
Participants
- Age range 16 – 68
- Participants: 4-6
- Psychographics (age/income): Varying
- Preferred qualities: Has used a medical patient portal for themselves to track or pay online.
Tasks
- Testing if patients can easily find billing (Goal 1)
- Testing if patients can easily find past payments from patients(Goal 2)
- Testing understanding of how their payments were applied (Goal 3)
- Seeing if the breakdown of payment application makes sense to patients and if this is useful to their task of reconciling billing (Goal 4)
- Does the feature allow the user the confidence to know if a balance in the past has been paid or not? (Goal 5)
- Would this patient use this tool? (Goal 5)
Task Completion
The majority of tasks were completed with little to no hints given. During the process of questioning, I realized that the tasks strayed from the overall focus of seeing if the feature was helpful and understood. After deliberation and peer review, I narrowed the questions and tasks to only address the functions of the feature being tested. Below are the main issues found during testing:
Tier 1 Issues
1- Make scanning medical payment and office visit information easier- use simple vocabulary / direct phrases
“I wonder if those two …could be combined? Like it was like another …[piece of info]… to read. That didn’t really need to be there. You know what I mean? …When it comes to it just seems like taking up like more reading for the same idea.”
– Participant 4, Age 41
2- Make it clear that there is more information that the user can access without overwhelming the user- this is specific to the feature showing billing/service/insurance payment information.
“I would not show any information. I would do service details and an arrow and all the content under that and billing details and an arrow like I wouldn’t show any of the others like, don’t show anything until you expand it.”
– Participant 5, Age 3
Tier 2 Issues
Make seeing and filtering most recent payments easier- show immediately last payments made in payment history and make terminology for sorting and filtering more universal.
“Well, I’m looking at my payment history. Why can’t you just put in a date, payment month or whatever? Choose payment month instead of all these little blocks with filters and sorts? Why can’t you just put a payment month and just put a thing that says month? Let them click on the month or have a drop down that says month and not to pick on the month rather than that sort and filter?”
– Participant 3, Age 68
Reflection & Iterations
Overall the feature was deemed helpful when confirming medical billing payments in MyChart- the main issue to resolve with iterations was the simplification of shared information.
I simplified the content shown to the user by focusing on keywords and more familiar terminology; this would help with scanning info for individual dates of service. I made the payment history tab load the most recent patient payments while using more direct call-to-actions for the filter and sorting buttons.
Check out the updated prototype created on Figma.
Below are some impressions from the youngest and oldest UX test participants about MyChart with the feature in general. I included them to illustrate the breadth of user needs, understanding, and expectations that need to be considered for further MyChart and feature development iterations.
“I would look at this. If it’s easy to look at and I understand how to use it, yeah, just thinking it needs to be extremely simple.”
– Participant 3, Age 68
“It seems relatively, relatively easy. Like, I understand all the little logos and like, I don’t know how to explain …the web design? I just don’t understand all the words because I’ve never paid medical bills.”
– Participant 6, Age 16
Reflection & Iterations
Overall the feature was deemed helpful when confirming medical billing payments in MyChart- the main issue to resolve with iterations was the simplification of shared information.
I simplified the content shown to the user by focusing on keywords and more familiar terminology; this would help with scanning info for individual dates of service. I made the payment history tab load the most recent patient payments while using more direct call-to-actions for the filter and sorting buttons.
Check out the updated prototype created on Figma.
Below are some impressions from the youngest and oldest UX test participants about MyChart with the feature in general. I included them to illustrate the breadth of user needs, understanding, and expectations that need to be considered for further MyChart and feature development iterations.
“I would look at this. If it’s easy to look at and I understand how to use it, yeah, just thinking it needs to be extremely simple.”
– Participant 3, Age 68
“It seems relatively, relatively easy. Like, I understand all the little logos and like, I don’t know how to explain …the web design? I just don’t understand all the words because I’ve never paid medical bills.”
– Participant 6, Age 16
Project Next Steps
Obviously more than a few interviews, personas, and iterations need to be completed for the success and usability of this feature for the application.
Next steps would be to create another round of usability interviews with some A/B testing to see if perhaps more or less info might be needed to help with medical billing reconciliation. Is it simplified enough or too simple- only further interviews would be able to tell.
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