What is CWOW?
CWOW (Clinical WithOut Walls) is five year initiative at DaVita to build a new web responsive application that replaces a legacy system that allows Clinicians (except Physicians) take care of their patients at DaVita Dialysis Clinic. 
Patient Notes
Patient Notes is a critical component of the patient care workflow that allows clinicians to document every single interactions and event about a patient that will remain in the patient chart. 
My responsibilities included design the entire feature from the scratches and working with the product team to define the global Note design pattern that allows Clinicians to create and view Notes in CWOW application.  
Requirements
Business
We started with business requirements that were provided by the product team.
1) A structure of a Note contains Type of Note, Event Date & Time, Created Date & Time, Author with their role, Care Category Tags and the Note detail that can have up to 5,000 characters.

2) While a clinician is writing a Note about a specific event, they always reference the patient information in the patient chart. Therefore, the app must provide the user an ability to navigate around the app without losing Note creation screen freely.

3) There are four type of patient Note: Normal Note, Late Entry Note, Addendum and Linked Note
   - Late Entry Note is a note that has Created Date and Time at least 24 hours after the actual event/encounter date and time. I.e., A clinician met a patient and discussed with them about an incident that caused bleeding during their treatment on 04/26/2018 18:35. If the clinician creates a note on 04/27/2018 19:43, the application automatically classify the Note as Late Entry Note.
    - An addendum is a note that is created by the original author of a patient Note that they created and linked to a Note to provide additional information about a particular event that wrote a Note about before. Addendum doesn’t have Event Date & Time. You can think am Addendum is a comment on a comment that you have written for a Facebook post.
    - Linked Note is similar to Addendum but is created by a person who is NOT the original author of a Note. Identical to Addendum, Linked Note doesn’t have Event Date & Time. You can think a Linked Note is a comment that you write about a comment that is written by another user for a Facebook post.

5) A retraction is a form of deleting. Retracting a patient Note will remove the Note from the patient chart but will be retained for auditing purpose from another application. Retracting a patient Note will also retract all of the attached Addendums. However, Retracting a Note will NOT retract all of Linked Notes. Instead, the Linked Note will become "orphan" Note. Once Linked Note is unlinked, the event date & time of a patient Note that this Linked Note was attached, will now be copied over to the "orphan" Linked Note. The “orphan” Linked Note will now have Event Date & Time along with Created Date & Time.

6) Because the clinician can edit their Notes, we need to provide the ability to view the edit history of their Notes.
7) There are seven different roles at the clinic that can create Patient Note:
RN - Registered Nurse
RD - Registered Dietitian 
MSW - Master Social Worker
LPN/LVN - Licensed Practical Nurse/Licensed Vocational Nurses 
PCT - Patient Care Technician
AA - Administrative Assistant
FA - Facility Administrator

Technical
Along with business requirements, there are few technical limitations that we need to keep in mind.
1) There is a concern about the app performance so we can't display more than 10,000 characters on the screen.
2) Currently, the clinician can only create one new Note at a time.
Wireframe
As a UX designer at DaVita, I am responsible for working to Product Owner, Business Analysis and application user interface architecture to figure out the details for Note and create the wireframes to explore options how we can provide all of the Note functionalities based on the requirements and the technical limitations. In CWOW, we usually don't have enough time to conduct user research to understand the problem and the why behind a specific set of features, instead, demonstrating the solution based on the business requirements by creating wireframe and conduct usability testing or A/B testing to validate our solutions.

After discussing solutions with the design team during our design collaboration weekly session, a usability testing and A/B testing, below is the highlighted of the wireframe that we are confident will provide an efficient and scalable solution. 
Usability Testing Prototype:
Visual Design
The CWOW design team has UI designers who will use our design component library to produce high fidelity design. However, I was given a chance to work on the visual design for patient Note as well. 
The Visual Design has been reviewed with the development team. The design specs are uploaded on Sympli.io
Below is the final visual design solution.
Create New Note
A Note can be created from everywhere within the patient chart; hence, a "New Note" button is placed in the patient banner. Clicking on "New Note" button will open the new Note creation popup window. The popup window appears on top of the screen, and the user can freely navigate to the different part of the patient chart. This solution is similar to Facebook and LinkedIn's message boxes.
The user can also expand or collapse the new Note creation popup window freely. 
Note List
We chose the card design pattern for each Note in the Note list. For each card, the user can quickly view the type of Note, the event date & time, author with their role, Care Categories Tags and a one-line preview of the Note detail. Besides, they quickly view how many Addendums or Linked Note this Note has. 

For Linked Note, we do not display the Event Date & Time since they do not have one. Instead, we show the date and time that it is created or linked. The Linked Note will also show right below the Note that is connected to.

The purple card indicates it is the user's Notes, while blue cards are Note from other clinicians. 
Note Detail
Clicking on the Note will display the Note details, related Notes either Addendums or Linked Note. The action bar contains three Note action: View Edit History, Add Addendum or Linked Note and Modify which will present two options of Edit or Retract.
Create Addendum or Linked Note
Creating new Addendum or Linked Note will open a popup window just like creating a new Note. However, since they do not have Event Date & Time, but instead, they are linked to a Note, we show which Note that they are going to be linked to. By clicking on the link, the app will display the Note details of the Note.
Edit History
Edit History provides users options to select the edit version that they want to view. The difference between the select version and the previous version are highlighted in red and green for what has been removed or added, providing the user a clear understanding of what they changed on the Note.
Edit History - PDF Design
It is a global requirement that we always need to provide the user the functionality to print the patient detail on their chart. Therefore, I am responsible to design PDF version of the Patient Note by using the global PDF template.

Because of the data structure of Note and limitations of PDF0-generating application, we have to change the design of viewing Edit History. We must display two different versions of the Note side-by-side based on the selected version, instead of showing what has been removed or added similar to the app interface.
Case Study
Note List
Note list can become overwhelming with a large number of patient Note, we were exploring different ways of using color to help users quickly find the Note that they are looking for. Since it is not a business requirement, we were free to explore options. Below are options that we considered.
1) No differentiation. One color for all Notes
2) Using color to indicate the role of the author who wrote the Note.
3) Using color to indicates which Note is the user's Note and which Note is created by other authors. 
4) Using color to indicates the Note type.
After discussion with the business team and quickly usability testing with clinicians, we learned that they don't want the Note list to be too colorful, Note type is not very important, which lead us to the decision of choosing option 3.
Edit History
The architecture team decided to use the third party tool to compare differences between two version of a Note. However, the process of obtaining the contract can take up to 6 months because they have to go through a complicated approval process. Scale-Agile doesn't provide a short release cycle, and a temporary solution is needed for displaying Edit History. We decided to minimize the effort by using the same pattern that we used for the PDF version for the web interface. 
Displaying two version side-by-side to demonstrate the differences between two version is terrible user experience. However, because of the DaVita approval process and technical limitation, we have to compromise the user experience to release the feature sooner to the user. 
Updated Wireframe
In CWOW, every new feature that we create must go through the approval process with Legal, Compliance, and Privacy (LCP) team. Business requirements and wireframes are used to get approval from LCP team. 

Since the purpose of wireframes is to demonstrate the functionality and how it works, it does not reflect how the final solution will look like. Quite often, we change the visual of the screen entirely during the visual design stage. Even there are no changes to the functionalities of the application, LCP can argue that they didn't approve the visual design which will cause the delay and require the re-approval. Therefore, we need to re-create the wireframe that looks very similar to the visual design for the future iteration of the feature set. 
Future Features
There are few features that we are considering for the future iteration:
Filtering and Sorting
The note list will be overwhelming. Finding the right note is impossible. Hence, filtering and sorting will be implemented. 
    Filtering Criteria are: 
        - Date Range on Event Date
        - Author Role
        - Author Name
        - Care Category Tags
        - Facility
    Sorting
        - Event Date: Latest to Earliest
        - Event Date: Earliest to Latest
        - Author: A to Z
        - Author: A to A
        - Facility Name: A to Z
        - Facility Name: Z to A
Snippets
The clinician can have a template that they would like to use to write a Note for patients, so we are going to provide the functionality that allows them to create snippets
Importing Data to Note
This functionality allows the clinician to add the patient data such as lab result, allergies, etc... to the patient note to provide extra information about a specific event that the Note is intended for.
Lesson Learned
Validating solutions are great but without understanding the "why", we may solve the wrong problem in the wrong priority order. Since everyone in the product team was once a clinician, they offer an excellent knowledge about how to better serve clinician in the clinic setting with based on their experience. However, it is challenging to persuade them to think broader and look at the problem from a different perspective that affects how they write business requirements.
The technical limitation can be frustrating because it avoids us from providing the best user experience. 
What should I have done differently? 
RESEARCH first. 
Understand clinician's workflow. Identify pain points. Prioritize the needs. Define problems. Design requirements. And then repeat the same process that I have done for this project.
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