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CASE STUDY
Overview
While the ECOMP website has helped US workers file claims and submit medical documents for work-related injuries, it hasn’t been great at supporting Claims Examiners with Periodic Entitlement Reviews (PERs).
The current setup is clunky and makes it tough to verify compensation eligibility and manage Form CA-1032 submissions on time. We decided to utilize the ECOMP website and completely overhaul the current PERs workflow to make the claims process smoother and more user-friendly.
Role
User Experience
Visual Design
Prototyping
Workshop Facilitation
Team
1 Project Manager
1 Business Analyst
4+ Engineers
Stanford ML Team
AWS
Time
6 Months
Challenge
The manual PER process was struggling with high error rates and inefficiencies because of the sheer volume and complexity of cases.
Claims Examiners (CEs) find it incredibly tedious and time-consuming to sift through medical records, review CA-1032 forms, and assign appropriate letters for additional information or final decisions on claimants' benefits.
Solution
Transform and simplify the annual Periodic Entitlement Reviews (PERs) process, offering users a centralized and intuitive experience.
This empowers Claims Examiners (CEs) to efficiently review documents with AI support and code PERs in a unified platform.
The guided workflow streamlines the entire process, providing multiple access points for reviews and expediting decision-making for CEs.
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UNDERSTANDING THE PROBLEM
Discovery
Business Perspective
Historically, there has been a high error rate in PERs. There is a high volume of cases and many of the cases involved digging through years’ worth of medical, making for a time-consuming and tedious process for CEs.
Business Goals:
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In order to minimize the risk of user error, a review process guidance is needed
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Utilizing the new AI sort tool to minimize medical document search times
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Integrate the new interface with the original database (iFECS).
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Provide backend logic based on the information in the claimant's form and their medical records to the CE.
User Perspective
Completing a PER can be highly exhausting for users, primarily because of the multitude of tools they must utilize. The introduction of the electronic CA-1032 has required that Claims Examiners (CEs) manually record claimant entries for integration with the suggestion logic.
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User Goals:
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Reduce the time it takes for them to make a decision
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Minimize the amount of tools and tabs used so information doesn’t get losses in the review process
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Utilize their mental models from prior tool usage to aid in their transition to a new interface.
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Research + Definition
Key Insights
Wizard Flow: Allow CEs to focus on one question at a time so that they are making conscious choices.
Centralization: Creating a one-stop shot experience, where the CE does not have to leave their screens to complete most tasks.
Pre-Population: Aggregate information from other sources to save the user from entering information we already know.
Forward Progression: Save information to the path that you selected and if they go back they can have that data set there.
Minimal Clicks: Reducing time by finding ways to shortcut clicks without damaging the UX experience.
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EXPLORE
User Flow
How do we structure a review process with multiple steps?
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Several iterations were made to the user flow by the client, mainly to understand how this new interface could communicate with their outdated database.
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Using multiple alignment meetings, we helped guide conversations to help them finally align their vision for this project.
EXPLORE
The Prototype
What can we do to make the review and input process easier for examiners to avoid fatigue?
The client had many ideas for this project. It was important to align on what they envisioned and what would make the user experience better. As the final design evolved, we remained focused on four key design principles to minimize error and streamline the intake process.
OUTCOME
#1: Less Clicks the Better
Focusing on fewer clicks and interactions is the best way for the CE to move quickly through the review process.
With the wizard flow format, we created a form input style based on choosing your own adventure.
The journey of the user is tracked by a progress circle.
In cases where no answer is needed, we would skip the question since it is irrelevant to the case being reviewed.
OUTCOME
#2: Centralization is Key
By combining all interactions and information onto one screen, fatigue from switching between tabs to view documents is reduced and data is not lost.
If supporting information is needed, we can provide it without interrupting our main task.
A collapsible drawer holds useful information that can be accessed when needed and hidden when the user needs to focus elsewhere.
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OUTCOME
#3: Pre-population to save time
The is massive amounts of information to sift through, and with the help of recording as they work, CE will not need to re-enter decisions they made along the way.
To streamline case reviews, CE leverages recorded decisions, reducing redundant data entry. Utilizing claimant data history and previous CE choices enhances the user experience by minimizing repetitive updates.
The guided review process incorporates backend logic that suggests choices for user confirmation or override, further enhancing efficiency.
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OUTCOME
#4: AI Sort Intergration
Utilizing the medical sorting AI tool provided by Sanford and AWS, we can help reduce the workload and time spent on review.
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This tool would highlight text that held relevant key words that doctor’s would use. This would help CE find medical evidence that would support the need of benefits.
The documents with the most key words would be sorted from most to least importance.
