Enhancing access to nephrology care: telenephrology dashboard optimization via human-centered design

Abstract

Background: Ensuring that patients, especially those in underserved areas, have access to specialized nephrology care is essential to addressing the increasing burden of chronic kidney disease. To address this, we developed the Telenephrology Dashboard for the 150,000 Veterans served by the Iowa City Veterans Affairs Health Care System (ICVAHCS). Our goal was to optimize the dashboard as a comprehensive and practical tool for end-users in order to monitor kidney health and facilitate remote nephrology consultations.

Methods: The optimization process adhered to the Human-Centered Design (HCD) framework, encompassing five stages: Empathize, Define, Ideate, Prototype and Test. Research team members spent 10 h observing nephrologists during remote consultations and supplemented these observations with semi-structured interviews with clinicians to gain insights into existing workflows and challenges. A rapid ideation workshop was then held to propose innovative solutions that balanced technical needs with user preferences. Subsequent prototyping and testing helped refine and evaluate the proposed designs, identifying key areas for improvement.

Results: The iterative design process identified three critical needs: (1) improved clarity in visual data representation, (2) enhanced data accuracy, and (3) a balance between standardized features and customization options. Five dashboard prototypes were created, tested, and iteratively refined into a final version. The completed Telenephrology Dashboard includes five core features: (1) graphical representation of kidney function trends, (2) tables summarizing key lab data, (3) functionality to examine specific events in detail, (4) customizable views tailored to user workflows, and (5) integration of predictive kidney disease progression models.

Conclusion: The Telenephrology Dashboard was developed using a Human-Centered Design approach to improve remote nephrology consultations. Future efforts will focus on evaluating its impact on user satisfaction, referring clinician satisfaction, access to nephrology care, and patient care outcomes.

Clinical trial number: Not applicable, as this is not a clinical trial.

Keywords: Chronic kidney disease; Clinical decision support; Dashboard; Quality improvement; Telehealth; Telenephrology.

Fig. 1

Human-centered design process for telenephrology dashboard development. The design team employed an iterative and nonlinear process developed by the Hasso Plattner Institute of Design at Stanford (d.School). The five stages of this design thinking process included Empathize, Define, Ideate, Prototype, and Test

Fig. 2

Clinician Empathy Map. The clinician empathy map captures key insights into nephrologists’ thoughts, visual interactions, feedback, and actions while using the Telenephrology Dashboard. It is organized across four dynamics: presenting data clearly, building patient trust in remote care, balancing standardization with customization, and streamlining consultations. These categories help identify challenges and opportunities to improve the provider experience and enhance the dashboard’s effectiveness

Fig. 3

Finalized Prototype of the Optimized Telenephrology Dashboard. The finalized prototype included five features that were generated in the Ideate stage: (1) Graphical display of kidney function, (2) Tables synthesizing lab data, (3) Options to drill down events to specific times, (4) Customization of views, and (5) Integration of kidney disease progression models