title: User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits.
abstract: BACKGROUND
  Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits.
  
  
  OBJECTIVE
  Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization.
  
  
  METHODS
  We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work.
  
  
  RESULTS
  Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and to reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (eg, the ability to raise private or sensitive concerns) and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match sex and race/ethnicity of the actors with patients.
  
  
  CONCLUSIONS
  User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities.
authors.affiliation: Center for Vulnerable Populations, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States. Courtney.Lyles@ucsf.edu.
authors.forename: Courtney R
authors.identifier: http://orcid.org/0000-0002-1111-8595
authors.initials: CR
authors.lastname: Lyles
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0003-3880-0735
authors.initials: A
authors.lastname: Altschuler
authors.forename: Neetu
authors.identifier: http://orcid.org/0000-0003-3486-2023
authors.initials: N
authors.lastname: Chawla
authors.forename: Christine
authors.identifier: http://orcid.org/0000-0001-6258-0221
authors.initials: C
authors.lastname: Kowalski
authors.forename: Deanna
authors.identifier: http://orcid.org/0000-0002-0643-813X
authors.initials: D
authors.lastname: McQuillan
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0002-5264-0670
authors.initials: E
authors.lastname: Bayliss
authors.forename: Michele
authors.identifier: http://orcid.org/0000-0002-6889-2063
authors.initials: M
authors.lastname: Heisler
authors.forename: Richard W
authors.identifier: http://orcid.org/0000-0002-6164-8025
authors.initials: RW
authors.lastname: Grant
keywords: chronic disease; computers, handheld; health communication; medical informatics; mobile applications; primary health care