Day 0
Expanding oncology software to accomodate Transplant & Cellular Therapy
My role: Leading user-centered research and design, managing stakeholders, and engaging SMEs
Tools:
Figma
Google Meet
Confluence & Jira
Internal AI
Methods:
Agile
Kanban
Directed Storytelling
Affinity Diagramming
MEDITECH
At MEDITECH, I work to improve our EHR product, Expanse. My team is one of a handful that work to support enhancement requests from our largest customer, HCA. My team is unique in that we don’t specialize in a particular module of the software, so we must be adaptable and always ready to dive into unfamiliar territory.
The Problem
The oncology module did not support medication administration days (AKA “admin days”) in the notation that is required for transplant & cellular therapy (TCT).
In Short…
The Solution
We introduced two new admin day notations that allow clinicians to practice advanced cancer treatment therapies, carefully balancing constraint and flexibility.
What Surprised Me
Transplant & cellular therapy includes CAR-T Cell Therapy, in which the patient’s own white blood cells are harvested and modified to target cancer, and then returned to the patient’s body, on admin Day 0.
The Users
Medical Oncologists & Nurses need an accurate, chronological timeline to administer the right drugs on the exact right day.
Oncology Pharmacists need clear visual notation to verify complex medication orders without risking misinterpretation.
The Process
The first task, even before user research, was to understand the context of the problem. What are admin days? What are they used for? What are cycles? What are treatment plans? I prepared myself by consulting various internal resources:
An Oncology designer/SME
Internal Oncology Stakeholders Meeting (development and client services staff and management)
Educational videos about treatment plan ordering
Using and testing the software
Understanding Oncology
The Problem
In the electronic health record system, cancer treatment schedules (protocols) were built to always start on "Day 1". If a patient needed medication before the start date, the system forced clinicians to use a clunky notation like "1B1" (meaning 1 day before Day 1).
However, in specialized treatments like stem cell transplants, medical professionals universally anchor the treatment around the infusion day, which they explicitly call "Day 0". The days leading up to the transplant are negative (Day -2, Day -1), and the recovery days are positive (Day +1, Day +2). Because the software could not handle Day 0 or negative numbers, major hospital networks like HCA were forced to manage these complex, life-saving treatments entirely on paper.
Discovery
During user research, the team uncovered a sharp divide in how different clinics operate:
The Transplant Clinics: Considered Day 0 and negative integers (-2, -1) to be essential medical terminology.
The General Clinics: Sites treating "solid tumors" (like breast or lung cancer) almost never use Day 0. In fact, some sites strongly preferred the old "1B1" notation. Pharmacists warned that in a fast-paced clinic, a busy doctor might completely overlook a tiny minus sign (e.g., confusing Day -1 with Day 1), creating a significant patient safety risk.
Design Constraints
Safety First: We could not force negative numbers on clinics that didn't want them, as it introduced unnecessary medication error risks.
Visual Noise: When dealing with negative number ranges, a standard hyphen creates severe visual ambiguity (e.g., -5 - -3 looks like a math equation or a typo).
Data Integrity: We could not rely on "on-the-fly" data conversions to automatically switch old plans to the new format, as silently shifting dates on active cancer patients is highly dangerous.
The Solution
To accommodate specialized transplant therapies without disrupting standard oncology workflows, the design team implemented a system of plan-specific dictionary settings to control how administration days behave and display.
The "Include Day 0" Toggle: A new "Yes/No" setting was added directly into the Treatment Plan Dictionary (where treatment plans are built and defined). By default, this field is left blank (which the system treats as "No"). This essentially splits the system into two distinct workflows: "Day 0 Plans" and "Non-Day 0 Plans".
Tailored Logic for "Day 0 Plans" (Transplant Therapies):
For these plans, Day 0 officially becomes the cycle start date. System prompts automatically update to ask for days "Before Day 0" instead of "Before Day 1".
Strict Notation Rules: To align with medical standards, negative days are strictly formatted with a minus sign (e.g., -2, -1) and positive days are formatted with a plus sign (e.g., +1, +2).
High Visibility: Because Day 0 is clinically significant, it is programmed to always display in the patient's treatment summary widget.
Safe Flexibility for "Non-Day 0 Plans" (Solid Tumors):
Plans without a Day 0 continue to use standard positive integers (e.g., 1, 2).
The Notation Preference Setting: A second dictionary setting was introduced to let clinics choose how they want to display negative days for standard plans—either adopting the new "-n" format (e.g., -1, -2) or keeping the legacy "nBn" format (e.g., 1B1, 2B1). If left blank, it defaults to the legacy format.
Smart Error Prevention: If a user selects "Yes" to include Day 0 on a plan, the system automatically locks the negative notation to the "-n" format and disables the option to use the legacy "1B1" format, ensuring clinical accuracy is maintained.
Clearer Range Displays: To resolve the severe visual risk of displaying negative ranges—where a hyphen could mean "minus" or "through" (e.g., -7--1)—the system allows users to type the shorthand but will automatically convert and display the range safely as "-7 thru -1"
The Impact
By trusting the user's clinical intent and providing flexible, plan-specific tools, the software now accurately mirrors the real-world medical pathways of transplant therapies. This allows major hospital networks to finally digitize their most complex treatment plans, eliminating dangerous paper workarounds while maintaining strict safety standards for all other cancer patients.