Human-centred co-design of a dual-purpose heart failure dashboard

Heart failure is a condition where the heart struggles to pump enough blood to meet the body's needs. It is a long-term illness that affects millions of people worldwide, often requiring a complex web of care that stretches from hospital wards to home visits. For patients, this journey involves many different doctors, nurses, and specialists, each holding a piece of the medical puzzle. The challenge is that this information is often scattered across different computer systems, written in different formats, or hidden inside handwritten notes. When a patient moves from a hospital to a community clinic, or when a new doctor takes over their care, that vital history can disappear into the gaps between these systems. This fragmentation makes it difficult to see the full picture of a patient's health, leading to missed opportunities for treatment and unnecessary hospital visits.

To solve this, a team of researchers in Australia set out to build a new kind of digital tool. They did not simply design a screen and hope doctors would use it. Instead, they invited the people who actually do the work—doctors, nurses, hospital managers, and patients living with heart failure—to build the tool together. This approach, known as co-design, treats the end-users as experts in their own right. The goal was to create a single dashboard that could show both the big picture of how a whole service is performing and the detailed, personal story of an individual patient. By bringing these two views together, the researchers hoped to create a system that helps clinicians make faster, better decisions while also helping managers understand where their resources are needed most.

The study began by listening to the people who deal with heart failure every day. The researchers interviewed thirty-six individuals, including senior cardiologists, junior doctors, nurses, hospital executives, and patients who had lived experience of the disease. They asked these participants about their daily struggles. The doctors described spending hours hunting for information, scrolling through endless electronic records to find a single test result or a note about a medication change. They explained that reconstructing a patient's history felt like trying to assemble a jigsaw puzzle where half the pieces were missing or stored in a different box. Patients, meanwhile, described the exhaustion of having to tell their story over and over again to different specialists, often feeling that no one truly knew their full medical history.

From these conversations, two distinct but connected needs emerged. The first group, consisting of hospital managers and service leaders, needed a way to see where all their patients were at any given moment. They wanted to know which patients were in the hospital, which were at home, and which were connected to community support services. They needed to see if patients were receiving the right treatments and to spot patterns in how different hospitals were performing. The second group, the clinicians treating patients at the bedside, needed a way to quickly understand a specific person's health. They wanted a clear summary that showed what medications the patient was taking, how their heart function had changed over time, and whether there were any gaps in their care that needed fixing.

The team translated these needs into two complementary views of a digital dashboard. The first view, designed for service management, acts like a map of the entire heart failure population. It shows where patients are located across different hospitals and community programs, allowing managers to see the flow of care. It highlights whether patients are getting the standard, evidence-based treatments they should be receiving and compares how different sites are performing. The second view, designed for the clinician, acts as a personal health timeline for an individual patient. It gathers scattered information—past hospital admissions, current medications, test results, and notes from different doctors—into a single, easy-to-read page. This allows a doctor to see at a glance if a patient's condition is improving or deteriorating and to understand why certain treatments might have been stopped or changed.

During the design process, the researchers built rough sketches and digital prototypes, then tested them with the same group of doctors, nurses, and patients. This testing revealed that the most valuable feature was the ability to see the "big picture" and then zoom in on the details. For example, a manager could see that a specific hospital had a high number of readmissions, click on that data, and immediately see the list of patients involved and their individual medical histories. Similarly, a doctor could look at a patient's summary, see that a key medication was missing, and then check the notes to understand if the patient had stopped taking it due to side effects or if it was simply an oversight. The participants emphasized that the tool needed to be fast and reliable, working on tablets or computers without long loading times, so it could be used during busy ward rounds.

However, the researchers were careful to note that building the visual display is only half the battle. The real challenge lies in the data underneath. Much of the information doctors need, such as the specific type of heart failure a patient has or the reasons for stopping a medication, is often written in free-text notes rather than entered into structured computer fields. To make the dashboard work, the system must be able to read and understand these unstructured notes, pulling out the relevant facts and organizing them alongside the structured data. The team found that without this ability to integrate information from different sources, the dashboard would just be another screen showing incomplete data. They also stressed that the tool must show where information is missing or uncertain, so clinicians do not make decisions based on gaps in the record.

The study concluded that while the design of the dashboard is ready, its true value has not yet been proven. The prototypes successfully identified what clinicians and managers need to see, but the system has not yet been tested in a live hospital environment to see if it actually improves patient outcomes or reduces hospital stays. The researchers plan to move forward by building the necessary data connections and launching a trial to see if this linked view of service and patient data helps doctors provide better care. The work highlights that technology alone cannot fix fragmented care; it requires a deep understanding of how people work and a tool that fits seamlessly into their daily lives, bridging the gap between the administrative needs of a health system and the personal needs of a patient.