REASONABLE ADJUSTMENT FLAG / EMIS HEALTH
Dedicated UX Designer · EMIS Web & EMIS X · NHS primary care · 11 months, discovery to delivery
For GPs, nurses, reception teams and care navigators
THE WORKFLOW PROBLEM
Adjustment data was already in the patient record, but buried in free text and secondary tabs. Interpreter and Easy Read needs surfaced mid-consultation, and staff relied on sticky notes and verbal reminders between tasks.
WHY IT MATTERED
The Equality Act 2010 expects reasonable adjustments to be anticipatory. When nothing was visible, clinicians read silence as "no need", risking communication breakdown, distress and unsafe decisions.
Interpreter and Easy Read needs were repeatedly discovered mid-consultation across observed NHS practices.
MY OWNERSHIP
I owned the design direction across EMIS Web and EMIS X.
I observed users in NHS practices, mapped where adjustment awareness failed, and made the call on the Precis Bar badge over a banner, defending it against stakeholders who wanted stronger interruptive alerts.
I worked with engineering to find the feasible point for EMIS Web (record load) and with clinical directors to validate the safety hierarchy.
With the team: Engineering built it, product shaped scope, and Clinical Design Directors reviewed placement and provenance.
We delivered: the build and EMIS Web feasibility with engineering, SNOMED CT mapping with product, and placement and safety review with Clinical Design Directors.
Illustrative recreation: persistent RADF badge in the Precis Bar, and the dedicated Patient Flags workspace. [Replace with redacted shipped screen.]
THE DECISION I CAN DEFEND
A Precis Bar badge, not a banner.
The Precis Bar is the one element persistent across all 12 EMIS modules, so the badge stays visible at zero viewport cost. A full-width banner would have taken about 10% of the workspace and competed with allergy and drug-interaction alerts, risking alert fatigue.
Also rejected: a badge in patient search, which needed an API call per result at 6,500+ practices, so record load became the first feasible point. A flag inside Patient Details or Clinical Summary failed on RBAC, free-text capture and scalability to CPIS and FGM.
DESIGNED FOR THE REAL SYSTEM
Reception sees that a flag exists, never clinical detail. Clinicians see structured SNOMED CT adjustments with author, role, organisation and review history. Free-text flags were ruled out under NHS DAPB4019.
EVIDENCE AND CLINICAL REVIEW
Contextual observation, a service failure map and documented design alternatives. In expert clinical review, Clinical Design Directors endorsed the placement, safety hierarchy and provenance model. Onboarding dependency was rated Medium.
WHAT THE DESIGN ESTABLISHED
WHAT I WOULD MEASURE NEXT
Validated through expert clinical review; no post-rollout metrics yet. Next: audit missed adjustments and interpreter bookings.
"The persistent precis bar badge addresses a failure mode we've documented for years." Clinical Design Directors, EMIS Group