Volume 46, Issue 6, December 2025, 100920Author links open overlay panel, Highlights•

Ambulatory ECG service improvement idea from a rural general practitioner.

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Regulatory body involvement.

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Medical service UCD with UML, SWOT and additional costs analyses.

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Implementation resulting in a best practice compliant service.

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Positive balance for Social Security after operation.

Abstract

User Centered Design (UCD) is widely used in computer science and service provision, not so in public health administration. As a regulatory body (e.santé Occitanie) we applied UCD to design, deploy and assess a new medical service (ambulatory ECG at the local medical practice) at the request of a local general practitioner (GP). Method. We used semi-directed interviews starting with the GP to define the user groups profiles, as-is scenario and personae. We organized a focus group with the local stakeholders and representatives of Social Security, Regional Health Agency and e.santé Occitanie to refine the expression of needs. We used a SWOT to categorize the internal and external factors impacting the service. We designed a first specification prototype and a preliminary assessment of additional costs from the point of view of the Social Security. When the service started we arranged an 8-week prospective survey to verify the medical indications adhered to best practices. We ran an observational costs analysis on the first full year of operation. Results. As the study started in 2018 we had to cope with COVID 19 induced delays and changes. End of 2021 we could observe the start of the operation of the optimized version of the service with 4 steps instead of 9 in the as-is version. The 8-week medical indication survey showed full compliance with best practices. In 2022, first full year of operation, 39 patients had an AECG, less than expected, probably due to a waiting list effect. The additional costs analysis gave a benefit for Social Security of 12,397.05 € at 95% of expectations. After absorption of investment costs, expected benefit is 16,479.45 € at 98%. Conclusion. As a regulatory body, we successfully implemented the full UCD cycle on a bottom-up medical service improvement proposal. The service is still operating and has been spontaneously adopted elsewhere. UCD applied to selected local proposals could unveil a wealth of quality of care improvement solutions while keeping the costs down.

Graphical abstractDownload: Download high-res image (81KB)Download: Download full-size imageIntroduction

Public health administrations, at least in our corner of the world, tend to implement mostly top-down policies. Yet local stakeholders may raise interesting issues that could benefit a wider public. User centered design is becoming a recognized way to improve the uptake of medical best practices [1]. Could user centered design (UCD) [2] be used by a regulatory body to improve health care services?

Policies in France have limited the access to medical studies to limit the access of the consumer to medical services and avoid excessive consumption due to excessive offer. Those policies have an increased impact on sparsely populated rural areas such as Ariège district in the Pyrenees Mountains. Since 2003, the national regulations have fostered telemedicine as an accepted medical practice in its own right. More recently, the Social Security is increasingly implementing its funding as part of its regular processes.

We are describing how: we used UCD to improve, on request of a general practitioner (GP), access to 24 hours ambulatory ECG (AECG) and observed the results of the implementation. The results include verification of activity level and relevance as well as of financial return.

Section snippetsMethod

We first used UCD from the start point of the raw expression of needs by a local stakeholder. The investigator was the physician consultant to e.santé Occitanie. We analyzed the use context and defined the as-is scenario through semi-directive interviews with the applicant, then local stakeholders. We refined the expression of needs during a focus group with local stakeholders and the representatives of the regulatory bodies in charge. We described the results in terms of actors and workflow.

Results

A semi-directed interview with the head physician of Maison de Santé Pluriprofessionnelle Avicenne (local practice, MSP) gave the first information and the service framework. It was then completed with complementary interviews with the nurses and manager involved at MSP, the nurse and the cardiologist of Centre Hospitalier Ariège Cousserans (CHAC, local general hospital) who were expected to read the AECG.

Refined needs expression focus group was organized and carried out locally by the

Discussion

We will discuss the relevance of using a UCD to design a technology based medical service. Compare our use case with other work using the same approach in the same field. Discuss the differences between the ISO 13407:1999 norm and the way we applied the method. Discuss the choice to base our risk management on a SWOT analysis and not on ISO 14971 norm. Discuss the observation method of the implemented service both for the medical service and the financial issue.

Conclusion and perspectives

We could prove with that case study that a regulatory body can avail of user centered design (UCD) as a throughout design and validation process to improve health care services. We started from a need expressed by a local GP. We used systematically UCD in a public health context. We used UML to identify the actors and processes (original and optimized). We brainstormed a SWOT with the stakeholders and then implemented together a risk management process. We ran the service and evaluated the

CRediT authorship contribution statement

Pierre Rumeau: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Marc Dupui: Writing – original draft, Resources, Investigation, Conceptualization.

Author contributions

All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.

Informed consent and patient details

The authors declare that this report does not contain any personal information that could lead to the identification of the patient(s).

Human and animal rights

The authors declare that the work described has been carried out in accordance with the Declaration of Helsinki of the World Medical Association revised in 2013 for experiments involving humans as well as in accordance with the EU Directive 2010/63/EU for animal experiments.

Funding

This work has been supported by: Agence régionale de santé Occitanie, Groupement d'Intérêt Public e.santé Occitanie.

Declaration of Competing Interest

The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper.

Acknowledgements

We thank Mrs Calaret from MSP Avicenne for her help with liaison, Mrs Riquet from the local branch of RHA for participating and organizing the contacts with the Social Security, Mrs Cabanes from RHA headquarters for allowing the work and finding the funding, Mr Gelabert from the local Health Insurance branch of the Social Security, Mrs El Boukhari, department of telehealth at e.santé Occitanie for missioning the work and all the participants to the interviews and the brain storming. We also

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