WSIB: Audiometry Form

UX/UI Design Intern

4 Designers, 4 Developers, 1 PM

May to August 2023

OVERVIEW

Digitizing the hearing assessment process for Ontario workers susceptible to NIHL

The Workplace Safety and Insurance Board (WSIB) is an independent trust agency under the Ontario Ministry of Labour that provides no-fault collective liability insurance and access to health and safety information for employers. Last spring, I had the opportunity to join WSIB as one of four design interns, focusing on digital infrastructure and service design for noise-induced hearing loss (NIHL) claims.

How I added value—a TL;DR

Throughout my time with the WSIB, I was able to broaden my understanding of service design in the context of digital health services. My day-to-day included touchpoints with project managers, preparing design files for handoff, and planning research activities to gain a deeper understanding of how hearing practitioners navigate WSIB infrastructure and communication channels.

Final landing page design for audiometry form proof-of-concept.

CONTEXT

What is noise-induced hearing loss?

Noise-induced hearing loss (NIHL) is a type of hearing impairment caused by exposure to loud noise, resulting in temporary or permanent damage to the ears. According to a 2023 statistic from the Canadian Centre for Occupational Health and Safety (CCOHS), an estimated 11 million Canadians between the ages of 19 and 79 have worked in noisy environments. Of these 11 million workers, over half were defined as vulnerable to noise and did not use hearing protection in the workplace.

Between 2012 and 2022, the WSIB accepted a total of 53,995 NIHL claims derived from the workplace. The last three years saw a distinct spike in claims accepted, culminating in a peak of 7,867 claims in 2022 (via Compcore Law Group). Needless to say, NIHL has become increasingly prevalent in Ontario—and the WSIB acknowledges this upward trend.

Evaluating the initial claim process

Initiating an NIHL claim with the WSIB starts with recognizing symptoms like distorted speech, ringing in the ears, and difficulty hearing high-pitched sounds. Awareness is typically followed by seeking a referral from a family doctor or directly contacting an audiologist. After diagnosis, the audiologist discusses treatment options, and the individual can then choose to file an NIHL claim through the WSIB online services portal, either personally or through a third party.

Timeline illustrating the WSIB's initial claim process for noise-induced hearing loss (NIHL) with the following steps: 1) Patient acknowledges hearing loss, 2) Patient seeks audiologist support, 3) Audiologist runs hearing assessment, 4) Audiologist issues NIHL diagnosis, 5) Audiologist shares results with WSIB, 6) Patient or third party submits WSIB claim, 7) WSIB initiates claim review process.

Evaluating the patient's care journey raises a key question: what are the inadvertent experiences of an audiologist when working with patients and WSIB infrastructure?

Follow-up image of the same timeline, with steps 1, 2, and 6 faded out. Steps 3 to 5 are highlighted: 3) Audiologist runs hearing assessment, 4) Audiologist issues NIHL diagnosis, 5) Audiologist shares results with WSIB, followed by a prompt asking 'What does this look like in practice?'.

research

Completing a hearing assessment

In completing a hearing assessment, audiologists are required to submit a form containing patient information, claim details, and the results of a completed audiometry—a diagnostic test that measures an individual's hearing thresholds to assess the type and severity of hearing loss.

Using Maze, our team conducted a study with eight audiologists to gain insights into their experiences in facilitating hearing assessments and post-test communications with the WSIB. Since the PDF document of the form is the only means of completion provided by the WSIB, we uncovered several pain points within the current hearing assessment process:

As WSIB claims are typically reviewed by claims adjudicators, hearing assessment forms completed in writing set the precedent that all adjudicators should know how to read an audiogram and various handwriting styles.

The special characters used to visualize the results of the audiometry mean that common PDF editors cannot be used to complete the hearing assessment form digitally, requiring specialized software that is not accessible to all practitioners.

By providing the form exclusively in PDF format that must either be physically filled out or completed using specialized software, complications can manifest in under-resourced areas where document management may be logistically complicated.

Breaking down form content

In converting the PDF form to a digital solution, our team organized a card sorting exercise with five audiologists from the same Maze study to define a cohesive structure for the digital form. The existing form content was represented as cards, and participants were asked to:

Group the cards based on what they would expect from a section of the form
Name each group according to their understanding of the content
Systematically order the groups to reflect their placement in the form
Indicate instances of optional form fields/actions

Mock screen showing the setup of the card sorting activity in Maze.

Though our team had originally explored the viability of a single-page form design for this PoC, we looked toward progressive disclosure to support the separation of page content (and substeps, by extension).

build

Leveraging an existing design system

Our PoC exists within WSIB Online Services—the WSIB's dedicated portal for claim management. In creating this PoC, fostering an understanding of its existing design system allowed my team and me to visualize edge cases when proposing new components and design assets to accommodate the structure of the form design.

Landing page

In completing the hearing assessment form, audiologists have the option to start a new form from scratch or submit a scanned copy of a physical form. This was achieved by my developer colleagues, who created an OCR model that extracts text from the audiogram form and stores the data to be displayed on the frontend.

An external link to the original PDF has been included on this landing page to ensure continuity between both methods of form completion.

Form navigation

In utilizing progressive disclosure to break down form content into steps and substeps, form navigation required additional explorations into navigational controls and visual cues to ensure audiologists can seamlessly move between sections with as few actions as possible.

Currently, the WSIB uses a step tracker to indicate users' progress on a form and navigation buttons to move backward and forward:

Page navigation bar from the WSIB's corporate design system and its placement on the audiometry form.

Visually displays which section of the page the user is currently on

Not inclusive of non-sequential forms like the hearing assessment

Does not visualize form substeps that exist within a broader section

In consultation with our project manager, we designed a collapsible sidebar that allows audiologists to toggle between sections and substeps as they scroll through form pages:

Collapsible page navigation bar redesign to accommodate access to subsections while completing the audiometry form

Visually displays which section of the page and substep the user is currently on

Reduces click count on sections with multiple substeps

The sidebar becomes the only element on the form that displays substep progress

To accommodate form sections with multiple substeps, we designed an additional progress bar to visualize within-section progress:

Step tracker design to visualize form section progress while the redesigned page navigation bar is in its collapsed state.

Though these approaches reduce page density and accommodate the non-sequential structure of the hearing assessment, they are deviation from the existing navigational components and require additional testing to validate their usability.

Audiogram chart

In facilitating the hearing assessment digitally, I designed an audiogram chart that updates in tandem with the corresponding threshold values selected through form fields. This was later developed using React and Chart.js:

Audiometry Information subsection of the Medical Case History section. The form has fields for entering air conduction (AC) thresholds and bone conduction (BC) thresholds at different frequencies, with a chart on the right that updates based on input. Tabs at the top allow navigation between sections: Patient Information, Type of Assessment, Medical Case History, Audiometry Information, and Review & Submit.

Validated through A/B testing, 4 of 5 audiologists preferred the chart situated to the right of form fields rather than above.

To reduce page density, we introduced a toggle component to separate otoscopic tests between the left and right ears:

Toggle component on the Audiometry Information page to switch between left and right ears for completing and comparing data. The values for hearing levels in decibels (dB) include separate otoscopic symbols for both ears across air conduction (AC) and bone conduction (BC) tests.

Contextual validation

As the hearing assessment form is non-sequential with several optional form fields, users may be more prone to skipping information integral to diagnosis and claim evaluation. Upon review, audiologists are provided with a list of sections and substeps with incomplete fields and are prompted to review them if needed:

Warning message displayed on the top of the 'Review & Submit' section of the audiometry form, highlighting subsections with incomplete fields.

next steps

Continued user testing

Due to time constraints, our team was unable to validate our design decisions in page navigation with audiologists and the design system team at the WSIB. Further testing and concept validation would be valuable as this project enters its next stages. We also missed the opportunity to conduct moderated usability testing, and I believe valuable insights can be drawn from observing usage patterns first-hand.

Designing for tablet usage

Our initial Maze study with audiologists revealed that tablets are commonly used in audiologist communication. As this PoC aims to evaluate the use of emerging technology and the value proposition of converting to a digital form, our project scope limited us to designing exclusively for a desktop interface.

retrospective

Reflecting on a fast-paced summer of valuable takeaways

I can go on and on about what a fun summer I had with the WSIB (and the love I developed for Downtown Kitchener 🫶). In retrospect, I wrapped up my internship with some integral learnings for my growth in design:

Service meets UX design: During my time at the WSIB, I was able to explore service design in practice and its ability to provide a holistic lens for problem-solving. I believe there is so much value in exploring how service and UX design work in tandem—and I'm super excited to see how these learnings inform my future work.

In research, one size doesn't fit all: One of my biggest takeaways from this project came from my exposure to evaluating research methods and knowing when to deploy them. Under tight deadlines, it is vital to foster shared expectations with stakeholders and assess the validity of methods based on desired learnings.