Oncology Software / Hardware Design

Evangelos Stamelos, MIS, Sr. Project Manager of Informatics & Digital Pathology, gave me a walk through of the department showing me the process and the size of the lab. MSK has the most slide scanners in the world (80+) and we scan more than 5,000 specimen slides a day.

Attending clinicians were very eager to contribute to our process. Dr. Matt Hanna, a leader in Digital Pathology, took me down a tour of all the variations of hardware and tech he explored for the last decade.

Fortunately, my research transcended outgoing and incoming classes of fellows giving me a unique opportunity to interview clinicians on both side of a competency spectrum.

Outgoing fellows bemoaned navigating ancient applications while incoming fellows were perplexed that MSK’s version didn’t match their school experience.

A must-have system in a pathological laboratory for advanced data management, MSK forked the repository long-ago; our custom version cannot consume the latest updates. A more modern version needs to replace it.

Access to attending pathologists was invaluable, so I prioritized every session. Each lasted nearly three hours, combining iPhone recordings with iPad sketches.

Immediately after, I found a quiet space to organize and summarize key insights.

Because UX is highly valued at MSK, the department already had a user flow map from "specimen delivery" to "lab processing" to "scanning" to "encasement" to "case assignment" to "fellow review ", and finally,  "attending sign-out".

I imported the recordings into Dovetail review and make notes - double checking my observations to see if I have missed anything.

After I look over the videos, I clarify my notes to create accurate user journeys of everyone who I observed.

I created a detailed user journey, incorporating any current moment from the legacy map, to give the department the de-facto source of truth.

While “solutionizing” may be frowned upon in development, it’s at the core of Product Design. When I listen to someone in this context, I naturally visualize UI elements coming together in real-time—it’s an instinctive process. I only wish I could show you exactly what I see.

Fellows often manage the workload - the deciding factor is the amount of slides in a case. Here, Holly does a fantastic job showcasing the data points that the fellows need to make those decisions - clearly showing the priority as well as one click "filtering" by team, department, and urgency.

Every researcher, clinician, or scientist I’ve ever asked has given an emphatic “Yes!” when asked if they wanted a timeline. And not just a simple bullet-point list sorted by date—they wanted a real, visual timeline. Our users were no different.

MSK has an extensive archive of cases dating back to the early 1980s, which pathologists frequently reference for clarification—some even marking seminal moments in cancer research. However, accessing these cases has traditionally been a cumbersome process. Through our research, we discovered an opportunity to seamlessly embed this archive within the UI, not only improving accessibility but also enabling powerful search functionality.

Synoptic Worksheets is a technology developed by MSK to transform the scattered information within an Accession Case into structured, easily accessible data. Within the app, users can effortlessly search and retrieve key details, allowing them to quickly mark and document the identification of cancerous cells.

After walking through our application, the sign-out process practically designed itself. Instead of pathologists having to collect notes and switch between three separate applications, they could simply navigate to the sign-out screen to confirm their observations. For fellows, the process was just as seamless—they could easily flag cases for review.

Figma makes prototyping effortless, but I always set up our prototypes with an introduction and a task menu. The introduction helps testers practice “thinking aloud,” while the task menu provides specific functionalities to test and makes it easier to locate the start of a task in recorded sessions.

From the first round of testing, we discovered that pathologists were confused upon logging into the app—they didn’t realize that their assigned work was automatically scoped based on their login credentials. In CoPath, they were accustomed to manually searching for their assignments each time they logged in. We also found that the hero section had more filters than necessary. For the second round of testing, we streamlined the experience, delivering a more efficient and intuitive version.

Although attachments were included in the first round, they were more of an afterthought. Observing users constantly switching between screens, we learned that they wanted all attachments—along with a thumbnail gallery of all slides—consolidated into a single, scrollable page. They needed a comprehensive overview, as they would frequently revisit cases even after sign-out. The most critical item was the requisition form, which served as the key reference for each case.

While CoPath allows users to leave comments, it’s impractical to log in just to check for updates. In practice, requisition forms were often covered in Post-It Notes, as they served as the central reference point for each case. Recognizing this, we introduced a modern, integrated comment thread—much to the delight of the fellows—allowing for seamless communication without the need for makeshift paper notes.

From a previous project, I had discovered a GitHub repository with a prototyping environment built on Salesforce’s Lightning Design System and Nunjucks, which proved invaluable for high-fidelity prototyping. By the time everything was set up, Holly was ready for the second round of user testing—and we already knew users were frustrated by the lack of interactivity. To address this, I dedicated a sprint to creating the necessary data models and setting up the tests, ensuring a smoother and more engaging experience.

After the second round of user testing, we analyzed the results in Dovetail  and found that this version truly resonated with our end users. We successfully addressed most of the issues that had plagued the earlier iterations, making significant improvements to the overall experience.

While I appreciate modern design tools like Figma, Sketch, Zeplin, and InVision, I take an old-school approach to delivering wireframes. I emphasize thorough documentation, ensuring juniors label everything clearly in Figma.

As a software engineer, I know that six months down the line, revisiting code without proper comments can be a challenge—usually, there’s only time for quick fixes.

To streamline development, I require my team to document everything: user stories, bullet points, and exported images, all compiled into PDFs. I call this the “Silver Platter” approach—wireframes are neatly packaged into user stories and stored in the backlog, ready for developers when they need them, allowing us to move forward efficiently with the next iteration.

Great work deserves recognition, so we shared our product with the broader MSK community through a Quarry Pi review and created a poster to showcase it at conferences.

(Click the picture to see the poster!)

During our discovery, we recorded 90 hours of video, fabricated 500+ designs, produced 3 hi-fidelity prototypes, and tested them with 12 users.

These in turn took 40 hours to analyze and 80 hours to render the first prototype

The final prototype design was then transformed into Agile User Stories and assigned to the developers in their coding sprints. The first prototype failed 7/9 tests, the second failed 3/9 tests and the final version failed no tests.