Designing Health: Beyond The Electronic Medical Record

I recently attended HxRefactored, a healthcare conference aiming to “bring designers and developers together to improve the health experience.” The conference, held in Brooklyn, NY, indeed pulled quite a crowd and surfaced some interesting perspectives. It consisted primarily of talks, workshops, and panel discussions pertaining to “development” or “design” within the context of the health experience. I attended a dozen talks examining topics ranging from design research techniques (i.e. journey mapping, persona development, use scenarios) to…online pornography, I’ll explain in a minute. I’d like to share some of my takeaways as well as extend the discussion. The current state of the health experience is fragmented and limited in scope- failing to connect disparate sources of data into one cohesive system that paints a clear picture for individuals and society as a whole.  

Back to online porn, Cindy Gallop, of TED fame, created the website makelovenotporn.com (landing page is SFW). The site, which is not anti-porn, serves to educate the public about the differences between porn and real world sex. It does so through user generated content that is indeed real. What made Gallop’s talk relevant in a comparatively sterile health/design conference was just that- healthcare solutions in the past, have been sterilized and hard to relate to due to a lack of human emotion and holistic understanding. For example, Gallop explained that in order to really influence something, “you need to change the language around it.” That has certainly started to happen in the health world- although there are some parts of the industry that seem stuck in the past, specifically Electronic Medical Records (EMR).

In the current world of healthcare software solutions, EMR attract an incredible amount of mindshare and resources- EMR seemed to dominate the conference, perhaps because they are and have been the status quo for so long. What is an EMR? At the core, this is the software that some doctors furiously type into when you go in for a visit, attempting to document everything. In the past, medical records were paper-based files that detailed your hospital visits (or “encounters” in EMR language, friendly right?) prescriptions, injuries, conditions, etc. There has been an immense amount of academic and commercial study of EMRs in an effort to assess and improve upon them (notably, David, G. 2012)- I’ll add only a little to the pile, focusing more on opportunities and examples that look at how design has already helped the evolution of the health experience. EMR systems are just the beginning.

1. EMR & Information overload

EMR vendors seem to be stuck in a strange position where they don’t want to get caught not having a certain piece of information available in their software (even with so many third party EMR customization vendors). The result is information overload for the person entering data into the EMR during a visit (i.e. your doctor). This has numerous negative impacts.

- Incredibly high information density, which works for some people in certain contexts, demands the doctor’s full attention. This means decreased attention on you, the patient (i.e. Eye contact, emotional understanding, support) 

- Increased time needed for input. Doctors are busy. Every minute spent on an EMR related task is a minute not spent on actual patient care. Combine this with the already tight time constraints doctors face.

- Ethnographic design research (such as David, G. 2009 Discovering Work Through Ethnography) has been leveraged to help understand the reality of the entire context in which EMR data is collected, stored, and used. This has helped gain insight into the true needs and desires of the various stakeholders, without having such a negative impact on the actual health experience- needless to say, continuous field research is needed, especially efforts that take a step back to examine the health experience as a whole, and take into account new sources of data generation that are being created.

2. Not enough of the right information

The nitty-gritty details that make up our lives (and health) don’t fit neatly into the empty text fields of a clunky computer system. Information collected in EMR is not telling the whole story- it fails to connect the dots that fall outside of “encounters”. This is not an invitation for more text fields. Systems could integrate data from both existing and new methods of data collection that is more relevant, timely, accurate, and actionable (think outside the hospital i.e. wearables and other examples in #5 below). When data from disparate sources is pulled together, it will be easier to spot patterns in the population (i.e. through machine learning), leading to new health insights. The aforementioned advances combined with human doctors and researchers will revolutionize our health.

3. Poor (or no) visual representation of health data

One fantastic speaker at the HxRefactored conference, Stephen P. Anderson (www.poetpainter.com), spoke of designing for understanding. He visually explained how effective visualizations can vastly improve our comprehension of data. Yet most EMR interfaces still look like they’re stuck in the mid-90’s. Visualizations are useful not only for displaying data, but also for entering and manipulating data (think sliders, interactivity). 

4. Limited visibility into my data -> less ownership

The data contained in your EMR is all about you, yet, have you seen yours? Sure it is available upon request, but why isn’t your health information streamed directly to you in real-time? Why isn’t it easily available to you? If you visit the doctor’s office and are diagnosed with something, rather than a rack of paper pamphlets in the waiting area, health data and preventative/corrective actions could be made more customized and relevant to you, so that you can act on it.  

5. New Technologies: HealthTech/DigitalHealth/mHealth

I’ve already touched upon future technologies, below are some specific examples of products that are mostly available today. The future of the health experience exists in concepts such as “user generated healthcare”, “lifestyle based intervention”, and “predictive medicine”. These new opportunity spaces are made possible by advances in [often mobile] technology, and fueled by the desire for an understandable, realistic, affordable, and actionable perspective on one’s own health. The examples I’ve selected will by no means instantly make the world healthier, but just may help act as scaffolding for future growth and awareness of our health.   

Cue $150 (cue.me) 

Cue is a “deep” health tracker that uses lab grade tissue processing to provide you with a detailed look at your health (i.e. testosterone level, inflammation, fertility, influenza, and vitamin D). The companion smartphone app tracks these variables over time and provides suggestions on how to correct your levels. Never before has such technology existed for home use.

 

Wello $199 (azoi.com) 

“It’s more than an iPhone case, it’s a powerful health monitoring device” that uses imbedded sensors (in an iPhone case) to deliver a snapshot of your health. It measures your heart rate, blood pressure, blood oxygen level, respiration, stress level, heart activity, and temperature. It gives you affordable access to data that used to require expensive equipment- and most importantly you carry it with you wherever you go. 

 

uChek $99 (biosense.in/uchek) 

Uses your iPhone’s camera and flash to analyze urine analysis test strips at home. The companion app helps you track levels of various chemical and vitamin levels in your body (i.e. Bilirubin, Ketone, pH, Protein, Urobilinogen, Nitrite, and Leukocytes) it also helps you make sense of what the key indicators mean so that you can make smart adjustments to your lifestyle/diet.

 

Wearable fitness monitors from fitbit, Basis, Jawbone etc. $59-$199 

These have been around in one form or another for years, but the price, functionality, and acceptability is now more in-line with the mainstream expectations. Awareness of what these devices can do has continued to improve- and new offerings with advanced features are sprouting up.  

Neuma $1,500 (neumitra.com)

Neumitra (one of the aforementioned advanced offerings) is a stress management data analytics startup that offers a unique personal stress monitoring and management service. Using embedded sensors, Neuma provides real-time, in the moment, stress feedback. Essential worked to create a low-profile, wrist-worn sensor that monitors the users relative stress level to provide visual and tactile feedback while worn, and more detailed visualizations through the users mobile device. Integrated calendars and location services allow users to understand event and location based stressors to further their understanding and stress management effectiveness.

 

WellDoc (WellDoc.com) 

WellDoc is a diabetes monitoring and education system that operates outside the clinical setting. Essential’s research with physicians and patients enabled WellDoc to create smart Web and mobile tools that coach diabetes patients to improved clinical outcomes and serve as a model for other chronic diseases.

 

MeYou Health (meyouhealth.com) 

MeYou Health is a healthcare start-up created by Healthways to engage, educate, and empower people to pursue healthy lifestyles. Through multiple engagements, Essential has helped MeYou Health and Healthways form early perspectives and user experience strategy in areas core to their mission. Essential used the process of participatory research to explore the ways in which potential customers define well-being, connect well-being and social networks, and physically map their interpersonal interactions, motivations, and barriers relating to wellness. From these rich activities we identified patterns that helped frame a user-driven product development strategy for using game and social network dynamics as motivation for people to achieve lasting health and wellness-promoting behavior change. 


iRobot RP-VITA (irobot.com)

iRobot and InTouch Health partnered to create a revolutionary new telepresence robot that extends the reach of physicians and nurses everywhere. Essential gave RP-VITA its human touch through the integrated design of a remote control app, onboard interface and industrial design, putting the patient/caregiver connection at the forefront of every design decision.

Apple HealthKit & Samsung’s Digital Health Initiative 

Apple announced a connected health platform, called HealthKit, that brings together data from the growing array of connected health devices into one place on your iOS device, which may unlock the power of Apple’s ecosystem to millions of customers (the way that only Apple seems to be able to do). Rival Samsung, also jumped onboard with it’s own Digital Health Initiative aiming to fund health software programs with an initial $50 million fund. Samsung combined that arm of their initiative with a hardware based health tracking platform, called SAMI, to keep tabs on your body at all times. With such large players aligning resources behind the new health experience, it seems that things are about to get a lot more interesting...