Written by Michelle Kim and Alex Tam
A few weeks ago, we invited design leaders from John Maeda’s KPCB Dimsums group into an online conversation about designing for healthcare. We decided the best way to start talking about healthcare was to ask people about their own experiences, good or bad. To no surprise, everyone had a wealth of mostly negative experiences to share and all seemed to agree on one point, healthcare needs to become human again.
In an age where information technology has empowered people to manage their own finances and services, our healthcare system has lagged behind. A mix of well intentioned, smart people, operating in a system with misaligned incentives, has lead to entrenched players and products that have not evolved to meet the needs of patients and providers. Healthcare services will undergo a transformation just as banking, shopping, and travel did over time. Expectations for better services and good user experiences are rising and changing incentives are disrupting the status quo.
Why now
In 2014 a staggering $4.3 billion dollars went into funding digital health startups and more designers are working in digital health than ever before. Why so much attention from investors and why does design matter so much now in this new landscape? Were our predecessors complacent with care with little consideration for patients? Or has something fundamentally changed? Why is the market finally demanding good quality design? Designers have always been problem solvers looking to have impact. They’ve always been attracted to healthcare while many are unable to participate.
The time to participate and change the game has come. Humanity is now interacting with technology at a frequency that demands better experiences in every aspect of their lives. Furthering this, John Maeda’s design in tech report posits that adding more technology no longer cuts it as a key path to a happier customer. If this is true for the broader scope of technology, we can assume that this thinking no longer applies to healthcare. We’ve been applying technology to healthcare for decades with expensive and convoluted systems that do not respond quickly to changing user needs. The entire system is being challenged by people hungry for change.
As designers, we are constantly seeking to understand challenges people face. We must stay tuned to disruptive technologies and services that enable better user experiences and meaningful behavioral changes. Our conversation with design leaders pointed to themes in healthcare affecting both people managing their own healthcare and people providing healthcare services. We discussed challenges to the industry and how design is making an impact for both consumer and enterprise markets.
Consumer health
Consider a patient’s journey through the healthcare system from diagnosis and treatment of a chronic condition like diabetes.
- The patient has to go through the obscure process of finding a doctor they are comfortable with and is covered by their insurance.
- If he does not know what’s wrong, he can see a series of doctors that run batteries of unknown tests and wait for unknown periods of time to learn what’s wrong.
- Once diagnosed, he is sent home, maybe with some pamphlets, a prescription, and some big lifestyle changes.
- In a few weeks, bills arrive in the mail for different services with costs that are difficult to anticipate accurately.
From a medical perspective, the healthcare system has done it’s job. A patient was diagnosed and treated correctly and people are getting paid for their services. However, if we look through a human lens, the journey is full of poor user experiences.
- It is difficult for the patient to understand which doctor to find since there are few measurements of cost vs. quality of service.
- Information is gated and held by the health systems so that it forces the patient to wait for a series of handoffs before they get test results back.
- Patients are given a treatment plan that they have little say over executing and have little structure to follow through.
- On top of all this, health insurance is an opaque system that is completely opposite any other free market consumer purchasing experience, which on it’s own creates a wealth of stress and anxiety.
Incredibly, a painful system has persisted like this for decades. However, there is hope that with healthcare reform, advances in technology, and demands from consumers, the landscape will be disrupted.
One of the biggest drivers of change is the shift towards consumers taking more responsibility over their own care. After decades of opaque billing and paternalistic care, patients are getting more equipped to have agency over their own health. Access to information continues to improve and tools are emerging to help consumers navigate the system to find the right services, participate in their treatment planning, and collect more information about their progress to follow through on getting the best outcomes for themselves.
Information and knowledge are key ingredients to empowerment and both are now more accessible than ever before. Many health systems like Mayo Clinic are now using technology to participate in the Open Notes movement and give patients transparency into their own health records soon after they see a doctor. Practice Fusion allows patients to retrieve aspects of their own health records so that families can have conversations around key information for care decisions and treatment. Designers are absolutely critical to this process. Complex information, traditionally facilitated by trained people, is now accessible directly. This information must be “designed” for consumers in a way that is digestible, reassuring, and more importantly, actionable towards better outcomes.
The good news about the bar being low is that designers have their work cut out for them. Better patient experiences can mean better patient outcomes. In one example of better patient journeys, one participant in our talk described one of the better ‘designed’ experiences she has seen in the industry:
“Of all the medical programs, hospice does know the progressive steps leading to death and makes it as easy as possible for both the dying and their families. Bringing some of that awareness back to the very beginnings of life care would have a HUGE impact on well-being.” (Karin Hibma)
Understanding every step of progression helps patients and caregivers plan, anticipate, and coordinate better. When designers look at different life stages like fitness, pregnancy, cancer, disease management, and medicine as entire experiences, they can effectively create tailored experiences that can change both the way people are treated and behave.
Other encouraging signals for consumer health come from the trend of wearable technologies and the emergence of ‘designed care’: fitness apps, pregnancy apps, and period tracking apps. We are now starting to see this in top chronic conditions like diabetes management and coaching. We are shifting the scales to the patient by placing design and technology in the patient’s home. There are now ways to see your doctor via video chat (telemedicine), you can now track all of your medication and adherence on your phone (Mango Health), and you can even engage with your certified diabetes educators on the web (Welkin Health / Omada Health). With all of these new tools and services, consumers are able to structure how they follow through on health and the market has shown favorable responses to these new developments. Designed technology around patient health has now become a fulcrum to turn the industry as consumers continue to demand better experiences.
Enterprise healthcare
We expect better experiences for consumers to lead to better health, and the same can be said for the people managing health systems and delivering care. There are many examples of doctors frustrated with their software solutions and even doctors who have retired early from practicing medicine during the recent mass migration from paper record keeping to electronic health records.
“It’s hard to find certain items in the computer system. [The physicians] have to click-clickclick-click. They count their clicks. … It’s not laid out how their workflow is, and I think it’s just sometimes when you’re in [the EHR] you go from page to page to page and then you forget where you started. And so you kind of get lost in the route. It’s hard adjusting to, you know, sitting in a room with a patient and having to put things in a screen while still engaging the patient.”
(RAND study on Factors affecting physician professional satisfaction)
These are systems where design can have a tremendous impact to create user experiences that serve healthcare providers. Yet, in many cases, there has been little to no design effort in the companies that make these systems.
There is a huge need in the enterprise space for better healthcare provider experiences but the provider landscape is different. Consider a health system as an entity that is responsible for delivering a service in a commercially responsible way. You start to discern how a health system can spend a billion dollars on an information system that is optimized to collect data with accurate billing as it’s core purpose. This optimization has left good user experiences for the actual users of these tools as an afterthought. As these massive capital expenditures have decade long commitments, there is little ability for the end users to demand change.
To compound the problem, the rising cost of healthcare has put pressure on providers to increase their throughput of delivering care. Just as John Maeda demonstrated that higher frequency interactions with mobile technology has raised the bar for good design, higher throughput medicine also raises the need for experiences that fit well within the provider’s workflow. Design has the power to reduce friction in provider workflows by introducing well designed technology, adding value without adding unnecessary interruption.
The last decade has seen major shifts in technology adoption in the workplace, which has largely been driven by the “bring your own device to work” movement. The working population brought their personal mobile technology to use as business tools since the incumbent enterprise tools did not provide the user experiences that individuals wanted and could not respond fast enough to meet evolving needs. There are more barriers to this happening in healthcare but that should not discount that the demand is still there. Opportunities exist to improve experiences and companies like Augmedix and Practice Fusion are listening directly to their user base of doctors and investing heavily in designing technology products to meet these needs. Product experiences that blend seamlessly into provider workflows can save time, meaning more patients can be seen at higher quality and with higher provider satisfaction.
There are many indications that patients also want to participate and bring their information tools into the healthcare setting in a “bring your own device to the doctor visit” movement. Advancements in wearable technology coupled with the quantified self movement means that monumental amounts of data about the patient is available through consumer-centric health apps. This is going to pose many challenges for providers (and already does). The Journal of the American Informatics Association wrote an article on how visual analytics can be the key to helping tie together the pieces.
“As the volume of health-related data continues to grow at unprecedented rates and new information systems are deployed to those already overrun with too much data, there is a need for exploring how visual analytics methods can be used to avoid information overload.” (Ohno-Machado)
While quantified self is mostly thought of in relation to fitness, it’s application can be highly useful in relaying back meaningful data to those who care for your health. If all of this information can be presented in a usable format, it gives providers a more complete picture of the patient leading to a more precise and effective execution of care.
Large quantities of data will play a role at a bigger scale. In this country, we are moving from a healthcare system that incentivizes every individual procedure performed, to a model of paying for overall healthy outcomes. A major component of this is the collection, synthesis, and presentation of this mass quantity of data to look at the health of whole communities. Information design and information visualization has a role to play here. Big Data dashboards, presented well, can synthesize health metrics for a patient population and allow providers focus their limited attention on patients that need it the most. As these systems get more sophisticated, we will be able to anticipate the progression and management of diseases better so that we can be more proactive and keep people healthier for longer.
Wrapping up
While our seminar anecdotes were mostly negative, when we started talking about the future of healthcare, it generated a voice of hope. This is why healthcare has become such an inescapable field. While there is an endless sea of frustration and inefficiency, it is the hopeful underbelly that draws designers like moths to a flame. Designers! Feel the tremors of change around us!
The system is ready for designers to have a bigger impact. It is our jobs to raise the heavy bar from the ground up. People are ready to be equipped with the tools to be healthy, mindful, and educated. As technology evolves, design is still human-driven. New technology and devices cannot take the place of people engaging with people to understand underlying needs and offer help. Technology is a vehicle and design is the driver that can take these tools where they need to go to make healthcare human again.
Michelle Kim is Lead Designer for Mango Health. Mango Health is a mobile health company that focuses first on helping with the first critical step for better health: medication management. Using principles from gaming, Mango Health strives to create meaningful behavior change through a fun, pleasant user experience.
Alex Tam is the Head of Design for Augmedix. Augmedix is a digital health company dedicated to re-humanizing healthcare. Doctors spend hours each day attending to information systems when they could be spending more time caring for patients. Augmedix uses Google Glass to help doctors focus more attention on their patients by giving them a real-time support team to manage information systems and documentation on their behalf.
