Coforma Brings Human-Centered Design to Indian Health Service (IHS) Partnership
When the Department of Health and Human Services (HHS) Office of the Chief Technology Officer (CTO) sought to deploy innovative methods to approaching Health Information Technology, they called on Coforma (formerly &Partners), owned by Eduardo Ortiz (EO) and Victor Garcia (VG), to support a human-centered design approach to identifying technical gaps in the current electronic health records system utilized by the Indian Health Service (IHS).
IHS is currently undergoing a Health Information Technology (HIT) modernization project to improve on critical healthcare services provided to American Native and Native Alaskan populations. The primary focus of the modernization is the Resource and Patient Management System (RPMS), which is a decentralized, integrated HIT solution for managing clinical and administrative information in healthcare facilities.
The Coforma group leveraged their expertise in modernizing government systems from a human-centered perspective to assess RPMS and implement best-in-class and new-to-this-market design and technology approaches.
In an effort to better understand the value of approaching HIT modernization by focusing on human-centered design and technology approaches, Coforma shared key insights about how their methods and mission impact the project in a Q&A with the IHS.
How have you applied innovative methods to technology design in the Indian Health Service project?
EO: People are always at the center of everything you do, especially when you’re talking about healthcare. This is the first time that a human-centered design approach has been deemed a requirement of a technical assessment of the systems used to provide these services to American Native and Native Alaskan populations. The most important thing we’re doing, which is innovative in and of itself, is we’re listening to the users in those communities where IHS systems are used, trying to define what the problems are, and then trying to figure out how to address those problems.
VG: We recognize the technology is important, but we don’t start there. The approach for trying to answer whether RPMS could be modernized needed to start with the people behind it, and not from a purely technical perspective, otherwise we risked missing an opportunity to think past the limitations of the current systems.
EO: To that end, we implemented a series of techniques from the human-centered design space. Contextual inquiries, KJ methodology, diagrams, journey maps, card sorting, design studio, empathy maps, stakeholder and user interviews, user scenarios, and task flow analysis just to name a few. Those activities individually don’t mean much, but it’s how we’re using them as a whole and what we are using them for that’s innovative — together, these methods allow us and our partners to develop a clear understanding of the situation on the ground and truly grasp the challenges from a People, Process, and Technology point of view, humanizing our approach.
What new, nuanced solutions have resulted from using innovative methods in the IHS project?
VG: It results in a more holistic view of the problem, and in the right questions being answered. It’s much harder to discount a real user’s lived experiences with a system when we’re hearing directly from them than it is to discount someone above or outside the organization without direct experience living day-to-day with the technology.
EO: Using innovative methods helped us create a framework that puts the user at the center of it all rather than putting the technology at the center. In the project we’re working on with the IHS, users are patients, healthcare workers, network administrators, system engineers, programmers, hospital administrators — anyone and everyone that interacts with the RPMS and the electronic health record system is technically a user of the system. We’re looking at their specific pain points and the different goals they are trying to achieve in order to map out the best solutions.
Once you were able to frame the problem in this way, and those innovative applications of methodologies were put in place, what changed?
EO: One of the things we created was a custom framework that’s used to assess legacy systems. This framework was created specifically with RPMS in mind. It’s based on a number of scientific publications, but it’s something that didn’t exist before we created it. This will enable us to clearly document the things that are working, how they are working, and why they should continue. It will also enable to document the things that are not working, why they are not working, how they should be addressed. This will also show what is missing, which will allow the team to make determinations as to what comes next. We can then prioritize the work that needs to be done, because this is merely one step in a multistage, multistep process.
The methods you’re using on projects like IHS aren’t totally new to you. You used similar methodologies with US Digital Services at the White House. Can you talk about that genesis and the spark behind these methodologies?
EO: These methodologies have been used for years by designers, however more recently they’ve been popularized and used successfully within government office like the Lab at the Office of Personnel Management (OPM), 18F at General Services Administration (GSA), and the US Digital Services within the White House. The reason why we decided to use these methods and why they’re effective is they allow us to critically understand who our users are, who are not our users, and establish a very clear context as to the services that need to be provided in order to ensure that everyone is taken care of.
When it comes to healthcare, there is no such thing as an edge case. When you say there’s an edge case in the healthcare space, you’re saying there’s someone that doesn’t get medical treatment and that is simply not okay.
What limitations existed when you were working for the federal government that you no longer face in the work you’re doing now?
VG: Trying to get approvals to do things in an Agile way, to run experiments, to build MVPs, to talk to actual real users in the field, and to throw away the typical federal government runbooks and ways of buying technology was the toughest. It’s a little easier now because we get to choose which projects we work on, find good partners, and to just do all of those things and show our partners the value of it.
The synergy between human-centered design and technology forms the foundation of Coforma. How do you see that synergy activated in your partnerships and projects?
VG: It’s just kind of what we do.
Sometimes we work with companies that think they have a technology problem, and we’re able to add value by focusing on humans first…
EO: Everything that we do is from the standpoint of People first, Process second, Technology third. That’s how we see everything and how we address everything. The reason we do that is we want to make sure that every single decision we make is from the ethical standpoint that no human being will be caused harm. Then we look at the processes to understand what will it take to actually put this into place, which may mean two, three, four, five attempts at getting it there. And then we want to ensure that whatever decision is made can technologically be delivered to the best possible solution. Having an understanding that it may take some iteration and time to get it done is critical.
Are there any challenges that arise when you work with partners who are less focused on people-centered design and therefore potentially less aware that getting the results they want may take more time? How do you overcome challenges between human-centered design and technology-centered design?
VG: This is probably the toughest thing. Helping people trust the process is an important first step. Once information from users starts coming through, we can often connect that to the technology needs and show how we’re able to drive better decisions, stories, and architectures. Often, companies will build and work off of a set of requirements that come from technologists, or project managers, or other stakeholders who represent the interests of users but aren’t the actual users themselves.
EO: At the end of the day, everyone wants to do what is best for their users, their citizenry. Sometimes people don’t have the framework to understand it. That’s where we come in. We show our partners, this is what your users are saying. These are the types of problems users are having. We show it to them in stories. We show it to them in sketches. We show it to them in ways they can understand. All of a sudden, the conversation changes because we are speaking the same language; and that is honestly what takes the most time — we need to be able to develop that common language among the partners and teams. Our job is to make sure that everyone has the information necessary to make the best decisions possible to ensure humans are accounted for at every single step.
This post was updated 9/27/2020 to reflect the company’s name change.
