In this episode of Healthcare + Design, I interview Daniel Ritzenthaler, Senior Product Designer at Iora Health. Iora Primary Care (Iora Health’s consumer brand) provides primary care designed for the needs of people 65 and older on Medicare.
When was the first moment you realized you wanted to be a designer? What first got you interested in design?
I was good at math in high school, but didn’t find it interesting. I took the risky path and went to art school. It was so much harder, but far more satisfying. Unfortunately, I didn’t know what to do with the degree and, for a while, regretted my choice.
My college introduced me to a “design” job that was more HTML/CSS than design. I took it. I learned to code as fast as possible.
Two years later I designed and wrote the front-end code for a small web-based application. Something clicked. I knew I wanted to do this. Unfortunately, this would only be a small fraction of my job. So I quit and started a design shop with a friend.
Can you explain your career thus far and how you ended up designing in the healthcare space at Iora Health?
I owned a small design shop for a few years and hired a handful of employees. The company drifted away from web-based applications to marketing and promotional websites. The shift, in combination with the stress of owning a company and managing people, caused me to lose interest.
The juice wasn’t worth the squeeze anymore.
I jokingly (not really) call this my quarter-life crisis. I considered changing careers, but chose to rededicate myself to web-based applications, but this time, with startups.
It was tough to start over. I didn’t have a reputation or any friends in the startup world. I had to swallow my pride and get scrappy again.
A couple years later HubSpot, a hot local startup, acquired my favorite client. They invited me to join as the second designer. I helped build an amazing design team and left shortly before the company went public.
While thinking about my next adventure, a friend introduced me to Iora Health. Our first meeting was a professional courtesy. I had no experience with health care at that point. It sounded boring (spoiler: it isn’t).
One thing surprised me. Their business model seemed to enable their goal. As obvious as it sounds, that was rare with many of my early-stage startup clients. Most of the time their mission was at odds with their revenue options.
Another thing grabbed my curiosity; a large part of the audience using the software would be employees. Plus, there was a strong culture of interacting with the clinical staff. The administration burden of user research was tiny. I could be closer to the “customer” than any other time in my career.
That was enough to push me over the edge.
What I didn’t realize at the time was that an employee can’t quit using the software without quitting their job. Adoption, usage, and retention are far less potent signals. I can’t easily build theories through quantitative data. I have to get closer to people and better clarify their intentions.
A huge decrease in research cost came with a huge increase of effort interpreting research results. Even three years later, I’m still adjusting.
You were an early member of the team at HubSpot. What was that experience like? What is the difference between designing on a small team vs a larger more established team/company?
When I started, HubSpot was already past 150 employees. They had a strong development team, but no dedicated designers for the software. They had designers splitting time with their marketing and promotional websites. A handful of software developers also had design interests.
After HubSpot acquired my client, their designer became the head of product design. I was his first dedicated design hire. For the first couple of years it was a mercenary lifestyle — going wherever I seemed to have the most value. Hopping from one team to another as they needed help. It oddly resembled freelancing.
Eventually, we hired more designers and built a research team. We started untangling the system around the designs. We flushed out principles so our designers could better delegate their work. Everything started to click.
As the designers integrated into the development teams, HubSpot disbanded the design team. The designers were to report to their development team managers.
Maybe I forgot to check my ego and my pride kept me from allowing a non-designer manage me. Years later, I still wonder. I overstepped my bounds playing manager too many times and alienated myself from all the actual managers.
Several people coached me to adjust. I never did. It was time to go. Even though I was sad to leave, I learned so much during my time at HubSpot and will be forever grateful.
Can you explain what Iora Health is and what benefits it offers its users?
Iora Primary Care (Iora’s consumer brand) provides primary care designed for the needs of people 65 and older on Medicare. One of the things I find most interesting is how much time our clinical staff spends with their patients. In a value-based model our business does better when we improve people’s health and keep them healthy. If we can prevent someone from visiting an emergency room, for example, we both win. This often comes from proper management of chronic conditions like diabetes combined with being available at the right time for our patients. This takes time — more time than fee-for-service models allow.
As you can imagine, there’s a lot of tricky bits to untangle in healthcare to make this work on a large scale. Doctors, nurses, health coaches, and other medical professionals still have very tough jobs.
We have to tease out the unnecessary work, automate the repetitive work, and make better sense of what’s left. This gives our staff even more time to care for their patients.
Why do you work at Iora Health? More specifically why did you choose to design in the healthcare industry?
I’m a little masochistic. HubSpot already had a strong technical culture, but I was skeptical they were genuine about building a strong design culture. A small part of me wondered if it was even possible.
I knew it would be several years before design could take hold in an organization already set in it’s ways.Why would I do that to myself?
Iora Health is different, but the industry is similar. Healthcare is set in its ways, which aren’t always supportive of the healthcare professionals caring for patients. That’s not fair. It’s better to say the industry is optimizing for efficiency at the expense of logical interfaces. Every electronic medical record I’ve seen is dependent on training. Nobody can figure them out on their own. People suffer through incredible amounts of trial and error.
Is it possible to break this pattern? How many years will it take?
I have no idea.
There’s something exciting about it, though. I hope I can help Iora take a different path. I hope Iora becomes influential enough for others to follow.
What are your aspirations for the healthcare industry when it comes to human-centered design? Where would you like to see healthcare move in the future? What opportunities do you see for design to influence the healthcare space? (Pick whichever question you would like to answer)
Technology is moving fast. Sophisticated medical tools are getting smaller, simpler, and easier to use. More medical professionals will be able to perform related tasks with less training. Tools and activities will shift from large hospitals into small primary care clinics. This is a big tectonic shift happening in healthcare right now (among others).
The software we use to manage all of this information needs to do the same. It needs to be more usable by more people with less training. The leaders will be the “operating system” for much of the work shifting into primary care.
The big systems used in big hospitals are no longer compatible.
How do we make things easier to understand, easier to use and not sacrifice utility? How do we fold in new ways of doing things, while preventing as much disruption to habits and routines as possible? This is where designers excel.
I’m not sure I have any particular aspiration. It’s no longer a choice — this all seems inevitable. Let’s get to work!
How big is your design team? How do you split up work amongst everyone on the team? Do you all work together? Do you work closely with developers and other members outside of the design team?
Iora is now over several hundred employees and a large majority of them are in clinics around the country. Depending on who you count (data, security, etc), the team working on the software used in clinics is in the teens, so it still feels like a small startup.
There are two designers. We are on the “product team” and contribute to the longer term thinking and planning. We also spend a lot of time untangling immediate work with the development team managers.
I prefer the manager/designer relationship to be like the writer/editor relationship. The designers may not be the genesis of the work but, they clarify, push for more detail, trim the excess, and force focus.
I don’t think managers can do this on their own; it’s too hard. The greatest writers in the world don’t go solo. They hire he greatest editors in the world. They make each other better.
What are the biggest/most interesting design challenges you are currently facing at Iora Health?
It’s always tricky arguing the value of software that is easy to use. You either have someone at the top who gets it, or you need to be great at selling it. Iora has a bit of both, depending on the team and the situation.
A new capability will always seem valuable, but improving an existing capability often takes a lot more convincing. Someone has to evangelize the work and explain why it’s important. Many think a new feature, even when executed hastily, is better. Sometimes they’re right, but most of the time they’re wrong.
People beat themselves up. They are “not computer people” and blame their upbringing. Whether we admit it or not, we exploit this destructive behavior. We make bad software. They blame themselves for not getting it. We get off scot-free. Every time we hear someone say they are “not a computer person” we should feel shame. Our bad software made them feel that way. That’s on us — not them.
I believe designers are an important part of a company’s DNA since they contribute to its culture, principles, and values. How has Iora Health built a culture that fosters design?
There’s not yet a strong and pervasive design culture in Iora, but there is a design friendly culture. The developments teams work in a quick, iterative fashion. Leadership is encouraging and supportive of visiting clinics. These two things make building a design culture easy.
We’ve recently been untangling and declaring our values. We’re formalizing our research and information synthesis tools. Breaking down seniority level responsibilities. Helping frame our development team’s work in forms of progress (as opposed to requirements and specifications). Proposing large scale design system work. And more…
There’s momentum. Things are happening!
As the results become visible to the rest of the company, we should see more momentum. The vibe in the company is that everyone wants to see design flourish, but there’s a lot of uncertainty about how to do it. If we can show a working system, we’ll get even more support.
How does data play a role in making design decisions? How do you design with the data you have on the Iora Health users?
We have sophisticated tools for patient population data. How many patients? In what markets? Their medical conditions? Their risk factors? That kind of thing.
Although, when building the software, we’re far more invested in qualitative studies. It’s normal to take part in four observational interviews a week. It’s rare that we go more than two weeks without an observational interview. We’re always talking to people using the software we design.
The majority of our concern is figuring out what people are going through. Qualitative studies give us this window.
I’m sure over time, we’ll invest more into quantitative tooling.
Healthcare is a confusing mess to someone like me who is new to the industry and sees how poorly designed everything is. How did you learn more about the industry better and get caught up to speed before you started designing and leading the team at Iora Health?
I lean on leadership and domain experts in the company. Iora is big on welcoming new people. They’re also great at helping people with industry and medical questions.
In the first couple weeks I had lunch with the Chief Operating Officer. After passing 100 employees, he still took the time to hang out with me. For a while I thought I was special. I later found out he does that with everyone.
I recently joked about getting lunch again. It happened a couple of days later. That’s pretty cool. Am I special now? Probably not. That’s just how he is.
Also, several people behind the scenes at Iora Health are practicing doctors. I’m always surprised when I see someone is cancelling meetings because they are covering for a doctor on vacation. It’s so easy to forget that they are practicing doctors.
I’ve heard rumors that a few healthcare professionals chose to work at Iora because of the nice software. In five years, I want that to be a normal comment.
What are some other healthcare startups who really value design that inspire you?
Sometimes competitors can be a distraction, because there are too many unknowns. The part of their software that you’re excited about might be the part that is under-performing. Don’t make that part of your software.
Spend more time with the people using your software. That’s it. Seriously.
What advice can you give to young designers looking to make connections and break into the industry at larger startups? What advice can you give to other designers and entrepreneurs working in smaller healthcare startups?
Make stuff. Write stuff. Network.
Making stuff helps you practice converting ideas into reality. Most ideas aren’t immediately compatible with reality — if ever. This process is more valuable than having the original idea. This process generates the better, more compatible, ideas. I don’t think you can sustain that virtuous cycle any other way. If you’re not making the stuff of your ideas, your ideas will regress to the mean.
Writing stuff helps you practice converting your ideas into workable plans. You’ll never reach the peak on this. You can always get better at explaining things. Your ability to explain what you intend to do will become more valuable than your designs. It’s never too early to start building this skill.
Networking helps you see the impact of what you make and write. Most of the value from my side projects and writing comes from real people. I’ve never made or written something to build an internet audience. It’s to have something useful to say when I meet real people. It’s to show them that I’ve been thinking and caring about the topic for weeks, months, and years.
Even in ways that seem trivial. If you make something, write something, and talk about them with real people, you’ll improve faster than most of your peers.