Interview with Rebecca Ackermann — Senior Product Designer at Amino
Healthcare + Design Episode #1
Rebecca discusses the difference between working at an agency and a product company, her own reasons for designing in healthcare, the challenges in the space, the process of listening to users needs and testing assumptions, how to better educate yourself on healthcare topics and exercise your empathy muscle for the end users, and the design leadership and process at Amino.
Can you explain your design career thus far and how your journey has led you to Amino in the healthcare industry?
Yeah sure. I’ve had a sequitous path in design. I started out actually as a magazine editor. Even though in college I majored in art. I was working with words more than images. I decided I wanted to go back to school so I went to Pratt for grad school for design. While I was there I was also working on book design and magazine design. During that time I really realized that what I wanted to be working on was something interactive. My thesis there was around health. How to make something that could capture the way that people were feeling because it’s such a difficult thing to communicate how you are feeling. The doctor asks “How are you feeling today?” and it’s really tricky. There are sorts of forms and methods that people have made. I wanted to explore that. That’s what I did in grad school.
Then I started working at agency called Code and Theory in New York. Worked on a lot of big projects for companies like Dr. Pepper but also working on the redesign of the Los Angeles Times and Mashable. So I was sort of getting away from healthcare and then an opportunity arose while I was there from a different startup than Amino.
At the time it was called Project Florida because it was under wraps. Later it became Sum. It was started by the founder of Skype who really wanted to get into the health space. I went over there as a senior designer and we were working on a wearable product and also a app to go along with it. That was really about behavior change and trying to measure things like heart rate ad heart rate variability to tell you if you were feeling stressed or feeling relaxed. If you had not just gotten enough of your steps but also if you had worked out your heart enough. We were really trying to dive into something that a lot of other wearables were doing which was getting the longitudinal data instead of just the episodic data that was available at the time. I was there for 2 years working on a mobile app and also the UI for the wearable. I worked with a fantastic team, people from Foursquare and Google and all over the place. It was great however we unfortunately got shut down before we were able to launch and I think part of that was the fact that we were working on hardware and hardware is really hard. That’s really what got us in the end. I decided to get away from hardware but I really wanted to stay in the healthcare space.
I think one thing that I really liked about Amino when I was looking around was that it was really about decision making and really helping and empower people to make better healthcare decisions. The rich data was also really appealing to me because while I was at Sum we were really talking about the quality of data streams. Having that as a company it’s really valuable because you really want to have access to your own storehouse of data. As a user and consumer it’s really valuable because we always talk about big data but it’s pretty scary when we talk about it in that way but it really can be used to help you. You’re own data can be used to help you. That was really appealing to me about Amino.
What does Amino do and what benefits does it offer its end users?
At Amino, we are trying to help people make better healthcare decisions. What that means right now is helping connect people with the right doctor for them. That means the doctor who has the most experience with people with their needs and people like them. The example we often use is asthma. Say you’re looking for a doctor to treat your asthma, the doctor that treats asthma in a 5 year old is very different than from the doctor that treats asthma in a 60 year old. If you’re just going to be googling asthma doctor you might come up with something really wacky. We are really looking at what happens in the patient doctor interactions in the hospital or the office setting and seeing who the doctor is actually treating and how much experience they have with that exact complaint. The reason we are able to do this is we have a lot of insurance claims. We can look at which doctors are treating which types of patients for which types of conditions. Right now what our product is is a doctor finder but really what we are trying to build on that is to offer many more axes to make decisions around their healthcare.
What’s the difference between designing at an agency and a product focused company?
They are very different. In some ways they are kind of the two poles of design. The exciting thing about working at an agency is you really get to walk into a place and say “I know how to fix all your problems”. You get to work on really big problems and at a really interesting point of change for companies. For instance with the LA Times, that is an organization that has won Pulitzer prize after Pulitzer prize, it’s really an important piece of California history, LA history. The people we got to interact with in the newsroom were just amazing with what they do so to have this institution say “we want to change the way we do everything digitally” was pretty amazing. So it means you can walk in and say “we are going to reimagine this institution but in digital form”. It wasn’t just about what the newspaper looks like online, it was about how you publish stories online, the pace of stories, the types of stories, the way that the homepage can change overtime, the way that you can take a reader from one story to another story and what that linkage really is. I think that in agencies you get to work on those sorts of problems and then you get to walk away. They (the LA Times) have undone some of the things that we did overtime. They have made some tweaks that I wouldn’t necessarily have made.
Hayden: Yeah how frustrating is that. I do freelance just small websites, obviously not the LA Times or anything cool like that but, you have a design in mind and you see it so clearly in your head and then you publish it and it maybe looks good for a day and then something gets changed.
Yeah exactly! That’s the appeal of working on a product is that you get to stay with it and you get to make sure your vision is realized and you can keep iterating on it too. We had a lot of hunches when I was working at an agency. We would say, “You know based on the research we that did for another project or based off the research you have done here that this is really going to work”. We weren’t really able to test it after the fact and iterate on it and really meet user needs based on what we put out there. I think that is a really great thing about working on a product. You can say, “here’s what we think and now users what do you think?”. You can really make sure you are hitting the things that you thought you were going to be hitting. That is the appealing part about working on a product. The challenge of working on a product is that you have to stay. At an agency you can come in and make a big splash and walk away. For a product there are a lot of unsexy pieces of the puzzle that you have to be working out and continually tweaking in order to get it right. I think you have to have some patience and a tolerance for phasing, which is not really something you have to deal with when you’re at an agency.
Everyone has problems with healthcare in some sense. What’s your story?
Yeah my younger sister has had chronic health problems her whole life. My parents are older, in their 70s, so they are starting to experience health problems as well. I would say for the past decade I have been thinking about healthcare and how frustrating it is to interact with the system and how frustrating it is to get continuous treatment or sort of a cohesive system of care. It’s difficult. You have these episodes where you are interacting with the healthcare system but it’s very hard to string them together that makes sense which is something we are working on at Amino, looking at an episode of care. I think everyone has a personal experience and I do as well. I was living in New York for a long time and now I’m living in San Francisco but my family is living in Texas so even trying to know and be in contact with the doctors that are treating my family in Texas is ridiculous.
What are some challenges with healthcare regulations when designing at Amino?
There are a lot of regulations and we have to work within them. A lot of things that are important to use like patient privacy and making sure we are keeping patients safe and secure is important to use as a consumer brand just as it is important to use as individuals. We don’t worry too much about those because they really tie into what we are trying to do. Those aspects of regulation aren’t difficult to design around. I think what’s more difficult to design around is data and the limitations of the data. Some of that can be related to regulations. All of our data is deidentified which we wouldn’t want it any other way but it does make some things difficult.
Hayden: Can you explain what deidentified means?
It means that we can see the claims for a patient but we don’t know the name of that patient or the location of the patient or anything like that. It means it’s a little harder to create a clear picture of one healthcare consumer’s journey throughout their life which is something that could make an amazing product about cohesive care. However, it’s essential to make sure the data is private and nothing is happening to people’s precious data. I think there are all sorts of things about data that you understand that you start to work with it. One is that humans input the data so it seems like, “oh it’s all data driven. It’s all numbers and it’s all amazing” but you have to deal with a lot of human error too and not even human error but just human stuff. Maybe this doctors assistant put in this code and then this other one put in a different code just because they had a different opinion about how it should be coded. Connecting the two can be really hard. Things like that are tricky to design around.
I think the other thing that is tricky to design around is a lot of caveats that come with data. We worked a really long time on what we call our experiencing matching system. We have an algorithm that matches you with the best doctors for you that have the most experience with you. That means we are looking at all of the patients they have seen over time and the number of patients they have seen who have your age, gender, condition and ultimately your preferences if you select filters to do that. Studies have shown that doctors with more experience with patients like you perform better but you know with any scientific study there are caveats. People like you is a really tricky thing to say without saying what “like you” means. We’ve done a lot of different experiments with how explicit we are with what that means. We had actual patient counts for a while because it was actually creating more confusion than clarity. I think there is a sort of dance between total transparency of data and analyzing and digesting it into a form that really makes sense. It’s not about masking or obscuring the data but making sure people can use it. So that it’s actually usable instead of a direct translation of what you have.
How do you go about using data to empower the user at the right time they need that specific information? How do you get feedback on the data you present? Is it a constant iteration process until you get it right?
People always say “users don’t know what they want”. You have to be very careful about how you’re interpreting what they say. It doesn’t always mean that they hate a feature it just means they don’t understand the meaning of that feature because you haven’t given it to them in a way that is understandable. We heard a lot of feedback about the experience match in particular, users say, “I’m not really sure why this is important, it seems like it’s important but what does this number mean?”. We have taken at it and tried to push out something that was a direct translation of the feedback and we did more work before we gave it back.
How do you go about getting user feedback? How do you watch users use your product at Amino?
We use a lot of things like usertesting.com where we can see videos of users engaging with the product and they pull from people all over the country and if you wanted people from all over the world. That’s really been super useful because it means that we can also target the type of person we are interested in. If we are using a pregnancy use case we can find people who are actually pregnant or who have been recently pregnant which means they have real insight of how they would look for a doctor. This is instead of putting people in an imaginary land of looking for a doctor. That’s something we talk about a lot, we really want to make sure that we are talking with people who actually have these needs and who are really making those decisions. You make the decisions in a different way than you think about making those decisions. We use usertesting.com, Google surveys and Survey Monkey, things in which we can get a big pool of feedback to be able to look at it from a little bit of a quantitive perspective and then with usertesting.com looking at it a qualitative perspective. We make sure we have a diversity of location but also targeting the type of people we are trying to get feedback from.
How do you find that person? For example, a pregnant woman in Austin, Texas. How do you find that person and test them?
The amazing thing about usertesting.com is they do that for you. I don’t mean to be an ad for usertesting.com but there are a lot of great user testing products out there that really do that heavy lifting for you. It’s fantastic. At my previous job at Sum, we did a lot of in person groups, friend pairs, and individual tests and that was a lot of useful qualitative feedback. It’s a real challenge to get a diversity of opinion. We actually took our whole design team to Chicago, we were in New York at the time and then we came out to the Bay area, to do that sorts user testing which I think is valuable at some point. The great thing about all these online tools is that you can get someone in Chicago but you don’t have to go to Chicago and maybe you can find someone in Peoria, Illinois which is actually more useful than Chicago.
You get all this feedback from the users and it’s diverse. How do you go about deciding on which feedback to improve first?
It’s not a science. I think if we get a really strong signal then we try to go towards that and if we get a strong signal that also aligns with our hunches we move that way too. Of course there are the priorities of the business and if there is something that really aligns with that then we move that way. Or also, if there is something that is diametrically opposed to that then raises the alarms for us. It’s definitely not an exact science. We just try to keep moving and keep getting feedback to hear more and push more out.
When you first started working at Amino, how did you educate yourself on the healthcare space and the specific problem areas you would be designing for?
Reading. Reading a lot. Luckily there are a lot of information out there about healthcare and about doctors and about quality measures and things like that. I did a lot of reading. Looking at other products out there in the space and really trying to use them, downloading a bunch of apps and trying to use all the apps, and also drawing on my own healthcare experience too. I have an eighth month old so when I started Amino I was pregnant and I moved to San Francisco so I was seeing a new doctor. I was trying to get a pediatrician. I was actually going through all of the things that an Amino user goes through so I was trying to lean into that a little bit and do a little bit more and test my own assumptions about it. I think the thing to do always with research is to read as much as you can, use as many products as you can, but also to try to exercise your empathy muscle and get out there and experience what these users are experiencing.
How do you interact with everyone on the design team? Do you work closely with developers and other members outside of the design team at Amino?
This is a process that we are still working on. At Sum it was a process we worked on the whole time I was there, and at the agency, Code and Theory, it was something we worked on the whole time. It’s something that is always top of mind and always changing. At Amino, two of the cofounders are design leaders, Sumal and his wife Maudie. Sumal is the head of design and Maudie is the head of experience and from the product side user experience she runs a lot of our tests and our analytics and working with product to improve it. To me, when I was actually looking for a job, it was amazing that there was design leadership in the cofounding team. That speaks to how design is represented at Amino, it has a seat at the table, obviously data is important and business is important but design is important. I think it is a pillar of our differentiation is that we have a really good experience. It’s not just about delivering the best kind of information but making it beautiful, digestible, and clear. Part of how we make sure that happens is we work really collaboratively all the time amongst all the teams. I think everyone will say we have an interdisciplinary approach.
Design is a core part of the product. It’s not just connecting people to care but it’s connecting them to care that is empathetic and user driven, which is design essentially. Every evaluation of a feature or direction we really have to step back and think about it from a design perspective. One of the things that’s so difficult about healthcare is it’s impossible to understand and I think design can really make that better and Amino believes that as well. Every feature that we put out has a design angle and isn’t just data driven.
What’s your design process like at Amino?
It changes over time. As a team of four, we used to be a team of three but we recently hired a fourth, we’re a small team so we have the luxury of being able to get in the same room together and make decisions together. I think there are other ways to do it where each designer is responsible for a project and it stems out from the nucleus of the design team and then come back to feed it and then go back out again. If we grew that might happen more but I think what’s really great about having a small team is that we can all make decisions together.
We will have a project that is a cross disciplinary project that we have to figure out from a design perspective and usually what we do is get in a room and do what we call “brainsketch”. It’s not really brainstorm which often leads to a whole meaning of nothing. What we do is we have a pad of paper and pens and we do little sprint sketches around the idea of user accounts, for example. We will spend 15 min of everyone sketching on their own and then we will discuss everybody’s ideas and have a conversation from that and then go back and do another 15 min sketching and have more conversation and so on. At the end of it we have a stack of sketches and also a bunch of ideas that we discussed. Then one person will take those sketches and synthesize them and try to pull out the ones that are really important and put together, almost like a wireframe, high fidelity. Then we all sit together again and talk about it and get feedback and go through that sort of process. When it’s a big idea we do this more to really make sure we are working through the tough problems. When it’s a smaller one then it takes a little bit less time. We stopped doing it a little bit but then we realized we really really needed it so it’s something that we try to do with every new feature and project.
If Rebecca Ackermann walked into a legacy IT healthcare company and started trying to design do you think you could make the impact you’re making at Amino?
That’s a very hard question because part of the reason that legacy IT still exists is because they have a really strong foothold. Some of that is political, some of that financial and some of that is regulatory but they are in the door and they’ve had a really long time to be working on these problems. I definitely don’t think they are motivated by consumers in the same way startups are and the way we are and the way consumer driven products are but it doesn’t mean they aren’t successful. I think that it’s a question of reach versus effectiveness. One of the benefits of working a startup is that you can be more effective but I think reach is the challenge. A company like Epic has contracts with all of the hospitals and can reach all of the doctors and all of the nurse practitioners and they can learn a lot from that and they can also affect a lot of change. However, maybe they don’t care as much about the patients.
Have you found that other healthcare companies are willing to work together to share data and help this healthcare process improve?
Data is always tricky. In an industry as competitive as healthcare is also really tricky. There’s a lot of money on the table. People who already have a foot in the door and there are other people trying to get in the door so it’s a competitive landscape and those sorts of partnerships are tricky. There are ongoing conversations going on about data and data privacy and what it means. For example, Apple deciding whether to unlock the phone. It’s part of the national digest as it should be but it’s still just a really tricky area.
What does the relationship look like between Amino and doctors offices? How does that interaction work? Are they excited about what you’re building?
We are actually not working with doctors offices and hospitals right now. We are getting our data from our data claims. That was a calculated decision that we are a consumer company and a lot of other doctor finders out there are really working with offices in a way that negatively affects the consumer experience. We want to make sure that we are really aligned with the consumers. We do have ways that doctors can reach out to us and we have reached out to doctors in the past to get validation. We have, not just doctors, but heads of departments on our board and they are making sure we have medical validation for everything we do. In terms of the business of a doctor’s office we are trying not to serve them as much as we are trying to serve the patient.
Healthcare is intimidating looking from the outside in. You are right in the middle of it trying to fix the problems. What advice can you give to young designers and younger design team looking to make a difference in healthcare?
It’s really a thorny problem and it has a lot of different areas in it too. It’s not one thorny problem it’s a hundred different thorny problems. I think the only thing to do is realize that everyone is trying to figure it out and nobody knows the right answer yet. It’s a messy time which is really great because it means you can get it in and get some experience and figure out the way that you want to approach it. I think also taking risks is good at this point because it’s such a messy environment you can take big bets because there’s no sure way forward right now. One thing we liked to talk about a lot at Sum and hardware was there was a time before the iPod. There was a lot of crappy devices out there and everyone was trying to figure out how to make the perfect one and then the iPod came out and it really crystalized everything. In healthcare there isn’t an iPod yet for a lot of different problems. I think it’s an exciting time when you realize you could be the one that makes the iPod for healthcare. It’s a great time to jump in and take risks and there is no real reason not to.
Thanks to Rebecca Ackermann for taking the time to share her wisdom and speaking with me!
Rebecca Ackermann on Twitter
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Learn more about Amino and their mission at amino.com
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