The future of Healthcare: a world of possibilities
The 2nd edition of the London UX Design Healthcare Conference took place in April and proved rapidly that designing for healthcare is not a niche but the tip of the iceberg of a fast growing industry.
Recent investment trends show that the healthcare industry has exploded with an unprecedented amount of venture capital, nearly doubling to $8.1B from 2017 to 2018 in the United States. Diving more specifically into emerging technology, it reveals the importance of Augment & Virtual Reality within the medical industry. Immersive tech is ranked as number 1 in the business market share (71%), and as number 3 in the consumer market share (36%), based on a Jabil 2018 study shared by Anja Maerz.
However, what makes this a less commonplace design field, are the many regulations and technological constraints that are driven by engineers and clinicians. Let’s deep dive into the four challenges that we discovered with our peers when considering to design for healthcare.
1 // Overcoming the pitfalls of patient data management
The question of data usage and its transfer in a clinical context was continuously raised during the two days of the conference. Due to no data management across the healthcare industry, most patient information is unavailable or isolated.
Context
Each clinic and hospital set up their own infrastructure which results in no standardised terminology and no database connectivity. The information is inconsistent or not the same across different medical institutions, the medical files are decentralised and there is no shared patient history.
As a result clinicians are wasting time by having to chase information from other surgeries and hospitals, and make medical decisions without the complete patient context at hand. Hospitals are understaffed and demand is high. Because of time pressure and lack of permissions, the medical personnel is able to dispose of local patient data only. As a consequence, patients are perceived and treated as health conditions, not as individuals. This can lead to tragic situations during emergencies, when time is extremely crucial.
Challenges
- New system adoption
In her talk, Sarah Thew, set the stage by reminding the words of a patient she interviewed “The system does not wrap around the patient.” Sarah believes that the sharing of health records is now a top priority in the Healthcare Industry. Unfortunately neither the European nor American governments support the process of getting everyone onto the same medical database. The challenge is huge as it includes a significant budget and amount of work on new system adoption where every medical institution already has its own infrastructure that they are happy with.
2. Data security
Moreover, additionally to new system adoption, we our faced with design challenges surrounding privacy and data security. General Data Protection Regulation’s (GDPR) new rules give European Union users more control over their personal data. For businesses, the regulation has made new foes. Designers are fully affected as we have to create clearer interfaces that make navigating privacy easier for users. Data privacy in a clinical context is even more complex. Health information is sensitive and data storage and transmission has to be carefully protected and follow strict legislation.
3. Too much data can be as bad as not enough
Sarah Thew points out “However without consideration of the content of records, and the uses to which shared data will be put, the value of integrated records will be limited.” Too much data can lead to a sense of overwhelm and hinder the understanding of what actions and decisions have to be taken accordingly to the shared patient information.
The question is how to create a system that streamlines the NHS staff work by enriching what they do, not about filling out their work with more administrative tasks nor replacing them by automated systems.
2 // Clinical safety — addressing errors in the clinical context
Designing interactions for clinical usage is a huge responsability. People make mistakes, it happens, but a latent error can lead to a tragic accident! Dr. Nick Fine @doctorfine gave an interesting last minute talk at #UXDH19 about clinical safety and both, human and machine errors.
His talk evokes a well-known book of Dr. Robert Wachter “The digital doctor. Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age” and the tragic case study of how alarm fatigue and entrusted technology contributed to a 16-Year-Old’s Dramatic Hospital Poisoning, in the story: “How Medical Tech Gave a Patient a Massive Overdose”.
Digital transformation within the healthcare industry transforms not only the way doctors and personnel work, but it shifts their relationships with each other and with theirs patients.
It is natural for our generation to expect that automation would make things better for our complex world, still full of the paper trail, where most jobs involve carrying out some type of manual tasks. We take it on faith that the computers know what they are doing. “Humans have a bias toward trusting the computers,” Dr. Wachter writes, “often more than they trust other humans, including themselves.”
The reality is different. Automation fixes small mistakes but can create some truly epic ones as well. Technology can lead to signifiant errors. In the clinical context technology should not replace human responsability. The last verification and final decision should always be reserved for a doctor. Sometimes it won’t be, and this is one of the huge risks concerning system automation.
Before the digital era, doctors had to pay a great attention of their patients’ treatments as they could only rely on their own expertise. Nowadays, if they rely 100% on the digital system, they won’t double check medical decisions. There won’t be anybody to eliminate egregious errors along the process as everybody entrusted technology.
Even if a system alerts about an error being made, notifications are so common that doctors, pharmacists and nurses learn to ignore them! If a tragedy happened all the blame would go to the doctor. Everybody will demand more medical training of them in order to adopt the new digital solutions and reduce risks.
However, tech is just a piece of the puzzle and the point is somewhere else!
“Computers should become servants rather than masters, and do enough of the busywork so that doctors may actually return to the fundamental work of medicine: diagnosing, treating, comforting, teaching, and discovering.” writes Dr. Wachter.
And having more time to treat patients as individuals not as conditions.
3 // Patients rely more on themselves to get treated
As the lack of affordable healthcare is growing, patients seek out alternative care, or treat themselves by being more aware of their health. Thanks to technology that is at our fingertips or wrists rather, patients can now track all sorts of physical indicators, from sleep, weight, pulse, blood-pressure, to physical activity.
As Elisa de Galdo pointed out the future of preventative medicine now has the capacity to track everything that goes into your mouth thanks to this ingestion sensor design by Tufts University. Clinicians can now also anticipate medical interventions thanks to tele-health systems that track and evaluate on a daily basis patients vitals from the comfort of their homes.
Patients are stocking up with all this immense amount of available data and digital treatments options yet it is not medically clear how to process it, and when you actually have a medical diagnosis, clinicians don’t take this data into consideration. Are patients being mislead by data that is not clinically proven to be accurate? What criteria should patients rely on when evaluating if an app is there to support their health and treat them?
There are so many digital apps out on the market, to help patients improve improve their lives, however they should not be confused with digital therapeutics which go through clinical trials and are certified. These apps are simply there to help you improve your behaviour when it comes to your lifestyle and health. But this distinction, is not common knowledge for consumers. It is important for us as designers to understand this distinction when designing for either types of technology, make our users also aware of this, as well as redirect patients to the right professional references when possible.
4 // Defining a designer’s role for the future of Healthcare.
Service design methodology can bypass medical or technological limitations.
As John Maeda recently said in his 2019 Design in Tech Report :
“I believe that the supporting role is what best describes how design can have the greatest impact in the technology industry today”
Designing for Healthcare is complex. As designers, we won’t obtain the same level of medical expertise as doctors. It is not our profession to treat people. However, we can support clinicians through our user-centred approach to facilitate the way the medical field can evolve and interact with patients. But as Dr. Nick Fine @doctorfine pointed out, medical devices have come to existance mostly thanks to the minds of engineers and sales who see the business opportunities to improve clinical care.
More over, even if these devices are brought to market, and that European legislation forces to discontinue obsolete, no longer conform devices, getting them off the market and out of the clinics will take the most time. Medical care is not homogenous, and not all clinics can afford to upgrade regularly their medical resources.
That’s is where our role as designers will become more and more critical, in order support business drivers & find alternative ways, to improve the overall service quality of the medical journey.
Here are 3 great examples of how a user-centered approach can improve clinical care:
This app stopwatch design for The Angels Initiative helped increase the survival rate of incoming ER patients. The goal of the app is to track all time spent treating the patient in the ER and document each procedure in an effort to improve and find opportunities for time savings throughout the process, posteriori, to reduce the chances that patients will come out a stroke with permanent side effects.
2. The Birthing Experience
The second concept was shared by Rose Mathews @Rose_Matthews, who created this installation in a Hospital in India this object below for their maternity clinic. In India it is not custom to have newborn babies be skin to skin with their mothers right after birth. It was challenging to explain to the parents and relatives why this was so important. Nurses would invite the mother and father to go into this installation. Inside, it was cosy, warm, and shielded from the busy noise of the clinic. Once the parents were invited out of the installation, they noticed the temperature, light and noise difference, of the exterior. Then comes the revelation of the baby’s perspective. Indeed through this installation of the Womb the parents can feel what the newborn must feel at birth and empathize why being comforted on the mothers warm chest.
3. Virtual Reality Psychosis Therapy
The VR industry is also a key medical advancement that is challenging traditional medication treatments, as Indira Knight, from the London College of Art, shared at UXD London, a remarkable VR clinical project that offers an alternative therapeutic treatment for patients with psychosis. Her team has designed a medical protocol to be used by therapists, for 30 minute immersive sessions with patients, helping them overcome their psychosis through 6 different VR environments. Indira’s project with start clinical trials in July, in the hopes that it will be validated as certified digital VR therapy.
Understand the risks of empathy.
This is a trait clinicians are really good at…how to detach from a suffering patient on an emotional level and focus on a treatment. For us, designers, it is hard not to make personal connections, as we become so invested in our users. It is a real challenge when you confront suffering patients! However, too much empathy can be risky for the project. The Healthcare Industry Ecosystem is complex and the importance is to see its bigger picture clearly, without any bias. Yvonne Gillis shared a great reference during her talk on the Design Empathy Framework, that explains the case. Sometimes the solution is not about designing for the patient, but the clinicians, or other hospital staff.
See things as an outsider and do not side with only one player, because you can miss the core of a problem!
Conclusion
At WeDigital.Garden, we have had the opportunity to work on multiple design projects in the healthcare industry, such as Domido the case study we presented at UXD Healthcare London, that sought out to improve the door to door patient transportation experience, while also bringing more value to an outdated ambulance network.
As @DrGylesMorriso perfectly introduced in his opening talk: our main challenge as designers on all projects is achieving behaviour change.
Every clinic is unique and works differently. Each have different resources, address different demographics and the design solutions should be flexible and modular to overcome adoption hurdles.
Several speaker case studies were successful because they found the right medical clinic partner to start the change (culture, budget), and adapted process accordingly.
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