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Design Healthcare for People at Their Worst

by Brian Eastwood | April 19, 2016

Much of the rhetoric surrounding healthcare innovation is happy. Smiling young people run along a river on a sunny day, then check their FitBits. Smiling parents hold iPads while they connect to a smiling pediatrician over video chat. Smiling nurses use state-of-the-art equipment as they treat plain-faced but nonetheless hopeful patients.

At its core, though, healthcare is not happy. Sick people want to get better, not receive constant reminders that they are sick. Medical professionals want to help patients, not select an ICD-10 code from a pull-down menu. No one wants to think about what it will all cost.

Thus the recent Healthcare Experience Refactored (HxR) conference in Boston challenged those building the healthcare technology of tomorrow to design apps and devices for users who are at their worst, not their best – to bring empathy into the user experience, to make systems simple, and, ultimately, put the “care” back in “healthcare.”

As we all know, it’s a laudable mission but a difficult one. A billion-dollar innovation is a mere drop in the bucket in a $3 trillion (and growing) market. On top of that, the most impactful and necessary innovations – improvements to clinical workflow and data integration – garner little attention alongside this week’s latest fitness apps or wearable tech updates. Consumers (and the media) care less about the accuracy of the heart rate monitor or pedometer because, look, the watch band comes in fuchsia now!

Clinical workflow and data integration matter because the narrative matters. STAT News recently ran a thoughtful piece lamenting the loss of the patient story in healthcare’s rush to implement electronic health record (EHR) systems. Digitization has no doubt benefitted an industry bogged down with paper, but boiling down a patient’s medical history to a series of bullet points and billing codes fails to capture that patient’s motivations, goals, and obstacles in their journey to better health and wellness. It also chills the patient-physician relationship, as the conversation is interrupted to input information or wait for load screens to disappear.

For too long, the end users of healthcare IT have been treated as an afterthought as paper-based and manual processes are simply replicated using a screen, mouse, and keyboard. With no thought given to workflow or usability, pull-down menus, lists, free-form text fields, and customizations abound – not to mention frustration. That’s why it’s time to kill the patient portal, ditch the cluttered EHR, scrap the standalone schedule, and smash the fax machine.

Healthcare applications and devices in all their forms must be designed for end users, not outdated workflows. They must return joy to the practice of medicine and allow patients to live with their conditions, not cope with them.

Above all, systems should serve patients, physicians, and nurses when they are at their very worst – in the moments following a crushing diagnosis, for example, or the final hours of a double shift in the ED. If users can stand the systems then, there’s no telling what they can do when they are happy.



2 responses to “Design Healthcare for People at Their Worst”

  1. Mark Feinholz says:

    Not so sure how helpful this is.

    How about some specific ideas for solutions instead of just broad complaints about the state of tech in healthcare.

    I don’t see how conclusions like this help: “Healthcare applications and devices … must be designed for end users, not outdated workflows. They must return joy to the practice of medicine…”.

    And, you are starting with an assumption that I don’t really agree with: “… the most impactful and necessary innovations improvements to clinical workflow and data integration…”

    Really? I happen to believe that the most impactful and necessary innovations are those that can actually help people change their lifestyle behaviors, behaviors that are marching them into (or deeper into) preventable chronic disease.

    So it could very well be that a less than perfectly accurate heart monitor that actually gets worn and used because of the fuchsia band is far more useful and innovative than the ugly accurate one that is left in the sock drawer.

    That fuchsia band might actually return the ‘joy’ that you hope for in healthcare applications.

    Yes, recording health records on the computer during a visit with a clinician does introduce a new wrinkle into the flow of the experience for both patient and clinician, and the EHR’s UX needs to continue to improve to make this as seamless as possible.

    But managing the introduction of a ‘computer’ into the encounter is a new skill and responsibility that the clinician must learn how to manage. It is too easy to always simply blame the UX of the EHR. The clinician needs to step up and own this instead of just blaming the EHR for degrading the patient experience because getting the data into the system for the future is a new critical part of the success of the on-going health care experience.

    The EHR UX will never be perfect for a given encounter because every encounter is different – will we always just keep blaming the EHR?

    So yea, a fuchsia colored band on the heart rate monitor is in my opinion more important than the placement of a textbox in the GUI of the EHR.

    • Mark,

      Thanks for taking the time to write a cogent and complete response.

      I wholeheartedly agree that innovations driving behavior change are both necessary and powerful. The challenge in healthcare design is getting the information from those devices into the hands of medical professionals (whatever their title) who can further influence behavior change.

      Yes, these medical professionals must face the fact that patient-generated health data is the future, along many other types of technology that they feel impedes the practice of medicine, but the reality is that the EHRs in place at many of today’s healthcare organizations are ill-equipped to accept this data, let alone present it to clinical staff.

      EHRs are admittedly an easy target, but it’s because they were built to as systems of record to collect billing information and not as systems of engagement that construct a patient narrative that, in turn, can be shared among care team members. The new era of healthcare design hinted at in this post will shift the focus away from EHRs and toward systems that, yes, have a UX simple enough for clinical staff having a bad day but also aggregate data from patients and all points of care to create a longitudinal patient record that everyone can access as patients continue their journey to better health.

      Whether those solutions will be next-generation EHRs, care management, population health management, patient relationship management, some combination of those four, or something else entirely is something that remains to be seen, as none of those solutions are mature enough at this point to be declared a “winner” or “loser.” Whatever the case, these solutions must adapt to new clinical workflows — not just where and when a text box or drop-down appears during the course of a patient encounter, but whether it brings clinical value beyond meeting a meaningful use or quality requirement — and accommodate data sources above and beyond those used during a clinical encounter, including heart rate monitors.

      In the end, it’s less about the color of the wristband or the presence of the text box and more about creating a positive experience for patients, caregivers, and the medical professionals trying to achieve those goals of behavior change.


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