By: Steven Chan, MD/MBA
To sum up the spirit at Health 2.0’s inaugural Health: Refactored code & design conference – it’s energetic yet complicated. Complicated for the sheer amount of work — the sheer amount of opportunity — available in the healthcare technology space.
It’s also partly because the healthcare industry has an enormous amount of catching-up to do, encumbered by entrenched players and cumbersome regulations.
Aaron Sklar, managing director at HealthaGen, said during the user experience panel that more work had to be done when it comes to creating apps to influence health: “We’re at the very early days, and we’re all taking shots in the dark, to be honest, trying out different things…things we’ll try to figure out for years to come.”
However, lots of reasons to be optimistic exist. Government officials, businesses, and developers all want to bring forth change in this industry, as evidenced by this conference’s didactic sessions. From UX (User Experience), UI (User Interfaces), & U: Designing for Health to Dreaming of Data: Big, Open, & Interoperable, this event brought together key industry players: Microsoft’s HealthVault, Nuance, IDEO Design, the Department of Human Health Services, and many others. Conspicuously absent from this conference: physician groups, nursing organizations, and academic researchers.
Here is the first of our two part series summing up the conference.
Government efforts in spurring innovation
Bryan Sivak (@BryanSivak), Chief Technology Officer for the Department of Health and Human Services, first kicked off the conference by discussing the federal government’s open health initiatives, pointing out resources available here.
Sivak states that his group is attempting to make the NPPES (National Plan & Provider Enumeration System) file available, a file that has all of the information about healthcare providers in the nation. His group is also holding Datapalooza hackathons in Washington, D.C., incorporating Raspberry Pi hardware for device entrepreneurs. His particular department is attempting to catch up, since a lot of the backend systems they have are still 1970’s-era systems. This old technology is holding back their ability to update and liberate open data.
Dreaming of data: big, open & interoperable
In the Dreaming of Data panel, speakers discussed the challenges of using data. Shahid Shah (@ShahidNShah, slides here), President & CEO of Netspective, also spoke on barriers, such as those enacted by government. He claims that it is a “myth” that integration is complex, that healthcare data cannot be integrated and requires large expensive vendors. Interoperability is hampered by a “permissions-oriented culture” where front-line clinicians can’t even access the data without an EMR getting in the way or a vendor blocking them from using the data.
“The largest EHR in the world only has a part of the patient’s world,” Shah claimed.
Shah further provided more strategic technical details on how developers and engineering architects can approach projects, encouraging developers to use standardized formats (such as HL-7 API’s) and use open source software. He doesn’t believe “incumbent” vendors should be the de facto companies dictating data sets. In fact, developers should focus on working with data instead of working with apps. All apps should be working with the same pool of “federated” data to prevent vendor lock-in according to Shah.
Chuck Freedman (@chuckstar), a director at Mashery, believes the current development trends include:
- single sign-on where users can log in once, instead of having to sign into multiple applications
- portable data that “should be there” whether patients walk into a restaurant, into a gym, or into a hospital
- a provider ecosystem: Freedman states legislation in the works will eventually make this more seamless
Freedman further advises developers scrutinize platforms for:
- excellent support: Freedman cites Aetna’s CarePass Sync as a platform that provides excellent support, especially with dealing with OAuth, with visuals and graphics included in their developer documentation. Freedman also advises that developers look at active forums where the company is also involved, and allows the community to produce best practices.
- sample code: Developers should be able to get on-the-fly working models and implement this into their code easily, even with code-generating scripts. Some companies even allow access to their GitHub code repositories.
- app promotion: Freedman believes platforms should “promote innovation in their platforms,” even creating a consumer-facing version of their site like Aetna is doing with www.carepass.com. They can then promote developers’ applications on their website.
UX, UI & U: Designing for Health
Although enterprise software — such as electronic medical records — aren’t well-known for their usability, consumer health technologies distinguish themselves and make themselves more attractive by polishing usability factors. In this case, the user interface (UI) as part of the whole user experience (UX).
The first step in good design is asking: What problem are we trying to solve?
Aza Raskin (@Aza), vice president at Jawbone, a device company, believes that creators often try to solve the wrong problems. Constraints can create lots of creative solutions, Raskin states. This creativity manifests itself in the 140-character limit of Twitter, haiku structure, and the constrained number of square feet in urban apartments. Asking the right questions can fundamentally change health and by following a very tight constraint, creators and entrepreneurs can have much broader thinking.
“The right questions to ask,” Raskin notes, “are (1) the ones that preclude reliable, already recognized answers, (2) that promote novel ones, that (3) help you fail forward.”
Raskin later adds, “Ask physicians for their problems, but don’t listen to their solutions.”
After asking the right questions comes the initial designs of the product. World-renowned design firm IDEO’s Gretchen Wustrack (@geewu) believes designers of successful healthcare products “lead with love” and learn to engage patients, to encourage patients to work with the product instead of close their ears.
Wustrack provides these key strategies, from the viewpoint of the user:
- “Make it personal.” People should be willing to give up their own personal information. At a TED conference, IDEO created an introductory genomics experience for visitors, processed four particular genes overnight from each visitor’s cheek swabs, and created 30-second clips of music for each individual based on their genomic results. He states, “this opened up the conversation about people’s individual health, and engaged them with a positive first experience instead of a ‘what are you gonna do with my data?”
- “Show me I’m not alone.” For folks going through a healthcare crisis, they feel isolated.
- “Connect me to what matters.” Wustrack says that this taps into what patients or people love. IDEO helped design a Star Trek-like device, Scanadu, to diagnose illnesses using sensors for temperature, urine, and even a camera scanner to visually match dermatological rashes. No one was interested in the product until they discovered that parents wanted to use this on their children, so they began marketing this towards parents.
- “Celebrate the Small Victories.” IDEO created a pre-diabetes coach website tool that brought other patients together. This let them achieve a goal of reducing serum glucose levels and, once achieved, allowed the participants to celebrate their achievement together.
- “Lighten Up.” IDEO helped create an unplanned teen pregnancy tool for women between ages 18-29. “We learned that sex education for everyone kicks in at the wrong time and in the wrong context!” IDEO ultimately worked on creating a birth control website called Bedsider, which engages visitors to check out different birth control methods. It even includes videos of women sharing what they used (e.g. IUD, dome, etc.) to share what they know.
Wustrack adds, “One of the things I think about when starting design is ‘What’s the right mental model we want people to have with this service?’ I think focusing purely on health is the wrong mental model. Bedsider’s model was ‘this site will help you have a better sex life.'”
“Healthcare providers may think they’re transmitting all the right information, and most times, patients aren’t getting a fraction of that because [when they’re acutely ill] they’re in a vulnerable state. It’s complex information and they’re kind of compromised if they’re hearing news about a diagnosis, so there’s a lot that gets missed, and I think with my ‘Lead for Love’ idea, it’s for providers as well: empathizing where that patient is. Knowing that facts alone isn’t enough: I would contend that it’s not the first thing patients need. First, they need understanding. First, they need a hug. Then, they can engage with the facts and the regimens.”
Why do healthcare applications fail?
In the final closing UX/UI session, panelists discussed the pitfalls that bedevil healthcare app designers. One of the panelists, Alex Tam (@AlexTam), a user experience designer at San Francisco-based firm Frog Design (@frogdesign), works on gamification and rapid prototyping and was recently published in the book Innovations with Information Technology in Healthcare.
Tam believes that healthcare apps often have poor design because they are designed for the wrong time and for too generic of a purpose: “People don’t think about general-purpose apps. Apps don’t target specific problems [enough]. I have this hypothesis that healthy people don’t think at all about healthcare, but when they become sick, that’s all they think about. There’s a huge gap there. Healthy people shouldn’t have to think about healthcare.”
Raskin adds, “People making the decisions [of a product’s design] aren’t the people having to live with the ramifications of those decisions. Some guy so far removed from the [patient & provider] system that creates those products.”
Wustrack also notes, “Apps that frustrate me keep on asking me for data — and it’s work! It’s not really connected with my life. It feels like an additional step I have to do, and it doesn’t help me for what my real needs are.”
Though, there are opportunities for healthcare apps to thrive. Tam notes one golden area that app developers can target.
“Areas that are lacking [in apps create] the conversation between provider, caregiver, and the patient. I think that’s going to help people manage diseases. It’s not the 7-minute visit, but 3 months after the diagnosis or treatment. There aren’t lots of apps that help people along the way of long-term disease management.”
More to come
Tomorrow, we’ll cover more ground in designing user experiences. We’ll also cover keynotes and product highlights from Microsoft HealthVault’s Sean Nolan, Nuance Healthcare & startup sense.ly, and more. Stay tuned to @imedicalapps for further live coverage.
Steven Chan, M.D., M.B.A., is a resident physician at the University of California, Davis Health System, researching mobile technology, psychiatry & human behavior. Steve previously worked as a software and web engineer as well as creative designer at Microsoft & UC Berkeley. Visit him at www.stevenchanMD.com and @StevenChanMD.