IDEO is a world-renowned international design firm and innovation consultancy that has worked with everyone from Walgreens to Medtronic and the Mayo Clinic. Yesterday, we shared IDEO Director of Health and Wellness Stacey Chang’s thoughts on how to approach design for mobile health apps and devices.
In this article, we focused on moving mobile health technology into the real world, in particular to the third world settings. Here, he shares with us his insights into mobile health technologies and what healthcare professionals — physicians, dentists, pharmacists, and even medical students — should ask themselves when crafting their own apps.
iMedicalApps is all about mobile technology in healthcare. What do you think about the hype surrounding these mobile apps?
Stacy Chang: A lot of apps do [cool] things like measure blood pressure from a cuff, pulse measurement, or even do ECG’s … but the problem is that all it does is take existing medical devices into a platform with you all of the time. It changes the locus of care, but the problem is that it’s not fundamentally shifting the paradigm that this technology platform can allow.
So in the developing world, the iPhone might be the only infrastructure around. And there are fewer doctors than the Bay Area. How does this platform provide an interesting conduit of care that doesn’t exist in that area? This is a platform for telemedicine … that’s obvious. But how do you do other things? Can you use this as a digital coach for a low-skilled medical worker to do things they couldn’t otherwise do? There are things that are not exploited in the grand realms of apps.
The current work is replicating medical devices and not fundamentally creating value. [What would save costs enormously is having] a lower cost community health worker to follow an app to look at birthing procedures…but you couldn’t do that here because the FDA would have a field day.
Brazil, China, and Russia… they do have a less tortuous regulatory system. Think about China: they are overwhelmed by the health needs of the population, and they don’t have enough doctors to respond to it!
China has 3 tiers of hospitals. First, they have Shanghai, Beijing, major city hospitals. They look like our American hospitals. Because they are so spectacular, everyone wants to go there. The second tier: smaller cities, local provincial hospitals. Then the third tier: mostly backwoods medical clinics. But the problem is that the first-tier hospitals are overwhelmed. In their cultural norm, the government pays for it, so they wait and wait and wait for healthcare that is marginally better than second-tier hospitals.
Are you thinking of things like telestroke, teledermatology, or telepsychiatry services, where physicians are on call and cover multiple remote hospitals from a central location?
Stacy Chang: That happens in less common circumstances for less common specialties than here… but it’s a much greater problem in magnitude. There you can understand the value more poignantly and do something more effective. I’ve told a lot of people over the years that I think that healthcare reform globally will happen outside of the developed systems because they have to be more innovative to get things done there and they’ll be giving care more effectively. [Look at] Aravind Eyecare – they basically created a factory for cataract surgeries, and they are so efficient, people walk in the door and get the surgery. It’s lower cost and higher quality than any US institution. The need is higher and the regulation is lower.
So I ask device creators, “That’s great that you have a pulse meter, it makes it a little more convenient. But it doesn’t use the technology to fundamentally change healthcare.”
I practice psychiatry & behavioral health. There are lots of products being launched for critical care, internal medicine, dermatology, and other specialties. What about psychiatry?
Stacy Chang: You know, no one touches that in healthcare. It’s much easier to work on chronic disease. But mental health, we don’t do as much work on it [in technology]. It’s very subjective — the ability to track improvement and apply interventions — and it takes time, effort and interpretive skill to see a lot of the change. There are not as many hard metrics. You can measure glucose, or blood pressure. But because [mental health] is less quantifiable, you can’t claim value [was added financially in a business sense]. There are the pharmaceutical solutions, but beyond that, there’s not a lot.
Something we talk about as a group in IDEO is to get into mental health more, since design thinking goes into emotional tools. But we don’t have people coming to us to pay for these services.
And finally, on a personal note, what led you to here, IDEO? Designing world-changing healthcare solutions?
Stacy Chang: I was a mechanical engineer. This is my third time at IDEO. I was an engineer, worked for a competitor, then went to Stanford, then to Chicago leading projects and doing some design. Then I left for two startups, then got poached by a friend for their financial services software. Then, I came back to IDEO 8 years ago and was just a senior project lead then, working for all kinds of stuff, like long haul air travel. But I married a physician, my mother is a healthcare worker… and I ended up taking over the medical products group and took over the healthcare practice 4 years ago. It wasn’t unpredictable but it was [an unconventional route]!
Steven Chan, M.D., M.B.A., is a resident physician at the University of California, Davis Health System, researching psychiatry, telemedicine, mobile technology, & 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.