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Is Design Important In Healthcare?

May 7, 2013


I’ve been in the healthcare delivery business now for 30 years and I can confidently say we’ve paid almost no attention to design.  Systems are built around physicians’ desires and workflows, and physicians tend to be quantitative, content-focused and able to handle multiple variables at once.  Perhaps that is why we have not put a premium on design.  As we get closer to a world where we are engaging patients in their own health outcomes, design will be much more critical.

I am not talking about designer drugs — using highly specific molecules based on genetic signatures to attack cancers and the like — which are truly amazing.  I also saw one of the first real-world examples of designer organs that I’m aware of recently where a toddler born without a trachea had a transplant of a plastic tube lined with her own cells grown in the lab.

Rather, I’m talking about design in systems used for day-to-day delivery of care.  First, a couple of examples where design is wanting:  A little over a year ago, Medicare put in place a payment rule that penalized hospitals if a patient is readmitted within 30 days of discharge for the same condition.  CMS published a listing of what these penalties might be, based on the readmissions rates of each hospital the year before.  It is a 59-page PDF file.  The information is all there, but the design leaves a lot to be desired.  By contrast, the folks from Health Recovery Solutions took the same information and presented it in a much more digestible way at checkmypenalty.com.  Here you enter your hospital’s name and get a clear, one-page output that visually shows your exposure on readmissions, which can be understood at a glance.

The second example is the Blue Button initiative.  A bold and exciting move by the Department of Veteran’s Affairs, the idea is that clicking on a blue button on a web page allows a Veteran to download his or her health information.  The downside, at least in the beginning, was that the resulting file was an ASCII text file.  This file format combined with the ‘medical-ese’ made for a rendering that was less than ideal for the Vets.

At the Center for Connected Health, we strive to bring healthcare into the day-to-day lives of patients as a continuous function.  In doing so we’ve discovered that small design principles can make a big difference.  To illustrate this, I first want to point out the relationship between engagement and outcomes.  This is best illustrated in a study we published (J Diabetes Sci Technol 2012;6(6):1328-1336) on our Diabetes Connect program.  In this particular paper we observed that patients who upload their glucometer readings more frequently have better outcomes.  Likewise, if a primary care practice enrolls patients in the program, those that upload earliest after enrollment do better. Our interpretation is that patients who care enough to test their glucose early and often probably pay close attention to other aspects of their care (diet, exercise, medication adherence) and thus frequency of glucometer uploads is a proxy for adherence.

Here’s an analogy for you.  If you shop at Amazon or Apple, you see different designs that decrease the friction of commerce (one-click purchasing or mobile in-store purchasing) in order to motivate sales.  It is just easier to shop with these two vendors than many others.  Likewise, if we know that frequency of uploads predicts better outcomes, we should design our programs to make it easier for patients to upload.

We had a chance recently to compare the same to variables noted above (time to first upload and frequency of uploads) using two different in-home data-gathering hubs.  In one case, patients had a phone-modem-based solution where they had to plug their sensor into the modem and push a button to upload.  In the second case, using a wireless device, they had only to plug the glucometer in with a cable (skip pushing the button).  The results of this comparison were impressive.  The design which did away with pushing the button was correlated with earlier time to first upload and more frequent uploads over time – both were statistically significant. (J Diabetes Sci Technol 2013;7(3):623–629)

Sometimes what seem like simple design tweaks make a big difference.

We have a long way to go.  That also means there is great opportunity for those in the information design community to have a profound effect on the quality of healthcare delivery.  In the U.S., where the price-to-quality ratio of healthcare delivery is embarrassing, that should result in exciting, improved outcomes.

23 Comments leave one →
  1. May 7, 2013 12:31 pm

    Great topic Joe as it gets to the heart of health care solutions. Where before you have the gadgets, before you have the cool flash and the sweet “solution in a box” you need to have great design of not only the solution but also of what is being solved. Unless the workflow is designed effectively, any solution will just be a temporary plaster on the long term problem. So in the end, of course, you need a well designed, effective engaging solution but you also need to make sure that the problem itself has an efficient, logical, effective workflow.

    Howard

  2. May 7, 2013 5:59 pm

    Good article, Joe – and good comments Howard. We at XTensionDesk have gone through a similar process to solve the problems associated with prolonged computer use. As an extreme example, our design IS the solution, in that it enables the users to move as their bodies wish to throughout the day. For too long the office furniture industry has tried to make their offerings look appealing at the cost of functionality (as the healthcare device industry did, also). Regards, Craig Dye

  3. May 7, 2013 11:54 pm

    Reblogged this on lava kafle kathmandu nepal <a href="https://plus.google.com/102726194262702292606&quot; rel="publisher">Google+</a>.

  4. Jermaine permalink
    May 8, 2013 1:52 pm

    Great article. I am aiming to bring some of this innovative problem solving here to Jamaica with low-cost solutions.

  5. barbara permalink
    May 9, 2013 10:33 am

    Thank you. In our quest to personalize healthcare technologies, designers can’t help but consider the human experiences of illness and health. I hope we (and our designs) can even become advocates for doctors buried by billing checklists and patients overwhelmed by data. Technology, in a way, may become an unexpected and provocative advocate for the human-side of effective healthcare!

  6. Amy permalink
    May 10, 2013 7:27 am

    Great post Dr. Kvedar. I agree that this is something that is very often overlooked. I think spending time on good design often feels like fluff. I get frustrated at times beause I’m known as the person who makes things look pretty. It seems to vastly oversimplify the work I do and the user experience I create. Fortunately I find that my efforts are appreciated, probably because it’s refreshing in a healthcare and IT environment when design is not always a priority. That’s why I refused to use the Partners standard PPT template when designing our gamification presentation for last year’s Innovation program!

  7. May 10, 2013 8:18 am

    Those who say fluff are ill informed.

  8. okoyeozo kate permalink
    May 14, 2013 5:56 am

    Great info,only for us to put into practice,vry educative too.keep it up,
    hoping to get there some day

  9. May 18, 2013 4:30 pm

    Excellent article. Steve Jobs & friends created an amazing IT revolution by delivering insanely well-designed products. BUT – it is an intricate dance of art, science and intuition.

  10. May 30, 2013 3:37 pm

    Your entry startled me, Joe, with how much health care is changing. I’m no longer a lone voice in the wilderness! To the best of my knowledge, I was the first to advocate for user-centered design in patient devices and information, beginning at Baxter Healthcare in 1986.

    I launched a company in 1997 with CIGNA as my first customer, to redesign products, processes and patient education materials from the patients’ point of view. I have a two-decade library of videotapes, field notes, still photos and audiotapes of the patients’ view on patient education, providers’ false assumptions about patients, and what the barriers are to successful self care. Yes, some of the changes are simple, as you say, but others are more complex and nuanced. We have a portfolio of studies, published and unpublished, of the difference design makes.

    There may be ways for us to collaborate–it’s worth a chat, don’t you think?

    Sylvia Aruffo, PhD
    CEO
    Communication Science, Inc.
    1550 Barclay Boulevard
    Buffalo Grove IL 60089
    847-850-7500

    • May 31, 2013 10:20 am

      Thanks so much for your commentary. Its great to hear from a genuine pioneer.

  11. Daniel Fell permalink
    May 30, 2013 5:42 pm

    Good article and great examples. As a marketing and advertising firm we see the glaring lack of design everywhere in healthcare – from wayfinding and patient flow to web sites and educational materials. But the good news is there are more examples of strong design and innovative thinking than ever before. The strongest healthcare brands have learned to value design and that’s a trend we don’t see slowing down anytime soon.

    Daniel Fell
    President
    ND&P

  12. May 30, 2013 5:46 pm

    Nice post! I hope you are aware of the DiabetesMine Design Challenge & Innovation Program we’ve been running since 2008, a patient-led initiative to improve tools and care: http://www.diabetesmine.com/designcontest

    • May 31, 2013 10:18 am

      Thanks for your kind words and for letting me know about the Challenge.

  13. May 30, 2013 5:50 pm

    Joe,
    A corollary of your important perspective is that the best design is form facilitating function.
    MedSentry has the privilege of working with CCH to test a medication adherence device that lets us see pills in a day by time organizer. Our senior nurse made, I believe, a valuable Design Decision. In filling the box, patients and family caregivers preferred clearly labelled lids which identify each dose compartment. By contrast, VNAs and pharmacists, including robotic ones, are very familiar with a 7 by 4 dose array; by making the top plates, removable, they can gain unimpeded access to the 28 individual cups. When the device is ready for reminding and monitoring-top back on-inspection of contents is limited to only those cups whose lids were opened by the patient.
    David Bear, MD
    Co-Founder, MedSentry, Inc

  14. David Lester permalink
    May 31, 2013 3:11 am

    Joe, another superb commentary. I would like to point out that there are some very interesting activities where design has been important. Here in Australia, the Cochlear Ear device was designed by a leading design artist, so there are examples like this all over. I think where it is VERY interesting is the design of communities that are occurring for aged residences and also (highly recommended) housing for independent living for people with physical disabilities. These communities take into account the environment and the nature of the assistive technologies that are used internally and externally for the residences. I think there is a lot to learn from what is going on in this space. Their focus is on the system and provided services, not individual technologies, where health care needs to go!

  15. Rohit permalink
    June 3, 2013 6:00 pm

    As you describe, Joe – we’re seeing some examples of design – but we need a lot more. We only have to look through the UIs of the majority of the provider-facing applications to see that functionality trumped design and sadly, until recently, without much choice. Our experience with innovative design has demonstrated incredible behavior changes just through software offered via the native iPad experience. Providers, now buying their own devices, requesting user-ids or renewing existing ones in many cases for lack of use, and several hundred percent higher utilization through these mobile apps – not at home or on the proverbial golf course – but right in the office or care environment, right next to the fancy flat-screen computer with all its trappings; all with zero promotion or coaching or coaxing. ’nuff said. We -as consumers, have been a lot more progressive than “we” as practitioners or professionals. But in the final analysis, if we all agree that we are indeed all consumers – and if we let these worlds collide more frequently, we stand the chance of getting to the results and experiences we all want and deserve.

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