Author Archives: Amol Utrankar

Apr 15 2014
Design

Workarounds

Stanford Medicine’s MedX Live is a phenomenal venue for public dialogue on healthcare innovation. Recently, MedX Live invited IDEO Health and Wellness Director Dennis Boyle to discuss design thinking in medicine. The talk (video here) is worth viewing in its entirety; Boyle brings a seasoned experience and a forward-thinking vision that offer exceptional insight for aspiring health innovators.

What resonated most strongly, for me, was Boyle’s advice to the Stanford students in attendance: pay attention to workarounds as opportunities for impactful design. In many ways, this mindset captures perfectly what we’re doing in the Medical Media Arts Lab: observing workflows, identifying opportunities, and developing human centered solutions.

Workarounds are a fantastic concept for design thinking in healthcare, because anyone who’s ever stepped into a hospital knows too well how much happens at the margins of the clinical workflow.

In the Cardiovascular ICU, workarounds happen every day. Before rounds, fellows record the salient features of a patient’s electronic record onto scraps of paper. They use these notes to present patients and make annotations, then go back to the EMR to make edits and document a plan of care after rounds. We realized that this two-hour digital-analog-digital exercise could be avoided if EMRs were re-designed to align with clinical needs. We realized that if we could design a platform for streamlining, analyzing, and relaying clinical data, we could make technology that worked for physicians, and not against them.

Thus, I present a challenge for every physician, administrator, designer, and patient. Ask yourself the following questions:

  1. What are of workarounds I encounter in my daily routines?
  2. How does the ‘standard’ design fail to encompass my needs?
  3. If functional constraints—cost, culture, time, technical expertise—were no object, what would I do differently? What goals would I achieve?
  4. What would have to happen to bring those ideas to light?

Of course, these are uphill challenges. It’s easier to default to the status quo, because “it’s what we’ve always done.” It’s easier to constrain ourselves with “Why not?” than to explore opportunities with “Why?” But if we think critically about our surroundings, if we question our assumptions, and if we take resolute actions towards a creative destruction of the clinical environment, we can transform healthcare and put patients and providers back in control.

*Note: To view the presentation, skip ahead to the 12:05 mark.

Mar 21 2014
Design

Room to Create

This semester, as we’ve investigated strategies to improve inter-professional communication and care coordination in intensive care unit (ICU) rounds, I’ve been surprised by two things:

  1. Everyone’s seen the problem. This isn’t a situation where astute perception revealed systemic undercurrents; anyone who’s participated in rounds is intimately familiar with its inefficiencies. Everyone understands this, but nobody has definitively addressed it.
  2. Everyone’s thought about solutions. Whenever we’ve discussed rounds with a patient or provider, it’s profound how much they’ve given this thought. Anyone can readily suggest areas for impact, or even specific methods for improvement. Why hasn’t intuition translated to innovation?

It’s attention – or more specifically, the scarcity of it. Nobody recognizes the opportunities for creative destruction in healthcare better than the people who spend each day in the trenches of clinical medicine. But after patient care, administrative hurdles, research responsibilities, teaching duties, continuing education, and something that might resemble a personal life, providers have neither the interest nor the capacity to cultivate an innovative spirit.

Which leads me to ask: what might healthcare look like if we gave providers the time and space for disruptive thinking?

What if medical teams borrowed from Dropbox’s Hack Week? What if health institutions, as Google did, allowed every provider 20% of their time for creative ventures? What might the likes of the inventive energies and constructive cultures that created GMail, AdSense, and Google News do for healthcare? A different approach to ICU rounds? A re-designed EMR interface? A stronger capacity to screen for, and address, the social determinants of poor health? The opportunities are limitless.

And thus, for healthcare providers, students, patients, entrepreneurs, everyone, I offer these thoughts:

  1. What would you do if 20% of your professional time was protected for creativity and inspiration?
  2. In what ways does your work atmosphere cultivate innovative vision, and how could it better meet that goal?
  3. Beyond limits to time and attention, what are other functional obstacles to innovation in health settings, and how can we mitigate them?
Mar 12 2014
Communication, Culture Video

Presidents, Physicians, and Public Dialogue

http://www.youtube.com/watch?v=6wGN-lbd7Ss

If you haven’t yet seen President Obama’s interview with actor-comedian Zach Galifianakis, you’re missing out.

President Obama makes a clever pitch to the Young Invincibles—uninsured millennials in their 20s—to sign up for health insurance under the Affordable Care Act. It’s sharp. It’s fresh. And it works.

For physicians in the Digital Age, President Obama’s interview offers valuable insight.

Be accessible. There’s no jargon or formality to President Obama’s pitch. He understands his audience, and brings both content and tone to its level. For health communicators, it’s essential to be mindful of where the audience comes from and form-fit the message accordingly. Public conversation, especially something on as massive of a scale as social media, isn’t something that health providers are trained to do. But if we are to inform popular opinion and create public dialogue, it’s something we’ll have to learn.

Be visible. How often do we catch people talking about what’s playing on C-SPAN? Never. A politician press conference? Rarely. News commentary talk shows? Sometimes. The president’s comedic interview? It’s everywhere. The President drew some criticism for informality, but he made headlines, sent a message, and inspired conversation. Similarly, health communication has to transcend academic journals and medical conferences to go where the patients are: online. Even the best professional, peer-reviewed content can’t generate dialogue or spark disruption if there’s no audience for it.

Be innovative. This may be the Oval Office’s first use of viral video for political outreach, but it certainly won’t be the last. As digital communication expands to new collaborative platforms, “the medium is the message” becomes increasingly relevant. Academic blogging and tweeting is an excellent start, but as new avenues for dialogue emerge, look for opportunities to reach different audiences, share different messages, and try different strategies for engagement.

As the Web turns 25 this year, it’s hard to overlook the transformative impact it’s had on the way we connect, communicate, and collaborate as a society. What’s been less dynamic is our willingness to embrace new forms of media to reach new levels of engagement. Boldness in public communication is something that needs to be wired into medicine at all levels, from medical training to clinical practice to institutional leadership. If the President isn’t above it, then heck, neither are we.

Feb 28 2014
3 Comments
e-patient, Technology

Quantify Yourself

As Socrates once said, “to be is to do.”

As an aspiring physician, I’ll soon enter a clinical environment that’s more data-driven and technology-oriented than ever before. More patients are using mobile applications to track their health data. More providers are incorporating patient-generated big data into clinical decision-making. More devices are becoming integrated into the Internet of Things, a connected contextual framework with the power to drive personalized, predictive healthcare.

In class, we’ve discussed how e-patients can use self-tracking to build awareness and control over their health status. In our design setting, we’ve examined how intensive care physicians have to consolidate vast quantities of data into a cohesive patient narrative and a plan of care. But there’s discussing and observing, and then there’s doing. I decided to take it a step further. I wanted to situate myself in the patient’s, or provider’s perspective, using self-tracking to inform and inspire my own health behaviors.

Over the past 30 days, I’ve used Azumio’s Argus to construct a digital timeline of my lived experiences. Every morning, I log my sleep, heart rate, and blood pressure. As I walk across campus, I measure my steps and calorie consumption. When I sit down for a meal, I take a snapshot of my plate. With each meal, I record how many glasses of soda and/or water I’ve had. When I hit the Rec Center, I record my exercise by type and duration. If it’s a weeknight study session, I count how many cups of coffee or tea it takes to power through it. If it’s a weekend, as I hit the bars, I save how many bottles of beer or glasses of wine I’ve had. And at night, I check my pulse and blood pressure again right before my head hits the pillow.

Now, the critical question: what have I learned?

Commitment. Between Week 1 and Week 4, my “compliance” fell from 96% to 63%. It takes a committed, conscious effort to record every meal, every vital sign, every exercise, every minute of the day. I hold a new-found respect for the diabetic patient who has to monitor his blood sugar, manage his appointments, and mind his meals; it’s a process that’s both distracting and exhausting.

Awareness. As much as the constant inputs were a challenge, they empowered me to become cognizant of my daily behaviors. Did I really eat pizza and chips for lunch that often? I went that long without drinking water? Do I really spend so much of my day in a sedentary state? To record empowers us to know, and to know inspires us to act. I wonder if, as we move towards ‘ambient-tracking’ devices, we’ll lose this sense of awareness and agency.

Application. So often I found myself asking, what really matters? Argus would frequently warn me that I hadn’t drank water in three hours, or congratulate me for walking 10,000 steps that day. Did these things necessarily make me a healthier person? As we realize our ability to quantify everything, it’s important for us to isolate signals amidst noise. It’s necessary that we identify the parameters that matter for health versus those that don’t. It’s vital that we appropriately calibrate the thresholds of behavior that justify a congratulatory or cautionary alert. Data for data’s sake is useless; the next step is to make that data actionable.

If you haven’t quantified yourself yet, it’s a must. Data is a ubiquitous element of our modern lives. When we quantify ourselves, we can critically evaluate our daily experiences from a birds-eye vantage point. We can channel those insights into knowledge and action to enrich our lives. And, as future physicians, we can learn what it means to gather data, make sense of data, and use data to drive clinical decisions.

Feb 24 2014
Communication

A Recipe for Public Thinking in Academia

Nicholas Kristof’s latest column on academia’s detachment from public issues raises many excellent questions for intellectual leadership in a digital era. Should academics be more visible in public debate? Should their work more directly address current policy matters? Should academic culture be faulted for fostering insular thinking?

The one question Mr. Kristof didn’t address is the one most worth asking: What can we do about it? How can we better connect academics to social issues, public conversations, and societal interests? As we discuss matters of health design, e-patients, and digital presence in “Medical Media Arts Lab,” can we look beyond the individual to understand the systemic inhibitors of public engagement in academia?

Kristof’s piece suggests the solution is for individual academics to simply become more involved:

Professors today have a growing number of tools available to educate the public, from online courses to blogs to social media. Yet academics have been slow to cast pearls through Twitter and Facebook.

While individual willingness to participate in the public forum is important, these issues run deeper than that. We need more than intent and a platform. What we need is a broad rethinking of the way we educate, evaluate, and engage in academia.

Education. During her training, an academic will learn how to ask a research question and develop a method to test it. What she won’t learn is how to communicate it. And I don’t mean the sort of weighted jargon of p-values and regression coefficients, but the type of dialogue that can spark a bus stop conversation or tell a story at a high school career fair. If we want academics to be publicly engaged, let’s start by teaching them how it’s done.

Evaluation. In today’s publish or perish climate, engagement that can’t be measured in citations or impact factors is an afterthought. What earns tenure is a publication in Science or a major NSF grant, not a Twitter feed or a NYTimes column. To cultivate holistic academics, we need holistic measures of value and impact. Would we need Kristof’s article in a world where public impact was a factor in grant awards or tenure decisions?

Engagement. Perhaps the strongest, and toughest, catalyst for public thinking is a cultural shift where academia embraces its role as a service to the public. Public scholarship isn’t simply ignored in today’s academia, but often actively discouraged. To advocate and engage is to sacrifice credibility and accountability, the currencies upon which research careers are built. Rather, academia should embrace the accountability and responsibility that comes with public research dollars. It should recognize the pedestal for impact and change that their expertise confers, and leverage it for public good. This culture shift won’t be simple, but it’s absolutely critical.

Academics must recognize the importance and imminence of a shift towards public engagement. Those who don’t will soon meet the most compelling impetus of social change: obsolescence. In the age of crowdfunded citizen science ventures, patient-driven medical research, and growing popular antagonism towards science, those who don’t embrace the public sphere will find themselves consumed by it.

This post is a modified version of the original, which appears here.

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