Medical Futures Lab

Guest posting by Andrew Dumit

I recently wrote a blog post about the poor UX/UI design in electronic hospital records (EHRs). While this is an unfortunate symptom of a stagnant, low competition market, there are ways to improve the EHR experience by understanding the conversations and work that needs to go into improving the current EHRs. The problem with communicating a solution to a technical expert is not unique to medicine, but the implications are especially important in the field.

In a conversation I had with an Epic technician at a local hospital, she explained the best way to get my team’s project (a clinical pathway for the liver transplant team) completed. She told us that having a clear picture of what it should look like helped her understand what we wanted to get accomplished and she was able to show us a way that we might be able to implement it within Epic. Obviously, it’s not exactly what we hoped for due to the limited customization possible in Epic, but it’s a better lead than we had hoped for.

Working towards implementing our solution led me to a realization of a disconnect between doctors and technicians in regards to EHR use. That disconnect takes the form of doctors misunderstanding the capabilities of the technicians and the technicians not having the ability to think like a doctor. And while both sides are understandable in their current state, the problem can be solved.

First, on the doctor side, doctors need to understand that their EHR technicians are neither medical professionals nor design experts. This means that when asking for a solution to be implemented, doctors must have both a clear picture of what the solution should look like and what all of its functions should be. The clear picture of the solution should be communicated and drawn out so that the technician can understand exactly what the solution would look like once implemented and the capabilities fully explained in non-medical terms. With these two tasks done effectively, a technician will be able to do a more complete and effective job at implementing the doctor’s proposed solution.

Now, on the technician side, there are two possibilities. The first one is that technicians may need to be trained in design techniques. Technicians need to understand that doctors do not know basic design techniques and so it’s important that in the process of creating a solution they improve upon the base design given by the doctor. If this were the case, they could take a technical solution from a doctor and create a complete and easy to use implementation.

The second possibility is that technicians could attend some of the meetings where doctors discuss the problems they’re having. If they did this, technicians might be better able to understand the complex problems the doctors are dealing with and would be able to do a better job of creating a solution to the problem.

In the end, the problem with customizing EHRs is a communication problem where neither side fully understands the other. And, like other communication problems, this problem can be solved by increasing the levels of communication and having both sides understand the capabilities and knowledge of the other

Guest posting by Sharon Syau

While reading Dr. Lisa Sander’s Every Patient Tells a Story, I was noticed that she talked often about “the patient’s bedside” and about what doctors do “at the bedside.”  By using these phrases, she locates the patient, at least within the diegesis of Every Patient, to a particular space—the hospital bed.  

Why do hospitals need beds?  Certainly, beds provide an amount of utility.  Sick patients may be most comfortable in beds, and they’re more transportable if they’re in beds already outfitted with wheels.

But could hospital beds be there for the simple reason that they’ve always been there and patients have always been in them?  I had a friend who was in the hospital a while back.  At some point during his stay, a nurse came in and told him she needed to take some blood.  My friend, who was sitting in one of the chairs in the room, said that was fine and proffered his arm.  The nurse asked him to move to the hospital bed before drawing his blood.  (I’m not sure why the move was necessary.)

Posture is Powerful

There may well be very good reasons for hospital beds—I could see safety and/or liability being a potential concern—but I also think it might be worthwhile to think about whether those beds are necessary for every patient.  Beds can be disempowering places.  When we imagine someone who is “bedridden,” for instance, we tend to imagine someone who relies on other people for most activities.  When patients are in an unfamiliar space like the hospital, then, could being in a bed affect how empowered they feel?

Social psychologist Amy Cuddy makes an interesting argument about posture, perceptions during social encounters, and physiology.¹ The crux of her argument is this: the way we position our bodies before an evaluative social encounter—“tak[ing] up space” with high power poses versus “mak[ing] ourselves small” with low power poses—has a significant impact not only on what types of hormones (specifically testosterone and cortisol) our bodies produce, but also on how confident and comfortable we appear to others.

Looking at these power poses again, I can’t see myself doing any of those in a hospital bed.  While that may say more about me than hospital beds, beds are still not the usual place of authority or power.  Think of successful company executives, kings, or superheroes, and I’m willing to bet none of them were in beds when you first imagined them.

Hospital Gowns : Redesigned :: Hospital Beds :                (A Good Old Analogy)

While I haven’t read anything about people rethinking hospital beds, Kaiser Health News (KHN) has reported that some hospitals—like the Cleveland Clinic—have already redesigned hospital gowns in an effort to improve the patient experience.²

When KHN asked patients to weigh in on the traditional gowns, they pointed out problems.  Steven Shepard, for instance, describes them as “a ridiculous garment that serves little purpose other than expose [his] backside.”  Paula Flemming, though, touches on a more abstract problem, saying that she “could probably communicate more confidently with medical providers if [she] didn’t start the visit feeling unable to dress [her]self.”

Back in 2010, the Cleveland Clinic redesigned its hospital gowns with more comfortable fabric and “complete derriere coverage,” and was pleased to report that patients felt far “‘more comfortable in the new design, not just physically but emotionally.’”²  Changing the gown, then, also changed the patient experience.

Hospital beds, as potentially low power places, might reinforce the feeling of “disempower[ment]” that the hospital gowns tend to generate, a feeling that negatively affects the patient experience.²  If testing the redesigned hospital gowns caused “patient-satisfaction scores [to] noticeably increas[e] in a few days,”² could redesigned hospital beds also have a similar effect?

Amy Cuddy’s research tells us that posture can profoundly affect our physiologies and how positively other people perceive us, leading us to several open questions about hospital beds and the patients in them.  How, for example, do patients position their bodies when they’re in hospital beds?  Do their respective postures affect the way their physicians perceive them?  More importantly, does posture affect the way patients perceive themselves?

Rethinking hospital beds and looking into these questions seem to be worthwhile steps moving forward.  After all, patients currently spend most of their time wearing hospital gowns, which already being redesigned, and lying in hospital beds.

Notes:

1. For Amy Cuddy’s TED Talk on body language and self-perception, click here.
2. For more from KHN about “updat[ing] the hated hospital gown,” click here.

Image Sources:

1. Every Patient Tells a Story
2. High and Low Power Poses
3. This Is Why It’s the ICU

Guest posting by Sarah Bakhiet

My team’s project involves pediatric liver transplant patients who must take a host of medications before and after their transplant. One vital medication is PROGRAF, which is an immunosuppressive drug that is taken post-transplant for the rest of the patient’s life. There is a lot of information that must be remembered while taking PROGRAF in order to avoid liver rejection, kidney failure, and other complications, so I thought an infographic would be an effective way of presenting this information.

Sources:
http://www.rxlist.com/prograf-drug/medication-guide.htm

Guest posting by Sanjana Puri

“Could a system be built to ‘demonopolize’ health care knowledge? To move it out of the heads of specialists into networks of primary care providers in remote places so they could manage complex illnesses in their local settings? And could rural clinicians provide care that was on a par with specialists?”

These were the questions Dr. Sanjeev Arora sought to answer through Project Echo (short for Extension for Community Healthcare Outcomes), a project that began as an attempt to demonopolize specialized hepatitis C knowledge and spread the information to rural areas in New Mexico. Today, the solution is transforming the world’s access to health care.

Dr. Arora brought together a team of specialists and developed a model that combined video conferencing technology to facilitate weekly case-based training (similar to the teaching approach in medical schools) with collaborative care and careful patient tracking. He then used these trainings to teach hepatitis C information to recruited local providers. Here’s an image from Project Echo’s website, depicting how it works:

Photo credits: http://echo.unm.edu/

I wondered if this same practice could work in rural areas of Texas, where there are also large gaps in healthcare:

“In rural Texas, sixty-three Texas counties have no hospital. Routine medical care is often more than 60 miles away — and specialty care is almost unheard of.  Most of Texas’ 177 rural counties, home to more than 3 million people, are considered medically underserved.”

The need for Project Echo in Texas is clear.  I researched and found that Project Echo has a site at Baylor St. Luke’s Medical Center in Houston, another urban area. Still, some of the most underserved areas are in West Texas and the Panhandle, where I realized medical care simply does not exist.

Texas is unique, with giant voids of healthcare scattered throughout the state. Major steps have been taken to address this problem: rural lawmakers have fought for recruitment programs, scholarships, and loan repayment for young doctors who go into rural medicine.

Yet these incentives don’t seem to be enough: 27 counties don’t have a single primary care physician. Before Texas can begin to address the specialized knowledge divide, Texas must address its lack of primary care physicians in rural areas. Incentives must be persuasive; until the last legislative session, the loan repayment programs hardly made a dent in the average medical student’s debt.

Perhaps it’s time to make a push for even greater incentives for young physicians to work in rural Texas, beginning as early as high school. To ECHO, Texas must have community health professionals to extend health care knowledge.

Texas should be like a bat and ECHOlocate more physicians for rural areas.

Guest posting by Allyson Knapper

Technology has become such an integral part of our lives that it’s nearly impossible to go a few hours without using some type of machinery, whether it’s a cellphone, a computer, or a television. Having grown up with these technologies, children often know how to use them better than their parents. In fact, youth spend on average 7.5 hours a day in front of a screen (1). This number continues to increase annually, correlating with the rise of obesity in youth. Although it is recommended that kids exercise at least sixty minutes a day, 74% of children fail to meet the daily suggestion (2). Because technology is here to stay and will most likely become even more pervasive with time, it is important that we start teaching children how to develop healthy relationships with electronics. Even more so, the time they do spend with their devices can be used to promote a healthy and active lifestyle. Below I describe two cool apps that target the younger generation.

PowerPod Wristbands

A 2013 public health report revealed that children living in Snohomish County, Washington had the highest rate of obesity in the state. In response, the county’s Health Leadership Coalition created a new program called Get Up & Go, which provided thousands of elementary aged children in the county with wristbands that used a 3-axis accelerometer to measure the intensity and duration of physical activity (3).

At the end of every school day students would be able to sync the wristbands with a computer in order to track their activity. What I like about this solution is that it involves the entire school community, as students are able to see their classmate’s progress online.  This has led to a friendly competition amongst the students that in turn encouraged more physical activity. Furthermore, research has shown that there is a significant decrease in movement after sixth grade, so engaging the students while they are still young can lead to healthier lives later on (4).

 Zombies, Run! 3

Zombies have taken over the planet, and it’s up to you to fight them off. Zombies, Run! 3 is an app available on iPhones and Androids that turns exercising into an interactive game.  As you run, the story unfolds through a series of directions and voice recordings that are heard through your headphones between songs on your custom playlist. You are tasked with rebuilding the base that houses the lone survivors, and the farther you run, the more supplies you can collect. What’s great about this app is that it is targeted towards middle school students, and the 160 different levels and optional interval training encourage kids to keep moving.  Additionally, players are able to track their running progress and can see how much they have improved from using the app.

For more information, visit the games website https://www.zombiesrungame.com/

References

1. http://www.huffingtonpost.com/dr-jim-taylor/kids-technology_b_1890772.html
2. http://www.webmd.com/children/news/20110414/most-young-kids-dont-get-enough-exercise
3.http://www.sqord.com/index.php#features
4. http://www.komonews.com/news/local/School-official-launch-new-program-to-fight-childhood-obesity-229407611.html?tab=video&c=y

Image Sources
1. http://snocohealth.org/wp-content/uploads/2013/12/Machias4.jpg
2.http://media.tumblr.com/34da1d628f8a8096d5296e55425f6667/tumblr_inline_n4135pcXyf1qz8b2h.png