Medical Futures Lab

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.

I have had an idea for a while, but I’m still not sure whether it is something that people need, desire, or would find beneficial. So I’ve decided I’m going to publicly share it on this forum, and see what kind of feedback I can get.

Throughout the semester in class we’ve touched on the subject of authenticity over the internet. It can be very difficult to assess a person’s credibility and authenticity on the web. This is a problem with the internet in general, but it’s an even bigger concern in medicine where information related to health is being shared. How can I be sure this individual’s advice is credible? How do I know this isn’t some company trying to scam me, or an individual who enjoys trolling the internet? It can be hard.

Completely unrelated to that we’ve talked about the disparity between the number of individuals who own smartphones or the number who have internet access and the number of individuals who are actively engaged in their health.

But maybe these two things aren’t unrelated? I have a feeling that there is a relatively large segment of the population that might not be active because they don’t feel safe and secure with both the information they are sharing and the information they are receiving.

So that’s the problem – here’s the idea.

If you are familiar with Doximity (https://www.doximity.com/about) you know they have done an excellent job verifying the credentials of physicians and giving them a portal that they feel secure communicating in. For patients, there are online portals like PatientsLikeMe which are fairly popular, but they don’t have nearly the kind of security that a site like Doximity does.

But what if we combined the two?

Doctors are very familiar with their patients. If we create a patient centered portal that works with Doximity we could use doctors to verify the credentials of patients as true patients.

Here’s how it would work. Suppose I have diabetes; in order to gain access to the secure diabetes portal I would send my doctor the equivalent of a friend request on Facebook asking for permission to access the portal. My doctor would then verify that I am a diabetes patient, and only then would I be able to access the information and share my information over the portal.

While this may seem unnecessary or cumbersome it adds value by creating a portal where each patient knows that the individuals they are communicating with are truly patients concerned about one another, not companies and not trolls. It could also potentially provide doctors with a more secure and private place to communicate broadly with disease communities.

The technology and software for this is easy. But are there people out there that could use this? That’s the tough question. Thoughts?

Source: Wikipedia

In Medical Media Arts Lab, we have been encouraged over and over again to consolidate our research and design through the use of stories; so far we have produced storyboards for the problem as a whole and written multiple narratives from the perspective of our problem stakeholders. Before these exercises, I could not clearly see the benefits of storytelling, but I am now very aware of their effectiveness. Witnessing the power of storytelling, I began to cogitate on why they are so potent; With this blog post I’d like to explore some perspectives on the power of representing problems in the form of stories.

The IDEO Human-Centered Design Toolkit directly addresses and prescribes storytelling. Specifically, it recommends storytelling in the step right before materials/solutions are produced. One reason for the use of storytelling is that it the stories give real, human-centered ideas and solutions that are synthesized from research and thought:

“Telling stories is about transforming the stories we heard during research into data and information that we can use to inspire opportunities, ideas and solutions. Stories are framed around real people and their lives, not summaries of information.”

The other reason why they are proponents for this type of storytelling, is that they help solutions designers think in terms of specific events, rather than in general summaries:

“Stories are useful because they are accounts of specific events, not general statements. They provide us with concrete details that help us imagine solutions to particular problems.”

Another interesting perspective is that storytelling is fundamental to being human, and is necessary for human survival. Personally, I can see the motivation for this strain of thought; for me, stories grab my attention, foster empathy, and are easy to process cognitively. For instance, today I attended some presentations from electrical engineering researchers who were describing their ongoing research. It was no surprise to me that the presentations about an ongoing problem that were framed as stories were engaging and had me quite interested, while the other ones that framed the problem via a bland description of the problem had me feeling drowsy. It is the format of a story that somehow makes the problem come to life in a way that feels natural and is captivating.

Whatever the reason for storytelling, I am grateful to have had experiences this semester that have reinforced its strengths. It has helped me already in my classes, and will undoubtedly aid me in the future for problem solving and communication.

Good UI design is KEY

Last time, I discussed why design considerations are fairly important. Now, I want to discuss some of the actual principles in design. Today, I want to discuss some Human-Computer Interaction principles in general, as they are of more general use to everybody. I also want to note the principles involved specifically with mobile apps and mobile health apps, but to remain brief, I will stick to one topic at a time. Honestly, I could probably write pages on this subject: It is important, I began a class on it some time ago, and there is enough material to teach entire courses on the topic (see:  1  and 2 , at Rice.)

Most general design principle information actually comes from psychological principles dealing with perception, attention, and memory. We use these higher level functions to interact in the world and with our devices, so they must take them into account. In An Introduction to Human Factors Engineering, as pulled from Wikipedia, Christopher Wickens et al. defined 13 principles of display design, which can be readily used in mobile app design as well as in designing other things, as they mostly deal with the higher level cognitive abilities I just mentioned.  They can divided into a few subgroups, of which I shall talk about instead of the actual principles, because that would take too long. If you’re interested though, take a look at the above link.

Perceptual Principles

These principles revolve around the idea that, as people, we can only perceive reality in certain ways, and design needs to accommodate for that. The size of the display we have is limited (iPhone or Android or other smartphone screens), and they must be readable to the majority of the patients, many of whom are old and are losing eyesight. Alternatively, we can remove as much text as possible and use symbolic stand-ins and videos. One of the principles, redundancy gain, is rather useful, as it suggests that by presenting a signal more than once, even in different physical forms, the client will understand it better.

Mental Model Principles

We have past experience with the way the world is organized, so going into an app or other resource, we have some idea about how they are supposed to work. This is one of the large reasons why testing a project with a designed interface with a small sample size is good: the developers are likely to be tech-savvy, and if their population does not have the same expertise, ideas that seem simple to the devs will be difficult for the users.

I’m using twice, but its so relevant!

Principles Based on Attention

A display will have the client divide their attention into multiple areas. The distance between areas should be minimized to reduce the small but certainly present cognitive load that results from the distance between elements in a display. Using multiple resources to present information helps here too.

Memory Principles

Generally, we want to reduce the amount of memory clients have to spend trying to make an application function. We can do that by “piggybacking” on their existing knowledge (as I mentioned earlier), by predicting actions for them (e.g. pulling up a list of what exercises they will need to do that day), and by being consistent across displays.

The Face-up side is not immediately obvious. Not good design, at least to us

The design strategies themselves, of course go much deeper than that, but as Wickens et al. proved, one could write an entire book on the matter. These considerations, however, will certainly be useful in app design.

Over the last month, Team SAVE has conducted interviews with patients who have participated in or are currently participating in clinical trials. In each interview, we asked the patient about their experiences, opinions, and suggestions. While conducting these interviews, we noticed a common thread among what many of the patients said; in almost every interview that we have conducted thus far, the interviewee has said something along the lines of:

          “I am only alive today because of pure chance and luck”

In most of the situations, the interviewee had been in a late stage of cancer, and by chance had stumbled upon a clinical trial that miraculously reversed their condition. In one case it was a faint suggestion online that had caused them to seek out the trial. In another it was a lucky reference from a doctor who recommended another doctor who just so happened to be studying the exact mutation of the patient. In these cases, the patient somehow managed to find a suitable trial, when the odds of finding one were close to none.

Luck should be erased from the equation of clinical trials. In other words, the recommendation that the doctor gave to visit a specialist for some disorder or the advice given on a website should not happen by chance. In an ideal setting, the right information about trials should always naturally travel to the patient. To remedy this situation, we have been designing the role of a clinical trials navigator, who will consistently provide education about trials, help patients obtain trials information. The navigator will be the person that the patient sees soon after diagnosis, and during the meeting with the navigator, the patient will be brought up to speed about clinical trials, and relevant trials will be suggested by the navigator. We hope that this will remove the chance required for patients with specific mutations who need cutting edge medicine.

Although most of the interviewees shared a similar story, some did not. One, in particular, had a completely opposite story. After being diagnosed with cancer, they immediately searched online for a possible mutations, and came to their doctor prepared with clinical trials in mind. It would be ideal if every patient acted like this, but unfortunately not every patient is so equipped. Going forth we are looking to design our solution in a way that engages not just the patients who would seek out help by themselves, but those who would not seek out aid, and are really the ones who need help the most.

Image Source: http://farm8.staticflickr.com/7221/7175331883_80d3ebae45_b.jpg