Design | Medical Futures Lab

Feb 28 2014

Communication, Design, e-patient, Electronic Medical Record, Health, Prototyping, Technology

Ping. Have It Your Way.

Ping. That must be my daily reminder. How am I feeling now in terms of arousal and valence? Well, I just had my weekly meeting with my research advisor. He was really getting into the nitty-gritty and suggested that I should have been farther along with my project. I don’t even like this project. I wish I could just get it over with… Anyway, probably low valence. It was a pretty negative experience. Also high arousal… He really stresses me out, and I could feel my blood pressure rising.

Photo Credit: mzstatic.com

One of the greatest benefits of mood tracking is increased self-awareness. Mood tracking apps like Moodscope and Mobile Therapy remind users to take a step back and to reevaluate their life choices. They can reflect on what is bringing them happiness and what is bringing them down. By connecting their moods with other factors happening in their lives, users can develop a greater understanding of themselves with respect to their environment.

The beauty of mood trackers is that they also provide spatial and temporal information. Users can link their moods to their immediate spatial surroundings and to the time of recording. By randomly sending pings throughout the week, these apps can help users determine where and when they tend to feel upset or happy.

Additionally, mood trackers do not only take in information, they can also offer advice. Mobile Therapy offers therapeutic exercises, including breathing visualization and muscle relaxation. It also offers strategies to quit smoking, treat anxiety, and detect relapses in psychotic disorders. Ideally, these mood tracking apps could personalize therapeutic exercises to a user’s specific input. You could “have it your way” by inputting end goals, such as cultivating happiness or controlling the relaxation response.

Photo Credit: play.google.com

With most mood trackers, it is also possible to add information through texting—users can share paragraphs of information if they feel inclined to do so. Therapists and physicians could use these self-reflections to see how their patients are doing over time. Appointments with health professionals are short, and they are not necessarily indicative of how the patient normally acts. Some patients may experience white coat syndrome, so there is an additional benefit of having records of patients outside of the doctor’s office.

In the future, perhaps these apps could notify the patient’s physician directly. Jon Cousins describes the benefits of connecting his data to those close to him: “We leave traces of ourselves with our numbers, like insects putting down a trail of pheromones, and in times of crisis, these signals can lead us to others who share our concerns and care enough to help.”

If physicians have access to their patients’ personal information, they can individualize their treatments. While there would be a lot of information to handle, this issue could be alleviated with efficient organization and clean programming. It is possible to automatically assemble the relevant information in a visually aesthetic way, and these apps track not only the physical health of users, but also their mental and psychosocial health.

Feb 28 2014

Art, Culture, Design, Humanities, Medicine

The Art of Medicine

Is medicine a science or an art?

Physicians and artists alike have tried to answer this question for over two thousand years. The former tend to claim that medicine is predominantly a science, and that it is an art only because it involves skills acquired by experience or observation. The latter commonly say that medicine is predominantly an art, for it evolves on the basis of human values and seeks to heal above all else.

So which is it?

It’s not a science. It’s not an art. It’s both.

Effective medicine employs science to accurately diagnose and treat, but it also utilizes art to arrange our awareness of health and healing into a storied structure. This “narrative medicine,” as it’s often called, takes a medical story and unfolds it in a way that gives meaning and purpose to both illness and the experience of recovery.

Narrative medicine, however, is not the only art form to have influenced medical storytelling. Throughout history, each introduction of digitalized technology into medicine—take the X-ray, the CT scan, and the ultrasound, for example—has utilized illustrative visualization to enhance medical accuracy.

Analogous to illustrative visualization, recent development in graphics hardware has enabled the rendering of innovative medical imaging methods that are completely changing the way that we see and study the human body. These new techniques enable both photo-realism and a technical form of hyperrealism in art in which it’s possible to enhance medical visualizations to better convey information.

But medical illustration and anatomical imaging are beginning to break out of the confines of the hospital. They are beginning to crawl into the dirty gutters and cracked sidewalks of the real world in the form of something known as street anatomy.

damien_hirst_virgin_mother

(photos courtesy of http://streetanatomy.com/2007/02/15/damien-hirst-anatomical-representation/ and http://vi.sualize.us/praying_street_skeleton_graffiti_street_anatomy_picture_5Qqm.html)

Street anatomists are experimenting with new mediums, such as papier mâché, graffiti, and sculpture, to portray the human body in creative new ways. Thanks to this new form of biomedical visualization, human anatomy is no longer contained within the human body. Science no longer lives in a hospital. Take a look around and you’re bound to notice your skeletal system plastered to a telephone pole or your back muscles adhered to the side of a Metro bus. You may even discover that your heart has been spray-painted on the side of your apartment complex.

I went ahead and gave street anatomy a whirl, too. Here’s what I ended up painting:

While painting these on the concrete floor of my dorm room, I was silenced by the realization of how truly incredible the human body is.

It is a wonder of science. It is a work of art.

Feb 27 2014

Design

Technology is only one piece of the puzzle

I come from a computer science background.

Thus, I have grown accustomed to immediately think of a technical solution when I am presented with a problem:

http://doreenrainey.com/wp-content/uploads/2012/01/TheresAnAppForThatHeader.jpg

For obtaining driving directions, I think of Google maps.
For spreading awareness of a cause or an event, I think of social media websites like Facebook, Twitter, and Youtube.
For improving the organization and workflows of hospitals, I think of electronic health records.
For banking, I think of Chase’s online platform.
For improving education, I think of Khan Academy.

In the last month and a half, however, my tendency to naturally think of technology has been disadvantageous.

When our team was confronted with the initial problem of increasing clinical trial enrollment, we gravitated towards technical solutions. Some of out initial solutions were an online game, a Yelp/eHarmony-like website, and an online clinical trials matching system with human navigators. When I was thinking of these ideas, I was operating under the assumption that clinical trial enrollment is low because the solutions we thought of don’t exist. This was partially because our project was in its preliminary stages, but it was mostly due to my orientation towards technology.

After performing more research, we found discovered that there is a wealth of technologies and platforms that exist online. Websites like Emerging Med and The American Cancer Society’s Clinical Trials Matching Service are just a few examples of the many existing implementations of the ideas that we came up with.

http://cdn.cultofandroid.com/wp-content/uploads/2012/04/shock.jpg

I was in shock. Some implementations of our ideas had already been around for over a decade. If our solutions had already been implemented, then why is the clinical trial enrollment rate still so low? My scope of thinking began to expand. As it expanded, I began to see the importance of a holistic and interdisciplinary approach to problem solving. Although it is useful that I have the knowledge and skills to create a website or make an app, it is not the most important thing; technology is only a small piece in the puzzle that is improving clinical trial enrollment.

After this realization, our team has been approaching the problem from a greater diversity of perspectives. Lately our team has been viewing the problem from a marketing and public health standpoint. Rather than focusing on providing help online, it may be valuable to focus on connecting people to existing online resources. By expanding our focus, we hope to come up with an effective solution.

Feb 18 2014

Communication, Design, Health, Technology

The Plight of the Primary-Care Physician

Type in “reasons for shortage of primary-care physicians” into Google and you will be led to almost 3 million responses. Most of these articles list the same few reasons including:

The lack of financial stability involved in going into primary-care medicine
A shortage of primary-care residency positions
The current state of primary-care, where physicians see too many patients per day while navigating through the convoluted web of medical insurance

Photo Credit: www.dreamstime.com

Now type in “how to solve the primary-care physician shortage” into Google. Again, you will be bombarded with millions of articles, many of which discuss trying to utilize the power of other health professionals some of which include nurses, physician assistants, pharmacists, dietitians, and psychologists. While this seems like a viable solution, the most obvious impediment is communication between these different health providers. Currently, the primary-care physician serves as a reference point between their patients and a sea of other healthcare providers. This only reinforces the current problem with primary-care, where physicians are reaching a cognitive overload. So what can be done to solve this problem? Or more specifically:

Can advances in technology help a primary-care physician maximize their limited time?

Photo Credit: www.hcplive.com

The limited time between a physician and patient is one of the greatest problems in managing complex health problems. One potential solution, mobile applications, allow a physician to be kept up to date on a patient’s progress. Currently, applications allow patients to track various health parameters associated with their chronic condition, and send a report of these results to their doctor. However, the information sent their doctor is often in an unorganized format and is highly variable in form due to the large volume of mobile applications available on the market. In order for this solution to be effective in maximizing the physician’s time, the information must be conveyed in a standard format, and must be available to the physician prior to the appointment.

The other communication problem that drains the time and energy of primary-care physicians is trying to coordinate care with other health providers. Many primary-care physicians still coordinate care over the phone, which can be extremely time-consuming. We need to find ways to streamline communication among different providers. This could include a redesign of electronic health records to better facilitate between physician communication, or an app which not only links a patient to their different providers, but the different providers to each other.

While these changes alone will not solve the primary-care physician shortage we will face in the coming years, they will allow a primary care physician to maximize their time with a patient during a 20-minute appointment. This will lead to better health outcomes, which is the ultimate goal of medicine.

Feb 17 2014

Design

Where are the study results?

If you were asked to name at least one specific clinical trial and what the basic outcome of the trial was, would you be able to answer?

I considered this question for a few minutes, and the most relevant thing I could retrieve from my memory was a scene from the 1990 Robert De Niro and Robin Williams movie Awakenings, in which Robin Williams performs trials on a group of long-term catatonic patients in an attempt to “awaken” them from their states. The result of the experiments is that the patients are freed briefly from their catatonic states, and although they eventually relapse, the protagonist’s life is meaningfully changed. Though it is a dramatic story from the realm of entertainment, it is a good example of a positive portrayal of clinical trials.

(http://moviereviewwarehouse.files.wordpress.com/2012/01/awakenings1.jpg)

This one example, however, is the only instance I could produce.

I suspect the result for the average American is probably similar. One could argue that the question is not practical and that it is akin to asking someone to recall the abstract of an article from a scientific journal, but how can someone volunteer themselves for something that they cannot link positive outcomes towards? Many actually have a negative perception of clinical trials. The Center for Infomation & Study on Clinical Research Participation (CISCRP) conducted a survey in 2006 on 900 US adults and found that the public’s perception of clinical trials is that they are for patients that are “very sick without any other options”, or that they are “looking to make money” (http://www.ciscrp.org/professional/facts_pat.html). Furthermore, 34% of Americans said that they “Do Not Admire” people who volunteer for clinical trials.

But why are clinical trials viewed so negatively? Should they not be something that is valorized, much like blood or organ donations are? As clinical trials are a driving force behind innovation in treatment, especially in oncology, it must be that the uncertainty and lack of information about clinical trials is powerful enough to overcome its positive features. A possible solution is to make the results of clinical trials publicly accessible. Over half of the respondents to a survey conducted by CISCRP in 2005 said that “they would have greater trust in clinical research if the results were made available on a public website registry” (http://www.ciscrp.org/professional/facts_pat.html). Since 2005 there have been advances in this area, such as the release of results by ClinicalTrials.gov, but there is still an abysmally low rate of 2-7% accrual for adult cancer patients (Thompson, Social Media in Clinical Trials).

In order to explore the state of clinical trial visibility online, I decided to check ClinicalTrials.gov. Searching “testicular cancer texas”, I looked for studies marked as “Completed”, and found that it is not easy to see clear, positive results from the trials. In fact, for all of the completed studies in my search results, none of them had published results. In addition, I imagine that the descriptions of the studies would not be easily processed by the average person because they use much scientific, medical, and other technical language. Although precise language is a prerequisite for scientific research, could there not be a way to make this information easier to digest for a casual visitor? If such a source existed, then maybe the question posed at the beginning would have been easier to answer.

(http://clinicaltrials.gov/ct2/show/results/NCT00109993)

Medical Futures Lab

Category Archives: Design

Ping. Have It Your Way.

The Art of Medicine

Technology is only one piece of the puzzle

The Plight of the Primary-Care Physician

Where are the study results?

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