Doximity for Patients: A secure environment for patient communication

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?

Taking Heart Transplants to the Next Level…But Should We?

This is so crazy how relevant this is to our project, but I saw this news story shared on my Facebook newsfeed: Link here because I can’t embed the video for some reason.

While we’re working on telling the story of artificial hearts in the Texas Medical Center, at the same time researchers in the Texas Heart Institute right here in Houston are taking heart transplants to the next level. Bypassing even a total artificial heart transplant, they are now using stem cells to manipulate pigs’ hearts into hearts that can work in humans. In the video, you can see so far they have successfully been able to transforms the cells the pig’s heart into a mold of a human heart and the next step is to insert cells inside the heart so that it will properly perform the pumping functions. It was crazy how the reporter was able to hold this modified heart (still white from being grown by stem cells) and squeeze it like it was a toy.

However, the meat of the piece started when the reporter started questioning Dr. Doris Taylor, the head researcher, on the ethical implications of conducting this stem cell research. I was surprised at how quickly Dr. Taylor defended her work, probably because this was a commonly asked and attacked question. Instead of thinking about the lives that may be lost by using stem cells, she reasoned that because she had the ability and the tools able to save lives, even if those tools were stem cells, it would be “morally wrong not to go forward using those tools”.

I noticed in this video how they utilized emotional (ethos) and moral (pathos) appeal to convince the viewer to support the stem cell research. The beginning of the news piece features a young woman who, suffering from a terminal heart disease, waited and eventually received a traditional heart transplant from a dying man. I was kind of confused at first because I thought the news piece was going to be more of this young woman’s story but instead turned into a news story about stem cell research. However, they brought her back at the end of the piece and asked her if she would support someone getting a heart made out of stem cells, and with tears in her eyes, the patient talked about how lucky she was to get a heart and how if it was possible in any way for others in need to get the same she was all for it. Now, I do have my own opinions about whether it’s morally right to conduct stem cell research and I won’t be sharing it here, but to me it was an obvious storytelling tactic to get viewers to sympathize and support stem cell research.

The concept of ethical conduct in research and treatment has been an ongoing issue for the physician. Dr. Akers faced similar concerns and backlash when he performed testing of artificial hearts on animals and in society today the hot topic is the consequences of using stem cells. I am not a medical student, but I have heard that when a student first enters medical school they must recite the Hippocratic Oath that states they will vow to take care of the patient as best they can and do no harm to them. But for the physician (and the government), is the best way possible a solution that involves stem cells and should stem cell research be considered unfairly taking a life from another to save someone else? Or is it indeed is morally wrong not to use whatever means possible to save a person’s life?

The Power of Storytelling

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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.

 

Principles of Design (abridged)

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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!

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 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.

A Vital Change

Google recently announced a project in which they plan to develop contact lenses that measure a person’s blood glucose level. The project is very much in the early stages of development but it indicates the potential for furthering involvement of technology in healthcare. It is imperative that the healthcare industry supports technological innovations such as this that will improve patient care. Technology must be viewed in the same way as medication in how beneficial it can be to global health.

Google describes the project as a potential game changer for diabetes treatment. The function of the contact lens is to measure glucose levels in tears, thereby making it easier for diabetes patients to determine their blood glucose level. At the moment, a patient must draw his or her blood which can be a difficult and painful process. What ends up happening is that patients fail to regularly check their blood as often as they should and develop further complications as a result. How the data from the lens is made known to the patient is not currently established. Some have suggested a series of blinking lights in the lens that notify the wearer when it is time to take insulin. Another approach is to somehow transmit the data to the user’s smartphone where it is displayed in an application and stored on a secure Google server. In the latter solution it would also be possible to send this stored information to the patient’s physician, providing them with updates on the patient’s progress and insulin usage. A cutting-edge solution to treat diabetes more effectively is vital considering it is one of the fastest growing diseases in the world.

 

In this modern age of technology and rapid development of new and exciting products that better quality of life the healthcare industry must be more open and supportive of innovation in patient care. Not to say that it is currently averse to the prospect but there exists a lot of red tape and inefficiencies that slow progress. The industry must be willing to adapt as quickly as the rest of the economy in order to realize vital improvements that will help patients today. The laggard mentality and outdated ideals prevalent in the healthcare system must adapt to the current culture of innovation and ubiquitous use of high-tech devices. This will ensure projects such as the Google contact lenses become tangible products.

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