5 Questions

Design is Medicine

September 16, 2013          

Episode Summary

Healthcare is deadly. As patients and clinicians, we have long passed the threshold of comprehension when it comes to the amount of data and variables that support life-critical decisions. The system needs to be redesigned and re-imagined. True change comes from establishing a vision for healthcare that will modernize how doctors and patients interact with their health data to quantified and measurable medicine.

In this episode of The Digital Life, we discuss the idea that “Design is Medicine,” with Involution Studios Creative Director, Juhan Sonin. In his health design practice, Sonin explores how linear-thinking human beings can interpret non-linear, unbalanced health metrics, and how healthcare can be saved through coordination, presentation and design.

Join us as we look at the design, data, and policy challenges, as well as the scary new ideas being invented to solve them, that makes tackling the healthcare problem daunting and exciting.

Hi. I’m Dirk and this is the Human Factor. This week we’re talking about design is medicine. I think medicine, or more specifically or I guess more generally, health, is really the most interesting space for design I think in general, but specifically for information design today. The reason is sort of multifold.

Part of it is the fact that our health is, I think at the end of the day the single most important thing for any of us, so the potential impact and stakes of dealing in health are significantly high. Second is the issue of complexity. Everything that goes into being really healthy is A, complicated in individual nodes, but B, hyper complex in the context of looking at it all as a system. There are so many vectors.

Just being very superficial about it and not covering most of them, simply thinking about sleep, exercise, diet, mood, schedule, just those few things, each of them, the correct way to live a healthy life is relatively complicated for most of those, sort of at the true level, not at the level of here’s advice like eat more vegetables. That’s kind of always good but not getting at the real nugget of what’s happening any why and, frankly, that that is incomplete advice.

Furthermore, the fact that, ultimately, it’s highly customized what one person needs to be healthier as compared to another is dramatically different. It can range from reasons that we certainly don’t even think of now, from I’m Scandinavian and so historically we’re used to less sunlight and we’re used to a different pace of living, as opposed to someone who is in Africa, for example. That over many generations has an impact.

Today, on the rhythms of our life and as we disperse around the globe and do very different things in very different places, we are not necessarily in harmony with the self that is sort of at its genetic essence, having come down from generations before. The point being is that the complexity is enormous just with specific items. Then if you get into how they all fit together, forget about it. It’s pretty ridiculous.

All of this, sort of upping the ante, is the access to data that we have now, that is essentially unprecedented. It’s so easy to get things like your genetic information, get things like your exercise each day, your sleep, and not just how long you sleep but the quality of your sleep and more information on what that looks like. At the Six Sigma, at the bleeding edge level, it’s actually shocking and somewhat delightful the amount of data that we can get about ourselves.

From a design perspective, and really especially, I think, this issue of health impacts all of the design disciplines. There’s wonderful, deep stuff to do just across the design continuum, but especially from an information design perspective. Information design is very near and dear to my heart. I spent a couple of years in my career focused primarily on it.

This space is ripe for it and it gets back to the volume of data and the volume of factors and then the complexity of their interrelationship. At the end of the day, at some point in the next ‘n’ years, we need to have a way for someone to go to one place and understand the interrelationships of the decisions that they make. I can relate it to some of the things that I talked about before, whether it be what we’re eating, how much we’re moving, how we’ve scheduled the rhythm and pace of ourselves, our sleep, the whole nine yards. That needs to be condensed into one space that’s not data, but is insight. It’s insight based on all of these different factors interlocked and interworking with each other and, to a large degree, highly customizable.

What we should be able to get to, given modern scientific knowledge about our health, given access to data that we can capture, and then given the ubiquity of computing devices giving us screens that can push interfaces at us that are essentially built from that data and the knowledge behind it, it’s life changing. It’s somewhere that we have to get.

The hardest part of it is the complexity. It is all of this interrelated stuff. If you go into all of the different things that make up our health, when you break them down into categories and subcategories, there’s dozens of them. Nobody to my knowledge has pulled them all together and understands how … let’s pretend that there’s 130 of them … how what’s happening with number one affects number 53. Yet the component parts are all kind of out there.

On the research and science side, they’re moving toward better understanding those things, but on the design side, we need to be very fast following, taking that knowledge, taking that insight, and translating it into actionable, useful interfaces. Right now, we’re largely in a generation of data presentation, where we can get pushed at us how many steps that we took in a day, for example.

While you can pretty quickly understand that 5,000 steps is probably the minimum we should be taking a day if we want to be healthy, 10,000 is more generally, there’s not much meat there. Questions like if I do 1,000 today but 7,000 the next four days, what’s the impact of that? Or, for me, I’m 6’4”, 260, someone else is 5’2”, 120, how does that impact the activity? We’re not there yet. We’re still in sort of very stupid data presentation solutions.

There’s just an ocean of things for designers to work on in the space of health, and especially for the information designers, because there’s so much information that needs to be organized and brought together and working nicely in a system. The impact of the work that we can do here is really powerful. It’s powerful, important, life changing. It’s really good stuff.

For those of you haven’t had the opportunity to design in health, and particularly design on some of these more bleeding edge things, it’s really easy, at this point, to just do it yourself, to get some data feeds for yourself and start to come up with solutions. It’s something that is really enlightening, is really challenging.

Also, increasingly as we go forward and the scientific knowledge continues to get deeper and more interwoven, the employment opportunities are nearly endless. It’s a great space to be in just from a personal and professional perspective. I’m, as you can tell, I’m really bullish on design and health and would certainly encourage you to try and get involved in it as well.

This is Five Questions. I’m Erik Dahl, and today I’m joined with Juhan Sonin, the Creator Director at Involution Studios Boston. Welcome back, Juhan.

Thank you for having me again.

Today, we’re going to be talking about technology and design and healthcare, and why don’t we jump right into it? I think the first question we want to start with is, what are the converging technologies and societal trends today that are bringing design to the forefront of health?

Let’s set the stage a little bit. Humans have treated their condition the same for millennia. We roam around, we eat mostly green stuff, we drink water. We screw and procreate. You know this routine, and as long as we’re feeling okay, we think we’re okay, and generally, that’s true. Then health happens usually whether we like it or not, and when we least expect it, and in the past, you visited your tribal elder who set broken bones before. You seek out the town doctor to diagnose and treat malaria or now, you go and get an MRI to reveal … like for me, I had a bicep tendon rupture after catching Udo flying off my living room couch. These are episodic issues, periodic exams, and an understanding of rare spikes in your health that require extreme intervention.

It’s amazing what’s transpired over the past century, over the past 40 years since I’ve been alive, or the past five even from barely being able to treat burn victims to spray painting on new skin based on your skin cells and being released days after major trauma. That’s amazing, so this technology and understanding of biology and the sciences is mind numbing in a really amazing way. Yet we’re still stuck in this land of episodic treatment and thinking, and humans, really, we don’t want to think about health, just as it was a millennia ago.

Let’s do a quickie thought experiment here. Suppose your data is just collected. All of your data surrounding your existence, from financial data, which is already happening today, to travel, to habits, to eating, to exercise, to examining your daily changes in your biome, all that is captured. It happens, and then you can see your data, see the trends, see your friends and family’s data to help them on their health journeys and life journeys. It’s at your fingertip.

Now, this is a stark contrast to what happens now in the design of your life, of your data and of your health, because it requires a ton of overhead to collect all this data. People have a hard enough time putting on their underpants and figuring out what refinancing a mortgage is. I’m being slightly over the top here, but we as a species are linear thinkers, and we ain’t so good at this multi-dimensional decision-making space and seeing every variable and doing the mental calculus to orchestrate our behavior to make fabulous decisions. That just doesn’t happen often. We fly by the seat of our frigging pants.

Couple that idea of barely being able to put on our underpants with the current massive proliferation of smart sensors. That industry is blowing up. There’s sensors everywhere. It’s like the DARPA line from a couple decades ago is actually now becoming true where smart dust is all around us. This is really the invasion of non-invasive diagnostics and surveillance. That’s like the converging tech and social trends that are now going to help bring health to another plateau.

If that’s the future, right, this idea of passive surveillance, non-invasive surveillance, and that’s what’s happening. There’s obviously pros and cons to that, but from a health angle, why should we care about this?

Look, right here in the design studio, I can easily count about a half dozen different wearable devices all the staff are wearing. From a Basis watch to the Fitbit bracelet to the BodyMedia band that I wear to the job on up, to the Phillips pedometer, whatever it is, there’s a ton of health devices in the studio. Even the AliveCor ECG iPhone case, to the digital scales to all the stuff. We’re surrounded by sensors. Now the problem with the current batch of wearables is just that, they’re wearable and require a metric ton of overhead to deal with. Let’s take the Withings Pulse, for example. Are you familiar with that little cute device? It tracks steps, general activity, sleep, heart rate on command. It’s really pretty amazing. It’s got this touch screen for swiping. It’s really quite beautiful, teeny form factor. Decent contrast on the screen, especially compared with my mediocre basis watch, but my biggest beef with all these micro wearables is that … drum roll … you’re not wearing it 24/7. Sticking it into your pocket is relatively easy, but it requires a pocket. Maybe I’m at home and I’m often pantless. Maybe that’s TMI for our audience, but I don’t wear it at night, and they’re always is switches to turn it on to nighttime mode, and it’s a lot of overhead.

Even my BodyMedia armband is not “Set it and forget it.” I’ve got it off for showering and charging and stuff. Even these new devices like the Shine, which was recently funded on Kickstarter, stuff from all the same sort of non-forgettibles syndrome. Form factor isn’t really the question because no form factor really hits in the head. Maybe it’s the implant or the invisible. That’s where we really need to go.

Now, there’s the flip side to this is from a wellness point of view is that, “Do off times really matter of your device?” Maybe this little health plug straps on when sickness is coming in, when you’re about to feel it and then reduces the symptoms and duration by 50-70%. Now, that’s a helpful device, but we’re not there yet.

I think that’s interesting. I think that’s been my same experience, with having the end user, requiring them to have all of this overhead, this management of infrastructure of this stuff that really gets in the way, and there’s another thing, and I don’t know if we have time to touch on it today, but just to bring it up, is I’ve talked to people, and they say, “I have all this data now, but my doctor won’t even look at it, and they don’t care about it, and they don’t even want to see it and consider it in their decision making and how they’re evaluating my health.” Maybe that means that those people need to find other doctors, but I think there’s that end of the feedback loop as well that is not just about collecting this data whether we can get it completely passive or not, but there’s that extra part in there around the healthcare provider and how they’re getting access to that data and what they’re doing with it, and do they even care about it.

Yeah, rock on. There was has to be one, the data itself and the quality and the fidelity that has to be clinically relevant. If it isn’t, it’s not good for you, the patient or for the clinic or hospital or nurses or whoever’s looking at it to have trust in it. I think you’re putting your finger on a really important variable that still needs to be conquered.

Given all of that, what do you see as the next challenges for designers and engineers in this healthcare space?

We’re going to design products to capture data beautifully. That’s a key thing here, and that usually is going to mean invisibly. I walk around my house. I stand on my desk at work. I go pee. All of that physiological data is snagged, and so that we can do massive DSP analysis on whether I’m getting worse or better based on a particular time line, and then also based on prior results, whether they’re mine or whether they’re a bigger population data as well. This is where I think machine learning and big data and design are going to crash together.

There’s still a ton of pain and mistakes in healthcare. If you look at just patient safety alone, there are almost a quarter million deaths by accident per year, and there are a ton of classic examples like anesthetics during surgery and allergies, and you can look on line to look at, “How do you improve patient safety and quality?”…and I think another aspect of this is that pharmacies now are being treated like drive-through fast food joints.

Ultimately, when you get home with that prescription, your hospital really should be this bathroom at home. That’s where I think more and more interesting stuff is going to happen is shouldn’t it tell you, just automatically, you walk into your bathroom, you put your prescription down on the shelf there. Shouldn’t that bathroom tell you, “Hey, your dosage is fubared.” Consider what that room is going to collect sooner rather than later. Hair follicles down the shower drain. You’re going to go pee, and you’re going to get GI and urinalysis from the toilet. Your biome sloughs off all the time, but the sink is going to capture it. You’re going to get weight and blood flow and facial expressions are all going to taken auto-magically, and this for designers and engineers is the key thing. It’s just going to happen.

You mentioned the overhead in terms of worrying about wearing something and then looking at the data and making a decision. I think there’s going to be no physical or mental overhead here. The bathroom’s going to become your health room, and all this data is going to be presented to you in such a way where you don’t have to think about it as much. It’s just, “Here’s what’s happening to you, and here’s what you do about it.” The majority of all your physiological signs are going to be snagged non-invasively. These sensors are going to passively sniff you. There’s no blood draws. It’s just whiffs and sniffs, and I think this is a key place for designers to become involved because all this has to be designed to feel wonderful, because I don’t want to think about health and security. I want to think about life, and I know that sounds cheesy and scary, but let’s focus on your dreams and living versus healthcare. God, that sucks.

It’s about invisible detection, and when it happens to be visible, and we have to engage with it, it has to be beautiful to engage with it, and that’s when I think about Woody Allen’s “Sleeper.” I keep using this example because I love it, but in this movie, you walk into the Orgasmatron. You have a blast for five seconds, and you walk out, and boom. Done. Sign me up for designing that thing.

Yeah. I think that’s right. Everything I hear you talk about is right. Reducing this overhead and then in the corollary to that, a reduction of overhead is then this increasing of feedback loops, so we’re not just reducing the overhead of this data collection, and the data’s not just going somewhere into the ether. It’s actually creating these well-designed feedback loops so that we can just live our lives without that extra cognitive load or having to process all of this information and make sense of it. I definitely see that as where things are going.

If we take this then to the logical conclusion, which I think is something that we’ve talked about before offline, is what will it take to get us from where we are now through the near future that you’ve talked about to the point where we’re at zero stage detection?

We’re getting biome analysis, emotional analysis, breath evaluation, voice analysis, so when you talk in your phone for four hours a day, it automatically listens to your voice and sees, “Is there anything wrong with it?” There are bots in our stomach, in our bloodstreams, churning through our bodies and gathering intel and more. We are able to see disease and conditions erupt at the cellular level. That’s where it’s going to go, Erik. Not when they actually physically manifest themselves so that our eyes, our bodies can see them. By that time, it’s freaking way too late. If health is beautifully integrated into our daily lives so that we’re getting this continuous assessment or feedback loops, which I like that, how you described it very succinctly and how we adjust those in near real-time, that’s like Step One.

Now when our digital health guards for lack of a better term, these digital services that pound on those massive data sets and prior patterns in our lives, these things are going to get us to keep us healthier and identify trends and reduce our sickness rates exponentially, and that’s really the Step Two. The other variables, some of which you’ve mentioned, Erik, like how patients get reimbursed or if this becomes something outside traditional insurance, and how to make sure these top 1000 or 100 health signals are clinically relevant and taken seriously by clinicians, are all part of this really big fuster cluck of hell and healthcare, but something that is ripe for beautiful design and beautiful engineering, and that’s where I think we should be playing a lot more.

Yeah. I think that’s interesting. You’re touching on these ideas that design is moving well beyond the idea of a hardware or product, these wearables that we talked about at the beginning of the conversation, to the concept of designing systems and policies and all of that political and policy infrastructure needs to change before we can see this sort of future manifest. I think there’s some other misconceptions, that this movement in healthcare and designing and all this stuff isn’t so that we can live forever, but it’s so that while we’re here, we can live better lives, and I think ultimately, that’s where all this is going. It’s exciting to think about all of the possibilities where designers and technologists and engineers can inject themselves into this space of healthcare, and I think it goes well beyond a lot of the typical conversations about, “How do we create these sort of healthcare products and things that seem to be pervasive in the media today?”

Yeah. I agree. This idea where designers and engineers can become involved at multiple levels of the discussion from at the protein level to the pixel level to the policy level. I think that is a key point you bring up. Love it.

Cool. Thanks for joining us, Juhan. I appreciate the conversation today, and we’ll see you next time.

Oh, yeah.

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