Bull Session

Challenges in Designing for the Patient Experience

January 22, 2015          

Episode Summary

Health is one of just a few universal human needs: From the moment we’re born to the moment we die, our health is at the forefront of our lives. Despite this inherent importance, American healthcare remains woefully out of balance.

We spend too much and get too little for our hard-earned dollars. According to a recent Medicare report, healthcare spending is projected to grow 1.1% faster than the rest of the economy during 2013- 2023, with its share of the GDP rising from 17.2% in 2012 to 19.3% in 2023. What else should we expect from a system that first prioritizes the administrative and business aspects, then clinical care, with the patient experience and patient / provider relationship placing a distant third?

The key to re-balancing the US healthcare delivery system and making progress toward reducing future costs, may lie in better understanding not its administration or even clinical care — while these both are important — but rather, the day-to-day needs of its patients. In this episode of The Digital Life, we dig into some of the challenges in designing for the patient experience.

Welcome to Episode 86 of The Digital Life, a show about our adventures in the world of design and technology. I’m your host, Jon Follett. With me is founder and co-host, Dirk Knemeyer.

Hi, Jon. What adventures are we going to be talking about this week?

I thought we would dig into an almost universal adventure for people which is the design of the patient experience, right? The reason I say that it’s universal and that … It’s probably not completely so, but from the moment that we’re born into this world and to the moment we die, at least in some section of the United States, a lot of those major events happen around the healthcare system. Obviously, birth being one of those, and then a lot of people go to the hospital in their final moments as well.

We got this all-encompassing or potentially all-encompassing universal experience that has so many different notes, and it’s proving to really be a challenge to design for, and we’ve got this at the forefront of our national discussion right now. For today, we’re going to start digging in just a tiny, tiny bit into what it means to be designing for the patient experience. I’m certain we will be revisiting this topic throughout the year and uncovering hopefully some more insight into it.

Yeah, it’s interesting. It’s complicated. The patient experience resides inside the rat’s nest that is the health industry, and the health industry is the yoke, duly yoked by the national government which is a bureaucratic fiasco, and the big insurance industry which is a blood-sucking soulless leach on the whole deal. Solving for this stuff is really tricky because of these huge monolithic actors that inherently, their motivations are contrary to the patient experience; and that doesn’t even get into the fact that the complexity around what really is best and appropriate for an optimal patient experience isn’t just in of itself an easy thing to solve in the theoretical without those huge barriers ever achieving. It’s tough, Jon.

Yeah. I think you put your finger on an excellent point which is the healthcare experience is really made up of both the clinical experience, so the quality of that experience, right? Which includes both … As you’re going through the clinic, how that’s happening, and then, of course, the outcomes which you … You’re hopeful that whatever you’ve been going to the hospital for gets solved. Then, over top of that, you were talking really about this administrative layer which includes both the government which access the insurer in some cases, and then the private insurance companies who are really attempting to track, and monitor, and ultimately, provide compensation for these services.

One of the big difficulties that any design initiative faces is trying to marry these pieces together when ultimately, the person, the trail for getting paid and for administering these services ultimately doesn’t really fall in with the group that you’re interacting with directly. Because everything is separated out, that makes it even more challenging. To make this even more complicated, I think there’s a third factor which I’ll call, considering the ecosystem of design when you’re designing for the patient experience.

Not only do you have to take into account the administrative and the clinical, but then there’s all of the elements that either are technological, data-driven, or behavioral that also contribute to the patient experience. You’ve got at least three major factors that can be variant and difficult to design for at any given time if you’re looking at something as holistic as this.

Yeah. When you’re talking about the self, you’re talking about all of the aspects that make up who and what we are. Something that is done in a limited or narrow way to optimize the patient experience could inadvertently be detrimental to the health and the welfare of the patient. Take something as simple as lights, so the directness of lights, or the brightness of lights, or the tint and hue of lights.

Those can have superficial benefits to how we see and how we perceive the things around us, but they can have complex benefits to how our body reacts based on maladies that we might have, based on our skin like there’s … And with N being a large number, different factors there, so it’s easy. It’s trivial in trying to optimize the patient experience to do something that is positive in one vector and is completely undermining the patient in ways that are discernable or not in others. It’s tough stuff, baby.

Yeah. We’ve taken this broad view at the massive system that we’re attempting to describe here. Now, let’s drill down a little bit because I think for us as guys who are software designers, there’s an aspect to this where there can be some positive momentum with the patient experience and address all of those factors that we’re talking about at least in a tiny bit, and that’s … I’ll call it the promise of understanding our patient metrics a little bit better. I want to touch on that a little bit because at Involution, we’ve spent a number of years working on a way of displaying the healthcare metrics for our patient in one picture.

That’s an open-source project called “hGraph” which has been rolled out at a number of national Fortune 500 companies. What that graphic does is enable patients to view all of their health … Their current health metrics in one view, and then also zoom in deeper to get the details. That view is meant to be shared with the clinician, with the doctor, so that you can have this ongoing discussion about the status of your health at any given moment. For my perspective, the hGraph solution is forward-thinking, and so far as it … It tries to tie together these elements from the patient side, from the clinician side, and also from the data side which is really being driven by our federal government in getting all of the practices up and running on EHRs.

Suddenly, you have this data that can be revealed to the patient. Hopefully, hGraph and other pieces of software like it can draw all of those desperate pieces together and begin to improve at least nominally, the way people are experiencing healthcare.

Yeah. HGraph is a powerful thing, but it rubs up on some potential issues itself. The example that I’m going to use, I talked about 23andMe on the show recently. In my getting my 23andMe results, I found them very interesting; but other people, either who I’ve purchased 23andMe access for or just who have done it and I’ve talked to about after the fact were really psychologically shut down by having access to some of that data. Whereas I thought it was interesting to see, “Okay. I’m more likely to die from these things. I’m less likely to die from those things.”

For some other folks who got that data, it was psychologically … I don’t want to overstate it. It was psychologically unnerving, let’s put it as a minimum, to learn those things. Either some questions about what is the impact of having visibility, and access, and in-your-face health data of different types, and then taking that even further related to the psychology of the person. One of the things that from health perspective we know so little about still is the inner workings of personality, and psychology, and really things around the self.

I think with something like 23andMe explicitly, but potentially, it was something like with hGraph, there are data that could exposed in blatant willful ways that are going to be to the detriment of certain personality types and types of people getting access to it. This just all goes to the complexity of designing for the patient experience because it’s so naughty.

Yeah. That was well-put, Dirk. I think part of that also reveals what is needed to design for the patient experience, and this is something we talked about quite often on the show and as part of our studio; but there’s this idea of a space being so broad and deep that you really need a team of experts, not just a single designer, but a cross-pollinated team that can really introduce into a solution set things from different types of design practice, engineering practice, a sociological psychology architecture, administration, policy making.
All of these disciplines have something to bring to bear on design for the patient experience. I think we are seeing more and more as we design for complex systems that it really does become about this cross-pollinated team. Moving forward, I see a lot of design for complex systems happening in this way.

Yeah, for sure. There’s no question about it.

I think as we start considering design for the patient experience, there’s … Not to make this even broader still, but to tie it into some of the other things that we’ve discussed on the show, this data which can be so intimidating is only growing even faster that we might like. Whether it’s the data that’s resident in EHRs, at hospitals and doctors’ offices, or data of that, our activities that we’re getting from these lovely wearables that we all seem to be wearing these days to even data that might be general population health data or, as you pointed out, genomic data that is newly introduced into the total healthcare experience.

There’s this additional thread of information overload that I think is also a factor as you’re talking about how people are able to process their healthcare experience. I think you really touched on that a bit with your 23andMe anecdote.

Yeah. The bottom-line I guess and I jumped right away that the big boulder is to all of the unknowns to insurance and the government, and oh my god, like these things just make it impossible. The bottom line is just it’s really hard; and we have to go in knowing that we could be making decisions with the best of intentions, but don’t have the best outcomes. Like when coal power was discovered 200-ish years ago at the … Or it could’ve been more. It could’ve been less. I don’t know, but whenever that was discovered, it was, “Wow, look at all those things this lets us do full speed ahead.” It’s only now hundreds of years later that we’re dealing with climate change and all of these big issues that are really bad in reality.
In designing for the patient experience, there’s a lot of those moments of unintended consequence where we can do things with the best of intentions with all of the knowledge that we have to date that as we gained more knowledge and better understanding the nooks and crannies of humanity that those turn out to be negative decisions. Hopefully, not so bad as catastrophic, but it’s just part and parcel with how complex the system is, with how complex we humans are, and it’s a really difficult problem space to get into.

Listeners, remember that while you’re listening to the show, you can follow along with the things that we’re mentioning here in real time. Just head over to TheDigitaLife.com. That’s just one “L” on “TheDigitaLife”, and go to the page for this episode. We’ve included links to pretty much everything mentioned by everybody, so it’s a rich information resource to take advantage of while you’re listening or afterward if you’re trying to remember something that you liked.

If you want to follow us outside of the show, you can follow me on Twitter, @jonfollett. That’s J-O-N-F-O-L-L-E-T-T. Of course, the whole show is brought to you by Involution Studios which you can check out at GoInvo.com. That’s G-O-I-N-V-O-.com. Dirk?

You can follow me on Twitter, @dknemeyer. That’s @-D-K-N-E-M-E-Y-E-R, or email me, dirk@goinvo.com.

That’s it for Episode 86 of The Digital Life. For Dirk Knemeyer, I’m Jon Follett, and we’ll see you next time.

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