At Healthcare Experience Design conference, designers rethink 'broken processes'
At the third annual Healthcare Experience Design conference on Monday, several hundred designers, developers and other creative thinkers put their minds to drawing up better experiences for patients and providers alike.
"We need you to help this industry learn how to do better," Jacob Reider, MD, chief medical officer at the Office of the National Coordinator for Health IT, told the crowd as the day began.
The day wasn't just about clunky, confusing, oftentimes aggravating electronic health record user interfaces – although there are plenty of those. (My wife, a Web designer, joined me at the conference to learn some new ways of thinking about her own profession; when I showed her some EHR screenshots, she recoiled in disbelief.)
Rather, the sessions and keynotes at the HxD conference took a broader view, rethinking the processes and systems involved in healthcare delivery and wellness – from physician workflow to patient engagement to population health.
Sandy Hilfiker and Molly McLeod, from Northampton, Mass.-based CommunicateHealth, which seeks to improve health literacy through user-centered design, showed how, in a nation where nearly half of Americans have limited literacy – and nine out of 10 have limited health literacy – patients must be drafted to serve as "co-creators" in the prototype stage of healthcare websites.
They offered a list of to-dos (and not-to-dos) for content developers: everything from avoiding long words and and dense walls of text, to specifying optimal color contrast and the best font sizes and line heights.
Toward the broader topic of how to drive patient engagement – or, as his session title put it, "How to Design User Habits" – Nir Eyal, a lecturer at Stanford, explained how some websites are "painkillers" (aimed at an obvious need, they serve a quantifiable market) and some are "vitamins" (targeting an emotions, engendering good feelings, they start out aimed at an as-yet unidentifiable crowd of user).
Sites such as Facebook and Twitter started out as so-called vitamins … but soon became indispensable to huge numbers of people, even filling deeper emotional needs than may initially have been anticipated.
The key to developing habit-forming technology, said Eyal, is to understand end-users' "internal triggers" – the emotional drives that motivate them – and develop technology that begins as "vitamin" and then "turns into a painkiller."
That's a lesson that could be learned, for example, by some health and wellness apps. As popular as they are, most are still often underused.
"Most people download health apps and never open them," said Cassie McDaniel, of the Centre for Global eHealth Innovation at Toronto's University Health Network.
McDaniel was a designer first, and only came to healthcare recently. She confessed that it was "kind of shocking for me to see" healthcare's often hidebound approach to visual representation and information architecture.
In her session, "The Embedded Designer: How to Make Designers an Integral Part of Your Team," McDaniel made the case that "design is teachable … it is a learnable skill." She said healthcare has a lot to learn from creative designers – and that the time is right to bring more of them into the fold.
"Designers would like to get into healthcare because they're excited about the challenge," she said. "They want to make a difference.
Whether working on patient-facing apps or physician IT, user-centered design – building upon deep research, prototyping, critical evaluation and a close eye on usage patterns – is essential, said McDaniel.
And just as designers must respect the deep education, knowledge and expertise of clinicians, she added, the opposite should be true: providers can learn a lot from what these right-brain thinkers have to offer.
There's "enormous potential to bring designers in," said McDaniel, adding that the still-small healthcare design culture is something that must be built upon. "We need role models if we want to create a sustainable health design community."
Just as healthcare has been transformed immensely in recent years by technology, it's poised to be changed by new ways of thinking about design.
As Jessica Kadar, principal product manager at Iora Health, an innovative accountable care organization based in Cambridge, Mass. explained, incremental changes to the system don't work unless you change the whole model
"You don't build an airplane by putting wings on a car," she said.
By rethinking the triangular relationship between people and processes, information technology, and payment reform, Iora has notched some impressive achievements, Kadar showed at HxD.
Its IT strategies are built around collaboration and patient-centeredness. It maintains its own team of developers and designers, all of whom go out to visit its practices, to see how technology is used and learn from it.
Instead of hunching over a laptop in a corner, Iora's docs project the EHR on a large screen, so the patient is involved in the discussion; it deploys OpenNotes, a technology that allows patients to review and add to their own charts.
The idea, said Kadar, is to approach seemingly intractable challenges from the ground up.
As another presenter, Richard Anderson, put it earlier in the day, too often EHRs are "automating broken processes."
"We build on top of them until they become intractable," Kadar echoed.
Nonetheless, "every barrier that we encounter now was once a design solution," she said. When designers complain about healthcare's ungainliness, "We're talking to our former selves."
The answer should be simple, said Kadar: "If something's not working, try something else."