The hard task of making life simple - designing humanity into digital health

At HealthXL, we have some incredible talent within our community. To showcase the type of thinking that will help drive change, every week we will be posting a piece from a community member. This week, we feature Kellee M. Franklin, the founder of Mindful Innovation Labs and advisory board member at Cambia Grove, Seattle's health innovation HUB.

“Simple is hard. Easy is harder. Invisible is hardest.” - Jean-Louis Gassee, a former executive at Apple Computers. 

I love this quote. I use it often when working with clients and teaching graduate students about the art of transforming systems. Sadly, in my international business consulting experience, we do not do a very good job of following Gassee's design mantra within the health industry. Digital health, for instance, has not necessarily become simple or easy for patients, and certainly not invisible.

As these technologies become an increasingly important part of the patient journey, what can we do to ensure Gassee's philosophy plays a part?

Design humanity into digital solutions

First, we need to design humanity into our digital solutions. Think about how complex and complicated all the systems that patients and their providers have to use as they navigate through the various processes. We are far from Gassee's design vision. 

We ask physicians to sign a pledge to "do no harm" as they enter the field, recognizing that they will be making decisions that impact and influence health lives. Why do we not ask the same of our digital health innovators?

As someone with a background in human-centered design, spending my foundational years working with many top-level U.S. Defense and Intelligence executives, I have witnessed how incredibly powerful the approach of collaborative design, data-analytic decision-making, prototyping and testing, and visualization of concepts can be to user adoption and business results. 

Fast-forward years later - as a breast cancer patient, I observed how these same principles could have a meaningful impact on the health experience. Yet, I came to realize how woefully applied and underutilized these approaches were in designing patient care. 

One common example is the use of patient portals. These popular online health applications are intended to allow patients and their providers to more effectively communicate with one another. However, research consistently shows that patient use of portals is low, largely because the onus is on the patient, often who is already under duress because of their health condition,= to do most of the heavy lifting. 

Complex medical conditions tend to require seeing multiple care providers. This results in patients filling out multiple portals with similar information. We must begin to ask ourselves: Is lifting and shifting a 10-page intake patient survey to an online portal or tablet really a digital transformation? As digital health innovators, are we making the patient experience simple? Easy? Invisible?

Design-thinking requires diverse-thinking

Second, we need to break old paradigms of thinking and invite outside ideas inside the health arena. It has been surprising to me to encounter so much resistance to change and innovative interventions across the industry. 

I think of experiences where I have been traveling in Dubai, United Arab Emeritus airport and I needed to criss-cross multiple terminals to catch my connecting flight. As a passenger moves from one part of the airport to the next, you are traversing through various levels of security points. The difference to the health experience? Unless you have a background in security, you might never be aware that you are being processed for security. The passenger experience is simple. Easy. Invisible.

Why are we not applying these same approaches to designing patient experiences?

Anil Sethi, founder and chief executive at Ciitizen, is one entrepreneur who is attempting to break traditional thinking in the health industry. 

As the former director of Apple's health care team, Sethi launched Ciitzen after losing his sister Tania to Triple-Negative Breast Cancer, an aggressive form of the disease. His sister's challenges of managing multiple specialists, numerous hospital systems, and countless medications, all while she was fighting for her life, inspired Sethi to learn how we might leverage advanced technologies like AI and others to help patients use their own data to advance and advocate for their best treatment options. Sethi is motivated to give patients like his sister greater access to care avenues by providing them more control over their own personal health data. 

There are lots of examples of entrepreneurs and health innovators like Anil Sethi doing transformative work. 

For instance, without the cross-pollination of ideas, use of genomic-testing, and the novel adaptive platform of the I-SPY clinical trial in 2013, I likely would not have survived Triple-Negative Breast Cancer, the same breast cancer Sethi's sister died from. We need to find ways to elevate these examples and educate the broader health community on these practices. 

Patient-empowered systems

Third, we need to design systems that are patient-empowered. 

Take for instance a recent visit I had to a specialist. Arriving at the office for the first time, I filled in the customary patient intake forms and I was taken aback by a three-question, single-page request. Surely I was missing the other nine pages, right? 

No, the doctor would explain to me, that was all he needed to treat me. Why? All the information typically collected in the long traditional intake forms often is never actually used but it has become an institutionalized procedure. That is, doctors have been taught that this is all the information you need to collect from an incoming patient. 

So, how do we design systems that are patient-empowered? 

Start with usability. Whether a process, procedure, or technology, these things are only as good as they are helpful and supportive (and used by) those they are intended to benefit. 

I can tell you of countless examples -- in many different industries -- where lots of money is invested in technologies that never get used or are misused. 

In health care, these poor design choices, where the patient is an after-thought, can have dire consequences. 

I think of my 80-year mother. She is pretty tech savvy -- but, as a daughter, helping her through her various health experiences is painful for me. From patient portals to tablet intake forms to email overload to receptionist depersonalization, these "digital transformations" adversely impact her care experiences. I have to imagine that these poor design approaches may result in patients choosing to avoid these care experiences rather than proactively taking responsibility for their wellness. 

We should design to increase the personal care time between patients and physicians and eliminate administrative burdens throughout the process. I do not know about you, but I know when I was sick, I wanted to be seen and heard by my physician. At that time, to be honest with you, the technology was irrelevant to me, unless it was causing me additional stress. Technology should supplement, and complement, our health experiences. Remember: "Do no harm".

Imagine a QR code, for example, that could be in the hands of every individual containing their health data. Available at their use and updated at their choosing. Like walking through that Dubai airport, personal health information is available at various points along one's health journey. The patient is equipped with and empowered to share their data.

Simple. Easy. Invisible.

If you want to take part in this series or would like to recommend someone, please email [email protected]