Can Designers And Developers Save Health Care?

Because the government’s efforts at doing so are fumbling at best, it may be up to an intrepid group of innovative thinkers to design ways to make our medical experiences better and more efficient.

Ryan Lochte’s grill wasn’t the only subject of controversy at this year’s London Olympics. An estimated 1 billion watched an over-the-top montage of everything British during the hotly anticipated Opening Ceremony. The performance, directed by Danny Boyle, best known for films like Slumdog Millionaire and Trainspotting, featured a boisterous celebration of the United Kingdom’s National Health Service (NHS), with actual doctors and nurses gleefully swinging around patients and hospital beds. The finale was a megawatt NHS sign covering the arena floor.

This piece is part of a Collaborative Fund-curated series on creativity and values written by thought leaders in the for-profit, for-good business space.

Why such brouhaha? The publicly funded NHS grants medical care to everyone. For free. No bills, no paperwork, no insurance--nada. It’s not without its drawbacks; visits are characterized by long wait times and it’s expensive to maintain. But what is clear, from the Olympics and from any conversation with a Brit, is how proud they are of their health care system.

As I watched, I wondered how the U.S. would choose to commemorate our system given the same opportunity. With costs approaching 18% of our GDP, it is probably not worthy of a musical tribute at the moment. And given the American celebration of free enterprise, we’re not likely to pass socialized medicine anytime soon. But we have a different road to a dance-worthy system, through the talents of the creative designers and developers that are entering health care from other sectors.

From our perch in Silicon Valley at Rock Health, we’re already seeing companies founded by individuals of diverse backgrounds that use technology and design to create better experiences–-and save the system billions of dollars. By putting user experience and design at the forefront, not only do they address problems of access and resource constraints, but also actually improve outcomes. Three areas you can see this outside-in thinking at work are moving from paper to paperless, inviting designers to look at old problems with fresh eyes, and creating patient resources that not only educate, but also delight.

Scaling paper

The U.S. health care system is still largely run on paper and clipboards, which seems unbelievable in a world full of increasingly ubiquitous tablets and smartphones. And as most of us have discovered, a paper brochure on the way out of a doctor’s appointment is not the best medium for effective follow up care instruction.

Nowhere was the opportunity cost of life-saving interventions via paper more clear than with the Diabetes Prevention Plan, or DPP. Born of a clinical research study to determine whether behavior change could outperform drugs, the DPP had unquestionably clear results. Participants who lost 7% of their body weight through dietary changes and increased physical activity dramatically diminished their chances of developing diabetes, soundly defeating the pharmaceuticals. So how was this life-changing intervention delivered to patients? You guessed it: on a piece of paper.

Enter Omada Health, part of our first class at Rock Health, which began its entrepreneurial journey at Ideo. They decided to take a famous diabetes prevention study and put it online, infuse it with social support, and add a wireless scale for tracking and accountability. Applying the design thinking that Ideo is known for, team Omada not only exceeded their projections for efficacy, they also made a product that their users loved. So much so that the pilot groups asked that the platform remain open even after the program officially concluded.

Omada Health is becoming the gold standard in group-based programs for chronic disease prevention, tackling issues through technology and thoughtful experience design. Their founding team featured an experience designer, a Harvard med school dropout and killer developer, all of whom combined their rich experience to create something that was not only effective, but also a joy to use.

From Fashion Week to Hospital Hallways

The designer of today’s flimsy hospital gown clearly had an exhibitionist side. While it’s true that the open back and thin fabric serve functional purposes, providing easy access for doctors and nurses to give injections and detect vital signs, patient experience is clearly secondary in this equation. In the context of our complex health care system, providing less drafty clothing seems like a small give with huge results, right? It turns out the hospital gown hadn’t seen a redesign since the 1920s, until when a few years ago high fashion interceded.

The Cleveland Clinic’s Chief Experience Officer, Dr. Bridget Duffy, heard firsthand the impact that these papery garments had on patients, and decided to recruit an expert who truly understood the power of well-designed clothing. Her co-conspirator? Why none other than the curator of fabulous fabrics, fashionista Diane von Furstenberg. The designer collaborated with the Cleveland Clinic’s team to create a bright and cheerful gown based upon the design of her iconic wrap dress. Patients loved it because it was colorful and returned their stolen dignity, and physicians were still able to access exactly what they needed. Everyone wins and, bonus, looks good while doing it.

Visualizing Anatomy

How much does the average patient remember about a doctor visit? Turns out, not much. A patient’s ability to remember details of an appointment drops precipitously from the moment they step out the door, with 80% of the information forgotten immediately, and 50% remembered incorrectly. And because none of it is recorded or accessible via email, there is virtually no way to understand a diagnosis without the help of WebMD or other oftentimes confusing online resources.

After 30 years of telling patients the same thing over and over, only to be peppered with confused phone calls days later, a spinal surgeon decided to create an app called SpineDecide to help his patients understand their diagnosis as well as the anatomy of the spine. And it worked, leading to less calls, more efficient visits, and increased patient satisfaction. SpineDecide inspired the founding of Orca Health, whose mission is to provide best practices and teach patients about their conditions and anatomy. They’re also firmly design-centered, utilizing gorgeous 3-D models and zooming to actually make learning fun and engaging. Orca’s subsequent apps have been downloaded hundreds of thousands of times, won awards, and most importantly, changed the way doctors are able to communicate with their patients.

Our best national resource is our wealth of entrepreneurial and design talent. Armed with the right tools and resources to help the doctors, nurses, and other medical professionals out in the trenches every day, they can power the next generation of health care in this country. Perhaps given some time, they’ll even help to build a system that is worthy of song and dance.

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13 Comments

  • cristina munoz

    For the tech savvy, the most distressing part of medicine has to be the state of electronic medical records.  These were created by the tech sector, not by doctors, and the state of the field is very weak.  Imagine if you worked for a company that needed vehicles to deliver products, and the drivers had to chose between the Yugo and the Ford Pinto.  (Kids, if you don't know what these are, just Google "50 worst cars of all time".)
     
    This leads to work arounds, such as:
     
    doctors or sitting at home at their laptops with piles of paper notes to enter into an electronic system, because the interface at work makes it impossible to enter data in real time
     
    medications ordered on the wrong hospital patient because the program used has such a tiny fonts, it is hard to see if you clicked on the wrong line
     
    nurses sending "patient visit summaries" to a fax machine that has on paper in it, because they need to prove that the visit summary was created (by hitting the Print button), but the patient did not want the paper, and a busy practice didn't want to waste hundreds of pages of paper to print something for the shredder
     
    truly integrated, functional medical records systems (e.g. the VistA system used by the VA) that are programmed in MUMPS
     
    If the United States can have a highway system that everyone can understand, and if EMRs are subsidized by the Federal government at a rate of $10,000 per doctor (via "meaningful use" incentives), we should have systems that are much clearer, much easier to operate, and much better integrated than we have now.

  • U.S. Defender

    I am a relative newcomer to health care.  After 25 years in Silicon Valley I was shocked by the lack of systematic approach when tackling a problem.  In fact the ability to even identify and define a problem has been a challenge.  Certainly designers and developers bring badly needed disciplines to the health care world.  But they can only be as effective as the health care professionals will let them be.  The best technology in the world won't help if the culture refuses to change.

  • Jules Siegel

    How long are wait times, generally, under NHS? I think you should state facts, if you have them, when making derogatory claims.

  • tyler

    could be years if it's not life threatening.

    1. i met a gentleman from the uk needing surgery for his eyelids because they were blocking his vision. he's been on the waiting list for at least a year. during which he was accidentally bumped off the list and then had to be added to the back of the line. he couldn't drive until the surgery was performed.

    2. my mother-in-law lived in australia for many years and needed tubes put in her ears. it took months. she couldn't be submerged in water until the procedure was done.

  • cynthia strawn

    There is something so basically wrong with healthcare I cannot imagine a fix-until the healthcare system admits how deeply the wrongs run. 
    To keep this simple, medications are being thrown out at the end of every month at every nursing home in our nation.
    How many do you say? Records are kept at the homes. Then, nurses dissolve the drugs in sinks, or flush them down commodes. Who cares? Certainly no one who deals with water safety.
    Millions of homes have been found to have drinking water contaminated with prescription medications, that got into the water table.
    Guess what? At one time doctors working at homeless shelters could not get access to these soon to be wasted meds. Vets couldn't get them for animals at humane societies. They could be bundled up and shipped overseas. Gee those pharmaceutical companies are slick.
    What to do? Have every nursing home buy a machine that stores the medications and can be recovered for each patient when due. They exist and are in use all over our country.
    Don't blame the nurses who save a few pills back for their grandmother/sister/ son,etc., because they can't stand the waste. What taxpayer can stand this waste! 
    And then there is the fraud...

  • ibor

    Sometimes I wonder about people who offer solutions to the mess we call Health Care in this country:  How much do they truly know--and I mean factually--about what has brought us  to this condition?  It's gone on for a half century or more.   Do they realize how much the cost and quality of health care in this country comes from the health insurers?  Do they not realize their millions of dollars of expenses (upwards of 20-30 percent), and the millions of profits the insurers receive, are the principal cause of the high-cost health care?  Have they ever seriously studied what a single payer system would do to assure that everyone would receive health care at far less cost?  Have they even heard of Physicians for a National Health Plan?  Are they aware of how single payer works in all the developed countries, and why oh why we in  this country fail to see it?  

  • mbrosch

    Are you? First of all we should never confuse health care and health insurance. Health care is the relationship the physician has with the patient. Health insurance is who pays the doctor. The one is the dog, the other is the tail. The issue is that in all "single pay" systems it is very much the tail wagging the dog. I am always surprised that anyone would miss the fundamental necessity that the doctor patient relationship is to be preserved At All Cost. If we stray from this tenant then all is (eventually) lost.     

  • civisisus

    Silly Valley denizens have had grandiose plans for remaking crappy old US health care since before Jim Clark's fatuous swipe with Healtheon.

    Smart people, lots of confidence, short attention spans, and limited understanding of forces that actually, y'know, drive how behaviors change in an environment as big and amorphous as health care. The latest wave is no less clueful than its predecessors - but hey! - good luck. Heaven knows change needs to happen.

  • h_mcq

    One small point regarding the dancing doctors and nurses of the NHS during the Olympic opening ceremony---they were not actual NHS doctors and nurses, but rather amateur or semi-professional dancers. They were volunteers however! Just imagine if more people volunteered to help sort out our healthcare problems. 

  • Guest

    Interesting, from a UK perspective, to see that the point most of us took from the 'gleeful' NHS section of the opening ceremony may have been been somewhat lost in translation. Many Brits took it to be a direct, artistic challenge to the current healthcare reforms, which are threatening to cripple the system: 

    http://www.independent.co.uk/n...

  • daniel

    are you seriously suggesting that re-designing hospital gowns is some sort of noteworthy accomplishment? if thats an example of the best our generation can do, we are in trouble.

  • mbrosch

    Here Here daniel! But that become the focus in the despotic world of the bureaucratic.
    Cake anyone? 

  • Chris Cavallucci

    Have you ever been in a paper hospital gown?
    The gown redesign is one small example of the a change to the patient experience. It may be a small change, but it does have an additive effect, and it is clearly an improvement. The redesign of entire hospitals is underway. Here's an example near me -- http://bit.ly/TqQLFM