Archive for: December 2006

Designing for Success

Dec 19, 2006, 6:45 AM, Posted by Theresa Kanter

I'm a person who appreciates good design, and have often wondered how products are designed.  When I'm using a poorly designed product, I ask myself if the developers thought about the user at all.  Last week I saw the opposite side of the design process coin when I attended a workshop held by the Center for Future Health (CFH) at the University of Rochester. The purpose of the workshop was to design a device for heart patients, or consumers, that could help them monitor their health. In the room were consumers, clinicians and the engineers who would actually design the device. The participants were able to learn from each other and develop creative concepts that may result in a breakthrough product. This was the first time I've sat in on a design session, but I thought the process was amazing!

CFH used a "fish bowl" format to conduct the meeting.  I had heard about this before, but had never seen it in action. In the center of the room was a round table with rectangular tables arranged in concentric circles around it. The focus of the discussion was at the round table in the center. At the start of the day, the consumers sat around the table with the facilitator. There were a few empty chairs in this inner circle. The facilitator asks the questions, and the people sitting in the inner circle can answer.  No one else in the room can talk, unless they join one of the empty chairs in the inner circle.  After the consumers had a chance to talk about their personal and health needs, the health professionals sat in the circle and talked about what they needed to provide the best medical care.

Why is this so cool?  Because the conversation can be very focused, and stay on point to answer the big question.  In this case, the question was: what kind of product would be best for patients/consumers? The health professionals and engineers joined the circle to ask clarifying questions, and occasionally to offer technical expertise, but the focus was on the needs of the patients. I think the fish bowl format is also a great way to moderate discussion among expert groups. The consumers are experts about their needs as heart patients. The health professionals are experts at providing care. The engineers know all about machine monitoring and gadgets. In this format, they each group had its chance to talk, and to listen. Sometimes in meetings people forget to listen, but in the fish bowl format, it was the job of those sitting outside the center circle to listen.

After a morning of "fish bowl" discussion, the engineers started talking.  The engineers divided into two groups and started brainstorming ideas.  It was remarkable to hear what they were coming up with.  Unfortunately, I couldn't stay for the conclusion of the workshop, but I know that the consumers, health professionals, and engineers came to consensus on developing a product. The working title of this product is PhyPod, and it responds to the needs of consumers and health professionals

Click on this icon for a sketch: A this product moves beyond a concept to a working model, I hope to share pictures of this tangible health monitor, and of consumers using it.

The Design - Comprehension Link

Dec 15, 2006, 2:02 AM, Posted by Elaine Cassidy

A really interesting article was published in USA Today on December 10 that highlights how prescription labels are difficult for people to understand, especially if their literacy skills fall below the sixth-grade level. Check out the article from USA Today yourself here. 

On the same topic, the Pioneer team recently funded a project that will assess the connection between prescription label design and patient behavior. Dr. Will Shrank and his team at Brigham and Women's Hospital are leading this study and they will examine whether the simpler, innovative prescription label and package design implemented by Target in 2005 might positively influence medication-taking behavior and patient safety.

PHRs: They're Hot, They're Sexy, But What Are They, Exactly?

Dec 14, 2006, 9:15 AM, Posted by Steve Downs

With apologies to Rolling Stone and Jim Morrison for the headline, it’s time to acknowledge the obvious: PHRs, or personal health records, are definitely in vogue – well at least among the health IT crowd, at any rate. I’ve just come back from the annual Connecting Americans to Their Health Care: Empowered Consumers, Personal Health Records, and Emerging Technologies conference(go here for the archived web cast of the plenary sessions), which we co-sponsored with the Markle Foundation and a number of HHS agencies, and among this substantially-sized (500 plus) crowd, PHRs are all the rage. We had representatives from consumer organizations, policy makers, PHR developers, researchers, and, in a sign of the times, some major tech industry players. Google, Microsoft, Intel, and Intuit (the Quicken and TurboTax people) were there and there in numbers. And among this crowd, there’s a lot of excitement and enthusiasm to move forward with PHRs. Rep. Patrick Kennedy, one of the keynote speakers, is even sponsoring legislation that would provide incentive payments to physicians for each patient of theirs who uses a PHR.

So we’re all in favor of PHRs, but it’s not at all clear if we’re talking about the same thing. Generally speaking, people refer to PHRs as online access to your medical record. It gets interesting and a bit confusing when one

starts to define the medical record. Is it the record that one provider or provider system maintains (see the EHR portals like MyGroupHealth)? Is it the combined records of multiple providers? Is it a record compiled and maintained by the consumer herself, perhaps derived from the shoebox of past invoices, lab results, and other artifacts of care encounters? These discussions get even more interesting when we move beyond the information that is typically stored in a provider’s record into the realm of readings and observations generated outside the health care setting. Someone may keep detailed notes of each headache he experiences. Sensors embedded in one’s bed can provide valuable data about sleep patterns. And what to do with the data from frequent blood pressure readings at home? Most PHR discussions tend to focus on the typical provider-based medical record while allowing for the potential for “patient-sourced” data. This reflects a perspective that the value of PHRs is in providing a person with access to the same information available to his or her care team. To oversimplify, a person should be allowed to know as much about herself as her doctor knows. In my mind, we should flip this thinking around and recognize that people know more about their bodies and their experiences than any health care provider could possibly know, and, augmented by some technologies, people could capture and share this knowledge much more effectively with their providers. 

One of the conference presentations that captures this point was Intel researcher Eric Dishman’s discussion about his work on Parkinson’s Disease. Parkinson’s is controlled (with great side effects) by medication. Balancing the beneficial effects of the medication with the detrimental side effects is a daily challenge, complicated by the fact the severity of the disease varies from day to day and even hour to hour. However, Parkinson’s suffers are typically assessed and have their medications adjusted by a neurologist every several months. As a result, they can be assessed on a particularly “up” (or down) day and the resulting medication change is then based on an inaccurate assessment. Eric’s team is looking at affordable technological means to measure this severity in the home so that medications could be adjusted almost continuously in response to the changing severity of the disease. Even if the medications were only adjusted infrequently, the daily recordings of the disease severity would provide a neurologist with a very different picture of the person’s response to the disease than the snapshot that comes from a bi-annual exam.

So where do these daily recordings of Parkinson’s severity fit in our different PHR schemas? They'’re not really part of the provider’s official record, are they? (Or at least not until a provider has seen them). But if I’m a Parkinson’s sufferer, I’d want them as part of my personal health record, if only so that I could share them with someone who could use them to understand the disease’s effect on me. Patti Brennan, a professor at the University of Wisconsin and director of RWJF’s Project HealthDesign program, once said something to the effect that we have to free ourselves for the idea that we should each have a single personal health record – that each of us should ever have one repository that contains all of our health information. Dishman’s work suggests that there are at least two – the official record maintained by a provider and the information maintained by an individual. However, even the latter approach reflects the metaphor of PHR as a book that we read rather than PHR as sources of data that can be used to support functions and actions. Moving beyond the record to think about the functions and actions the data and the record can support is the idea behind Project HealthDesign, but that’s a topic for another day.

In Other Blogs: Connecting Americans to Their Health Care

Dec 14, 2006, 4:18 AM, Posted by RWJF Blog Team

The recent RWJF and Markle Foundation-sponsored conference is generating activity on a number of blogs.   The Care Talk Gals discuss getting the conference's information to consumers here.   Much attention is also being paid to Adam Bosworth of Google's keynote speech.  See his own blog for a link to the speech itself, and visit summary news sites such as this one and commentators like Rough Type for reactions. 

Philanthropy for the Future

Dec 12, 2006, 9:03 AM, Posted by Susan Promislo

Lucy Bernholz highlighted Pioneer's blog, as well as the Games for Health contest  on her blog, Philanthropy 2173 -- thanks, Lucy!  Founder of Blueprint Research and Design, Lucy is an expert on future models and innovations in the world of philanthropy and social enterpreneurship.  Her blog touches on a variety of really interesting issues, ranging from how games can be used to further advocacy efforts to microenterprise to what Web 2.0 philanthropy might look like.  Some provocative viewpoints...check it out here.