Stimulating Innovation?

The enormous amount of money being spent on health information technology as part of President Obama's economic stimulus package should, among other things, yield potentially significant cost savings. In a study funded by key vendors of Electronic Health Record (EHR) systems, the Center for Information Technology Leadership predicts (pdf) "an annual net value of $19 billion based on a 10-year rollout and a usage rate of 80% of the U.S. population."

Pragmatically speaking, the point of the stimulus package is to get companies working in a challenging economic environment while also making significant investments in large-scale infrastructure projects. However, the sheer size of the problem, and the potentially significant payoffs and caveats of the current approach, has many people asking questions. In addition to concerns about technical implementation and other risks, there are concerns about how much attention will be paid to improving the patient experience, as we've discussed here previously.

It's natural for designers to talk about the patient experience because it falls within our area of expertise, but in approaching a broken health care system from a different perspective we are forced to confront other, more fundamental questions. Perhaps the most difficult and simultaneously revealing question is whether the existing healthcare system in the U.S. is, as a solution, addressing the right problems. Implementing EHRs should go some distance towards improving efficiency and accuracy and a host of other metrics, but what seems to be missing from the discussion is the question of whether the system as a whole needs a redesign.

For inspiration, we can look to a project called Open Health by the UK Design Council's RED group. While a few years old at this point, Open Health was influential on a personal level in helping frame my particular perspective on the potential for design to impact the healthcare space. I feel that the results of their work offer compelling evidence for the power of design in both their simplicity and efficiency.

Though we tend to think of a failing healthcare system in terms of symptoms (for example, insurance quagmires and interminable waiting), RED took a different approach and questioned the evolving role of the healthcare system in today's environment. Their findings included the following:

"The nature of the health problem in the UK has changed. The 20th century problem of infectious disease has given way to a prevalence of chronic disease, problems such as diabetes and obesity. 12 million (one in five) Britons suffer from a chronic disease and these numbers are predicted to rise, threatening to financially overwhelm current health services, which were not designed to address these issues."

You can read all about the project, the design techniques they used, and the project's results on the RED website, including two publications they released (RED Paper 01: Health and OPEN HEALTH) and a short film which nicely summarizes their research findings, approach, and design solutions. The important point, I believe, is that their work simultaneously questioned the fundamental assumptions of healthcare services while developing relatively low-tech, quickly implementable solutions. These solutions engaged end-users in the development and delivery of services which addressed highly relevant quality of life issues. I bring this up not to suggest we should be luddites, but simply to point out that we cannot expect an investment only in technology to result in a cure-all for our current healthcare problems: the human-facing side requires investment as well.

One result in particular of the Open Health project bears highlighting for its simplicity and potential impact. Using a technique of co-creation, RED collaborated with diabetes patients and practitioners to develop a tool called Agenda Cards (which was itself part of a larger service called Me2). Each card contains a statement such as "I want to know more about diabetes" or "It's hard to know what to eat." Patients set out the agenda for meeting with their practitioner by selecting the cards which they feel are the most important to them. This prioritization by the patient helps practitioners quickly focus the consultation and enables patients to reveal otherwise unexpressed issues: the cards can prompt patients to discuss issues which they may have forgotten to ask or wouldn't have thought to ask. Practitioners can focus less on diagnosis and more on developing a mutually agreed-upon care plan with the patient. The cards do not replace the conversation; rather, they serve as a starting point for a dialog.

The result of introducing this prototyped innovation of a deck of cards? An estimated savings of 80 percent of front-line worker time.

While a deck of cards will not by itself revolutionize medicine and healthcare, I also find myself balking at the notion that the EHR initiative will succeed simply because of the sheer size of the problem and the amount of money being thrown at it. To be clear: I think EHRs are a good idea, but I suspect they will be only part of an eventual solution. I have to wonder about the kinds of value we as designers could deliver if just a tiny portion of the $19,000,000,000 for health information technology was dedicated to research and development of smaller, discrete interventions and innovation unified under a larger healthcare strategy for the nation.

Dave Chiu, Interaction Designer, frog San Francisco