Design

Aardvark in North Carolina writes:

flying cadeuciiOn the Healthcare.gov web site I was filling the application – an arduous process that – even when pre-filled from last year, takes 30 – 45 minutes. At the review and sign, I found ONE date that was wrong: the day and month were inadvertently transposed. from 09/08 to 08/09. Since the information will be checked against tax records I thought it best to correct this prior to signing.

I clicked on the “edit” button which brought a box “Do you really want to edit your application”, Yes! That’s why I clicked the button – BOOM! back to “GO”,  

So it took almost 45 minutes to go through again, (I do work by the way, so this time consuming process is not OK), but I did it. THEN at review I found I had been so frustrated OR the process accepted the key stroke wrong so I now had 09/03 instead of 09/08.

 NOT wanting to go back to the very beginning AGAIN, I called the help desk, thinking this would save time. The agent was supportive and pleasant, but basically REFILLED the ENTIRE form again!!!!!!!

Continue reading “Healthcare.gov? Go to the Back of the Line!!!”

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IBM Golden Age

This might seem like a silly question with an obvious answer, but is it really?

The solution to any problem grows out of the environment in which it appears and from the mindset in which it was conceived.  In 1970, the answer to this question would have been a mainframe system.   By 1981, after the Apple II and a few other microcomputers had been around for a few years, the answer for most people at that time would still have been mainframes (or maybe minicomputers as well)  because microcomputers were still considered to be toys. When IBM released the IBM PC AT in 1982, microcomputers began to be taken seriously as computers—that is, computers that could be used for real business applications.  The arrival of reliable local area networking technology cemented the status of PCs as real business computers.

Initially, local area networks (LANs) were used to share printers, disk storage, and applications.  However, as servers became more powerful and disk storage more dense and affordable, database management systems and sophisticated client/server software appeared.

Client/server computing lowered the cost of owning essential business applications such as accounting systems that once would have resided on a minicomputer or a mainframe.  The tools for building client/server applications were reasonably priced compared to the minicomputer market.  As might be expected, the arrival of a relatively easy-to-set-up network operating system in the form of Windows NT (1993) put pressure on the minicomputer market.    Health technology companies were quick to jump on the Windows NT bandwagon, so that by 2000 most EHR systems for offices were Windows NT-based.

Continue reading “A Question for EHR Vendors: What Is a “Real” Computer?”

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Screen Shot 2014-10-28 at 9.34.48 AMThe Ebola crisis in Texas has tested our nation’s health care system in many ways, exposing weaknesses and potential breakdowns. In particular, the incident with the first diagnosed Ebola patient at Texas Health Presbyterian underscores a fundamental issue with information liquidity between providers, their care teams, and across the continuum of care. The ability to share information effectively is critical not just in responding to health care crises like Ebola — but also in delivering great, cost-effective care.

As athenahealth CEO Jonathan Bush said in an interview with CNBC earlier this month: 

“The worst supply chain in our society is the health information supply chain. It’s just a wonderfully poignant example, [a] reminder of how disconnected our health care system is. … The hyperbole should not be directed at Epic or those guys at Health Texas. The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network.”

Continue reading “Ebola and the Information Flow Challenge”

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People are becoming more conscious about their health. It’s why fitness apps are booming and both Apple and Google are looking to get into the health game. But apps that try to go beyond simple calorie counting and movement tracking often struggle to gain traction with users.

Although people are open to sharing how many steps they’ve taken or how much they weigh, they’re more hesitant to share their personal medical details.

Here are some data-related fears consumers often have with healthcare apps:

  • Personal medical information could get leaked. Revealing users’ medical information could be embarrassing and life shattering.
  • Companies could use the data for marketing purposes. Imagine your spam getting smarter about your personal health details. Companies are already pinpointing viewers’ interests, and revealing this information could expose you to targeted email spam and calls tailored to your health issues. Members of Congress have already discussed legislation that would forbid medical apps from selling personal data without the user’s consent.
  • Unqualified employees could access their information. Patients feel comfortable divulging medical information to a doctor, but they probably wouldn’t want the IT guy who supports the app to see and read their information.

There are many reasons people might hesitate to use your app. But by identifying potential concerns and considering them as you develop and market your app, you can quell their fears and ensure the long-term success of your medical app. Continue reading “Why Nobody Is Using Your Health App (And How to Fix It)”

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I’ve been thinking about EMRs, electronic medical records, lately. It’s a subject, despite some professional experience, I don’t feel particularly close to. In fact, if anything, they are a source of consternation.

As an industry insider, I see them as an expensive albatross around our collective neck. As a human centered design advisor, I see them as an encumbrance for both providers and patients.

And, as a patient I see them largely as an opaque blob of data about me with a placating window in the form of a portal.

Which makes me wonder, am I obsessed with EMRs lately?

One of the reasons is certainly my personal interest in technology. And, while I don’t work in health IT, it’s natural to draw some connections. For instance,Wikipedia is consistently in among the top 10 most visited internet sites ( it is currently number 6 ).

And, say what you will about citing Wikipedia, but a 2010 study found it as accurate as Britanica.

Google trusts Wikipedia enough to use it as the primary source for its knowledge graph cards; and we’ve all settled a bar bet by finding some fact where a Wikipedia article is the canonical answer.

The secret sauce for Wikipedia is in it’s roots. Literally, the root of its name, wiki, describes the underlying structure. Wikis were the internet’s a solution to knowledge bases – large repositories of information about a process or thing. Companies had been using knowledge base software for years. Traditionally, a central maintainer, often a sort of corporate librarian, curated information, such as common answers to customer questions, so customer service reps could find it quickly.

Continue reading “What If EMRs Worked Like Wikipedia?”

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Innovations Help Patients Share Their Lives with Health Care Providers

The California HealthCare Foundation (CHCF), Mad*Pow and Health 2.0 today announced the winners of the “Putting Care In Context” design challenge which sought innovative ways to help patients take an active role in sharing information about hurdles in their lives that impact health.

The three winning solutions each empower patients to share information about issues like hunger, poor housing conditions, stress, and isolation with their health care providers. The winners are:

  • First place: Healthify is a web-based platform used to assess patients’ social and behavioral health needs, refer patients to appropriate resources to meet those needs, and engage patients around their social determinants via interactive texting. The platform also provides dashboards for managed care plans and case managers to use, allowing them to better manage the social needs in their population and to efficiently search for social services.
  • Second place: Share4Care is a design prototype of an iPad app that would allow patients to document stress levels and issues in their life while in a clinical waiting room. The Share4Care app would then calculate a “Life Change Score” and assign a color (green, yellow, or red) that would be immediately available to the patient’s physician, prompting them to ask about factors that could impact the patient’s health.
  • Third place: MyDay Media Messaging Journal is a web-based platform that patients use to document their barriers to health through photos and text messages. The MyDay website and mobile app allow providers to view patients’ journal entries and follow-up to build patient-provider rapport, clarify journal entry content, and connect patients with resources.

The creators of these ideas will share $10,000 in prize money for their thoughtful, original work.

“We believe that healthcare providers must understand the hurdles in a patient’s life that can be a barrier to good health,” says Amy Cueva, Founder and Chief Experience Officer at Mad*Pow. “These winning concepts can help engage patients to share this important personal information, leading to more effective care.”

The challenge was first announced at the HxRefactored conference on May 14, 2014 in Brooklyn, NY. A healthcare experience, design and technology conference, HxRefactored fused the technical and creative elements of Mad*Pow’s Healthcare Experience Design Conference and Health 2.0’s Health: Refactored.

“The winning solutions – all at varying stages of development – demonstrate different ways that patients can be engaged to share information about their lives outside the clinic walls” said Giovanna Giuliani, senior program officer with the California HealthCare Foundation. “From a one-time assessment in the waiting room, to a daily social media-inspired approach, to a more developed web-based screening tool, these solutions will spark new ways to think about promoting conversations and care that addresses the whole person.”

For more information on the design challenge and the winning entries, visit http://bit.ly/CareInContext.

About the California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians, supporting ideas and innovations that improve quality, increase efficiency, and lower the costs of care. For more information, visit www.chcf.org.

About Mad*Pow

Mad*Pow is a design agency that improves the experiences people have with technology, organizations and each other. Using human-centered design, Mad*Pow creates strong multi-channel experience strategies, intuitive digital experiences and streamlined processes for its clients. The company has offices in Boston, Portsmouth, NH and Louisville. For more information, visit www.madpow.com.

About Health 2.0

Health 2.0 promotes, showcases, and catalyzes new technologies in health care through a worldwide series of conferences, code-a-thons, prize challenges, and leading market intelligence. Visit www.health2con.com for more info.

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flying cadeuciiIn an era of sophisticated information technology and rapid communication, the medical device community lags far behind other fields in its ability to alert patients about safety concerns.

For example, auto manufacturers and government regulators are able to quickly identify potential safety concerns by linking reports of crashes, malfunctions and defects with individual vehicle identification numbers (VINs).

They can then communicate recalls to affected customers by using their VIN. Manufacturers will issue notifications via mail or e-mail, or offer customers the ability to search the manufacturer’s website using their VIN.

In health care, drugs are tracked using a system established in the 1970s called National Drug Codes (NDCs). The 10-digit NDCs are assigned to all manufactured medications. The code tracks the vendor, product, and package code, which can then be captured in electronic health records and the FDA’s national database.

Unfortunately, we do not yet have a similar national system that can identify and communicate potential concerns for the tens of millions of patients with implantable devices such as pacemakers, glucose meters, artificial joints, and defibrillators.

Patients are bombarded by news stories about device recalls, but unless they have access to information about the exact make and model of their device, they have no way of knowing if they should be concerned. Since most medical device procedures take place in a hospital, a patient’s health care providers may also lack this critical, sometimes life-saving information.

The patient is then burdened with the task of tracking down their specialist or surgeon, in hopes that they documented the specific device information.

Clearly, the current health care information infrastructure does not yet support a robust surveillance system.

Continue reading “Medical Devices and Patient Safety: A Promising Path Forward”

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At the first White House public workshop on Big Data, Latanya Sweeney, a leading privacy researcher at Carnegie Mellon and Harvard who is now the chief technologist for the Federal Trade Commission, was quoted as asking about privacy and big data, “computer science got us into this mess; can computer science get us out of it?”

There is a lot computer science and other technology can do to help consumers in this area. Some examples:

•    The same predictive analytics and machine learning used to understand and manage preferences for products or content and improve user experience can be applied to privacy preferences. This would take some of the burden off individuals to manage their privacy preferences actively and enable providers to adjust disclosures and consent for differing contexts that raise different privacy sensitivities.

Computer science has done a lot to improve user interfaces and user experience by making them context-sensitive, and the same can be done to improve users’ privacy experience.

•    Tagging and tracking privacy metadata would strengthen accountability by making it easier to ensure that use, retention, and sharing of data is consistent with expectations when the data was first provided.

•    Developing features and platforms that enable consumers to see what data is collected about them, employ visualizations to increase interpretability of data, and make data about consumers more available to them in ways that will allow consumers to get more of the benefit of data that they themselves generate would provide much more dynamic and meaningful transparency than static privacy policies that few consumers read and only experts can interpret usefully.

In a recent speech to MIT’s industrial partners, I presented examples of research on privacy-protecting technologies.

Continue reading “Using Technology to Better Inform Consumers about Privacy Decisions”

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By DAVID DO, MD

Screen Shot 2014-04-27 at 10.28.54 AMWILD PREDICTION: It won’t be long before every patient has a Twitter feed, and doctors subscribe to them for real-time updates.

This is a time when the demands of being a physician are changing, and we need to leverage technology to maintain awareness of a huge number of patients. There is also increasing need for handoffs and communication between providers.

Here’s the bottom line: how can we improve technology when doctors seem so resistant? They are not happy with their EMRs, and rightly so, because they were built to do too much for too many.

Current system is inefficient

The EMR has become essential for documentation, billing, medical reasoning, and communication, among other things. Currently, documentation is built on a system of daily progress notes. If I consult a cardiologist about a case, he needs to go through each note, containing narratives, laboratory values, vital signs, and physical exams.

A patient with a seven-day hospital stay may have twenty notes that need synthesis to put together the story–this can take hours per patient!

In an age where more providers are involved in a patient’s care (whether due to duty hour restrictions, or the increasing presence of specialists for every problem), this inefficiency is not acceptable.

Continue reading “What an EMR Built on Twitter Would Look Like”

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apple storeJe n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte. —Blaise Pascal

Translation: I have made this longer than usual because I have not had time to make it shorter.

As Appley as it gets.

A while ago I was challenged to write about what an Apple-like approach to healthcare might look like.

That challenge has been weighing on me.

For starters, we’re all over Appled aren’t we? Maligned anecdotes about Steve Jobs and the iPhone make their way into almost every presentation remotely related to innovation or technology. Triteness aside, I’ve been stalled because Apple is really a philosophy, not a series of steps or lessons learned. (Although, they are nonetheless methodical.)

Instead, what I’ve been kicking around in the ole noggin are three notional predictions, which I’ll assert are inevitabilities which will fundamentally disrupt healthcare delivery as we know it today.

What follows is about as Appley as I’m likely to get. Despite big-bang product launches, Apple actually plays the long game. They introduce small features into products to affect user behavior years before a flagship product takes advantage of those reprogramed behaviors.

That’s how they disrupt.

I believe there are three meaningful, unstoppable trends, in our current world which will significantly alter healthcare. The steps taken towards these inevitabilities, along the way, are what will define the innovators and leaders. They are the ones who see this future and know how to drive towards it.

The three trends are:

  • Tools and culture which favor individual empowerment
  • The commoditization and automation of diagnosis
  • Accelerated globalization of treatment options

But wait, there’s Moore.

Don’t worry, I’m not going to leave you hanging. I’ll attempt to rationalize each of these points and explain why, particularly when considered as a bundle, they are a powerful force for disruption. And to prime that pump, we have to talk about Gordon Moore.

Continue reading “Moore’s Law in Healthcare – Three Predictions”

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