Hacking Healthcare: Designing Human-Centered Technology for a Healthier Future

By Shobha Dasari

Before getting an MRI, almost eighty percent of children need to be sedated to stay still enough for a good image. But in the year after the Children's Hospital of Pittsburgh installed Doug Dietz's new machines, they only needed to sedate two children. What did Dietz do differently?

Hacking Healthcare: Designing Human-

• Language: English
• Publisher: New Degree Press
• Release date: May 6, 2021
• ISBN: 9781636762449

Book preview

Hacking Healthcare

Shobha Dasari

new degree press

copyright © 2020 Shobha Dasari

All rights reserved.

Hacking Healthcare

ISBN

978-1-63676-631-7 Paperback

978-1-63676-245-6 Kindle Ebook

978-1-63676-244-9 Digital Ebook

To my parents and my brother for their unconditional support and for teaching me to dream big dreams and work hard to achieve them.

Contents

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Introduction

Chapter 1

Designed for Sickness

Chapter 2

Human-Centered Health Technologies

Chapter 3

HealthCARE

Chapter 4

The Clinician’s Role

Chapter 5

Work with Workflows

Chapter 6

Healthcare, the Eight-Headed Monster

Chapter 7

Patient as Innovator

Chapter 8

Designing for Health

Acknowledgments

Appendix

Introduction

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As a child, I spent a lot of time in doctors’ offices and hospitals.

When I was twelve years old, I suddenly became sick for no obvious reason. I was running high fevers, I lost my appetite, and I was always tired. My doctors were baffled—they couldn’t figure out what was wrong with me. For months I visited countless physicians, who all prescribed more blood tests and diagnostic imaging scans, then returned to me and my family with no answers and a referral to yet another doctor.

A few weeks before my thirteenth birthday I was finally diagnosed with an autoimmune disease. But the doctors’ visits didn’t stop there. The diagnosis was only the first step; now I had to deal with medications and regular blood tests, completely change my diet to avoid foods that triggered an immune response, and visit my doctor regularly to ensure I was staying in remission. To this day, my condition permeates my life in various ways—through paper cuts that take weeks to heal, stomach aches and fatigue, and a constant fear of getting sick.

This experience first inspired my interest in medicine and healthcare. I was motivated by the idea that I could help other people in the same way that my doctors and nurses helped me. At first I wanted to become a physician, so I immersed myself in learning as much about medicine and the human body as I could. Then, I discovered how technology was being used to revolutionize medical practice through wearable devices that can detect strokes or machine-learning algorithms that analyze patient data to create personalized treatment plans. I was inspired by the widespread impact these technologies have on people. I also found that I loved the process of identifying problems people face and using technology in creative and unconventional ways to develop solutions, which led me to begin pursuing a career in health technology innovation.

Now, I’m surrounded by some of the most innovative physician-inventors, startup founders, companies, and venture capitalists in the health technology space. A ten-minute bike ride takes me to Stanford’s Byers Center of Biodesign, where some of the world’s most innovative minds are currently trying to solve some of the biggest problems in medicine and health through design thinking and technology.

I’ve had all kinds of opportunities to get personally involved and learn more about the health technology space. I’ve joined groups like Stanford Health Innovations, which hosts hackathon events where innovators from all over the world come together to work on solutions to problems in healthcare and medicine. Through courses and working with startups, I’ve been able to learn about what goes into taking a health technology product from a concept to clinical adoption from people who have gone through the process dozens of times. As I interview and shadow physicians to learn about medical needs, design health technology concepts, and meet students and professionals who are passionate about the potential of technology to change healthcare for the better, I only get more excited about this field.

* * *

Health technology innovations are uniquely poised to improve the accessibility, affordability, quality, and efficiency of healthcare for much of the American population. Electronic health records, despite all of their flaws, have streamlined medical billing and allowed multiple clinicians treating the same patient to access their real-time medical information. During the COVID-19 pandemic, there has been a boom in telehealth usage, allowing home-bound patients to have appointments with their doctors while social distancing.¹ Health monitoring tools such as the Apple Watch’s electrocardiogram and heart rate monitor are now becoming more consumer-oriented and accessible to anyone.

The American healthcare system could benefit heavily from the widespread use of technology. According to the Centers for Medicare and Medicaid Services, healthcare spending in the United States was $3.6 trillion in 2018, almost 18 percent of our nation’s GDP.² According to a study in the Journal of the American Medical Association, approximately 25 percent of this spending was due to waste in our healthcare system, which includes low-value care and administrative complexity.³ The CDC also states that a whopping 90 percent of our national healthcare expenditure comes from treating people who have mental health conditions or chronic illnesses, like heart disease and diabetes.⁴ These are only a sample of the many areas where there is scope and necessity for technology to reduce costs while improving aspects of patient care.

And the health technology industry is growing to fit this role. A recent Rock Health study showed that investors poured $5.4 billion of funding into digital health companies in the first six months of 2020, setting the stage to surpass the $8.1 billion of funding in 2018 and $7.4 billion in 2019.⁵ The United States’ medical device market is the largest in the world, valued at $156 billion, which was 40 percent of the global medical device market in 2017.⁶ This large inflow of capital reflects the excitement among doctors, hospital executives, investors, and others in the space about the potential of cutting-edge technologies to improve healthcare accessibility, quality, and efficiency. 

Though this enthusiasm is encouraging, innovators will need to be very intentional as they pursue new solutions in healthcare. If you search health technology on Google, you’ll see articles with titles along the lines of the top ten health technologies every hospital executive should be excited about or the coolest technological advancements in healthcare this year. These articles provide laundry lists of ways that technologies like artificial intelligence, blockchain, and virtual reality can be used to improve healthcare. They tout these technologies as the future and claim that we’ll be seeing them in doctors’ offices within the next few years. 

But these futuristic technologies are often removed from the realities of American healthcare. The American healthcare system has some of the poorest outcomes of any developed country. Physicians are constantly overworked and burned out, and many citizens struggle to access and afford basic healthcare services, much less any high-tech or high-cost interventions.⁷ The COVID-19 pandemic and the resulting economic recession have only exacerbated these inequalities, revealing the implications of having high healthcare costs, employer-based health insurance, and poor healthcare infrastructure.⁸

While many of these issues are systemic and will require drastic policy changes, technology is still a powerful tool to reduce healthcare costs, increase accessibility to care, and improve the quality and efficiency of healthcare delivery. But today, technology in healthcare is not living up to its promise, and poor design is one of the main culprits.

* * *

In healthcare, we don’t have a technology problem; we have a design problem, claimed Dr. Bon Ku, an emergency doctor and the founder and director of the Health Design Lab at Sidney Kimmel Medical College at the 2019 Fortune Magazine Brainstorm Design Conference.⁹ In his talk, Dr. Ku detailed many examples of poor healthcare design he notices in a typical day on the job. He talked about how he uses a fax machine (yes, a fax machine in 2019!) to send files and how electronic health records systems are so poorly designed that doctors average about four thousand mouse clicks in just one shift. 

Dr. Ku’s most terrifying example of poor design was about rectal thermometers: the brand of rectal thermometers that his clinic uses looks very similar to their oral thermometers. The only difference between the two is a colored dot on the top of the device, red for rectal use and blue for oral use. It is so easy for a nurse, who is trying to juggle many tasks and patients at the same time, to forget to check the color of the dot and accidentally give a patient a rectal thermometer to put in their mouth.¹⁰

Poor design permeates healthcare, leading to a poorer delivery of care. For example, the unintuitive design and lack of interoperability (the ability to electronically share health data between systems) in electronic health records, Dr. Ku says, is one of the main reasons physicians like himself experience burnout. And in Dr. Ku’s own words, burned out doctors deliver burned out care.¹¹

Human-centered design, a core focus of this book, is a particular design methodology that places the focus on user experiences and needs. According to IDEO’s Design Kit, It’s a process that starts with the people you’re designing for and ends with new solutions that are tailor made to suit their needs.¹² The first, and most important, step of the human centered design process requires empathizing with the user and understanding their experiences to define use cases and requirements for a solution. From there, a designer will generate ideas, build quick prototypes, receive feedback, and update the solution accordingly, repeating this process until users are satisfied. Human-centered design ensures that real problems are being solved and that these problems are being solved in ways that actually benefit users and improve their experiences. 

Currently, human-centered design is not prioritized in healthcare, but it makes a world of a difference for both providers and patients when it is highlighted. One of my favorite examples of human-centered design in healthcare comes from Doug Dietz, whose story is featured later in this book. Dietz was an industrial designer at GE Healthcare, and he had designed a new MRI machine that was being installed for the first time in the hospital. While at the hospital, Dietz noticed a crying young girl who was absolutely terrified of his machine, causing him to realize that he needed to redesign it so that it wouldn’t scare children. To determine what improvements he needed to make, Dietz interviewed children and their parents about all aspects of the MRI process, shadowed them at the hospital, and brainstormed solutions alongside them.¹³

Dietz’s final MRI designs are colorful and stunning, and they have made the process of undergoing an MRI scan infinitely easier for children, their parents, and their healthcare providers. His work goes to show the power of human-centered design. Dietz identified a problem, incorporated his users at all stages of the design process, and ultimately created a simple but powerful solution that solves a real problem in healthcare in a fundamentally human way.

* * *

At its core, healthcare is about humans caring for humans. When innovating, the focus should be on the underlying problem and the experiences of the people who are affected by it. Carelessly throwing technology at a problem, much less a problem in a field as complex as healthcare, will rarely solve the true issue. As a result, while human-centered design is not uniquely applicable to healthcare, it should be an essential aspect of any health technology innovation process. At the end of the day, technology does not exist in a vacuum—it exists to work alongside humans.

To achieve this vision, the design and implementation of any health technology needs to be conducted strategically, and an innovator should gather insights at every step of the way from the people who will ultimately use the technology. By being conscious about how we innovate, we can purposefully invent the future in which we want to live—one where technology helps people live healthier and better lives. I am cautiously optimistic about the future of technology in healthcare—I believe it can have huge impacts on medicine and the delivery of care, but only if designed correctly. 

Healthcare, as a whole,