Every year, the biggest ideas in health care are presented at the Mayo Clinic’s Transform conference in Rochester, Minnesota. I was there this year to present a pre-conference workshop with a Continuum colleague on everyday creativity, and another pair of Continuum designers gave a main-stage talk entitled, "Patient Centricity: A design identity crisis." Also on the lineup were John Hockenberry and Roger Martin, bigwigs from J+J and GE Healthcare, and practitioners from the top-tier design and innovation firms. Many cutting-edge ideas were presented, along with some spirited debate on the hot topics of delivering care and the role of technology.
Here are my top five conference takeaways on the future design of health care.
First off, I keep running into the fact that…
It’s often said that humans can’t keep up with technology. To a certain extent, that’s true. Generations of technology happen much more frequently than generations of people. However, there is a counterintuitive corollary to that, which is that medicine is moving so fast that the IT systems that support it aren’t flexible enough to adapt.
In some cases, it can take almost a year for an IT provider to update a system in response to an advance in medicine. By that time, the state of the art has advanced again, leaving some systems in a perpetual state of slight obsolescence. The upshot from the design perspective is that you can’t design software based on the assumption that medicine is static. The practice of medicine changes constantly, and your product will have to change as well.
Which is by way of saying that…
You have to take into account all of the ways that people are going to screw it up. Electronic Medical Records, Clinical Decision Support systems, IBM’s Watson, and other technologies are fantastic innovations, but they all have the common disadvantage/advantage of having to interact with people.
As such, they have to be designed to leverage the things humans rule at (abductive reasoning, visuo-spatial memory, decision-making), while taking into account the things people suck at (free recall, parallel processing, working memory). It’s not a new message, but clearly it still needs to be beaten into our heads: Technology is necessary but not sufficient. It is only one aspect of a complex problem that is fundamentally a human one.
Speaking of humans making mistakes all the time, I was surprised to hear that…
I can only imagine how often modern physicians must roll their eyes at patients who, thanks to the Internet, know just enough to be dangerous. However, it came up in Dave deBronkart’s (a.k.a. ePatient Dave) talk that it might be more dangerous not to Google your condition than it is essentially to practice medicine on yourself. This was attributed to the usefulness of self-started patient communities that provide invaluable insight into what questions to ask, treatments to seek out, and condition-specific precautions to take. Dave talked about a recent study in which researchers expected to find scores of case studies of people dying because they relied on faulty health information on the web but actually found zero.
Intuitively, you just can’t design systems that allow people to cut the doctor out of the equation in favor of patient self-care. But on the other hand, if the above conclusion is true, it’s potentially encouraging that we could save time, money, and maybe even lives by using Internet resources. What if the role of the doctor changes from the go-to resource for all things health-related to more of a consultant who oversees patients who take care of themselves?
Which brings us to…
When taken in aggregate, several of the presentations at Transform led me to believe that we are at a very important crossroads right now when it comes to the poorly defined role of patients in the health care system. There was debate over whether patients should be treated like consumers or not, how either important or dangerous it is for patients to help one another navigate their condition, and the pros and cons of bringing certain procedures into the home.
In many ways, we’re advocating for making health care simpler for people. But when you start to encourage patients to do their own research, make informed choices about services, and take control of their treatment, it starts to sound like we’re making things much more complicated. No right answer emerged, but it was pretty clear that the way delivery systems are designed depends critically on how you define "patient."
And finally, overarching the whole conference there was the sense that…
I took a tour of the Mayo’s Center for Innovation (CFI), and it has an internal innovation team, space, and culture that would make most commercial firms jealous.
It’s all very exciting, but I found myself wondering how much the health care community at large believes in "design," broadly defined. The attendees at Transform self-select to be on the cutting edge and are open to hearing—and even eager to adopt—radically different perspectives.
But "design" can be an intimidating word to someone in health care who has always felt removed from it, like "biochemistry" or "computational neuroscience" can be intimidating words if you went to art school. I don’t think it was intentional by any means, but there seemed to be undertones of an "us vs. them" mentality.
Really, though, we can only achieve what we want to if it’s just one big "us." It is in the best interest of everyone involved if technology, design, business, and medicine are each leveraging the others’ unique perspectives while working together toward common goals; and we would do well as the self-defined community of innovators to tailor our messaging accordingly.[Photo by Ingred and Eric Chamberlin]